A randomized trial of short-term treatment with folic acid to reduce the oxidative stress of patients with chronic kidney disease

Background: Increased generation of reactive oxygen and nitrogen species in chronic kidney disease (CKD) patients leads to increased oxidative stress. The antioxidant capacity of folic acid has been shown to scavenge radicals efficiently. Objective: The current study was carried out to examine the effects of folic acid treatment on biochemical and oxidative stress biomarkers in patients in different stages of CKD. Methods: This was a randomized, non-blinded, clinical trial that assessed the effects of 3 months of treatment with 5 mg of folic acid daily or no treatment in 113 outpatients within CKD stages 3a and 3b. At the end of the intervention, we analyzed the data of 66 patients treated with folic acid and 47 in the control group. Serum homocysteine levels and biochemical and oxidative/nitrosative stress biomarkers were analyzed in all patients. Results: In most patients, folic acid treatment normalized homocysteine levels and increased antioxidant enzyme activity (paraoxonase 1) and decreased sulfhydryl (SH) groups. In addition, oxidative biomarkers (products of nitric oxide and lipid hydroperoxide) were significantly lower post-treatment compared to baseline in the active intervention group. In the no active intervention group, no statistically significant effects were found on the oxidative and biochemical biomarkers. Conclusion: Folic acid treatment in stages 3a-4 CKD patients effectively ameliorated their hyperhomocysteinemia and increased the activity of antioxidant enzymes, as well as decreased the levels of pro-oxidant biomarkers in stage G3a and G3b CKD patients. Folic acid treatment attenuated oxidative/nitrosative stress and may be considered as a possible strategy to improve redox status and diminish the damages associated with oxidative/nitrosative stress in CKD patients. Further studies are needed to confirm these findings.

Brief Negative Affect Focused Functional Imagery Training Abolishes Stress-Induced Alcohol Choice in Hazardous Student Drinkers

Introduction. Imagery-based stress management therapies are effective at reducing alcohol use. To explore the therapeutic mechanism, the current study tested whether brief functional imagery training linked to personal negative affect drinking triggers would attenuate sensitivity to noise stress-induced alcohol seeking behaviour in a laboratory model. Methods. Participants were UK-based hazardous student drinkers (N = 61, 80.3% women, aged 18–25) who reported drinking to cope with negative affect. Participants in the active intervention group (n = 31) were briefly trained to respond to personal negative drinking triggers by retrieving an adaptive strategy to mitigate negative affect, whereas participants in the control group (n = 30) received risk information about binge drinking at university. The relative value of alcohol was then measured by preference to view alcohol versus food pictures in two-alternative choice trials, before (baseline) and during noise stress induction. Results. There was a significant two-way interaction p < .04 where the control group increased their alcohol picture choice from baseline to the noise stress test p < .001 , whereas the active intervention group did not p = .33 , and the control group chose alcohol more frequently than the active group in the stress test p = .03 , but not at baseline p = .16 . Conclusions. These findings indicate that imagery-based mood management can protect against the increase in the relative value of alcohol motivated by acute stress in hazardous negative affect drinkers, suggesting this mechanism could underpin the therapeutic effect of mood management on drinking outcomes.

Increasing the completion rate of the advance directives in primary care setting – a randomized controlled trial

Background The completion rate of Advance Directives (ADs) has been low. This study aims to examine the effectiveness of two interventions 1) active counseling sessions coupled with passive patient education pamphlets, and 2) patient education pamphlets alone, compared with 3) control group (usual care), in increasing the completion rates of ADs in the primary care setting. Methods Multicenter randomised controlled trial in four public primary care clinics in Singapore under Singapore Health Services. Randomization was performed via block randomization with Sequential Numbered Opaque Sealed Envelopes. Participants were randomized into 1) active intervention group (both counseling by primary care physicians and patient education pamphlets) or 2) passive intervention group (only patient education pamphlets), and 3) control group (usual care) with follow-up at 6 weeks. The main outcome measure is the proportion of participants who completed / planned to complete) ADs six weeks post-intervention. Results Four hundred five participants were eligible to participate in the study. One hundred eighty-eight participants were recruited into the study (response rate = 46.4%), of which 158 completed the study. There was no significant difference between the control group, passive intervention group, and active intervention group, in terms of completion rates of ADs (29.4, 36.4, and 30.8% respectively). Conclusions This randomized controlled trial did not support the use of patient education pamphlets with or without active counseling sessions in increasing the completion of ADs in a primary care setting in Singapore. The optimal intervention strategy depends on each health system’s context and resources, taking into consideration patients’ profiles, which deserves further studies. Trial registration Registered on April 17, 2018 clinicaltrials.gov (NCT03499847).

