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JAMA Network Open Nov 2023Mobile mental health applications (apps) for moderate to severe depression are proliferating, likely owing to their capacity to overcome the limitations of conventional... (Meta-Analysis)
Meta-Analysis
IMPORTANCE
Mobile mental health applications (apps) for moderate to severe depression are proliferating, likely owing to their capacity to overcome the limitations of conventional psychotherapy, but research on the potential moderators of treatment efficacy is lacking.
OBJECTIVE
To examine the treatment efficacy associated with mobile app interventions for moderate to severe depression and identify the potential moderators associated with better treatment outcomes.
DATA SOURCES
PubMed, Embase, and PsycINFO were searched from their inception to January 22, 2023.
STUDY SELECTION
Only randomized clinical trials evaluating mobile app treatments in adults with moderate to severe depression that published their results in English were included in the analysis.
DATA EXTRACTION AND SYNTHESIS
Three independent researchers extracted and assessed relevant studies, their risk of bias, the characteristics of the population and study design, and the components of the intervention program following the Preferred Reporting Items for Systematic Reviews and Meta-analyses reporting guidelines. A fixed-effects model was used for data analysis, and exploratory post hoc meta-regression and subgroup analyses were also conducted. Data were analyzed from February 16 to March 25, 2023.
MAIN OUTCOMES AND MEASURES
The main outcome was changes in depression symptom severity from before to after treatment, measured by standardized depression assessment instruments. Secondary outcomes included study-, intervention-, and patient-level factors associated with app efficacy.
RESULTS
Of 2128 studies identified, 13 studies evaluating 16 intervention apps with 1470 participants with moderate to severe depression were included in the analysis. The overall pooled effect size of mobile app interventions vs both active and inactive control groups was 0.50 (95% CI, 0.40 to 0.61). Interventions with in-app notifications were associated with significantly lower treatment outcomes (standardized mean difference [SMD], 0.45; 95% CI, 0.29-0.60) than interventions without (SMD, 0.71; 95% CI, 0.54-0.87; P = .02). In addition, app interventions delivered for less than 8 weeks were associated with a significantly greater effect size (SMD, 0.77; 95% CI, 0.59-0.96) than interventions delivered for 8 weeks or longer (SMD, 0.43; 95% CI, 0.30-0.57; P = .004).
CONCLUSIONS AND RELEVANCE
In this systematic review and meta-analysis, the feasibility and efficacy of mobile app interventions were supported in treating moderate and severe depression, and practical implications were also provided for developing effective app-based interventions in clinical practice.
Topics: Adult; Humans; Depression; Depressive Disorder, Major; Mobile Applications; Behavior Therapy; Control Groups
PubMed: 37983028
DOI: 10.1001/jamanetworkopen.2023.44120 -
Neuropharmacology Oct 2021Increasing evidence indicates that the melanocortin and mesolimbic dopamine (DA) systems interact to regulate feeding and body weight. Because melanocortin-3 receptors...
Increasing evidence indicates that the melanocortin and mesolimbic dopamine (DA) systems interact to regulate feeding and body weight. Because melanocortin-3 receptors (MC3R) are highly expressed in the ventral tegmental area (VTA), we tested whether VTA neurons expressing these receptors (VTA MC3R neurons) control feeding and body weight in vivo. We also tested whether there were sex differences in the ability of VTA MC3R neurons to control feeding, as MC3R -/- mice show sex-dependent alterations in reward feeding and DA levels, and there are clear sex differences in multiple DA-dependent behaviors and disorders. Designer receptors exclusively activated by designer drugs (DREADD) were used to acutely activate and inhibit VTA MC3R neurons and changes in food intake and body weight were measured. Acutely altering the activity of VTA MC3R neurons decreased feeding in an activity- and sex-dependent manner, with acute activation decreasing feeding, but only in females, and acute inhibition decreasing feeding, but only in males. These differences did not appear to be due to sex differences in the number of VTA MC3R neurons, the ability of hM3Dq to activate VTA MC3R neurons, or the proportion of VTA MC3R neurons expressing tyrosine hydroxylase (TH). These studies demonstrate an important role for VTA MC3R neurons in the control of feeding and reveal important sex differences in behavior, whereby opposing changes in neuronal activity in male and female mice cause similar changes in behavior.
