6-week Postintervention Research Articles

A multifaceted training tool to reduce weight bias among healthcare students: A randomized controlled trial

BackgroundWeight bias toward people with obesity (PwO) is common in healthcare settings. Efforts to address weight bias in healthcare settings should begin during university studies. This study aimed to explore the effect of a multifaceted intervention on weight bias among undergraduate healthcare students. MethodsAn open label randomized controlled trial. The intervention tool consisted of short video lectures on obesity, vignettes simulating interactions between health professionals and PwO, and open discourse with a PwO. The control group received a short-written document on obesity. Online questionnaires on Anti-Fat Attitudes ('AFA'), short form of the Fat-Phobia Scale ('FPS'), Weight Implicit Association Test ('Weight-IAT'), and knowledge about obesity were administered at baseline, 1-week, and 6-week post-intervention. ResultsA total of 162, 152, and 146 students participated in the study at baseline, 1-week, and 6-week post-intervention, respectively. Their mean age was 25.8 ± 6.7 years and 88.3% were women. Means of AFA total scores and FPS scores decreased significantly over time only within the intervention group (P Time*Group = 0.002 and 0.014). Both groups showed a similar trend over time in mean scores of Weight-IAT (P Time*Group = 0.868) and knowledge about obesity (P Time*Group = 0.115). ConclusionsA multifaceted intervention resulted in a significant reduction in explicit weight bias but did not yield any additional advantages over the control group in implicit weight bias and knowledge about obesity. ClinicalTrials.gov numberNCT05482802.

Clinical and Ultrasonographic Effectiveness of Two Different Splints Used for the Treatment of Lateral Epicondylitis: A Prospective Randomized Controlled Study

ObjectiveThis study compares the clinical and ultrasonographic efficacy of 2 splint types, the lateral epicondylitis band (LEB) and the wrist extensor splint (WES), for treatment of lateral epicondylitis (LE). DesignRandomized controlled single-blind trial. SettingOutpatient clinic. Participants159 participants diagnosed with unilateral LE based on clinical and ultrasonographic findings, and 2-12 weeks from symptom onset, were included (N=159). InterventionsOne group received joint-protection education-only (wait-and-see), while the other 2 groups were fit with splints: one the LEB and the other the WES. Both splint groups received joint-protection education. Main Outcome MeasuresThe primary outcome measure was the Patient-Rated Tennis Elbow Evaluation (PRTEE) questionnaire. Secondary outcome measures were the Visual Analog Scale (VAS) for pain, hand grip strength by dynamometry, algometric measurements, patient satisfaction, and selected ultrasonographic parameters (maximum tendon thickness measurements (MTTM) in the capitellar-radiocapitellar region and total ultrasonography scale score [TUSS]). All outcomes were assessed at baseline, 3-weeks, and 6-weeks post intervention initiation. ResultsParticipants’ mean age was 46.85±8.63 years. Of the participants, 40.88% (n=65) were male and 59.12% (n=94) were female. The baseline median (1Q-3Q) values of PRTEE-total scores were 58.5 (51-68) for the LEB, 63.5 (56.25-70.25) for the WES and 57 (48-68) for the education-only groups. At 6-weeks, the PRTEE-total scores had decreased by 44 points for those randomized to the LEB, 46 points to the WES and 7 points in the education-only groups(P<.001). While the LEB and WES approaches were superior to the wait-and-see approach in algometric measurements, VAS, and PRTEE scores (P<.05), no significant changes were found in MTTM and TUSS values. The LEB group was superior to the WES group in hand grip strength and patient satisfaction (P<.05). ConclusionUsing either splint for 6 weeks can be considered effective for the relief of pain and increased functionality in persons with subacute LE, although the LEB had a more positive effect on grip strength and patient satisfaction than the WES.

LESSONS LEARNED DEVELOPING A NUTRITIONAL ADHERENCE INTERVENTION FOR DEMENTIA PREVENTION: A QUALITATIVE ANALYSIS

Abstract Lifestyle interventions show considerable promise in delaying the onset and reducing risk for Alzheimer’s disease and related dementias (ADRD). Unfortunately, scalable interventions that address issues of long-term adherence have not been adequately developed or disseminated. Especially important for this effort is iterative evaluation and adaptation of interventions using participant feedback throughout the development process. Using the NIH ORBIT model for behavioral intervention development, our team has established the proof-of-concept (N=9) and pilot tested (N=58) a Mediterranean ketogenic nutrition (MKN) adherence program for older adults at risk for ADRD. This program incorporates motivational interviewing strategies and cognitive behavioral skills training to enhance uptake and long-term adherence to MKN. For each of these pilots, participants completed exit interviews at the conclusion of the 6-week, group intervention and 3-months post-intervention. Qualitative and quantitative data on the acceptability of the program, as well as detailed participant feedback about their experience and recommendations for improvements were collected. While quantitative data demonstrate high acceptability, thematic analysis of qualitative interviews demonstrate a range of recommendations for enhancing and refining important components of the intervention that will be necessary for future scaling and dissemination. We discuss important themes, future directions of this work, and implications for lifestyle intervention development more broadly.

