PRISM :: Browsing by Author "Campbell, Tavis S."

Browsing by Author "Campbell, Tavis S."

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Open Access
A randomized controlled trial of a “Small Changes” behavioral weight loss treatment delivered in cardiac rehabilitation for patients with atrial fibrillation and obesity: study protocol for the BE-WEL in CR-AF study
(2024-10-11) Williamson, Tamara M.; Rouleau, Codie R.; Wilton, Stephen B.; Valdarchi, A. B.; Moran, Chelsea; Patel, Stuti; Lutes, Lesley; Aggarwal, Sandeep G.; Arena, Ross; Campbell, Tavis S.
Abstract Background Atrial fibrillation (AF) represents a global epidemic. Although international AF practice guidelines indicate weight loss for patients with AF and comorbid obesity (BMI ≥ 30 kg/m2) to alleviate symptom burden and improve prognosis, few cardiac rehabilitation (CR) programs include targeted weight loss treatment. Aims This RCT protocol will evaluate the efficacy of a “Small Changes” behavioral weight loss treatment (BWLT) to produce clinically relevant (≥ 10%) weight loss among patients with AF and obesity undergoing CR, relative to CR alone. Secondary aims are to establish efficacy of CR + BWLT for improving AF symptoms, AF risk factors, and health-related quality of life. Methods Adults (18 +) with AF and obesity will be recruited and randomized to receive CR + BWLT (intervention) or CR-only (control). Controls will receive CR consisting of supervised exercise and risk factor self-management for 12 weeks. The intervention group will receive CR plus BWLT (12 weekly, group-based virtual sessions, followed by 12 weeks of follow-up support). Weight and AF-risk factors will be assessed at pre-randomization, 12 weeks, 24 weeks, and 52 weeks. AF burden will be assessed using 30-s ECGs recorded bidaily and with AF symptoms. The primary endpoint of weight loss will be calculated from baseline to 52 weeks as a percentage of starting weight. Intention-to-treat analyses will compare the proportion in each group achieving ≥ 10% weight loss. Assuming success rates of 5% and 30% among controls and intervention groups, respectively, and a 30% loss to follow-up, 120 patients (60 per group) will provide 80% power to detect a difference using a two-sided independent test of proportions (alpha = 5%). Impact This clinical trial will be the first to demonstrate that adding BWLT to CR promotes clinically meaningful weight loss among patients with AF and comorbid obesity. Findings will inform design and execution of a large efficacy trial of long-term (e.g., 5-year) clinical endpoints (e.g., AF severity, mortality). Implementing weight control interventions designed to target the AF substrate in CR could dramatically reduce morbidity and enhance quality of life among patients living with AF in Canada. Trial registration ClinicalTrials.gov registration number: NCT05600829. Registered October 31, 2022.
Open Access
Adverse childhood experiences and HPA axis function in pregnant women
(Elsevier, 2018-05-28) Thomas, Jenna C.; Magel, Chantelle; Tomfohr-Madsen, Lianne; Madigan, Sheri L.; Letourneau, Nicole Lyn; Campbell, Tavis S.; Giesbrecht, G. F.; APrON Study Team
Open Access
Attentional Bias in Non-Smokers Who Use an Electronic Cigarette
(2019-08-19) Fitzpatrick, Chelsea Louise; McGrath, Daniel S.; Sears, Christopher R.; Campbell, Tavis S.; Stea, Jonathan N.
Electronic cigarettes (e-cigarettes) have been gaining popularity in recent years and are now being used in large numbers by youth who smoke tobacco cigarettes as well as among youths who do not smoke. Previous research has indicated that substance users can develop attentional biases towards stimuli related to their use. Yet, the existence of attentional biases among users of e-cigarettes remains largely unexplored. Using a sample of non-smokers, the present study examined whether e-cigarette users develop an attentional bias toward e-cigarette stimuli and whether this can be transferred to traditional cigarette stimuli. Using eye-gaze tracking to identify attentional biases, it was found that e-cigarette users significantly differed in comparison to controls in terms of the average amount of time that they attended to e-cigarette stimuli. However, e-cigarette users did not preferentially attend to e-cigarette stimuli over neutral stimuli. Furthermore, e-cigarette users did not attend more to smoking stimuli over neutral stimuli. Rather, e-cigarette users appeared to avoid smoking cues. The results of this study indicate that e-cigarette users’ attention towards e-cigarettes is increased in comparison to non-users, which may have implications as to how they react to e-cigarette cues in real-world settings.