Topics: Animals; Body Weight; Designer Drugs; Dopamine; Feeding Behavior; Female; Male; Mice; Mice, Knockout; Mice, Transgenic; Motor Activity; Neurons; Receptor, Melanocortin, Type 3; Reward; Sex Characteristics; Ventral Tegmental Area
PubMed: 34371079
DOI: 10.1016/j.neuropharm.2021.108746 -
Journal of Biomechanics Mar 2020The goal of the present study was to assess the effects of age and sex on trunk motor control. Fifty healthy adults (aged between 19 and 67 years, 28 males) participated...
The goal of the present study was to assess the effects of age and sex on trunk motor control. Fifty healthy adults (aged between 19 and 67 years, 28 males) participated in this study. Trunk motor control was assessed using force-controlled perturbations directly applied to the trunk. Admittance (inverse of lumped intrinsic and reflexive impedance) decreased with age and tended to be lower in females than males. The age effect on admittance was due to increasing intrinsic stiffness and damping with age, while intrinsic damping and position- and velocity feedback gains were lower in females than males. Feedback delays were not dependent on age. The decrease of trunk admittance with age is most likely due to increasing levels of antagonistic co-activation. Trunk admittance was (just) not significantly different between females and males, in spite of lower feedback gains and damping, possibly due to differences in trunk mass between sexes. These results imply that age and sex differences should be considered when assessing the relationship between back pain and trunk motor control.
Topics: Adult; Aged; Aging; Biomechanical Phenomena; Electromyography; Female; Humans; Male; Middle Aged; Motor Activity; Muscle, Skeletal; Posture; Sex Characteristics; Torso; Young Adult
PubMed: 31955870
DOI: 10.1016/j.jbiomech.2020.109607 -
Molecular Metabolism Apr 2024There is significant interest in uncovering the mechanisms through which exercise enhances cognition, memory, and mood, and lowers the risk of neurodegenerative...
OBJECTIVES
There is significant interest in uncovering the mechanisms through which exercise enhances cognition, memory, and mood, and lowers the risk of neurodegenerative diseases. In this study, we utilize forced treadmill running and distance-matched voluntary wheel running, coupled with light sheet 3D brain imaging and c-Fos immunohistochemistry, to generate a comprehensive atlas of exercise-induced brain activation in mice.
METHODS
To investigate the effects of exercise on brain activity, we compared whole-brain activation profiles of mice subjected to treadmill running with mice subjected to distance-matched wheel running. Male mice were assigned to one of four groups: a) an acute bout of voluntary wheel running, b) confinement to a cage with a locked running wheel, c) forced treadmill running, or d) placement on an inactive treadmill. Immediately following each exercise or control intervention, blood samples were collected for plasma analysis, and brains were collected for whole-brain c-Fos quantification.
RESULTS
Our dataset reveals 255 brain regions activated by acute exercise in mice, the majority of which have not previously been linked to exercise. We find a broad response of 140 regulated brain regions that are shared between voluntary wheel running and treadmill running, while 32 brain regions are uniquely regulated by wheel running and 83 brain regions uniquely regulated by treadmill running. In contrast to voluntary wheel running, forced treadmill running triggers activity in brain regions associated with stress, fear, and pain.
CONCLUSIONS
Our findings demonstrate a significant overlap in neuronal activation signatures between voluntary wheel running and distance-matched forced treadmill running. However, our analysis also reveals notable differences and subtle nuances between these two widely used paradigms. The comprehensive dataset is accessible online at www.neuropedia.dk, with the aim of enabling future research directed towards unraveling the neurobiological response to exercise.