#4877 THE EFFECT OF NURSE-LED 8-ZONE LUNG ULTRASOUND GUIDED TITRATION OF DRY WEIGHT ON HYPERTENSION IN APPARENTLY EUVOLAEMIC HAEMODIALYSIS PATIENTS

Abstract Background and Aims Hypertension related to subclinical volume overload is a common clinical problem in hemodialysis patients. Lung ultrasound (LUS) is a validated technique for minute titration of dry weight, but has limited adoption in clinical practice because it is currently a physician (nephrologist)-led methodology and time consuming with 24-lung zones needing to be imaged. This study aims to show that (1) a simplified 8-zone LUS protocol is effective at dry weight titration in clinically euvolaemic chronic haemodialysis patients, as determined by 24-hour ambulatory blood pressure monitoring (ABPM), and that (2) nurse-led LUS for dry weight titration is feasible and safe. Method This was a 6-week pre and post intervention study in 13 clinically euvolemic haemodialysis patients with chronic hypertension. 4 senior dialysis nurses with at least 4 years of dialysis nursing experience respectively were trained in LUS image acquisition and interpretation via a 1 day workshop by a certified Nephrologist and passed an image interpretation test. 8-zone LUS (which has been described by Volpicelli et al.[1]) was performed midweek, weekly. A Nephrologist reviewed all the acquired LUS images retrospectively. Dry weight was titrated down at a rate not exceeding 0.3 kg per week if LUS Kerley B lines exceeded 3 in any lung zone. All patients underwent 24-hour ABPM at baseline and after 6 weeks. Nurses underwent a post study qualitative survey to elucidate success factors and confidence in LUS technique. Results The study cohort was predominantly male (69%) and diabetic (92%), with an average age of 68 ± 10 years. The average time required for a nurse to complete 1 LUS scan was 3 ± 0.4 minutes. 75% of the cohort had dry weight reduction post-study, which ranged from 0.08 – 0.9% of initial dry weight. Correspondingly, the median number of ultrasonographic B-lines reduced from 4 to 3, although this did not reach statistical significance. Overall, there were reductions in 24-hour systolic BP (146.42±17.03 vs 139.08±12.40 mmHg; p = 0.067) and diastolic BP (72.75±11.79 vs 70.75±11.69 mmHg; p = 0.561). Similarly, there were trends towards improvements in pre- and post-dialysis systolic and diastolic BPs, although only pre-dialysis diastolic BPs showed statistically significant improvement (80±16.05 to 72.33±13.32 mmHg, p = 0.046). This may be related to small sample size. Nil adverse outcomes such as intra-dialytic hypotension, vascular thrombosis, cardiovascular events or fluid overload were reported during the study. 1 patient demised from pneumonia sepsis, which was deemed to be unrelated to the study. All nurses expressed confidence in LUS image acquisition and interpretation following the workshop. Their confidence was further bolstered by the end of the study. They also felt that point-of-care LUS was a useful skill for experienced haemodialysis nurses who were often responsible for day to day adjustment of fluid removal on dialysis. Conclusion We have demonstrated that nurse-led 8-zone LUS can effectively and safely titrate dry weight in chronic haemodialysis patients, as evidenced by improvements in 24-hours ABPM. Importantly, these results are similar to that of randomized controlled trials such as the LUST study where LUS was physician-led. There remains little doubt about the importance of LUS in volume assessment. In-depth studies are required to determine the competencies of, and risk-benefit assessment for nurse-led LUS, to improve the clinical relevance and penetrance of this tool.