Open Access
Biological embedding of perinatal social relationships in infant stress reactivity
(Wiley, 2017-02-21) Thomas, Jenna C.; Letourneau, Nicole Lyn; Bryce, Crystal I.; Campbell, Tavis S.; Giesbrecht, G. F.; APrON Study Team
Whereas significant advances have been made in understanding how exposure to early adversity "gets under the skin" of children to result in long-term changes in developmental outcomes, the processes by which positive social relationships become biologically-embedded remain poorly understood. The aim of this study was to understand the pathways by which maternal and infant social environments become biologically-embedded in infant cortisol reactivity. Two hundred seventy-two pregnant women and their infants were prospectively assessed during pregnancy and at 6 months postpartum. In serial mediation analyses, higher perceived social support from partners during pregnancy was associated with lower infant cortisol reactivity or larger decreases in cortisol in response to a stressor at 6 months of age via lower self-reported prenatal maternal depression and higher mother-infant interaction quality. The findings add to our understanding of how perinatal social relationships become biologically-embedded in child development.
Open Access
Design and Evaluation of a Brief Motivational Intervention to Promote Enrolment in Outpatient Cardiac Rehabilitation: A Mixed-Methods Feasibility Study
(2017) Rouleau, Codie R; Campbell, Tavis S.; King-Shier, Kathryn M; Tomfohr-Madsen, Lianne; von Ranson, Kristin M; Russell-Mayhew, Michelle K; Oh, Paul I
Objective: Patients who are referred to exercise-based cardiac rehabilitation (CR) following an acute coronary syndrome (ACS) event stand to benefit from a range of positive CR-related outcomes, including reduced morbidity and mortality. Yet, only 19-34% of eligible patients participate in CR in the United States and Canada. Motivational interviewing could be useful for encouraging CR enrolment, but empirical support does not exist. Research that examines patients’ decision-making about CR enrolment is needed to inform effective motivational intervention in this context. Methods: A two-part study was conducted to design and evaluate a brief motivational intervention to enhance intention to attend a 12-week CR program. Part 1 involved a qualitative examination of decision-making about CR enrolment using semi-structured interviews with ACS patients following CR referral but prior to enrolment (n = 14). A brief motivational intervention was subsequently designed to target obstacles to CR identified by patients in Part 1. Part 2 involved a two-group randomized controlled trial to examine preliminary efficacy and mechanisms of the intervention, using a usual care control group (n = 96). The primary outcome was intention to attend CR. Secondary outcomes included CR beliefs, CR barriers, self-efficacy, illness perception, social support, CR enrolment/adherence, and intervention acceptability. Results: Thematic analysis of qualitative data in Part 1 suggested the intervention should aim to bolster anticipated benefits of CR; assist patients in overcoming concerns about exercise, transportation, finances, and scheduling; and address contextual variables such as emotional distress and knowledge gaps. Randomization to the motivational intervention was associated with greater intention to attend CR (p = .001), greater perceived necessity of CR (p = .036), lower exercise concerns (p = .011), and higher CR adherence (p = .008), compared to usual care. Conclusions: Results provide preliminary evidence for the efficacy of a brief motivational intervention to enhance intention to attend CR. Implementing strategies that enhance the perceived necessity of CR and reduce exercise concerns may help improve adherence to CR following an ACS event. This body of work will help optimize efforts to promote participation in an under-utilized, cost-effective program that significantly improves ACS outcomes.
Open Access
Investigating Intranasal Oxytocin as a Treatment for Women's Chronic Pelvic Pain: A Feasibility Study
(2018-09-14) Flynn, Michelle Jacqueline; Campbell, Tavis S.; Noel, Melanie; Bergeron, Sophie; McGrath, Daniel S.