Topics: Mice; Male; Animals; Motor Activity; Brain; Physical Conditioning, Animal; Cognition
PubMed: 38428817
DOI: 10.1016/j.molmet.2024.101907 -
The Journal of Neuropsychiatry and... 2020Despite being a major cause of neurological disability, the neural mechanisms of functional movement disorders (FMDs) remain poorly understood. Recent studies suggest...
OBJECTIVE
Despite being a major cause of neurological disability, the neural mechanisms of functional movement disorders (FMDs) remain poorly understood. Recent studies suggest that FMD is linked to dysfunctional motor and prefrontal regions that could lead to motor and cognitive impairments. The aim of this study was to investigate different components of action control in FMD by using choice-reaction, stop-signal, and Simon tasks.
METHODS
Thirty patients with an FMD were prospectively recruited from the University of Louisville Movement Disorders Clinic and compared with 53 healthy control subjects, recruited from the Vanderbilt University Medical Center Movement Disorders Clinic. FMD motor symptom severity was rated with the Simplified Functional Movement Disorder Rating Scale (S-FMDRS). By using a computer and handheld response grips, participants completed three action-control tasks (choice-reaction task, stop-signal task, and Simon task) that tested action initiation, action cancelation, and interference control over actions. Action-control measures were compared between groups with analyses of variance.
RESULTS
Patients with FMD were less proficient in suppressing incorrect response impulses on the Simon task and were slower to stop on the stop-signal task compared with healthy control subjects. No significant correlation with neuropsychological measurements, S-FMDRS scores, and action-control measurements was observed.
CONCLUSIONS
These results suggest that two forms of inhibitory control, selective impulse inhibition and global action cancelation, are impaired in patients with FMD, independent of slowing on go reaction times. Improved understanding of action control in FMD may help in the development of new diagnostic and therapeutic strategies.
Topics: Adult; Aged; Conversion Disorder; Executive Function; Female; Humans; Inhibition, Psychological; Male; Middle Aged; Motor Activity; Movement Disorders; Psychomotor Performance; Psychophysiologic Disorders
PubMed: 31587628
DOI: 10.1176/appi.neuropsych.19030076 -
JAMA Network Open Nov 2023Randomized clinical trials (RCTs) testing innovative drugs must strive to use optimal control groups to reflect the best available treatments. A comprehensive evaluation...
IMPORTANCE
Randomized clinical trials (RCTs) testing innovative drugs must strive to use optimal control groups to reflect the best available treatments. A comprehensive evaluation of the quality of control groups in pivotal RCTs supporting systemic rheumatic disease (SRD) drug approvals by the Food and Drug Administration (FDA) is lacking.
OBJECTIVE
To examine the proportion of pivotal RCTs that used optimal control groups among RCTs supporting newly approved SRD drugs in the US over the past decade.
DESIGN, SETTING, AND PARTICIPANTS
In this study, individual RCTs supporting SRD new drug approvals by the FDA between January 2012 and October 2022 were analyzed for design, study duration, control group, and primary end point. The quality of control groups was determined by comparison with published guidelines before and during the trial.
MAIN OUTCOMES AND MEASURES
The primary measure was the proportion of RCTs using optimal control groups. Differences in response rate between investigating and control groups and the response rate of placebo control groups were also examined.
RESULTS
Between January 2012 and October 2022, the FDA approved 44 SRD drugs, involving 65 pivotal RCTs. Overall, 16 RCTs used optimal control groups. In 55 trials, no active groups were used, and more than 80% of these trials were suboptimal (47 trials [85.5%]). Among 56 trials for systemic arthritis, 49 trials used suboptimal control groups, mainly placebo or dose-response controls (47 trials), with a few active controls (2 trials). Studies of other SRDs frequently used placebo or dose-response controls but were considered optimal controls (8 trials). There was significant improvement in response rates of investigating compared with placebo groups, with relative risk mostly exceeding 1.50 (range, 0.90; 95% CI, 0.69-1.17 for anifrolumab to 11.00; 95% CI, 2.69-44.96 for mepolizumab). In all placebo-controlled trials, the median (IQR) response rate in placebo groups was 26.0% (19.2%-32.3%).
