Randomised controlled non-inferiority trial of primary care-based facilitated access to an alcohol reduction website

in BMJ Open (2017), 7(11),

Background: Brief interventions (BIs) delivered in primary care have been shown to be effective in reducing risky drinking, but implementation is limited. Facilitated access to a digital application ... [more ▼]

Background: Brief interventions (BIs) delivered in primary care have been shown to be effective in reducing risky drinking, but implementation is limited. Facilitated access to a digital application offers a novel alternative to face-to-face intervention, but its relative effectiveness is unknown.Methods: Primary care-based, non-inferiority, randomised controlled trial comparing general practitioner (GP) facilitated access to an interactive alcohol reduction website (FA) with face-to-face BI for risky drinking. Patients screening positive on the short Alcohol Use Disorders Identification Test (AUDIT-C) were invited to participate in the trial. Assessment at baseline, 3 months and 12 months was carried out using AUDIT and EQ-5D-5L questionnaires. Findings: 58 participating GPs approached 9080 patients of whom 4529 (49.9%) logged on, 3841 (84.8%) undertook screening, 822 (21.4%) screened positive and 763 (19.9%) were recruited. 347 (45.5%) were allocated to FA and 416 (54.5%) to BI. At 3 months, subjects in FA group with an AUDIT score of ≥8 reduced from 95 (27.5%) to 85 (26.8%) while those in BI group increased from 123 (20.6%) to 141 (37%). Differences between groups were principally due to responses to AUDIT question 10. Analysis of primary outcome indicated non-inferiority of FA compared with BI, and prespecified subgroup analysis indicated benefits for older patients and those with higher levels of computer literacy and lower baseline severity. Additional analyses undertaken to take account of bias in response to AUDIT question 10 failed to support non-inferiority within the prespecified 10% boundary.Interpretation: Prespecified protocol-driven analyses of the trial indicate that FA is non-inferior to BI; however, identified bias in the outcome measure and further supportive analyses question the robustness of this finding. It is therefore not possible to draw firm conclusions from this trial, and further research is needed to determine whether the findings can be replicated using more robust outcome measures.Trial registration number NCT01638338; Results. [less ▲]

Randomised controlled non-inferiority trial of primary care-based facilitated access to an alcohol reduction website: cost-effectiveness analysis

in BMJ Open (2017), 7(11),

Objectives To evaluate the 12-month costs and quality-adjusted life years (QALYs) gained to the Italian National Health Service of facilitated access to a website for hazardous drinkers compared with a ... [more ▼]

Objectives To evaluate the 12-month costs and quality-adjusted life years (QALYs) gained to the Italian National Health Service of facilitated access to a website for hazardous drinkers compared with a standard face-to-face brief intervention (BI). Design Randomised 1:1 non-inferiority trial. Setting Practices of 58 general practitioners (GPs) in Italy. Participants Of 9080 patients (>18 years old) approached to take part in the trial, 4529 (49·9%) logged on to the website and 3841 (84.8%) undertook online screening for hazardous drinking. 822 (21.4%) screened positive and 763 (19.9%) were recruited to the trial. Interventions Patients were randomised to receive either a face-to-face BI or access via a brochure from their GP to an alcohol reduction website (facilitated access). Primary and secondary outcome measures The primary outcome is the cost per QALY gained of facilitated access compared with face-to-face. A secondary analysis includes total costs and benefits per 100 patients, including number of hazardous drinkers prevented at 12 months. Results The average time required for the face-to-face BI was 8 min (95% CI 7.5 min to 8.6 min). Given the maximum time taken for facilitated access of 5 min, face-to-face is an additional 3 min: equivalent to having time for another GP appointment for every three patients referred to the website. Complete case analysis adjusting for baseline the difference in QALYs for facilitated access is 0.002 QALYs per patient (95% CI −0.007 to 0.011). Conclusions Facilitated access to a website to reduce hazardous drinking costs less than a face-to-face BI given by a GP with no worse outcomes. The lower cost of facilitated access, particularly in regards to investment of time, may facilitate the increase in provision of BIs for hazardous drinking. Trial registration number NCT01638338;Post-results. [less ▲]

A randomized controlled non-inferiority trial of primary care-based facilitated access to an alcohol reduction website (EFAR-FVG): preliminary results

in Addiction Science and Clinical Practice (2015), 10(Suppl 2), 29

Background The effectiveness of brief interventions for risky drinkers by GPs is well documented.[1] However, implementation levels remain low. Facilitated access to an alcohol reduction website offers an ... [more ▼]

