Sitting Time Reduction and Blood Pressure in Older Adults
Rosenberg D et al. JAMA (March 2024)
Bottom line: This parallel-group randomized clinical trial examined the efficacy of a sedentary behaviour reduction intervention in older adults. A total of 283 participants aged 60 to 89 years were randomized to either the intervention group, which received 10 health coaching visits (mix of in-person and virtual), sitting reduction goals, and a standing desk and fitness tracker, or the control group, which received 10 health coaching visits for general healthy living goals. The primary outcome, sitting time, was measured at baseline, 3 months, and 6 months. Results showed a reduction in sitting time of -31.44 min/d at 3 months (95% CI, −48.69 to −14.19 min/d; P < .001) and -31.85 min/d at 6 months (95% CI, −52.91 to −10.79 min/d; P = .003) in the intervention group compared to the control group. Systolic blood pressure was also lower in the intervention group by 3.45 mmHg at 6 months (95% CI, −6.68 to −0.28 mm Hg; P = .03). No study-related adverse events were reported in either group. In conclusion, a 6-month sitting reduction intervention showed promising results in improving cardiometabolic health in older adults.
Lower vs Higher Oxygenation Target and Days Alive Without Life Support in COVID-19 (HOT-COVID)
Nielsen F et al. JAMA (March 2024)
Bottom Line: This was a multicenter randomized clinical trial that included 726 adult patients with COVID-19 and severe hypoxemia receiving at least 10L/min of oxygen or mechanical ventilation in the ICU. The study compared the effects of targeting a PaO2 of 60 mm Hg (n = 365) versus 90 mm Hg (n = 361). The primary outcome was number of days alive without life support at 90 days and secondary outcomes included mortality, serious adverse events, and number of days alive and out of hospital at 90 days. The results showed that the PaO2 of 60 mm Hg group had a median of 80 days alive without life support compared to 72 days in the 90 mm Hg group (P = .009 by van Elteren test; supplemental bootstrapped adjusted mean difference, 5.8 days [95% CI, 0.2-11.5 days]; P = .04) . There were no significant differences in mortality or serious adverse events between the two groups. Overall, targeting a PaO2 of 60 mm Hg may be beneficial for adult ICU patients with COVID-19 and severe hypoxemia.
Integrated Hepatitis C–Opioid Use Disorder Care Through Facilitated Telemedicine
Talal A et al. JAMA (April 2024)
Bottom Line: This prospective, cluster randomized clinical trial using a stepped wedge design compared sustained virologic responses for hepatitis C virus among 602 persons with opioid use disorder. The intervention group received hepatitis C treatment with direct-acting antivirals through co-management with a hepatitis specialist via facilitated telemedicine, while the comparator group received standard-of-care off-site hepatitis specialist referral. The primary outcome was hepatitis C virus cure, with a 84.8% cure rate in the intervention group and a 34.0% cure rate in the comparator group. A higher number of participants (92.4%) in the telemedicine group initiated treatment compared to the referral group (40.4%). Additionally, illicit drug use decreased significantly among cured participants (referral: 95% CI, 1.2-4.8; P = .001; telemedicine: 95% CI, 0.3-1.0; P < .001). Overall, the study found that the intervention group had significantly higher cure rates and high participant satisfaction, with minimal reinfections. This study highlights the potential benefits of facilitated telemedicine in promoting hepatitis C virus elimination, especially for individuals with opioid use disorder.
Trial Files Issue #2024-08