Study protocol for approach bias retraining for nicotine addiction among dual combustible and electronic cigarette users

BackgroundElectronic cigarette (ECIG) use has become a popular method for nicotine delivery. Combustible cigarette (CC) cessation or reduction are the primary reasons for ECIG uptake among adults. Yet, most CC smokers who initiate ECIG use do not fully transition from CC to ECIG, despite intending to quit CC completely. Retraining approach bias, or the approach action tendency toward stimuli related to the substance of interest, has been effective in alcohol and CC use treatments. However, approach bias retraining for both CC and (ECIG) users has not been explored. Therefore, the objective of the study is to evaluate the initial efficacy of approach bias retraining among dual CC and ECIG users. MethodsEligible dual CC/ECIG using adults (N = 90) will complete a phone-screener, baseline assessment, 4 treatment sessions over 2 weeks, ecological momentary assessments (EMAs) post-intervention, and follow-ups at 4- and 6-week post-intervention. Participants will be assigned to one of three conditions at baseline: (1) CC + ECIG retraining; (2) CC only retraining; and (3) sham retraining. Participants will engage in a self-guided quit attempt to abstain from all nicotine products starting at treatment session 4. ConclusionsThe study may lead to a more effective treatment for at-risk nicotine users while simultaneously isolating explanatory mechanisms. The findings should guide advances in the theoretical conceptualization of nicotine addiction for dual users and mechanisms involved in maintaining and abstaining from CC and ECIG, and provide initial effect size data for a brief intervention, thus providing necessary data for a large-scale follow-up trial.Clinical Trials ID: NCT05306158

Effects of foot and ankle mobilisations combined with home stretches in people with diabetic peripheral neuropathy: a proof-of-concept RCT

IntroductionPeople with diabetic peripheral neuropathy (DPN) and limited joint mobility syndrome (LJMS) can experience increased forefoot peak plantar pressures (PPPs), a known risk factor for ulceration. The aim of this study was to investigate whether ankle and 1st metatarsophalangeal (MTP) joint mobilisations and home-based stretches in people with DPN improve joint range of motion (ROM) and reduce forefoot PPPs.Design and methodsSixty-one people with DPN (IWGDF risk 2), were randomly assigned to a 6-week programme of ankle and 1st MTP joint mobilisations (n = 31) and home-based stretches or standard care only (n = 30). At baseline (T0); 6-week post intervention (T1) and at 3 months follow-up (T2), a blinded assessor recorded dynamic ankle dorsiflexion range using 3D (Codamotion) motion analysis and the weight bearing lunge test, static 1st MTP joint dorsiflexion ROM, dynamic plantar pressure and balance.ResultsAt T1 and T2 there was no difference between both groups in ankle dorsiflexion in stance phase, plantar pressure and balance. Compared to the control group, the intervention group showed a statistically significant increase in static ankle dorsiflexion range (Left 1.52 cm and 2.9cms, Right 1.62 cm and 2.7 cm) at 6 (T1) and 18 weeks (T2) respectively p < 0.01). Between group differences were also seen in left hallux dorsiflexion (2.75°, p < 0.05) at T1 and in right hallux dorsiflexion ROM (4.9°, p < 0.01) at T2 follow up. Further, functional reach showed a significant increase in the intervention group (T1 = 3.13 cm p < 0.05 and T2 = 3.9 cm p < 0.01). Intervention adherence was high (80%).ConclusionsCombining ankle and 1st MTP joint mobilisations with home-based stretches in a 6-week programme in people with DPN is effective in increasing static measures of range. This intervention may be useful for improving ankle, hallux joint mobility and anteroposterior stability limits in people with diabetes and neuropathy but not for reducing PPP or foot ulcer risk.Trial registrationhttps://classic.clinicaltrials.gov/ct2/show/NCT03195855.

Examining the feasibility of a parental self-help intervention for families awaiting pediatric eating disorder services.

Waitlists for eating disorder (ED) services grew immensely during the COVID-19 pandemic. To address this, we studied the feasibility of a novel parental self-help waitlist intervention. Parents of a child/adolescent (7-17 years) awaiting pediatric ED services were provided with our intervention, adapted from the family-based treatment model, and consisting of videos and reading material with no therapist involvement. Parent-reported child/adolescent weight was collected weekly 6 weeks pre-intervention, 2 weeks during the intervention, and 6-week post-intervention. Recruitment and retention rates were calculated. Regression-based interrupted time series analyses were completed to measure changes in the rate of weight gain. Ninety-seven parents were approached, and 30 agreed to participate (31% recruitment rate). All but one completed end-of-study measures (97% retention rate). The average rate of weight gain was 0.24 lbs/week pre-intervention, which increased significantly to 0.78 lbs/week post-intervention (p < .034). Our findings provide preliminary evidence that this intervention is feasible. Future research is needed to confirm the efficacy of this intervention on a larger scale. The COVID-19 pandemic has resulted in several challenges in providing care for children and adolescents with eating disorders, including long waiting lists and delays in treatment. This study suggests that providing parents on a waitlist with educational videos and reading material is acceptable to parents, and may even help in improving the child's symptoms of an eating disorder.

