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TV-44749 is an investigational, long-acting, subcutaneous (SC) formulation combining olanzapine (OLZ) and an innovative copolymer-based drug delivery technology in a long-acting injectable (LAI) suspension intended to address the limitations of oral and intramuscular OLZ. Phase 1 trial results showed that TV-44749 exhibited a favorable extended-release pharmacokinetic (PK) profile and that once-monthly doses of 318, 425, and 531 mg yield comparable OLZ exposures corresponding to oral daily doses of 10, 15, and 20 mg, respectively. These results guided dose selection for the phase 3 SOLARIS trial (NCT05693935) in adults with schizophrenia (SZ). Through the double-blind, placebo-controlled, acute treatment phase (Period 1) of SOLARIS, all three TV-44749 doses resulted in significantly greater efficacy. The long-term safety data from SOLARIS (Period 2) demonstrated that TV-44749 was generally well tolerated. Across the clinical development of TV-44749, no suspected or confirmed post-injection delirium/sedation syndrome (PDSS) events were reported (3990 TV-44749 injections).
Objectives
The primary objective of the ORBIT trial is to assess the relative bioavailability of TV-44749 compared with EU-registered oral OLZ in adults with SZ, and support PK bridging between the two formulations. Secondary objectives include additional PK, safety, and tolerability endpoints. Trial design was based on the European Medicines Agency guidelines (Document: EMA/CHMP/EWP/280/96 Rev1) and TV-44749 phase 1 PK trial results.
Methods
ORBIT is an ongoing phase 1, 21-week, multicenter, open-label, multiple-dose, single-sequence trial in people living with SZ (NCT06315283). Adults (aged 18–64 years) clinically stable on oral OLZ 20 mg/day over ≥4 weeks before screening and not currently on other antipsychotic treatments were recruited in the US and EU. In treatment Period 1, participants receive oral OLZ 20 mg daily for 7 days. Treatment Period 2 comprises three TV-44749 531 mg once-monthly administrations. The primary endpoint is the OLZ exposure ratio between TV-44749 and oral OLZ administration over a 28-day dosing interval. Secondary endpoints include minimum plasma concentration at end of dosing interval and maximum observed plasma drug concentrations for both treatments. Safety and tolerability are also being assessed.
Results
Recruitment is complete, with anticipated trial completion by September 2025.
Conclusions
When completed, ORBIT trial results will add to the body of evidence, including modeling and simulation, to support establishing a PK bridge between TV-44749 and oral OLZ, and provide additional PK, safety, and tolerability data. TV-44749 may become the first LAI OLZ formulation that avoids the Risk Evaluation and Mitigation Strategy (REMS) associated with PDSS in adults with SZ.
Disclosure of Interest
A. Merenlender Wagner Employee of: Teva, K. Shulman Shareholder of: Teva, Employee of: Teva, R. Gidron-Budovsky Employee of: Teva, A. Elgart Shareholder of: Teva, Employee of: Teva, A. Jehassi Employee of: Teva, N. Sharon Employee of: Teva, R. Apolinario Shareholder of: Teva, Employee of: Teva, G. Davis Shareholder of: Teva, Employee of: Teva, K. Duma Employee of: Teva, M. Suett Shareholder of: Teva, Employee of: Teva, D. Gutman Shareholder of: Teva, Employee of: Teva, L. Rabinovich-Guilatt Employee of: Teva
Encapsulated saflufenacil uses a solid phase encapsulation, which is different than traditional herbicide encapsulations. Saflufenacil is released following dry conditions that allow the microcapsule to fracture. Thus, encapsulated saflufenacil is not available for foliar uptake using standard application methods. A trace amount of non-encapsulated saflufenacil remains in the formulation from an incomplete purification process and may cause foliar phytotoxicity from postemergence applications. Experiments were conducted using relative photosystem II (PS II) efficiency of corn leaf tissue to determine encapsulated saflufenacil bioavailability and to characterize saflufenacil microcapsule release under extended solution storage time. To evaluate injury potential, non-encapsulated, free saflufenacil was separated from the encapsulated formulation using microfiltration. An open-capsule treatment was created by allowing the encapsulated formulation to dry and then resolubilizing the herbicide. Relative PS II efficiency of the free, open-capsule, and encapsulated saflufenacil formulations were compared over 48 hours after treatment (HAT). By 48 HAT, dry and non-encapsulated saflufenacil reduced relative PS II efficiency greater than the encapsulated saflufenacil, indicating that saflufenacil was not released from the encapsulation unless it underwent a period of drying. Furthermore, the reduced relative PS II efficiency was similar for the encapsulated and free saflufenacil, corroborating that the level of phytotoxicity from foliar encapsulated saflufenacil applications originates from the trace levels of free saflufenacil in the product. Saflufenacil microcapsule stability was evaluated following mixing with water and storage for 0, 1, 3, 5, or 7 days. Phytotoxicity did not increase with extended storage times, as the reduction in relative PS II efficiency from 0 to 48 HAT remained mostly constant across solution storage times. Overall, this research substantiates that saflufenacil encapsulation works to reduce foliar injury and documents the encapsulation durability under extended storage in water solution.
