Treatment alliance and needs of care concerning religiousness and spirituality: A follow-up study among psychiatric inpatients.

BACKGROUND: Patient satisfaction with religious/spiritual (R/S) care during mental health treatment has been associated with a better treatment alliance. AIMS: To investigate the longitudinal relations between (un)met R/S care needs and treatment alliance/compliance over a 6-month period. METHOD: 201 patients in a Christian (CC) and a secular mental health clinic completed a questionnaire (T0) containing an R/S care needs questionnaire, the Working Alliance Inventory (WAI) and the Service Engagement Scale (SES). After 6 months 136 of them took part in a follow-up (T1). Associations were analysed using hybrid linear mixed models and structural equation modelling. RESULTS: R/S care needs decreased over time, but a similar percentage remained unanswered (e.g. 67% of the needs on R/S conversations in a secular setting). Over a 6-month period, met R/S care needs were associated with a higher WAI score (ß = .25; p < .001), and unmet R/S care needs with lower WAI score (ß = -.36; p < .001), which were mainly between subjects effects. Patients reporting a high score of unmet R/S care at baseline, reported a decrease in SES over time (ß = -.13; p < .05). CONCLUSIONS: Satisfaction with R/S care among mental health patients is related to a better treatment alliance. When unmet R/S care needs persist, they precede a decrease in treatment compliance. Mental health professionals are recommended to assess the presence of R/S care needs and consider possibilities of R/S care especially in the first weeks of treatment.

Evaluation of an mHealth intervention aiming to improve health-related behavior and sleep and reduce fatigue among airline pilots.

OBJECTIVES: The aim of this study was to evaluate the effects of an mHealth intervention (intervention using mobile technology) consisting of tailored advice regarding exposure to daylight, sleep, physical activity, and nutrition, and aiming to improve health-related behavior, thereby reducing sleep problems and fatigue and improving health perception of airline pilots. METHODS: A randomized controlled trial was conducted among 502 airline pilots. The intervention group was given access to both the MORE Energy mobile application (app) with tailored advice and a website with background information. The control group was directed to a website with standard information about fatigue. Health-related behavior, fatigue, sleep, and health perception outcomes were measured through online questionnaires at baseline and at three and six months after baseline. The effectiveness of the intervention was determined using linear and Poisson mixed model analyses. RESULTS: After six months, compared to the control group, the intervention group showed a significant improvement on fatigue (ß= -3.76, P<0.001), sleep quality (ß= -0.59, P=0.007), strenuous physical activity (ß=0.17, P=0.028), and snacking behavior (ß= -0.81, P<0.001). No significant effects were found for other outcome measures. CONCLUSIONS: The MORE Energy mHealth intervention reduced self-reported fatigue compared to a minimal intervention. Some aspects of health-related behavior (physical activity and snacking behavior) and sleep (sleep quality) improved as well, but most did not. The results show offering tailored advice through an mHealth intervention is an effective means to support employees who have to cope with irregular flight schedules and circadian disruption. This kind of intervention might therefore also be beneficial for other working populations with irregular working hours.

Neutral and acidic oligosaccharides in preterm infants: a randomized, double-blind, placebo-controlled trial.

BACKGROUND: Serious infectious morbidity is high in preterm infants. Enteral supplementation of prebiotics may reduce the incidence of serious infections, especially infections related to the gastrointestinal tract. OBJECTIVE: The objective was to determine the effect of enteral supplementation of a prebiotic mixture consisting of neutral oligosaccharides ((SC)GOS/(LC)FOS) and acidic oligosaccharides (AOS) on serious infectious morbidity in preterm infants. DESIGN: In a randomized controlled trial, preterm infants (gestational age <32 wk and/or birth weight <1500 g) received enteral supplementation of 80% (SC)GOS/(LC)FOS and 20% AOS (1.5 g . kg(-1) . d(-1)) or placebo (maltodextrin) between days 3 and 30 of life. Serious infectious morbidity was defined as a culture positive for sepsis, meningitis, pyelonephritis, or pneumonia. The analysis was performed by intention-to-treat and per-protocol, defined as > or =50% supplementation dose during the study period. RESULTS: In total, 113 preterm infants were included. Baseline and nutritional characteristics were not different between groups. In the intention-to-treat analysis, the incidence of > or =1 serious infection, > or =1 serious endogenous infection, or > or =2 serious infectious episodes was not significantly different in the (SC)GOS/(LC)FOS/AOS-supplemented and placebo groups. In the per-protocol analysis, there was a trend toward a lower incidence of > or =1 serious endogenous infection and > or =2 serious infectious episodes in the (SC)GOS/(LC)FOS/AOS-supplemented group than in the placebo group (P = 0.09 and P = 0.07, respectively). CONCLUSIONS: Enteral supplementation of (SC)GOS/(LC)FOS/AOS does not significantly reduce the risk of serious infectious morbidity in preterm infants. However, there was a trend toward a lower incidence of serious infectious morbidity, especially for infections with endogenous bacteria. This finding suggests a possible beneficial effect that should be evaluated in a larger study. This trial was registered at isrctn.org as ISRCTN16211826.