Immersive Reality Experience Technology for Reducing Social Isolation and Improving Social Connectedness and Well-being of Children and Young People Who Are Hospitalized: Open Trial.

BackgroundChildren and young people who are hospitalized can feel disconnected from their peers and families, which can, in turn, predispose them to psychological problems, including anxiety and depression. Immersive reality experience technology, recently developed by the New Zealand Patience Project Charitable Trust, may help to overcome these issues. Immersive reality experience technology uses immersive 360° live streaming and a virtual reality headset to enable children and young people who are hospitalized to connect through cameras located in either their school or home environment and via SMS text messaging with a designated buddy.ObjectiveThis trial aims to expand qualitative findings from a previous smaller proof of concept trial to ascertain the views of New Zealand children and young people who are hospitalized, their caregivers, and teachers regarding immersive reality experience technology and quantitatively evaluate the effectiveness of immersive reality experience technology in reducing social isolation and improving social connectedness and well-being using validated outcome measures.MethodsAn open trial of immersive reality experience technology was conducted between December 2019 and December 2020 for which 19 New Zealand children and young people aged 13 to 18 years who had been hospitalized at Starship Hospital—a specialist pediatric hospital in Auckland—for at least 2 weeks were recruited. All young people completed the Short Warwick–Edinburgh Mental Well-Being Scale, an abbreviated version of the Social Connectedness Scale, and the Social Inclusion Scale at baseline. Of the 19 participants, 10 (53%) used immersive reality experience technology as often as they wished over a 6-week period and completed postintervention measures. Semistructured interviews with a subset of the 10 young people, 4 caregivers, and 6 teachers were conducted immediately after the intervention.ResultsParticipants reported improvements in social inclusion (mean change 3.9, SD 2.8; P=.06), social connectedness (mean change 14.2, SD 10.0; P=.002), and well-being (mean change 5.7, SD 4.0; P=.001). Key themes from interviews with participants, caregivers, and teachers were the importance of support for using immersive reality experience technology, connecting versus connectedness, choice and connection, and the value of setting it up and getting it right. Recommendations for improving connectedness via immersive reality experience and related technologies were also provided.ConclusionsImmersive reality experience technology can improve the social inclusion, social connectedness, and well-being of New Zealand children and young people who are hospitalized. With some technological modifications and simplified implementation, immersive reality experience and related technology could become part of standard care and support children and young people who are hospitalized in New Zealand and elsewhere to sustain family and peer cohesion, experience fewer psychological problems, and more easily return to normal life following the completion of treatment.Trial RegistrationAustralian New Zealand Clinical Trials Network Registry ACTRN12619000252112; https://www.anzctr.org.au/Trial/Registration/TrialReview.aspx?id=376837&isReview=true

Effects of Acceptance and Commitment Therapy (ACT) on Mental Health and Resiliency of Migrant Live-in Caregivers in Canada: Pilot Randomized Wait List Controlled Trial.

