Rosa Dragonetti | University of Toronto (original) (raw)

Papers by Rosa Dragonetti

Diabetic medicine, Apr 10, 2024

JMIR Research Protocols, Jan 17, 2023

Background: The COVID-19 pandemic disrupted the delivery of diabetes care and worsened mental hea... more Background: The COVID-19 pandemic disrupted the delivery of diabetes care and worsened mental health among many patients with type 2 diabetes (T2D). This disruption puts patients with T2D at risk for poor diabetes outcomes, especially those who experience social disadvantage due to socioeconomic class, rurality, or ethnicity. The appropriate use of communication technology could reduce these gaps in diabetes care created by the pandemic and also provide support for psychological distress. Objective: The purpose of this study is to test the feasibility of an innovative co-designed Technology-Enabled Collaborative Care (TECC) model for diabetes management and mental health support among adults with T2D. Methods: We will recruit 30 adults with T2D residing in Ontario, Canada, to participate in our sequential explanatory mixed methods study. They will participate in 8 weekly web-based health coaching sessions with a registered nurse, who is a certified diabetes educator, who will be supported by a digital care team (ie, a peer mentor, an addictions specialist, a dietitian, a psychiatrist, and a psychotherapist). Assessments will be completed at baseline, 4 weeks, and 8 weeks, with a 12-week follow-up. Our primary outcome is the feasibility and acceptability of the intervention, as evident by the participant recruitment and retention rates. Key secondary outcomes include assessment completion and delivery of the intervention. Exploratory outcomes consist of changes in mental health, substance use, and physical health behaviors. Stakeholder experience and satisfaction will be explored through a qualitative descriptive study using one-on-one interviews. Results: This paper describes the protocol of the study. The recruitment commenced in June 2021. This study was registered on October 29, 2020, on ClinicalTrials.gov (Registry ID: NCT04607915). As of June 2022, all participants have been recruited. It is anticipated that data analysis will be complete by the end of 2022, with study findings available by the end of 2023. Conclusions: The development of an innovative, technology-enabled model will provide necessary support for individuals living with T2D and mental health challenges. This TECC program will determine the feasibility of TECC for patients with T2D and mental health issues.

CMAJ open, Mar 1, 2023

ver the past decade, vaping or electronic cigarette use has increased dramatically, especially am... more ver the past decade, vaping or electronic cigarette use has increased dramatically, especially among adolescents and young adults. 1,2 E-cigarette or electronic nicotine delivery systems (ENDS) were first introduced to the market as a smoking cessation aid. 3 However, ENDS have become increasingly popular among young neversmokers, 4-6 mostly because of the availability of e-cigarettes in appealing flavours and the perception of e-cigarettes as less harmful and less addictive than combustible cigarettes. 7,8 In 2021, 48% of Canadians aged 20-24 years and 29% of those aged 15-19 years reported having ever used e-cigarettes, whereas only 13% of adults aged 25 years or older reported having done so. 9 Dual use of cigarettes and e-cigarettes is also common among both adults and younger people. 10-12 Moreover, regular vaping is found to be associated with the subsequent initiation of cigarette smoking. 3-5 In 2020, 37% of the current e-cigarette users in Canada reported using combustible cigarettes and e-cigarettes concurrently. 13 The long-term health effects of vaping are still not fully known and need to be investigated. 3,7 In addition, dual use of cigarettes and e-cigarettes is associated with greater nicotine dependence, 14,15 poorer general health, 14 higher levels of inflammatory and oxidative stress biomarkers, 16 and higher risk of cardiovascular disease and metabolic syndrome than use of cigarettes only. 15 Although the use of e-cigarettes as a prescription for smoking cessation is promoted in the United Kingdom 17 and marketing authorization of vaping products is permitted in the United States, 18 several organizations (i.e., American Lung Association, World Health Organization, Smokefree.gov and Truth Initiative) recommend quitting vaping and advise against switching to ENDS from combustible cigarettes. 19-22

Trials, Apr 1, 2023

Background Women experience greater difficulty achieving smoking abstinence compared to men. Rece... more Background Women experience greater difficulty achieving smoking abstinence compared to men. Recent evidence suggests that hormonal fluctuations during different phases of the menstrual cycle can contribute to lower smoking abstinence rates following a quit attempt among women. However, these findings are limited by small sample sizes and variability among targeted smoking quit dates. This clinical trial aims to clarify whether targeting the quit date to the follicular or luteal phase of the menstrual cycle can improve smoking abstinence. Methods Participants will enroll in an online smoking cessation program providing nicotine replacement therapy (NRT) and behavioral support. We will randomize 1200 eligible individuals to set a target quit date: (1) during the midluteal phase, (2) during the mid-follicular phase, or (3) 15-30 days after enrollment with no regard to the menstrual cycle phase (usual practice). Participants will receive a 6-week supply of combination NRT consisting of a nicotine patch plus their choice of nicotine gum or lozenge. Participants will be instructed to start using NRT on their target quit date. Optional behavioral support will consist of a free downloadable app and brief videos focusing on building a quit plan, coping with cravings, and relapse prevention, delivered via e-mail. Smoking status will be assessed via dried blood spot analysis of cotinine concentration at 7 days, 6 weeks, and 6 months post-target quit date. Discussion We aim to overcome the limitations of previous studies by recruiting a large sample of participants and assigning target quit dates to the middle of both the follicular and luteal phases. The results of the trial can further elucidate the effects of the menstrual cycle on smoking cessation outcomes and whether it is beneficial to combine menstrual cycle phase timing strategies with accessible and low-cost NRT. Trial registration ClinicalTrials.gov NCT05515354. Registered on August 23, 2022.