Measurements of peculiar velocities in the local Universe are a powerful tool to study the nature of dark energy at low (z < 0.1) redshifts. Here we present the largest single set of z < 0.1 peculiar velocity measurements to date, obtained using the Fundamental Plane (FP) of galaxies in the first data release (DR1) of the Dark Energy Spectroscopic Instrument (DESI).We describe the photometric and spectroscopic selection criteria used to define the sample, as well as extensive quality control checks on the photometry and velocity dispersion measurements. Additionally, we perform detailed systematics checks for the many analysis parameters in our pipeline. Our DESI DR1 catalogue contains FP-based distances and peculiar velocities for 98, 292 unique early-type galaxies, increasing the total number of z < 0.1 FP distances ever measured by a factor of ∼ 2. We achieve a precision of 26% random error in our distance measurements which is comparable to previous surveys. A series of companion DESI papers use the distances and peculiar velocities presented in this paper to measure cosmological parameters.
We present 29 successfully recovered Civ time lags in Active Galactic Nuclei from the complete Dark Energy Survey Reverberation Mapping campaign. The AGN in this sample span a redshift range of $1.9\lt z\lt 3.5$. We successfully measure the velocity dispersion from the Civ spectral linewidth for 25 of these 29 sources, and use these to calculate new high-redshift black hole mass estimates, finding masses between 0.8 and 1.3 billion solar masses. We also identify a selection effect due to the duration of the survey that can impact the radius-luminosity relation derived from this and other (high-redshift) data. This paper represents the culmination of the OzDES Civ campaign.
Over the last decade, the Australian Dark Energy (OzDES) collaboration has used Reverberation Mapping to measure the masses of high redshift supermassive black holes. Here we present the final review and analysis of this OzDES reverberation mapping campaign. These observations use $6-7$ years of photometric and spectroscopic observations of 735 Active Galactic Nuclei (AGN) in the redshift range $z\in [0.13, 3.85]$ and bolometric luminosity range $\log_{10}(L_{\mathrm{bol}})\in [44.3, 47.5] \; \mathrm{erg/s}$. Both photometry and spectra are observed in visible wavelengths, allowing for the physical scale of the AGN broad line region to be estimated from reverberations of the H$\beta$, MgII and CIV emission lines. We successfully use reverberation mapping to constrain the masses of 62 super-massive black holes, and combine with existing data to fit a power law to the lag-luminosity relation for the H$\beta$ and MgII lines with a scatter of $\sim0.25$ dex, the tightest yet identified, fit specifically for consistency with high redshift AGN. We fit a similarly constrained relation for CIV, resolving a tension with the low luminosity literature AGN by accounting for selection effects arising from finite survey length. We also examine the impact of emission line width and luminosity (related to accretion rate) in reducing the scatter of these scaling relationships and find no significant improvement over the lag-only approach for any of the three lines. Using these relations, we further estimate the masses and accretion rates of 246 AGN with single epoch methods. We also use these relations to estimate the relative sizes of the H$\beta$, MgII and CIV emitting regions, and find evidence that the MgII emission may occur further out than H$\beta$. In short, we provide a comprehensive benchmark of high redshift AGN reverberation mapping at the close of this most recent generation of surveys, including light curves, time-delays, and a set of significantly improved radius-luminosity relations for use with high-redshift populations.