Background The effectiveness of brief interventions for risky drinkers by GPs is well documented.[1] However, implementation levels remain low. Facilitated access to an alcohol reduction website offers an alternative to standard face-to-face intervention, but it is unclear whether it is as effective.[2] This study evaluates whether online brief intervention, through GP facilitated access to an alcohol reduction website for risky drinkers, is not inferior to the face-to-face brief intervention conducted by GPs. Material and methods In a northern Italy region participating GPs actively encouraged all patients age 18 attending their practice, to access an online screening website based on AUDIT-C.[3] Those screening positive underwent a baseline assessment with the AUDIT-10[4] and EQ-5D[5] questionnaires and subsequently, were randomly assigned to receive either online counselling on the alcohol reduction website (intervention) or face-to-face intervention based on the brief motivational interview[6] by their GP (control). Follow-up took place at 3 and 12 months and the outcome was calculated on the basis of the proportion of risky drinkers in each group according to the AUDIT-10. Results More than 50% (n= 3974) of the patients who received facilitated access logged-on to the website and completed the AUDIT-C. Just under 20% (n = 718) screened positive and 94% (n= 674) of them completed the baseline questionnaires and were randomized. Of the 310 patients randomized to the experimental Internet intervention, 90% (n = 278) logged-on to the site. Of the 364 patients of the control group, 72% (263) were seen by their GP. A follow-up rate of 94% was achieved at 3 months. Conclusions The offer of GP facilitated access to an alcohol reduction website appears to be an effective way of identifying risky drinkers and enabling them to receive brief intervention. [less ▲]

A randomized phase II trial investigating the effect of platelet function inhibition on circulating tumor cells in patients with metastatic breast cancer.

in Clinical breast cancer (2013), 13(6), 409-15

BACKGROUND: Blockade of platelet activation and aggregation can inhibit metastasis in preclinical models and is associated with cancer prevention. To test whether disruption of platelet function with ... [more ▼]

BACKGROUND: Blockade of platelet activation and aggregation can inhibit metastasis in preclinical models and is associated with cancer prevention. To test whether disruption of platelet function with clopidogrel and aspirin would decrease the number of circulating tumor cells (CTCs) in patients with metastatic breast cancer, a randomized phase II study was performed. METHODS: Patients with metastatic breast cancer who were not currently receiving cytotoxic chemotherapy were eligible. Patients were randomized to receive either clopidogrel and aspirin or to a control group receiving no treatment. Phlebotomy was performed at baseline, at 2 and 4 weeks, and monthly thereafter to obtain specimens to assess CTC, platelet aggregation, and thrombin activity. The primary end point was the proportion of patients with detectable CTCs at 1 month. RESULTS: Forty-eight patients were enrolled and 42 were evaluable at 1 month. Baseline CTC numbers were >/= 5 in 13% and >/= 1 in 65% of patients. Despite adequate platelet function inhibition in the treatment group, the proportion of patients with detectable CTCs was similar between the clopidogrel/aspirin and control groups at baseline (P = .21) and 4 weeks (P = .75), showing no treatment effect. Measured endogenous thrombin potential did not correlate with CTC number. No bleeding-related serious adverse events (SAEs) occurred. CONCLUSION: The baseline CTC numbers were lower than expected, decreasing the ability to detect an impact of platelet inhibition on CTCs. Clopidogrel and aspirin were well tolerated. Future studies evaluating the potential therapeutic role of antiplatelet therapy in breast cancer remain of interest, and they may be informed by these results. [less ▲]

Range of magnetic correlations in nanocrystalline soft magnets

in Physical Review Letters (2003), 91

We have obtained the magnetic field dependence of static ferromagnetic correlations in nanocrystalline electrodeposited Co and Ni by means of the correlation function of the spin misalignment, determined ... [more ▼]

We have obtained the magnetic field dependence of static ferromagnetic correlations in nanocrystalline electrodeposited Co and Ni by means of the correlation function of the spin misalignment, determined from small-angle neutron scattering data. The approach yields a correlation length lC, which is a measure for the spatial extent of inhomogeneities in the magnetization distribution. The correlation length depends strongly on the applied magnetic field with values ranging from 94 nm in nanocrystalline Co at low fields to about 15 nm at saturation. The results for lC indicate that in Co the main source of nonuniformity in the spin system is the anisotropy field of each individual crystallite, whereas in nanocrystalline Ni the main sources of spin disorder originate from twin faults or from the defect cores of grain boundaries. [less ▲]

Rank n swapping algebra for Grassmannian

E-print/Working paper (2019)

The rank n swapping algebra is the Poisson algebra defined on the ordered pairs of points on a circle using the linking numbers, where a subspace of (K^n×K^{n∗})^r/GL(n,K) is its geometric mode. In this ... [more ▼]