CONCLUSIONS AND RELEVANCE
These findings suggest that the quality of control groups in RCTs leading to SRD drug approval needs improvement and that despite challenges in translating scientific theories to clinical scenarios, it is crucial to consistently prioritize efforts to promote appropriate control group selection to ensure the accurate assessment of innovative drug efficacy.
Topics: Humans; Arthritis; Control Groups; Drug Approval; Rheumatic Diseases; United States; United States Food and Drug Administration; Randomized Controlled Trials as Topic
PubMed: 37991756
DOI: 10.1001/jamanetworkopen.2023.44767 -
Journal of Neurophysiology Oct 2021How does the brain coordinate concurrent adaptation of arm movements and standing posture? From previous studies, the postural control system can use information about...
How does the brain coordinate concurrent adaptation of arm movements and standing posture? From previous studies, the postural control system can use information about previously adapted arm movement dynamics to plan appropriate postural control; however, it is unclear whether postural control can be adapted and controlled independently of arm control. The present study addresses that question. Subjects practiced planar reaching movements while standing and grasping the handle of a robotic arm, which generated a force field to create novel perturbations. Subjects were divided into two groups, for which perturbations were introduced in either an abrupt or a gradual manner. All subjects adapted to the perturbations while reaching with their dominant (right) arm and then switched to reaching with their nondominant (left) arm. Previous studies of seated reaching movements showed that abrupt perturbation introduction led to transfer of learning between arms, but gradual introduction did not. Interestingly, in this study neither group showed evidence of transferring adapted control of arm or posture between arms. These results suggest primarily that adapted postural control cannot be transferred independently of arm control in this task paradigm. In other words, whole body postural movement planning related to a concurrent arm task is dependent on information about arm dynamics. Finally, we found that subjects were able to adapt to the gradual perturbation while experiencing very small errors, suggesting that both error size and consistency play a role in driving motor adaptation. This study examined adaptation of arm and postural control to novel dynamics while standing and reaching and subsequent transfer between reaching arms. Neither arm nor postural control was transferred between arms, suggesting that postural planning is highly dependent on the concurrent arm movement.
Topics: Adaptation, Physiological; Adult; Arm; Humans; Motor Activity; Postural Balance; Standing Position; Transfer, Psychology; Young Adult
PubMed: 34433001
DOI: 10.1152/jn.00628.2020 -
Military Medicine Sep 2023The Cardiovascular Disease (CVD) Prevention project is a VA-DoD initiative, supported by the Joint Incentive Fund. The goal of the project is to create an innovative, 3D...
INTRODUCTION
The Cardiovascular Disease (CVD) Prevention project is a VA-DoD initiative, supported by the Joint Incentive Fund. The goal of the project is to create an innovative, 3D virtual space within the VA-Virtual Medical Center (VA-VMC) platform that provides Veterans and Active Duty Service Members with educational resources on the prevention of CVD.
MATERIALS AND METHODS
The Performance Health and Wellness Center is a new center within the VA-VMC. The space enables users to explore information and actionable resources on various risk factors related to CVD through independent and provider-led instruction, using a personalized 3D avatar.
RESULTS
Partners of DoD and VA envision users engaging with the learning resources securely and with a sense of anonymity, which can foster self-directed learning and healthy behavior change. The DoD is particularly invested in promoting CVD prevention through the early adoption of positive health behaviors and the Total Force Fitness framework. The VA team is also committed to supporting users by providing professionally led classes and support groups on various CVD risk factors like tobacco, diabetes, nutrition, and exercise.
CONCLUSIONS
This project is a unique and important collaboration during a time when telehealth and telemedicine services are in greater demand. The VA-VMC advances accessible, relevant, and evidence-based educational services for DoD and VA populations, and the Performance Health and Wellness Center, itself, presents Total Force Fitness concepts and a whole-person care approach while encouraging users to be actively involved in shared decision-making with their health care providers.