Laser–target interactions generate intense electromagnetic pulses (EMPs) that can interfere with measurements and damage equipment. In this paper we show that applying a magnetic field to nanosecond pulse laser–target interactions decreases the magnitude of EMPs. We demonstrate this effect in two experiments with different geometries (spherical versus planar), laser intensities ($\sim {10}^{13}$ versus $\sim {10}^{15}$ W/cm${}^2$) and applied field strength (12 versus 0.1 T) that both observed suppression of EMPs in approximately the 1 GHz band (by factors of $0.65\times$ and $0.32\times$, respectively). We then observe the opposite effect at high intensities with a picosecond pulse: for planar experiments with laser intensities of approximately ${10}^{19}$ W/cm${}^2$ and magnetic fields of 6–10 T, the magnitude of EMPs is increased by a factor of $1.75\times$. These results provide a benchmark for models of EMP generation, but suggest that magnetic fields are not a viable solution for mitigating EMPs in the high-intensity laser facilities where they are most damaging.
Sinusitis is a leading cause for outpatient antibiotics. An interruptive electronic health record alert was implemented to promote optimal antibiotic selection and duration for acute bacterial sinusitis when suboptimal treatment is ordered. After implementation, optimal antibiotic prescribing significantly increased 7% preintervention versus 30% postintervention, (unadjOR, 5.69; 95% CI, 2.36 – 13.72; P < .001).
Human milk and direct breastfeeding provide the optimal, biologically normative nutrition for hospitalised infants, with well-established benefits for immune, gut, cardiac, brain, and maternal health. Despite these benefits, human milk and breastfeeding rates for infants with CHD in high-resource countries are typically low, and there are no formal guidelines to drive CHD breastfeeding practice. Our aim is to (1) summarise the evidence on breastfeeding for infants with CHD, (2) discuss key barriers to and facilitators of breastfeeding in this population, (3) identify critical research and practice gaps to improve breastfeeding care in CHD, and (4) provide recommendations for clinical practice and future research.
Primary breastfeeding barriers for infants with CHD include (1) concern for dysphagia/aspiration, (2) concerns related to weight gain, (3) clinical instability/sickness, (4) developmental considerations, (5) general breastfeeding challenges, and (6) workflow and implementation issues, with racism and health disparities also contributing. The evidence to support these barriers is limited and often conflicting. Breastfeeding facilitators for preterm infants are well described, but facilitators may require modification for infants with CHD. Most lactation interventions have not been tested in CHD populations. Current evidence does not support automatic withholding of breastfeeding from infants with CHD; rather, the benefits of breastfeeding likely outweigh many potential concerns. There is a critical need for research and quality improvement to identify interventions that equitably and effectively support breastfeeding for infants with CHD and to evaluate the effect of breastfeeding on short- and long-term physical, psychological, and developmental outcomes for infants and families.
Observational studies indicate that higher educational attainment (EA) is associated with a lower risk of many mental health conditions (MHC). We assessed to what extent this association is influenced by genetic nurture and demographic factors (i.e., assortative mating and population structure).
Methods
We conducted a within-sibship Mendelian randomization (MR) study. The sample consisted of 61 880 siblings (27 507 sibships) from the Trøndelag Health Study-HUNT (Norway) and UK Biobank (United Kingdom). MHC outcomes included symptom scores for anxiety, depression, and neuroticism, measured using the Hospital Anxiety and Depression Scale, the 7-item Generalized Anxiety Disorder Scale, the 9-item Patient Health Questionnaire, and the Eysenck Personality Questionnaire, along with self-reported psychotropic medication use.
Results
One standard deviation (SD) increase in liability to EA was associated with lower anxiety (−0.20 SD [95% CI: −0.26, −0.14]), depression (−0.11 SD [−0.43, −0.22]), and neuroticism scores (−0.30 SD [−0.53, −0.06]), as well as lower odds of psychotropic medication use (OR: 0.60 [0.52, 0.69]). Within-sibship MR estimates remained consistent with population-based estimates: anxiety (−0.17 SD [−0.33, −0.00]); depression (−0.18 SD [−1.26, 0.89]); neuroticism (−0.29 SD [−0.43, −0.15]); psychotropic medication use (OR, 0.52 [0.34, 0.82]).
Conclusions
Higher EA or genetic liability to education reduces symptoms of anxiety, neuroticism, and psychotropic medication use. These mental health benefits do not seem to be explained by EA-linked genetic nurture or demographic factors. Regarding depression, results were less conclusive due to imprecise estimates, though beneficial effects of genetic liability to higher EA are possible and warrant further investigation.