Chronic pelvic pain (CPP) affects approximately 5.7-26.6% of women in the general population and has limited treatment options. Administration of oxytocin (OT) has been associated with reductions in pain in other chronic pain conditions. The current feasibility study was the first to investigate the OT-pain association in women with CPP. The aims were: 1) determine if a clinically significant change in pain intensity (1-centimeter improvement on a 10-centimeter visual analogue scale) could be detected following intranasal OT administration; 2) identify challenges in treatment and study protocol implementation. Women with CPP (N=18) were recruited from chronic pain and gynecology clinics for this randomized, double-blind, within-subject crossover trial (Registration#NCT02888574). Exclusion criteria included pregnancy, primary diagnosis of endometriosis, dysmenorrhea, interstitial cystitis, functional bowel disorder, fibromyalgia, or neuropathic pain. Currently, 11 women have completed the trial (2-weeks OT, 2-weeks washout, 2-weeks placebo, with random order of OT and placebo). Women recorded symptoms of pain at baseline and in daily diaries. One participant dropped out due to headaches following placebo administration, one did not complete daily diaries, and two were randomized despite having pain only during intercourse, leaving seven women in the analyses. Clinically significant change was reported for average and current pain following OT and placebo administration. Self-reported treatment adherence was near perfect. Participants viewed the treatment as credible, anticipating improved pain. Daily diary adherence was good. Challenges with protocol implementation highlight the need for more systematic eligibility assessments and recruitment strategies, and moving daily diaries to an online platform. Overall, a clinically significant change was detected on pain and the treatment protocol was feasible, though some adjustments to the study protocol are warranted before a subsequent trial is completed.
Open Access
Maternal sensitivity and social support protect against childhood atopic dermatitis
(Springer Nature, 2017-05-26) Letourneau, Nicole Lyn; Kozyrskyj, Anita L.; Cosic, Nela; Ntanda, Henry N.; Anis, Lubna; Hart, Martha J.; Campbell, Tavis S.; Giesbrecht, G. F.; APrON Study Team
Background: Many studies have identified associations between qualities of maternal–child relationships and childhood asthma, but few have examined associations with childhood atopic dermatitis (AD), a common precursor to asthma. Moreover, maternal psychological distress, including prenatal and postnatal depression, anxiety and stress, may increase risk, while social support from partners may reduce risk for childhood AD. We sought to uncover the association between maternal–infant relationship qualities (maternal sensitivity towards infant behavioral signals, controlling behavior, and unresponsiveness) and child AD after accounting for risk (i.e., prenatal and postnatal maternal depression, anxiety and stress) and protective (i.e., social support) factors. Methods: We conducted a secondary analysis of data collected on a sub-sample of 242 women and their infants enrolled during pregnancy in the ongoing Alberta Pregnancy Outcomes and Nutrition cohort study. Inclusion criteria required mothers to be >16 years of age, English speaking and <22 weeks gestational age at enrolment. Data on depression, anxiety and stress in the prenatal and postnatal periods and physician diagnosis of childhood AD at 18 months were gathered via maternal report. Maternal sensitivity, unresponsiveness and controlling behaviours were assessed via videotaped observations using the Child-Adult Relationship Experimental (CARE)-Index at 6 months of infant age. Results: Higher maternal sensitivity, or the inability of the mother to appropriately understand and respond to infant needs based on behavioral signals, predicted reduced odds of AD independent of and in combination with low prenatal and postnatal anxiety and high paternal support. After adjustment, higher maternal controlling behaviours and unresponsiveness also predicted greater odds of AD. Conclusions: Low maternal sensitivity is a risk factor for childhood AD, independently and in combination with perinatal anxiety and low social support. Thus, interventions that improve maternal–infant relationship quality, especially sensitivity, reduce anxiety and improve social support from partners could reduce odds of childhood AD.
Open Access
Mindfulness-based cognitive therapy for psychological distress in pregnancy: study protocol for a randomized controlled trial
(Springer Nature, 2016-10-13) Giesbrecht, Gerald F.; Dimidjian, Sona; Madsen, Joshua W.; Carlson, Linda E.; Letourneau, Nicole L.; Tomfohr-Madsen, Lianne M.; Campbell, Tavis S.
