Browsing by Author "Taylor, Valerie H."

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    Healthcare providers’ perspectives on implementing a brief physical activity and diet intervention within a primary care smoking cessation program: a qualitative study
    (2024-01-06) Minian, Nadia; Mehra, Kamna; Lingam, Mathangee; Dragonetti, Rosa; Veldhuizen, Scott; Zawertailo, Laurie; deRuiter, Wayne K.; Melamed, Osnat C.; Moineddin, Rahim; Thorpe, Kevin E.; Taylor, Valerie H.; Hahn, Margaret; Selby, Peter
    Abstract Background Post-smoking-cessation weight gain can be a major barrier to quitting smoking; however, adding behavior change interventions for physical activity (PA) and diet may adversely affect smoking cessation outcomes. The “Picking up the PACE (Promoting and Accelerating Change through Empowerment)” study assessed change in PA, fruit/vegetable consumption, and smoking cessation by providing a clinical decision support system for healthcare providers to utilize at the intake appointment, and found no significant change in PA, fruits/vegetable consumption, or smoking cessation. The objective of this qualitative study was to explore the factors affecting the implementation of the intervention and contextualize the quantitative results. Methods Twenty-five semi-structured interviews were conducted with healthcare providers, using questions based on the National Implementation Research Network’s Hexagon Tool. The data were analyzed using the framework’s standard analysis approach. Results Most healthcare providers reported a need to address PA and fruit/vegetable consumption in patients trying to quit smoking, and several acknowledged that the intervention was a good fit since exercise and diet could improve smoking cessation outcomes. However, many healthcare providers mentioned the need to explain the fit to the patients. Social determinants of health (e.g., low income, food insecurity) were brought up as barriers to the implementation of the intervention by a majority of healthcare providers. Most healthcare providers recognized training as a facilitator to the implementation, but time was mentioned as a barrier by many of healthcare providers. Majority of healthcare providers mentioned allied health professionals (e.g., dieticians, physiotherapists) supported the implementation of the PACE intervention. However, most healthcare providers reported a need for individualized approach and adaptation of the intervention based on the patients’ needs when implementing the intervention. The COVID-19 pandemic was found to impact the implementation of the PACE intervention based on the Hexagon Tool indicators. Conclusion There appears to be a need to utilize a flexible approach when addressing PA and fruit/vegetable consumption within a smoking cessation program, based on the context of clinic, the patients’ it is serving, and their life circumstances. Healthcare providers need support and external resources to implement this particular intervention. Name of the registry Clinicaltrials.gov. Trial registration number NCT04223336. Date of registration 7 January 2020 Retrospectively registered. URL of trial registry record https://classic.clinicaltrials.gov/ct2/show/NCT04223336 .
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    Neuroimaging Biomarkers for Youth At-Risk for Serious Mental Illness
    (2020-08) Nogovitsyn, Nikita; MacQueen, Glenda M.; Addington, Jean M.; Ismail, Zahinoor; Protzner, Andrea; Taylor, Valerie H.
    Background: Serious mental illness (SMI) is a constellation of psychiatric illnesses, commonly referring to major depressive disorder (MDD), bipolar disorder(s) (BD), and schizophrenia (SCZ). The diagnosis of SMI relies on a descriptive collection of behaviors with no objective measurements. Young individuals with early signs of developing mental illness are often misdiagnosed or diagnosed at later stages of illness when the opportunity for effective early intervention has passed. Therefore, there is a need for biomarkers that can identify youth at risk for SMI and stratify individuals into clinical stages so that appropriate interventions can be offered. Objective: The overreaching goal of my research is to enhance our understanding of the neurobiological changes underlying the early brain pathophysiology of (SMI). The ultimate aim of this dissertation is to identify neurobiological biomarkers for SMI that will have diagnostic or informative value in the classification of risk stages. Methods: By making use of data generated from two large Canadian studies, the Canadian Psychiatric Risk and Outcome Study (PROCAN), and the Canadian Biomarker Integration Network in Depression (CAN-BIND), I investigate specific structural and functional brain changes accompanying various stages risk and evolution of SMI. Results: This manuscript-based thesis presents structural and functional neuroimaging findings that parallel clinical presentation in youth-at-risk and adults with an existing mood disorder. Subtle structural changes within the hippocampus, amygdala, and thalamus were found in symptomatic at-risk youth with either attenuated or distress syndromes. Volume deficits within the body of the hippocampus were detected even in asymptomatic youth at risk due to the family history of an SMI. Moreover, in at-risk youth with a history of childhood abuse, structural deficits within the basal nuclei of the amygdala mediated the severity of depressive and anxiety symptoms at present. In adult patients diagnosed with MDD, specific patterns of hippocampal disproportions were not only indicative of depression status but also informed about the rate and the likelihood of successful antidepressant treatment. While deviations in subcortical limbic structures supported the transdiagnostic clinical staging model, functional connectivity changes within cerebello-limbic pathways were nearly exclusively indicative of high clinical risk for psychosis. Conclusions: Distributed limbic brain changes can precede the clinical onset of the mental illness, possibly, reflecting the cumulative impact of pernicious effects of stress. Together, these results can be offered in support of a transdiagnostic clinical staging for youth at risk of SMI.