The dhole Cuon alpinus is a large canid that is categorized as Endangered on the IUCN Red List and at risk of global extinction. Information on the spatial distribution of suitable habitat is important for conservation planning but is largely unavailable. We quantified the spatial distribution of potential range as well as the relative probability of dhole occurrence across large parts of the species’ global range. We used the MaxEnt algorithm to produce a multi-scale environmental niche model based on 24 environmental variables and dhole occurrence data from 12 countries. We identified three regions where dhole conservation should be focused: western India, central India, and across the Himalayan foothills through Southeast Asia. Connectivity between suitable areas was poor, so coordinated action among these regions should be a priority. For instance, transboundary dhole conservation initiatives across the Himalayas from southern China, Myanmar, north-east India, Nepal and Bhutan need to be initiated. We also highlight the value of improving dhole population viability on unprotected land and increasing monitoring in the northern parts of its historic distribution, in particular in areas within mainland China.
UK Biobank (UKB) is a large-scale, prospective resource offering significant opportunities for mental health research. Data include genetic and biological data, healthcare linkage, and mental health enhancements. Challenges arise from incomplete linkage of some sources and the incomplete coverage for enhancements, which also occur at different times post-baseline. We searched for publications using UKB for mental health research from 2016 to 2023 to describe and inspire future use. Papers were classified by mental health topic, ‘additional’ aspects, and the data used to define the mental health topic. We identified 480 papers, with 338 focusing on mental health disorder topics (affective, anxiety, psychotic, multiple, and transdiagnostic). The most commonly studied disorder was depression (41%). The most common single method of ascertaining mental disorder status was the Mental Health Questionnaire (26%), with genetic risk, for example, using polygenic risk scores, also frequent (21%). Common additional aspects included brain imaging, gene–environment interaction, and the relationship with physical health. The review demonstrates the value of UKB to mental health research. We explore the strengths and weaknesses, producing resources informed by the review. A strength is the flexibility: conventional epidemiological studies are present, but also genomics, imaging, and other tools for understanding mental health. A major weakness is selection effects. UKB continues to hold potential, especially with additional data continuing to become available.
Bipolar disorder (BD) is a chronic illness affecting approximately 2-3% adults worldwide. Mood stabilizers, such as lithium, valproate, carbamazepine, and lamotrigine are mainstays of the treatment. Despite their benefits, mood stabilizers carry a risk of side effects, which can lead to treatment discontinuation and non-adherence rates ranging from 10 to 60% in BD patients (Dols et al. Int Clin Psychopharmacol 2013; 28, 287-296). Dermatologic side effects, also known as cutaneous adverse drug reactions, are particularly distressing, often impacting patients’ self-esteem and social interactions, and contributing to non-compliance. These reactions can range in severity from mild rashes, acneiform eruptions, hair loss and psoriasis to severe, life-threatening conditions like Stevens-Johnson syndrome (SJS) and toxic epidermal necrolysis (TEN) (Mitkov et al. Psychosomatics 2014; 55, 1-20).
Objectives
Despite the well-documented association between mood stabilizers and dermatologic adverse effects (AE), the overall prevalence of these reactions across mood stabilizers remains unclear. This systematic review and meta-analysis aims (1) to estimate the prevalence of dermatologic AE associated with mood stabilizer (lithium, valproate, carbamazepine and lamotrigine) use in patients with BD, and (2) to summarize the available evidence on the onset and timing of these reactions.
Methods
We searched Ovid MEDLINE®, Embase, Cochrane Library, Web of Science, Scopus, and PsycINFO from 1970 onward for studies on dermatologic AEs in BD patients treated with lithium, valproate, carbamazepine, or lamotrigine (CRD42022357268). Study selection, data extraction, and bias risk assessment were performed by two reviewers. Meta-analyses were conducted to estimate the prevalence rates for dermatologic AEs.
Results
The initial database searches yielded 5,354 studies. 47 articles were deemed relevant and included in this systematic review. Study designs included 16 randomized controlled trials, 10 non-randomized open-label trials, 12 cohort studies, and 9 cross-sectional studies.