JMIR diabetes, May 9, 2023

Background: For individuals living with diabetes and its psychosocial comorbidities (eg, depressi... more Background: For individuals living with diabetes and its psychosocial comorbidities (eg, depression, anxiety, and distress), there remains limited access to interprofessional, integrated care that includes mental health support, education, and follow-up. Health technology, broadly defined as the application of organized knowledge or skill as software, devices, and systems to solve health problems and improve quality of life, is emerging as a means of addressing these gaps. There is thus a need to understand how such technologies are being used to support, educate, and help individuals living with co-occurring diabetes and mental health distress or disorder. Objective: The purpose of this scoping review was to (1) describe the literature on technology-enabled integrated interventions for diabetes and mental health; (2) apply frameworks from the Mental Health Commission of Canada and World Health Organization to elucidate the components, type, processes, and users of technology-enabled integrated interventions for diabetes and mental health; and (3) map the level of integration of interventions for diabetes and mental health. Methods: We searched 6 databases from inception to February 2022 for English-language, peer-reviewed studies of any design or type that used technology to actively support both diabetes and any mental health distress or disorder in succession or concurrently among people with diabetes (type 1 diabetes, type 2 diabetes, and gestational diabetes). Reviewers screened citations and extracted data including study characteristics and details about the technology and integration used. Results: We included 24 studies described in 38 publications. These studies were conducted in a range of settings and sites of care including both web-based and in-person settings. Studies were mostly website-based (n=13) and used technology for wellness and prevention (n=16) and intervention and treatment (n=15). The primary users of these technologies were clients and health

BACKGROUND For individuals living with diabetes and its psychosocial comorbidities (eg, depressio... more BACKGROUND For individuals living with diabetes and its psychosocial comorbidities (eg, depression, anxiety, and distress), there remains limited access to interprofessional, integrated care that includes mental health support, education, and follow-up. Health technology, broadly defined as the application of organized knowledge or skill as software, devices, and systems to solve health problems and improve quality of life, is emerging as a means of addressing these gaps. There is thus a need to understand how such technologies are being used to support, educate, and help individuals living with co-occurring diabetes and mental health distress or disorder. OBJECTIVE The purpose of this scoping review was to (1) describe the literature on technology-enabled integrated interventions for diabetes and mental health; (2) apply frameworks from the Mental Health Commission of Canada and World Health Organization to elucidate the components, type, processes, and users of technology-enabled ...

Preventive Medicine Reports

Appendix 1- Search Strategy. (DOC 31Â kb)

International Journal of Medical Informatics, 2014

Objective: To evaluate the impact of a high-alert medication clinical decision support system cal... more Objective: To evaluate the impact of a high-alert medication clinical decision support system called HARMLESS on point-of-order entry errors in a tertiary hospital. Method: HARMLESS was designed to provide three kinds of interventions for five high-alert medications: clinical knowledge support, pop-ups for erroneous orders that block the order or provide a warning, and order recommendations. The impact of this program on prescription order was evaluated by comparing the orders in 6 month periods before and after implementing the program, by analyzing the intervention log data, and by checking for order pattern changes. Result: During the entire evaluation period, there were 357,417 orders and 5233 logs. After HARMLESS deployment, orders that omitted dilution fluids and exceeded the maximum dose dropped from 12,878 and 214 cases to 0 and 9 cases, respectively. The latter nine cases were unexpected, but after the responsible programming error was corrected, there were no further such cases. If all blocking interventions were seen as errors that were prevented, this meant that 4137 errors (3584 of which were 'dilution fluid omitted' errors) were prevented over the 6-month post-deployment period. There were some unexpected order pattern changes after deployment and several unexpected errors emerged, including intramuscular or intravenous push orders for potassium chloride (although a case review revealed that the drug was not actually administered via these methods) and an increase in pro re nata (PRN; administer when required) orders for most drugs.