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    Reducing readmission rates for individuals discharged from acute psychiatric care in Alberta using peer and text message support: Protocol for an innovative supportive program
    (2022-03-12) Eboreime, Ejemai; Shalaby, Reham; Mao, Wanying; Owusu, Ernest; Vuong, Wesley; Surood, Shireen; Bales, Kerry; MacMaster, Frank P.; McNeil, Diane; Rittenbach, Katherine; Ohinmaa, Arto; Bremault-Phillips, Suzette; Hilario, Carla; Greiner, Russ; Knox, Michelle; Chafe, Janet; Coulombe, Jeff; Xin-Min, Li; McLean, Carla; Rathwell, Rebecca; Snaterse, Mark; Spurvey, Pamela; Taylor, Valerie H.; McLean, Susan; Urichuk, Liana; Tzeggai, Berhe; McCabe, Christopher; Grauwiler, David; Jordan, Sara; Brown, Ed; Fors, Lindy; Savard, Tyla; Grunau, Mara; Kelton, Frank; Stauffer, Sheila; Cao, Bo; Chue, Pierre; Abba-Aji, Adam; Silverstone, Peter; Nwachukwu, Izu; Greenshaw, Andrew; Agyapong, Vincent I. O.
    Abstract Background Individuals discharged from inpatient psychiatry units have the highest readmission rates of all hospitalized patients. These readmissions are often due to unmet need for mental health care compounded by limited human resources. Reducing the need for hospital admissions by providing alternative effective care will mitigate the strain on the healthcare system and for people with mental illnesses and their relatives. We propose implementation and evaluation of an innovative program which augments Mental Health Peer Support with an evidence-based supportive text messaging program developed using the principles of cognitive behavioral therapy. Methods A pragmatic stepped-wedge cluster-randomized trial, where daily supportive text messages (Text4Support) and mental health peer support are the interventions, will be employed. We anticipate recruiting 10,000 participants at the point of their discharge from 9 acute care psychiatry sites and day hospitals across four cities in Alberta. The primary outcome measure will be the number of psychiatric readmissions within 30 days of discharge. We will also evaluate implementation outcomes such as reach, acceptability, fidelity, and sustainability. Our study will be guided by the Consolidated Framework for Implementation Research, and the Reach-Effectiveness-Adoption-Implementation-Maintenance framework. Data will be extracted from administrative data, surveys, and qualitative methods. Quantitative data will be analysed using machine learning. Qualitative interviews will be transcribed and analyzed thematically using both inductive and deductive approaches. Conclusions To our knowledge, this will be the first large-scale clinical trial to assess the impact of a daily supportive text message program with and without mental health peer support for individuals discharged from acute psychiatric care. We anticipate that the interventions will generate significant cost-savings by reducing readmissions, while improving access to quality community mental healthcare and reducing demand for acute care. It is envisaged that the results will shed light on the effectiveness, as well as contextual barriers and facilitators to implementation of automated supportive text message and mental health peer support interventions to reduce the psychological treatment and support gap for patients who have been discharged from acute psychiatric care. Trial registration clinicaltrials.gov, NCT05133726 . Registered 24 November 2021
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    The development of a patient decision aid to reduce decisional conflict about antidepressant use in pregnancy
    (2022-05-13) Hussain-Shamsy, Neesha; Somerton, Sarah; Stewart, Donna E.; Grigoriadis, Sophie; Metcalfe, Kelly; Oberlander, Tim F.; Schram, Carrie; Taylor, Valerie H.; Dennis, Cindy-Lee; Vigod, Simone N.