Lithium was associated with acneiform eruptions in 4.4% (95% CI: 1.0-17.0%), rash in 1.8% (95% CI: 0.7-4.8%), and hair loss in 1.7% (95% CI: 0.4%-6.4%) of patients. For valproate, hair loss was observed in 4.6% of patients (95% CI: 3.0-6.7%) and rash in 2.9% (95% CI: 1.6-5.3%). Carbamazepine was associated with rash in 6.0% of patients (95% CI: 4.4-7.6%), but severe reactions such as SJS and TEN were not reported. Lamotrigine had the highest rash prevalence with 9.2% (95% CI: 7.2-11.8%), while severe reactions were rare (0.04%, 95% CI: 0.00-0.63%).
Conclusions
Mood stabilizers showed varying levels of dermatologic AEs, but severe reactions were rare. Future studies should explore factors influencing these outcomes, their impact on quality of life and treatment participation, and potential management strategies.
Functional impairment in daily activities, such as work and socializing, is part of the diagnostic criteria for major depressive disorder and most anxiety disorders. Despite evidence that symptom severity and functional impairment are partially distinct, functional impairment is often overlooked. To assess whether functional impairment captures diagnostically relevant genetic liability beyond that of symptoms, we aimed to estimate the heritability of, and genetic correlations between, key measures of current depression symptoms, anxiety symptoms, and functional impairment.
Methods
In 17,130 individuals with lifetime depression or anxiety from the Genetic Links to Anxiety and Depression (GLAD) Study, we analyzed total scores from the Patient Health Questionnaire-9 (depression symptoms), Generalized Anxiety Disorder-7 (anxiety symptoms), and Work and Social Adjustment Scale (functional impairment). Genome-wide association analyses were performed with REGENIE. Heritability was estimated using GCTA-GREML and genetic correlations with bivariate-GREML.
Results
The phenotypic correlations were moderate across the three measures (Pearson’s r = 0.50–0.69). All three scales were found to be under low but significant genetic influence (single-nucleotide polymorphism-based heritability [h2SNP] = 0.11–0.19) with high genetic correlations between them (rg = 0.79–0.87).
Conclusions
Among individuals with lifetime depression or anxiety from the GLAD Study, the genetic variants that underlie symptom severity largely overlap with those influencing functional impairment. This suggests that self-reported functional impairment, while clinically relevant for diagnosis and treatment outcomes, does not reflect substantial additional genetic liability beyond that captured by symptom-based measures of depression or anxiety.
Sustainable diets should promote good health for both the planet and the individual. While there is a clear association between lower environmental impact diets and better health outcomes, intervention studies are needed to determine the range of dietary changes and to understand inter-individual differences in response. Individuals having different responses to dietary interventions are underpinned by a variety of genetic, phenotypic and behavioural factors. The aim of this review is to apply the findings from previous literature examining inter-individual variation and phenotypic response to the future of sustainable healthy diets. Despite changing diets or improving diet quality, physiological responses are varied in randomised controlled trials. To better understand response, individuals can be grouped based on shared baseline characteristics or by their shared response to an intervention. Studies grouping individuals by shared characteristics use a metabolic phenotyping or metabotyping approach which demonstrates that some phenotypes are more predisposed to respond to a particular intervention. Tailoring dietary advice to metabolic phenotype shows promise for improving health and diet quality. However, more evidence is needed to understand the complexity that will come with whole dietary change in the context of sustainable healthy diets. We envisage a future where metabolic phenotyping is an integral element for prescribing personalised nutrition advice for sustainable healthy diets.