Role of antioxidant therapy in patients with moderate and severe COVID-19

The coronavirus disease COVID-19 is characterized by high mortality and the lack of effective etiotropic therapy. Activation of oxidative stress may be one of the links in the pathogenesis of organ damage of this infection. Objective. To assess the ability of Mexidol® to influence the rate of clinical improvement in pneumonia caused by the SARSCoV-2 virus in hospitalized patients with the novel coronavirus disease COVID-19 and concomitant discirculatory encephalopathy. 62 patients over the age of 18 years with confirmed new coronavirus disease COVID-19 according to computed tomography (CT) of the lungs (stages CT1, CT2, CT3) and PCR of a swab from the nasopharynx and oropharynx for SARS-CoV-2 virus RNA were included. After randomization patients of group 1 received an infusion of Mexidol® at a dose of 1000 mg/day, patients of group 2 – an infusion of isotonic sodium chloride solution for 7 days. Compared with the control group, the patients receiving Mexidol® therapy showed a significantly more pronounced decrease in body temperature, a tendency towards a decrease in the severity of shortness of breath. In the Mexidol® group, the concentration of superoxidedismutase did not change, while in the control group there was a tendency to its decrease, C-reactive protein decreased 2.2 times more than in the control group (p = 0.09). There was a tendency for a more rapid decrease in ferritin in the active intervention group. Mexidol® therapy can have a positive effect on the clinical manifestations and severity of laboratory-inflammatory syndrome in patients with the new coronavirus disease COVID-19. Key words: coronavirus disease COVID-19, oxidative stress, Mexidol

IADL DIFFICULTY AND MORTALITY IN ACTIVE: IMPLICATIONS FOR TRANSFER OF COGNITIVE TRAINING

Objectives: Our goals were to externally scale an IADL difficulty scale to the more recognizable Functional Activities Questionnaire (FAQ), and test whether cognitive training attenuates the relationship between IADL difficulty and mortality. Method: We leveraged externally available FAQ data from NACC to scale questions about IADL activities administered in ACTIVE (N=2,802) using item response theory. We modeled time to death as a function of IADL difficulty in ACTIVE using survival analysis, testing whether ACTIVE intervention group status modified the association between FAQ and mortality. Results: IADL difficulty in ACTIVE, scaled to the FAQ, was associated with a higher risk of death (Hazard Ratio, HR, 1.01, 95% Confidence Interval, CI: 1.001, 1.02). The relationship did not differ by ACTIVE intervention status. Discussion: Cognitive training does not modify the relationship between IADL difficulty and mortality, consistent with a hypothesis that proposed relationships between cognitive ability and IADL difficulty are correlational, not causal.

A Systematic Review and Meta-Analysis of e-Mental Health Interventions to Treat Symptoms of Posttraumatic Stress

Background Posttraumatic stress disorder (PTSD) is a stress disorder characterized by unwanted intrusive re-experiencing of an acutely distressing, often life-threatening, event, combined with symptoms of hyperarousal, avoidance, as well as negative thoughts and feelings. Evidence-based psychological interventions have been developed to treat these symptoms and reduce distress, the majority of which were designed to be delivered face-to-face with trained therapists. However, new developments in the use of technology to supplement and extend health care have led to the creation of e-Mental Health interventions. Objective Our aim was to assess the scope and efficacy of e-Mental Health interventions to treat symptoms of PTSD. Methods The following databases were systematically searched to identify randomized controlled trials of e-Mental Health interventions to treat symptoms of PTSD as measured by standardized and validated scales: the Cochrane Library, MEDLINE, EMBASE, and PsycINFO (in March 2015 and repeated in November 2016). Results A total of 39 studies were found during the systematic review, and 33 (N=3832) were eligible for meta-analysis. The results of the primary meta-analysis revealed a significant improvement in PTSD symptoms, in favor of the active intervention group (standardized mean difference=-0.35, 95% confidence interval -0.45 to -0.25, P<.001, I2=81%). Several sensitivity and subgroup analyses were performed suggesting that improvements in PTSD symptoms remained in favor of the active intervention group independent of the comparison condition, the type of cognitive behavioral therapy-based intervention, and the level of guidance provided. Conclusions This review demonstrates an emerging evidence base supporting e-Mental Health to treat symptoms of PTSD.