Clinically significant psychological distress in pregnancy is common, with epidemiological research suggesting that between 15 and 25 % of pregnant women experience elevated symptoms of stress, anxiety, and depression. Untreated psychological distress in pregnancy is associated with poor obstetrical outcomes, changes in maternal physiology, elevated incidence of child physical and psychological disorders, and is predictive of maternal postpartum mood disorders. Despite the wide-ranging impact of antenatal psychological distress on mothers and their children, there is a gap in our knowledge about the most effective treatments that are available for psychological distress experienced in pregnancy. Additionally, no trials have focused on potential physiological changes that may occur as a result of receiving mindfulness training in pregnancy. The proposed trial will determine the effectiveness of an 8-week modified Mindfulness-based Cognitive Therapy (MBCT) intervention delivered during pregnancy.
Open Access
Neuroanatomical Changes Associated with Working Memory Training in Healthy Adults
(2018-06-26) Savage, Linette; Goghari, Vina M.; Campbell, Tavis S.; Bodner, Glen E.; Lebel, Catherine A.; MacMaster, Frank P.; Yang, Lixia
The potential for working memory training to enhance cognitive and intellectual abilities is alluring across scientific disciplines and the general public. However, the field has been fraught with inconsistency and controversy. Heterogeneous methodological implementations have led to a divided and contrasting body of literature, which has collectively limited scientific transparency and advancement in the field. However, neuroimaging has the potential to clarify what, if any, benefit working memory training has on the adult human brain. A recent series of studies used functional neuroimaging to investigate neural activations associated with working memory training. This dissertation uses structural imaging to address another theoretical area: the neuroanatomical correlates of working memory training. Forty-eight healthy community dwelling adults, aged 18 - 40 years, completed a series of cognitive tasks and underwent magnetic resonance imaging (MRI) before and after completing a 6-week trial of working memory training (experimental condition) or processing speed training (active control condition). Group by time repeated measures Analyses of Variance (rm-ANOVAs) were conducted on MRI data to identify changes in surface area, thickness, and volume in theoretically relevant gray matter regions of interest, as well as overall gray and white matter volumes, associated with working memory training. Similar analyses were conducted to investigate changes in cognitive task performance in this sample. Null results were present across all neuroanatomical metrics after correction for multiple comparisons, and findings from cognitive tasks were consistent with the subset of literature suggesting that working memory training does not meaningfully benefit cognitive performance. Albeit limited by low statistical power and the confines of available technology, findings of this study, in consort with recently published investigations, strongly support the idea that working memory training is not an effective method for enhancing cognitive performance or inducing neoplastic changes in brain structure. We suggest that future studies continue attempts to resolve heterogeneity and polarization in this field, or alternatively, concentrate resources on identifying and refining mechanisms of change in populations who may benefit from rehabilitative forms of cognitive training.