Shift workers in Australia constitute approximately 16% of the workforce, with nearly half working a rotating shift pattern(1). Whilst poor dietary habits of shift workers have been extensively reported, along with increased risk of metabolic health conditions such as obesity, cardiovascular disease and diabetes compared to non-shift workers(2,3,4), studies on shift working populations rarely control for individual and lifestyle factors that might influence dietary profiles. While rotating shift work schedules have been linked with higher energy intake than daytime schedules(5), little is known about the impact of different night shift schedules (e.g., fixed night vs rotating schedules) on the diets of shift workers, including differences in 24-hour energy intake and nutrient composition. This observational study investigated the dietary habits of night shift workers with overweight/obesity and compared the impact of rotating and fixed night shift schedules on dietary profiles. The hypothesis was posited, that shift workers’ diets overall would deviate from national nutrition recommendations, and those working rotating shift schedules compared with fixed night schedules would have higher energy consumption. Participants were from the Shifting Weight using Intermittent Fasting in night shift workers (SWIFt) trial, a randomised controlled weight loss trial, and provided 7-day food diaries upon enrolment. Mean energy intakes (EI) and the percentage of EI from macronutrients, fibre, saturated fat, added sugar, alcohol, and the amount of sodium were evaluated against Australian adult recommendations. Total group and subgroup analysis of fixed night vs rotating schedules’ dietary profiles were conducted, including assessment of plausible and non-plausible energy intake reporters. Hierarchical regression analysis were conducted on nutrient intakes, controlling for individual and lifestyle factors of age, gender, BMI, physical activity, shift work exposure, occupation and work schedule. Overall, night shift workers (n = 245) had diets characterised by high fat/saturated fat/sodium content and low carbohydrate/fibre intake compared to nutrition recommendations, regardless of shift schedule type. Rotating shift workers (n = 121) had a higher mean 24-hour EI than fixed night workers (n = 122) (9329 ± 2915 kJ vs 8025 ± 2383 kJ, p < 0.001), with differences remaining when only plausible EI reporters were included (n = 130) (10968 ± 2411 kJ vs 9307 ± 2070 kJ, p < 0.001). These findings highlight poor dietary choices among this population of shift workers, and higher energy intakes of rotating shift workers, which may contribute to poor metabolic health outcomes often associated with working nightshift.
Approximately 15% of Australia’s workforce are shift workers, who are at greater risk for obesity and related conditions, such as type 2 diabetes and cardiovascular disease.(1,2,3) While current guidelines for obesity management prioritise diet-induced weight loss as a treatment option, there are limited weight-loss studies involving night shift workers and no current exploration of the factors associated with engagement in weight-loss interventions. The Shifting Weight using Intermittent Fasting in night shift workers (SWIFt) study was a randomised controlled trial that compared three, 24-week weight-loss interventions: continuous energy restriction (CER), and 500-calorie intermittent fasting (IF) for 2-days per week; either during the day (IF:2D), or the night shift (IF:2N). This current study provided a convergent, mixed methods, experimental design to: 1) explore the relationship between participant characteristics, dietary intervention group and time to drop out for the SWIFt study (quantitative); and 2) understand why some participants are more likely to drop out of the intervention (qualitative). Participant characteristics included age, gender, ethnicity, occupation, shift schedule, number of night shifts per four weeks, number of years in shift work, weight at baseline, weight change at four weeks, and quality of life at baseline. A Cox regression model was used to specify time to drop out from the intervention as the dependent variable and purposive selection was used to determine predictors for the model. Semi-structured interviews at baseline and 24-weeks were conducted and audio diaries every two weeks were collected from participants using a maximum variation sampling approach, and analysed using the five steps of framework analysis.(4) A total of 250 participants were randomised to the study between October 2019 and February 2022. Two participants were excluded from analysis due to retrospective ineligibility. Twenty-nine percent (n = 71) of participants dropped out of the study over the 24-week intervention. Greater weight at baseline, fewer years working shift work, lower weight change at four weeks, and women compared to men were associated with a significant increased rate of drop out from the study (p < 0.05). Forty-seven interviews from 33 participants were conducted and 18 participants completed audio diaries. Lack of time, fatigue and emotional eating were barriers more frequently reported by women. Participants with a higher weight at baseline more frequently reported fatigue and emotional eating barriers, and limited guidance on non-fasting days as a barrier for the IF interventions. This study provides important considerations for refining shift-worker weight-loss interventions for future implementation in order to increase engagement and mitigate the adverse health risks experienced by this essential workforce.
Community-engaged research is essential to advance the implementation of evidence-based practices, but engagement quality is rarely assessed. We evaluated community health centers’ (CHCs) experiences partnering with the Implementation Science Center for Cancer Control Equity (ISCCCE) using an online survey of 59 CHC staff. Of 38 respondents (64.4% response rate), most perceived their engagement positively, with over 92% feeling respected by ISCCCE collaborators and perceiving projects as beneficial. Limited staff time and resources were the main challenges identified. This study suggests the utility of gathering feedback to evaluate community research engagement and inform adaptations of research processes to optimize partnership quality.
It remains unclear which individuals with subthreshold depression benefit most from psychological intervention, and what long-term effects this has on symptom deterioration, response and remission.
Aims
To synthesise psychological intervention benefits in adults with subthreshold depression up to 2 years, and explore participant-level effect-modifiers.