Topics: Humans; Cardiovascular Diseases; Exercise; Telemedicine; Health Behavior; Health Facilities
PubMed: 37665591
DOI: 10.1093/milmed/usad166 -
Journal of Neurophysiology Oct 2021During active object manipulation, the finger-object interactions give rise to complex fingertip skin deformations. These deformations are in turn encoded by the local...
During active object manipulation, the finger-object interactions give rise to complex fingertip skin deformations. These deformations are in turn encoded by the local tactile afferents and provide rich and behaviorally relevant information to the central nervous system. Most of the work studying the mechanical response of the finger to dynamic loading has been performed under a passive setup, thereby precisely controlling the kinematics or the dynamics of the loading. However, to identify aspects of the deformations that are relevant to online control during object manipulation, it is desirable to measure the skin response in an active setup. To that end, we developed a device that allows us to monitor finger forces, skin deformations, and kinematics during fine manipulation. We describe the device in detail and test it to precisely describe how the fingertip skin in contact with the object deforms during a simple vertical oscillation task. We show that the level of grip force directly influences the fingerpad skin strains and that the strain rates are substantial during active manipulation (norm up to 100%/s). The developed setup will enable us to causally relate sensory information, i.e. skin deformation, to online control, i.e. grip force adjustment, in future studies. We present a novel device, a manipulandum, that enables to image the contact between the finger and the contact surface during active manipulation of the device. The device is tested in a simple vertical oscillation task involving 18 participants. We demonstrate that substantial surface skin strains take place at the finger-object interface and argue that those deformations provide essential information for grasp stability during object manipulation.
Topics: Adult; Biomechanical Phenomena; Equipment Design; Fingers; Humans; Motor Activity; Neurophysiology; Skin Physiological Phenomena; Touch Perception; Young Adult
PubMed: 34495789
DOI: 10.1152/jn.00358.2021 -
Journal of Neurophysiology Jun 2021Safe and successful motor performance relies on the ability to adapt to physiological and environmental change and retain what is learned. An open question is what...
Safe and successful motor performance relies on the ability to adapt to physiological and environmental change and retain what is learned. An open question is what factors maximize this retention? One overlooked factor is the degree to which balance is challenged during learning. We propose that the greater need for control and/or perceived threat of falling or injury associated with balance-challenging tasks increases the value assigned to maintaining a learned visuomotor mapping (i.e., the new relationship between visual input and motor output). And we propose that a greater-valued mapping is a more retainable mapping, as it serves to benefit future motor performance. Thus, we tested the hypothesis that challenging balance enhances motor memory, reflected by greater recall and faster relearning (i.e., savings). Four groups of participants adapted to a novel visuomotor mapping induced by prism lenses while performing a reaching or walking task, with and without an additional balance challenge. We found that challenging balance did not disrupt visuomotor adaptation during reaching or walking. We then probed recall and savings by having participants repeat the adaptation protocol 1 wk later. For reaching, we found evidence of initial recall, though neither group demonstrated savings upon reexposure to the prisms. In contrast, both walking groups demonstrated significant initial recall and savings. In addition, we found that challenging balance significantly enhanced savings during walking. Taken together, our results demonstrate the robustness of motor memories formed during walking and highlight the potential influence of balance control on sensorimotor learning. Most everyday tasks challenge our balance. Yet, this aspect of daily motor behavior is often overlooked in adaptation paradigms. Here, we show that challenging balance does not impair sensorimotor adaptation during precision reaching and walking tasks. Furthermore, we show that challenging balance enhances savings of a learned visuomotor mapping during walking. These results provide evidence for the potential performance benefits associated with learning during unconstrained, naturalistic behaviors.
Topics: Adult; Female; Humans; Learning; Male; Motor Activity; Postural Balance; Psychomotor Performance; Walking; Young Adult
PubMed: 34038257
DOI: 10.1152/jn.00627.2020