Open Access
Prenatal bisphenol a exposure and dysregulation of infant hypothalamic-pituitary-adrenal axis function: findings from the APrON cohort study
(Springer Nature, 2017-05-19) Giesbrecht, G. F.; Ejaredar, Maede; Liu, Jiaying; Thomas, Jenna C.; Letourneau, Nicole Lyn; Campbell, Tavis S.; Martin, Jonathan W.; Dewey, Deborah; APrON Study Team
Background: Animal models show that prenatal bisphenol A (BPA) exposure leads to sexually-dimorphic disruption of the neuroendocrine system in offspring, including the hypothalamic-pituitary-adrenal (HPA) neuroendocrine system, but human data are lacking. In humans, prenatal BPA exposure is associated with sex-specific behavioural problems in children, and HPA axis dysregulation may be a biological mechanism. The objective of the current study was to examine sex differences in associations between prenatal maternal urinary BPA concentration and HPA axis function in 3-month-old infants. Methods: Mother-infant pairs (n = 132) were part of the Alberta Pregnancy Outcomes and Nutrition study, a longitudinal birth cohort recruited (2010–2012) during pregnancy. Maternal spot urine samples collected during the 2nd trimester were analyzed for total BPA and creatinine. Infant saliva samples collected prior to and after a blood draw were analyzed for cortisol. Linear growth curve models were used to characterize changes in infant cortisol as a function of prenatal BPA exposure. Results: Higher maternal BPA was associated with increases in baseline cortisol among females (β = 0.13 log μg/dL; 95% CI: 0.01, 0.26), but decreases among males (β = −0.22 log μg/dL; 95% CI: -0.39, −0.05). In contrast, higher BPA was associated with increased reactivity in males (β = .30 log μg/dL; 95% CI: 0.04, 0.56) but decreased reactivity in females (β = −0.15 log μg/dL; 95% CI: -0.35, 0.05). Models adjusting for creatinine yielded similar results. Conclusions: Prenatal BPA exposure is associated with sex-specific changes in infant HPA axis function. The biological plausibility of these findings is supported by their consistency with evidence in rodent models. Furthermore, these data support the hypotheses that sexually dimorphic changes in children’s behaviour following prenatal BPA exposure are mediated by sexually-dimorphic changes in HPA axis function. Keywords: Bisphenol-A, Fetal exposure, Cortisol, Hypothalamic-pituitary-adrenal axis, Infant stress reactivity
Open Access
A Prospective Proof-of-Concept Study Evaluating the Influence of Patient Education on Knowledge, Attitudes, and Cardiac Rehabilitation Attendance among Patients with Coronary Artery Disease
(2019-08-23) Williamson, Tamara Marie; Campbell, Tavis S.; Rouleau, Codie R.; King-Shier, Kathryn M.; Doyle-Baker, Patricia K.; von Ranson, Kristin M.
Patient education (PE), delivered during cardiac rehabilitation (CR), aims to promote CR exercise attendance by imparting knowledge about coronary artery disease (CAD; medication, risk factors, etc.) and enhancing CR-related attitudes. This study evaluated the impact of PE on motivational treatment targets (CAD knowledge, CR attitudes), and CR exercise attendance. Adults (18+) with CAD referred to CR were recruited prior to attending PE. CAD knowledge and CR attitudes (perceived necessity/suitability, exercise concerns, barriers) were assessed pre/post-PE, and at 12-week follow-up. CR exercise attendance was obtained by chart review. Seventy-one patients (87% male) participated. CAD knowledge and perceived CR necessity improved pre- to post-PE; gains persisted at 12-weeks. Greater knowledge gains did not predict larger improvements in CR attitudes or increased exercise attendance. Whereas CR-based PE may be useful for improving CAD-related knowledge and perceived need for CR, more formative work is needed to determine whether PE can promote CR exercise attendance.
Open Access
Psychosocial Variables and Recovery from Coronary Artery Bypass Graft Surgery in Men and Women
(2014-05-02) Young, Sandra Nicole; Campbell, Tavis S.; Linden, Wolfgang
Coronary artery bypass graft surgery (CABG) is performed to improve impairing coronary artery disease (CAD). Although there is interest in how psychosocial factors impact CABG surgery recovery, little research has investigated psychological and social variables in combination in predicting long-term outcomes following CABG surgery. This dissertation examines the association of depression symptoms and social variables with long-term post-CABG outcomes: life function impairment in social and occupational areas (FI), mortality and morbidity. We hypothesize perceived social support will buffer the association between depression symptoms and outcome and associations may differ for men and women. This prospective, observational, single site study recruited 296 (42% female) post-CABG patients of whom 241 (81%; 44% female) participated at one-year follow-up. Depression symptoms, perceived social support, marital status, household responsibility and life function were assessed by self-report questionnaires in-hospital post-CABG and again one-year later. Mortality and CAD procedures were collected over 12 – 15 year follow-up. In adjusted models, greater baseline depression symptoms, lower perceived social support, lower household responsibilities, and not being married predicted greater one-year FI (R2=.20, p<.001). Baseline social support buffered the association between depression and FI in women (b=.14; 95%CI [.04, .23]) and more strongly predicted one-year FI for women (b=.29; 95%CI [.06, .52]). Long-term survival was also associated with one-year psychosocial measures. A one SD increase in depression symptoms led to greater hazard of mortality only at mean (HR = 1.67; 95% CI [1.21, 2.26]) and high social support (HR = 2.23; 95% CI [1.46, 3.40]). Additively, over the five years after follow-up, being married, greater household responsibility and better life functioning were also associated with improved survival. Regarding CAD procedures, only one-year depression symptoms and life function impairment were associated with greater odds of CAD procedure. Overall, this dissertation supports associations of depression symptoms, social variables and life function with long-term outcomes from CABG surgery. Results suggest perceived social support may be more important for women’s functional outcomes, while depression symptoms and being married with more household responsibilities may be important for men and women. Further, results suggest research should investigate timing of interventions for depressed mood and poor social support.