Abstract P130: Association between Weight Loss Program Attendance and Weight Loss among Adults with Serious Mental Illness

Introduction: Obesity is epidemic among adults with serious mental illness (SMI) (e.g., schizophrenia, bipolar disorder) and evidenced-based weight loss programs are needed for this group. We examined the association between attendance to program sessions and weight change among adults with SMI who were enrolled in a lifestyle-based weight loss trial. Methods: Overweight and obese adults with SMI were randomized to either a control group (n=147) or an active intervention group (n=144) that received weight loss classes (3/month), individual weight management sessions (monthly), and group exercise classes (3/week) during the first 6 months. These classes tapered off during months 7-18. Study staff maintained attendance records. Standardized weight was assessed at baseline, 6 and 18 months. Regression analyses included weight change as the dependent variable and controlled for sex, age, and site. Results: The active intervention group was 51% female with an average age of 47 years. Main results have reported significant weight loss at 6 (M=-1.7kg, SD=4.6) and 18 months (M=-3.4kg, SD=7.4). Attendance at 6 and 18 months are reported in the figure below. Attendance was not associated with weight change at 6 months. Overall percent attendance was not associated with 18 month weight change (B=-0.02, p=-.59). A second regression model included percent attendance individually for each of type of session and group weight loss attendance (B=-0.10, p=.04) was associated with weight loss; however, individual weight loss sessions (B=0.002, p=.95), and group exercise (B=0.08, p=.08) were not associated with weight loss. Conclusion: Although overall attendance was not associated with weight loss, attendance to the group weight loss session was associated with weight loss at 18 months. It is not clear if the content of the weight loss groups was particularly effective or if adherence to these sessions was the strongest indicator of adherence to the behavioral recommendations.

Goal Management Training in Adults With ADHD: An Intervention Study

Objective: This article describes a controlled, neuropsychological intervention study in adult ADHD. We examined whether adults with ADHD would benefit from a structured course based on Goal Management Training (GMT). The comprehensive course also included psycho-education on the important aspects of executive functioning as well as counseling with respect to coping behaviors. Method: The intervention group was compared with a control group of patients who received psycho-education only ( n = 12 and n = 15, respectively). The effects of the intervention were evaluated using subjective and objective test measures. In addition, a structured preassessment, an evaluation, and a group comparison were carried out by an experienced clinician, who was blinded to the intervention itself. Results: The results of the structured clinical interview obtained in the active intervention group were significantly better in the intervention group than those of the control group. Conclusion: The findings suggest that the combination of GMT with psycho-education and counseling may have validity for adults with ADHD.

Evaluation of the Two-Way Communication Checklist as a clinical intervention

BackgroundPatients and doctors often have divergent views on care needs.AimsTo examine whether providing patients with an opportunity to identify and discuss their needs would improve communication and induce changes in care.MethodPatients with schizophrenia (n=134) were randomly allocated to either standard care or use of the Two-Way Communication Checklist (2-COM). Before seeing their clinician for a routine follow-up, participants in the active intervention group were given 2-COM, a list of 20 common needs, and told to indicate those areas they wanted to discuss with their doctor. Outcomes were assessed immediately and again after 6 weeks.ResultsUsing 2-COM induced a stable improvement of patient-reported quality of patient–doctor communication (B=0.33, P=0.031), and induced changes in management immediately after the intervention (OR=3.7, P=0.009; number needed to treat, 6). Treatment change was more likely in patients with more reported needs, and needs most likely to induce treatment change displayed stronger associations with non-medication than with medication changes.ConclusionsA simple intervention to aid people in discussion of their needs results in improved communication and changes in management.