Method
Randomised trials comparing psychological intervention with inactive control were identified via systematic search. Authors were contacted to obtain individual participant data (IPD), analysed using Bayesian one-stage meta-analysis. Treatment–covariate interactions were added to examine moderators. Hierarchical-additive models were used to explore treatment benefits conditional on baseline Patient Health Questionnaire 9 (PHQ-9) values.
Results
IPD of 10 671 individuals (50 studies) could be included. We found significant effects on depressive symptom severity up to 12 months (standardised mean-difference [s.m.d.] = −0.48 to −0.27). Effects could not be ascertained up to 24 months (s.m.d. = −0.18). Similar findings emerged for 50% symptom reduction (relative risk = 1.27–2.79), reliable improvement (relative risk = 1.38–3.17), deterioration (relative risk = 0.67–0.54) and close-to-symptom-free status (relative risk = 1.41–2.80). Among participant-level moderators, only initial depression and anxiety severity were highly credible (P > 0.99). Predicted treatment benefits decreased with lower symptom severity but remained minimally important even for very mild symptoms (s.m.d. = −0.33 for PHQ-9 = 5).
Conclusions
Psychological intervention reduces the symptom burden in individuals with subthreshold depression up to 1 year, and protects against symptom deterioration. Benefits up to 2 years are less certain. We find strong support for intervention in subthreshold depression, particularly with PHQ-9 scores ≥ 10. For very mild symptoms, scalable treatments could be an attractive option.
Developing integrated mental health services focused on the needs of children and young people is a key policy goal in England. The THRIVE Framework and its implementation programme, i-THRIVE, are widely used in England. This study examines experiences of staff using i-THRIVE, estimates its effectiveness, and assesses how local system working relationships influence programme success.
Methods
This evaluation uses a quasi-experimental design (10 implementation and 10 comparison sites.) Measurements included staff surveys and assessment of ‘THRIVE-like’ features of each site. Additional site-level characteristics were collected from health system reports. The effect of i-THRIVE was evaluated using a four-group propensity-score-weighted difference-in-differences model; the moderating effect of system working relationships was evaluated with a difference-in-difference-in-differences model.
Results
Implementation site staff were more likely to report using THRIVE and more knowledgeable of THRIVE principles than comparison site staff. The mean improvement of fidelity scores among i-THRIVE sites was 16.7, and 8.8 among comparison sites; the weighted model did not find a statistically significant difference. However, results show that strong working relationships in the local system significantly enhance the effectiveness of i-THRIVE. Sites with highly effective working relationships showed a notable improvement in ‘THRIVE-like’ features, with an average increase of 16.41 points (95% confidence interval: 1.69–31.13, P-value: 0.031) over comparison sites. Sites with ineffective working relationships did not benefit from i-THRIVE (−2.76, 95% confidence interval: − 18.25–12.73, P-value: 0.708).
Conclusions
The findings underscore the importance of working relationship effectiveness in the successful adoption and implementation of multi-agency health policies like i-THRIVE.
Environmental impacts of food systems have stimulated research to examine how to create healthy diets that will be more sustainable while meeting nutrient requirements. Increasing compliance with existing food-based dietary guidelines in most jurisdictions could be a first step to improve health and reduce environmental impact. MyPlanetDiet was an all-Ireland 12-week randomised controlled trial designed to inform sustainable healthy dietary guidelines. Healthy adults (n 355) aged 18–64 years with moderate-to-high greenhouse gas emitting (GHGE) diets were recruited from three study sites on the island of Ireland. The aim of this research is to assess the relationship between dietary intakes, diet-related environmental impacts and metabolic health using baseline data collected during the MyPlanetDiet study. Dietary assessments collected using Foodbook24 were used to calculate diet-related GHGE, adherence to healthy eating guidelines (HEG) and healthy eating index (HEI) score. Anthropometrics and metabolic health markers (e.g. lipids, glucose and insulin) were included. Overall HEG adherence was low, with 43 % meeting zero or one HEG food group recommendations. Adherence to 4 + HEG food group targets was associated with 31 % lower diet-related GHGE compared with those with lowest adherence. Higher HEG adherence was associated with lower BMI and waist circumference and higher HEI scores. While our findings suggest HEG adherence is associated with positive health and environmental impacts, substantial behaviour change will be needed to meet existing HEG. Further research is needed to assess response and acceptability to HEG. However, adherence to HEG may be an important first step to reducing the environmental impact of food consumption.