Open Access
Rumination as a Mediator of Chronic Stress Effects on Hypertension: A Causal Model
(2012-02-16) Gerin, William; Zawadzki, Matthew J.; Brosschot, Jos F.; Thayer, Julian F.; Christenfeld, Nicholas J. S.; Campbell, Tavis S.; Smyth, Joshua M.
Chronic stress has been linked to hypertension, but the underlying mechanisms remain poorly specified. We suggest that chronic stress poses a risk for hypertension through repeated occurrence of acute stressors (often stemming from the chronic stress context) that cause activation of stress-mediating physiological systems. Previous models have often focused on the magnitude of the acute physiological response as a risk factor; we attempt to extend this to address the issue of duration of exposure. Key to our model is the notion that these acute stressors can emerge not only in response to stressors present in the environment, but also to mental representations of those (or other) stressors. Consequently, although the experience of any given stressor may be brief, a stressor often results in a constellation of negative cognitions and emotions that form a mental representation of the stressor. Ruminating about this mental representation of the stressful event can cause autonomic activation similar to that observed in response to the original incident, and may occur and persist long after the event itself has ended. Thus, rumination helps explain how chronic stress causes repeated (acute) activation of one’s stress-mediating physiological systems, the effects of which accumulate over time, resulting in hypertension risk.
Open Access
Social buffering of the maternal and infant HPA axes: Mediation and moderation in the intergenerational transmission of adverse childhood experiences
(Cambridge University Press, 2018-08-02) Thomas, Jenna C.; Letourneau, Nicole Lyn; Campbell, Tavis S.; Giesbrecht, G. F.; APrON Study Team
Supportive social relationships can reduce both psychological and physiological responses to stressful experiences. Recently, studies have also assessed the potential for social relationships to buffer the intergenerational transmission of stress. The majority of these studies, however, have focussed on social learning as a mechanism responsible for the intergenerational transmission of stress. Evidence of biological mechanisms is lacking. The objective of the current study was, therefore, to determine whether the association between maternal adverse childhood experiences (ACEs) and infant hypothalamic-pituitary-adrenal (HPA) axis function is mediated by maternal HPA axis function during pregnancy and moderated by social support. Data were from 243 mother-infant dyads enrolled in a prospective longitudinal cohort (the Alberta Pregnancy Outcomes and Nutrition Study). Maternal history of ACEs was retrospectively assessed while maternal perceived social support and salivary cortisol were assessed prospectively at 6-22 weeks gestation (Time 1) and 27-37 weeks gestation (Time 2), and infant cortisol reactivity to a laboratory stressor and maternal perceived social support were assessed at 5-10 months postnatal (Time 3). Results revealed that maternal HPA axis function during pregnancy mediated the effects of maternal ACEs on infant HPA axis reactivity, suggesting that the maternal HPA axis is a mechanism by which maternal early life stress is transmitted to offspring. Furthermore, social support in the prenatal and postnatal periods moderated the cascade from maternal ACEs to infant HPA axis reactivity. Specifically, prenatal social support moderated the association between ACEs and maternal HPA axis function during pregnancy, and postnatal social support moderated the association between maternal HPA axis function and infant cortisol reactivity. These findings highlight the social sensitivity of the HPA axis and suggest the utility of social relationships as an intervention target to reduce the effects of maternal early life stress on infant outcomes.