    Abstract Background People with moderate to severe depression in pregnancy must weigh potential risks of untreated or incompletely treated depression against the small, but uncertain risks of fetal antidepressant drug exposure. Clinical support alone appears insufficient for helping individuals with this complex decision. A patient decision aid (PDA) has the potential to be a useful tool for this population. The objective of our work was to use internationally recognized guidelines from the International Patient Decision Aids Standards Collaboration to develop an evidence-based PDA for antidepressant use in pregnancy. Methods A three-phased development process was used whereby, informed by patient and physician perspectives and evidence synthesis, a steering committee commissioned a web-based PDA for those deciding whether or not to start or continue antidepressant treatment for depression in pregnancy (Phase 1). A prototype was developed (Phase 2) and iteratively revised based on feedback during field testing based on a user-centred process (Phase 3). Results We developed a web-based PDA for people deciding whether to start or continue antidepressant use for depression in pregnancy. It has five interactive sections: (1) information on depression and treatment; (2) reasons to start/continue an antidepressant and to start/stop antidepressant medication; (3) user assessment of values regarding each issue; (4) opportunity to reflect on factors that contribute to decision making; and (5) a printable PDF that summarizes the user’s journey through the PDA. Conclusions This tool, which exclusively focuses on depression treatment with Selective Serotonin Reuptake Inhibitors and Serotonin–Norepinephrine Reuptake Inhibitors, can be used by individuals making decisions about antidepressant use to treat depression during pregnancy. Limitations of the PDA are that it is not for other conditions, nor other medications that can be used for depression, and in its pilot form cannot be used by women who do not speak English or who have a visual impairment. Pending further study, it has the potential to enhance quality of care and patient experience.
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    The Role of Adipokines in Understanding the Associations between Obesity and Depression
    (2010-07-28) Taylor, Valerie H.; MacQueen, Glenda M.
    Objective. Two major causes of disability, major depression and obesity, share overlapping psychosocial and pathophysiological etiologies. Studies are now focused on biological mechanisms linking the two illnesses, and there is interest in the role that adipokines may have in mediating the association between obesity and depression. We reviewed the literature to look at what is currently known about this association, focusing on the adipokines leptin, adiponectin, and resistin. Methods. A MEDLINE search, citing articles from 1966 onward, supplemented by a review of bibliographies, was conducted to identify relevant studies. Results. This paper identified plausible pathways underlying a link between adipokines and depression. Only a few studies have yet been conducted specifically examining these biomarkers in patients with depression, but the results are intriguing. Conclusion. This paper is one of the first to examine the association between adipokines and depression. It provides an overview of the physiological role of adipokines and summarizes the data suggesting that they may be dysregulated in major depression. This area of research may become increasingly important as new treatment strategies are developed.
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    The safety and efficacy of fecal microbiota transplantation in a population with bipolar disorder during depressive episodes: study protocol for a pilot randomized controlled trial
    (2021-07-14) Cooke, Noah C. A.; Bala, Asem; Allard, Johane P.; Hota, Susy; Poutanen, Susan; Taylor, Valerie H.
    Abstract Background Bipolar disorder (BD) is a chronic, debilitating illness with significant medical morbidity, often secondary to current treatments, and a high recurrence rate. This burden of disease reflects limitations in the tolerability and efficacy of current treatments. There is a compelling body of evidence linking the gut microbiota to mental illness, and while microbial manipulation via probiotic use has been studied as a therapeutic in BD, targeted trials of fecal microbiota transplantation (FMT) have not been conducted in this population. Methods and design We describe a pilot randomized controlled trial of FMT in participants with BD depression to assess the feasibility, efficacy, safety, and tolerability of this intervention. Individuals between 18 and 65 years of age will be enrolled in the study if they meet diagnostic criteria for a major depressive episode of at least moderate severity in the context of a BD diagnosis and have not responded to treatment for BD. Participants will be randomized 1:1 to receive either screened and processed donor stool (allogenic FMT) or their own stool (autologous FMT) via colonoscopy and monitored for 24 weeks post intervention. Depressive and manic symptoms, treatment acceptability, and gastrointestinal and other side effects are assessed at baseline (prior to randomization) and weekly. Stool samples to assess microbiome composition are obtained at baseline and 3 and 6 months. Discussion Currently, FMT represents a novel therapeutic option for treating BD depression. This protocol allows for the assessment of the feasibility, efficacy, acceptability, and safety of an intervention aimed at changing the microbiome in those with BD. Results from this pilot study will guide the development of larger trials of FMT for BD depression and may give more insight into how the gut microbiome are altered in those with BD depression. Trial registration Clinical Trials Gov NCT03279224