The Journal of continuing education in the health professions, Jan 14, 2018

Standard knowledge delivery formats for CME may have limited impact on long-term practice change.... more Standard knowledge delivery formats for CME may have limited impact on long-term practice change. A community of practice (CoP) is one tool that may enhance competencies and support practice change. This study explores the utility of an interprofessional CoP as an adjunct to a CME program in tobacco addiction treatment (Training Enhancement in Applied Counselling and Health [TEACH] Project) to promote and sustain practice change. A prospective cohort design was utilized to examine the long-term impact of the TEACH CoP on practice change. An online survey was administered to TEACH-trained practitioners to assess perceived feasibility, importance, and confidence related to course competencies, involvement in TEACH CoP activities, engagement in knowledge transfer (KT), and implementation of new programming. Chi-square tests were used to detect differences in KT and program development associated with CoP participation. Course competency scores from immediate postcourse surveys and long...

Implementation Science, 2015

American Journal on Addictions, 2008

Whereas strong efficacy research has been conducted on novel treatment approaches for adolescent ... more Whereas strong efficacy research has been conducted on novel treatment approaches for adolescent substance abusers, little is known about the effectiveness of the substance abuse treatment approaches most commonly available to youths, their families, and referring agencies. This report compares the 12-month outcomes of adolescent probationers (N ϭ 449) who received either Phoenix Academy, a therapeutic community for adolescents that uses a treatment model that is widely implemented across the U.S., or an alternative probation disposition. Across many pretreatment risk factors for relapse and recidivism, groups were well matched after case-mix adjustment. Repeated measures analyses of substance use, psychological functioning, and crime outcomes collected 3, 6, and 12 months after the baseline interview demonstrated that Phoenix Academy treatment is associated with superior substance use and psychological functioning outcomes over the period of observation. As one of the most rigorous evaluations of the effectiveness of a traditional community-based adolescent drug treatment program, this study provides evidence that one such program is effective. Implications of this finding for the dissemination of efficacious novel treatment approaches are discussed.

JMIR Mental Health

Background COVID-19 and its public health response are having a profound effect on people’s menta... more Background COVID-19 and its public health response are having a profound effect on people’s mental health. To provide support during these times, Canada’s largest mental health and addiction teaching hospital (Centre for Addiction and Mental Health [CAMH]) launched the Mental Health and COVID-19 Pandemic website on March 18, 2020. This website was designed to be a nonstigmatizing psychoeducational resource for people experiencing mild to moderate distress due to COVID-19 and the public health response to the pandemic. Objective The aim of this study was to examine the reach, usability, and user perceptions of the CAMH Mental Health and COVID-19 Pandemic website. Methods This study used a mixed methods sequential explanatory design approach, which consisted of the following 2 distinct phases: (1) quantitative data collection and analysis and (2) qualitative semistructured interviews. In phase 1, we analyzed Google Analytics data to understand how many people visited the website and w...

BACKGROUND People who smoke also have other risk factors for chronic disease such as sedentary be... more BACKGROUND People who smoke also have other risk factors for chronic disease such as sedentary behaviours and poor diet. Usual practice is to address smoking with the exclusion of these other behaviours. Clinical decision support systems (CDSS) are a promising resource to effectively support health care practitioners integrate interventions for diet and physical activity as part of their smoking cessation programming. OBJECTIVE The aims of this study are to: (1) assess whether adding a CDSS for physical activity and diet to a smoking cessation program affects smoking cessation outcomes, and (2) assess the implementation of the study. METHODS We conducted a pragmatic, hybrid type I effectiveness/implementation trial with 232 team-based primary care practices in Ontario Canada from November 2019 to May 2021. We measured the effectiveness of the CDSS using a two-arm randomized control trial comparing a CDSS for addressing physical activity and diet as part of a smoking cessation progra...

Additional file 3. Table 5: All Interventions That Reported Using Opportunity as one of the Mecha... more Additional file 3. Table 5: All Interventions That Reported Using Opportunity as one of the Mechanisms. Table 6: All Interventions That Reported Using Capability as one of the Mechanisms. Table 7: All Interventions That Reported Using Motivation as One of the Mechanisms.

Additional file 2. Quality Assessment and Data Extraction Form.

Additional file 1. Search Strategy for Medline.

BACKGROUND The emergence of novel coronavirus (COVID-19) has introduced additional pressures on a... more BACKGROUND The emergence of novel coronavirus (COVID-19) has introduced additional pressures on an already fragile mental healthcare system due to significant rise in depression, anxiety and stress among Canadians. While Cognitive Behavioural Therapy (CBT) is known to be an efficacious treatment to reduce such mental health issues, few people have access to it in an engaging and sustainable manner. To address this gap, a collaboration between The Centre for Addiction and Mental Health (CAMH) and the National Research Council of Canada (NRC) developed CBT based self-led, online, clinician-tested modules in the form of a videogame, Legend of Evelys, and evaluated its usability in the attenuation of COVID-19 related increase in stress. OBJECTIVE We discuss the conceptualization and design of new self-care modules in form of a videogame, its implementation in a technological infrastructure, and inclusivity and privacy considerations that informed the development of the videogame. A usab...

PRISMA-P 2015 Checklist. (DOCX 37Â kb)