Open Access
Sodium Consumption: An Individual's Choice?
(2012-01-03) Campbell, Norm R. C.; Johnson, Jillian A.; Campbell, Tavis S.
Excess intake of dietary salt is estimated to be one of the leading risks to health worldwide. Major national and international health organizations, along with many governments around the world, have called for reductions in the consumption of dietary salt. This paper discusses behavioural and population interventions as mechanisms to reduce dietary salt. In developed countries, salt added during food processing is the dominant source of salt and largely outside of the direct control of individuals. Population-based interventions have the potential to improve health and to be cost saving for these countries. In developing economies, where salt added in cooking and at the table is the dominant source, interventions based on education and behaviour change have been estimated to be highly cost effective. Regardless, countries with either developed or developing economies can benefit from the integration of both population and behavioural change interventions.
Open Access
A Study to Understand and Improve Sexual Activity after Acute Coronary Syndrome
(2018-12-13) Boothby, Célina A.; Rabi, Doreen M.; Campbell, Tavis S.; Santana, Maria Jose; Norris, Colleen
A major cardiovascular event, like acute coronary syndrome (ACS), can have an extensive and long-term impact on many aspects of a patient-partner relationship, including aspects of sexual activity (SA). Current clinical recommendations suggest that both patients and partners should receive SA support after an ACS episode. To this date, there has been little qualitative inquiry that engages both patient and partner perspectives on their opinions of by whom, where, and how, SA support should be provided post-ACS. The objectives of this thesis were to 1) characterize the experiences of re-engaging in SA post-ACS by patients and partners and to 2) determine if cardiac rehabilitation (CR) could be an acceptable and effective point of intervention for SA support post-ACS by patients and partners. A multi-methods study design was used to address both objectives through qualitative inquiry and a systematic review. The qualitative study provided supportive evidence of the importance of SA by patients and partners post-ACS, revealed that couples thought SA support was insufficient and articulated ways that education could be improved, and identified CR as a potential point of SA support. The systematic review revealed seven studies that reported a significant benefit in SA outcomes in the CR group, one study that reported significant harm, and eleven studies that reported a non-significant difference. This thesis suggests that there is room for improvement in terms of content and delivery of SA support to both patients and partners post-ACS, and that CR may be an appropriate place for such support.
Open Access
The eCALM Trial-eTherapy for cancer appLying mindfulness: online mindfulness-based cancer recovery program for underserved individuals living with cancer in Alberta: protocol development for a randomized wait-list controlled clinical trial
(Springer Nature, 2013-2-16) Dirkse, Dale A.; Campbell, Tavis S.; Speca, Michael; McCabe-Ruff, Kelley; Flowers, Steven; Carlson, Linda E.; Zernicke, Kristin A.
Elevated stress can exacerbate cancer symptom severity, and after completion of primary cancer treatments, many individuals continue to have significant distress. Mindfulness-Based Cancer Recovery (MBCR) is an 8-week group psychosocial intervention consisting of training in mindfulness meditation and yoga designed to mitigate stress, pain, and chronic illness. Efficacy research shows face-to-face (F2F) MBCR programs have positive benefits for cancer patients; however barriers exist that impede participation in F2F groups. While online MBCR groups are available to the public, none have been evaluated.
Open Access
The Impact of Mood and Anxiety Disorders on Incident Hypertension at One Year
(2014-02-02) Bacon, Simon L.; Campbell, Tavis S.; Arsenault, André; Lavoie, Kim L.