The rank n swapping algebra is the Poisson algebra defined on the ordered pairs of points on a circle using the linking numbers, where a subspace of (K^n×K^{n∗})^r/GL(n,K) is its geometric mode. In this paper, we find an injective Poisson homomorphism from the Poisson algebra on Grassmannian G(n,r) arising from boundary measurement map to the rank n swapping fraction algebra. [less ▲]

RANK-ORDER COMPETITION IN THE VOLUNTARY PROVISION OF IMPURE PUBLIC GOODS

in Economic Inquiry (2019), 57(4), 2163-2183

Ranking Arguments With Compensation-Based Semantics

in Principles of Knowledge Representation and Reasoning: Proceedings of the Fifteenth International Conference, KR 2016, Cape Town, South Africa, April 25-29, 2016. (2016)

Raoul Schrott’s Languages of Climate Change and Desertification. Writing and Reading Climate in the Desert

Presentation (2016)

Le rapatriement prématuré: analyse des déterminants psychosociaux, de la qualité de vie, des compétences relatives à l'employabilité et des capacités à gérer des problèmes auprès des militaires des Forces canadiennes stationnés en Europe. De la conception à l'évaluation d'une intervention psychosociale pour le prévenir

Doctoral thesis (2011)

Introduction. Early repatriation of Canadian Forces personnel deployed to Europe, mainly to NATO, defines military members unable to complete their postings. This is a recent problem and its reoccurrence ... [more ▼]

Introduction. Early repatriation of Canadian Forces personnel deployed to Europe, mainly to NATO, defines military members unable to complete their postings. This is a recent problem and its reoccurrence and prohibitive costs have a psychological and social impact at individual, family and institutional levels and therefore, have become a research priority. This thesis includes a group of doctorate studies whose innovative character undoubtedly helps understand this phenomenon and the factors contributing to its persistence or continuity. Goals. 1) Identify the determining factors (personal, interpersonal, environmental, institutional and social) involved with early repatriation; 2) Analyze over a period of three months the connection between quality of life, employability skills and problem management capabilities; secondly, identify the links between psychological quality of life and the factors that are mentioned, as well as the sense of belonging and socio-demographic characteristics; 3) Develop a program of preventive psychosocial actions for CF members serving in Europe (Programme d’actions préventives psychosociales destiné aux militaires des FC affectés en Europe (PAPFCE)); 4) Assess, with a group of participants, the quality and usefulness of the different components involved in the psychosocial intervention program and analyze over a three month period, the relationship between quality of life, employability skills and problem management capabilities for one group of participants and two groups not participating in the program. Method. In order to reach our goals, 343 CF members were invited to participate in various investigations. 1) Comments from soldiers that repatriated to Canada were analyzed. 2) A questionnaire based on previously established scales, was built to measure quality of life, employability skills, ability to manage problems and sense of belonging for newcomers of summer 2009. 3) Creation of the PAPFCE was designed and submitted to the newcomers of summer 2010. 4) A data comparison was carried out between the non participating military members and those who participated in the psychosocial intervention. Furthermore, using an evaluation grid, military members subjected to psychosocial intervention were questioned about the usefulness and quality of the different parts of the program. Results. A total of 74 military members participated in the project (participation rate 22%). The participants were men (81.1%), average age of 41.8 years [from 23 years to 56 years], using English at home (59.5%) and reported living as married (81.1%). Their job profile is as follows: 20.7 years of service in the CF [from 5 years to 38 years], non commissioned officers (52.7%) and Germany as place of employment (54.1%). The main contributing factors to early repatriation are: 1) deficiencies in the military selection process and its application, 2) occurrence or development of psychosocial problems, 3) application of disciplinary or administrative actions (such as revealing psychosocial imbalance), 4) expectations that were unfulfilled by the posting. After the first three months of deployment, quality of life, employability skills and capability to manage problems have not changed. The military member’s psychological quality of life is positively associated with "physical" and "social" aspects, the extent of "acquisition of social support" and the "restructuring" of the capability to manage problems. A data comparison between military personnel who participated in the PAPFCE and the non participants neither confirms its effectiveness nor significant contribution. However, for most participants, the quality of components and their satisfaction with the program were positively assessed, although the program did not seem to be able to prevent the occurrence of psychosocial problems, major factors for premature repatriation. Conclusion. The analysis of the determining factors involved in the success or failure of a military posting to Europe has led to a better understanding of the complexity of the cultural and professional adjustment process necessary by the members and their families. This work provides site specific realities to reflect upon and possible intervention methods that can be adopted to improve the posting or deployment support and encourages a more critical observation of challenges and issues that may have an impact on the future of the CF. [less ▲]