Background. Studies assessing the association between psychological factors and hypertension have been equivocal, which may reflect limitations in the assessment of psychological factors. Purpose. To assess the relationship between mood and anxiety disorders, measured using a psychiatric interview, and 1-year incident hypertension. Methods. 197 nonhypertensive individuals undergoing exercise stress testing at baseline provided follow-up data at 1 year. Baseline assessments included a structure psychiatric interview (PRIME-MD), physician diagnosis of hypertension, and measured blood pressure. At follow-up, hypertension status was assessed via self-reported physician diagnosis. Results. Having an anxiety disorder was associated with a 4-fold increase in the risk of developing hypertension (adjusted OR = 4.14, 95% CIs = 1.18–14.56). In contrast, having a mood disorder was not associated with incident hypertension (adjusted OR = 1.21, 95% CIs = 0.24–5.86). Conclusions. There are potential mechanisms which could explain our differential mood and anxiety findings. The impact of screening and treatment of anxiety disorders on hypertension needs to be explored.
Open Access
The Intergenerational Transmission of Stress: Investigating Mediators and Moderators of the Association between Maternal Adverse Childhood Experiences and Child Development
(2018-08-27) Thomas, Jenna C.; Giesbrecht, Gerald; Campbell, Tavis S.; Curtin, Suzanne; Noel, Melanie
Objective: The intergenerational transmission of adverse childhood experiences (ACEs) has been observed, however the biological mechanisms underlying these associations have yet to be elucidated. Given the dearth of research examining prenatal biological mechanisms, the overall objective of this dissertation was to understand the role of the maternal hypothalamic-pituitary-adrenal (HPA) axis during pregnancy in transducing the effects of maternal ACEs to child developmental outcomes. A subsequent aim was to evaluate social support as a moderator that may buffer the intergenerational transmission of stress. Methods: Data were from 356 pregnant women and their children enrolled in the longitudinal Alberta Pregnancy Outcomes and Nutrition (APrON) study. Maternal HPA axis function was assessed via self-collected salivary cortisol samples collected over multiple days in early (6-22 weeks) and late (27-37 weeks) pregnancy. Maternal ACEs, mental health, and social support were assessed via self-report measures. At 6 months of age, infant HPA axis reactivity was assessed via salivary cortisol samples at baseline and 20 minutes after a standardized laboratory stressor. At 4 years, child behaviour problems were assessed via a standardized maternal report. Results: Maternal ACEs were associated with higher morning cortisol levels and a flattened diurnal slope, consistent with a pattern of cortisol hypersecretion. Maternal HPA axis alterations mediated the association between maternal ACEs and infant HPA axis reactivity to stress at 6 months. These mediated effects were moderated by social support indicating that social support may be a factor that buffers the intergenerational transmission of stress. Maternal ACEs were associated with higher child internalizing problems at 4 years of age, and there were multiple mediators of this association including maternal HPA axis function, prenatal depression, and gestational age at birth. Unexpectedly, the HPA axis pathway predicted lower child internalizing problems and may represent a biological resiliency pathway in an otherwise healthy low sociodemographic risk sample. Conclusions: These studies provide the first evidence that prenatal maternal HPA axis function is a biological mediator of the association between maternal ACEs and child outcomes, and offers some insights into potential avenues for preventing the intergenerational transmission of stress.
Open Access
The Relationship between Multiple Health Behaviours and Brachial Artery Reactivity
(2012-02-29) Gordon, Jennifer L.; Lavoie, Kim L.; Arsenault, André; Meloche, Bernard; Ditto, Blaine; Campbell, Tavis S.; Bacon, Simon L.
Background. The effects of smoking, alcohol consumption, obesity, and a sedentary lifestyle on endothelial function (EF) have only been examined separately. The relative contributions of these behaviours on EF have therefore not been compared. Purpose. To compare the relative associations between these four risk factors and brachial artery reactivity in the same sample. Methods. 328 patients referred for single-photon emission computed tomography (SPECT) exercise stress tests completed a nuclear-medicine-based forearm hyperaemic reactivity test. Self-reported exercise behaviour, smoking habits, and alcohol consumption were collected and waist circumference was measured. Results. Adjusting for relevant covariates, logistic regression analyses revealed that waist circumference, abstinence from alcohol, and past smoking significantly predicted poor brachial artery reactivity while physical activity did not. Only waist circumference predicted continuous variations in EF. Conclusions. Central adiposity, alcohol consumption, and smoking habits but not physical activity are each independent predictors of poor brachial artery reactivity in patients with or at high risk for cardiovascular disease.