BackgroundTemporary migrant live-in caregivers constitute a vulnerable stream of temporary foreign workers in Canada. This is because the majority are racialized women from the Global South, the gendered nature of caregiving work has historically been undervalued, and their working and living spheres are intertwined which makes application of labor laws and surveillance almost impossible. Their invisible position in the fabric of Canadian society along with their precarious employment and immigration status place their mental health at jeopardy. There is a paucity of research about psychological support for this population.ObjectiveOur pilot study Women Empowerment—Caregiver Acceptance and Resilience E-Learning (WE2CARE) aimed to assess the efficacy of a 6-week online delivery of a psychological intervention based on acceptance and commitment therapy (ACT) in reducing psychological distress and promoting resiliency among live-in care givers in the Greater Toronto Area.MethodsA pilot randomized wait list controlled design was used. Participants were recruited by two community peer champions working with community health organizations serving migrant live-in caregivers. A total of 36 participants were recruited and randomly assigned to the intervention and wait list control groups; 7 dropped out of the study due to competing life priorities. Standardized self-reported surveys were administered online pre-, post-, and 6-week postintervention to assess mental distress (DASS-21), psychological flexibility (AAQ-2), mindfulness (CAMS-R), and Multi-System Model of Resilience (MSMR-I). Independent and dependent t tests were used to compare study outcomes at pre, post, and 6-week follow-up across and within both arms of the study. Linear mixed effects models were created for each outcome of interest from baseline to postintervention among intervention and control participants. Self-reported impact of the WE2CARE intervention was examined using independent t tests across the study arms.ResultsAverage age of participants was 38 years. Many were born in the Philippines (23/29, 79%). The data on the impact of the psychological intervention showed a lower level of depression, anxiety, and stress among the intervention group compared with the control. However, the differences were not significant due to small sample size and COVID-19 crisis (6.94 vs 9.50, P=.54; 6.94 vs 10.83, P=.20; 7.76 vs 10.33, P=.44, respectively). There was a significant improvement in mindful qualities and external resilience, particularly in life satisfaction and accessible support among the intervention group (37.18 vs 32.92, t22=2.35, P=.03; 20.29 vs 16.5, t21=2.98, P=.007; 8.47 vs 6.75, t14=2.41, P=.03; 7.59 vs 5.33, t16=.008, respectively).ConclusionsWE2CARE is among the first studies exploring the efficacy of online delivery of ACT in addressing mental health challenges among live-in caregivers. While there are increased web-based ACT interventions, few use group videoconferencing to promote peer connection and mutual support. WE2CARE showed promising results in reducing psychological distress and promoting mindfulness and resiliency. The intervention highly motivated participants to engage collectively in building social support networks.International Registered Report Identifier (IRRID)RR2-10.2196/preprints.31211

A Lifestyle Management for Arthritis Group education intervention for people with inflammatory and degenerative arthritis: An observational study.

Occupational therapy self-management groups aim to assist individuals to incorporate health-promoting behaviours and management strategies into their daily routines to promote wellbeing. The Lifestyle Management for Arthritis Group (LMAG) is a 2-h-long, occupational therapy educational-behavioural group intervention adapted from the evidence-based Lifestyle Management for Arthritis Programme (Hammond & Rayner,2013) and was delivered to inpatients with inflammatory and degenerative arthritis separately. The aim of this study was to evaluate the effectiveness of this intervention in an inpatient Rheumatology Rehabilitation setting. This was an observational study with a pretest-posttest design using multiple methods. A knowledge of joint protection survey was gathered at three intervals. In-depth semi-structured phone interviews were undertaken 6weeks post intervention. The quantitative data was analysed using IBM SPSS version 25, whilst thematic analysis was used to analyse the interviews. The results confirmed that the 36 participants who completed the study had increased joint protection knowledge immediately after LMAG and continued to retain that knowledge 6weeks post intervention. The majority of participants evaluated the intervention as excellent whilst empowerment emerged as the core concept from the qualitative analysis. These study findings suggest that the LMAG intervention can have a beneficial effect inimproving the self-management skills and confidence levels of patients with inflammatory and degenerative arthritis.

Pilot study of a well-being app to support New Zealand young people during the COVID-19 pandemic

BackgroundWell-being apps represent a promising and scalable approach for improving mental health outcomes in youth, especially during a global pandemic when access to face-to-face interventions may be limited. Whitu (meaning 7 in the New Zealand Māori language Te Reo) is a newly developed well-being app with 7 modules that support young people to learn and practice evidence-based coping skills, including relaxation, mindfulness, self-compassion, and goal-setting. ObjectiveDuring this pilot, we explored the acceptability, usability, and preliminary efficacy of Whitu before refining the app for a randomized controlled trial (RCT). MethodsWe recruited 20 New Zealand young people aged 16-25 years via social media to trial the first prototype of the Whitu app over 6 weeks. Within-group differences from baseline to 2- and 6-weeks post intervention in self-reported well-being, depression, anxiety, stress, self-compassion, optimism and sleep quality were evaluated using repeated-measures ANOVA. A further 21 participants aged 16-30 years were recruited to participate in 4 focus groups to give feedback on the app's usability and cultural acceptability. Feedback was analysed using directed content analysis. ResultsStatistically significant improvements in anxiety (p = 0.024) and stress (p = 0.017) were observed from baseline to 2-weeks post intervention. Improvements in well-being (p = 0.021), depression (p = 0.031), anxiety (p = 0.005), and stress (p = 0.004) were also observed from baseline to 6-weeks. No statistically significant changes were seen in self-compassion, optimism, or sleep quality. Effect sizes (partial η2s) ranged from 0.25 (depression) to 0.42 (stress). Qualitative feedback comprised of five key themes, namely: factors affecting engagement, issues with functionality, preferences regarding aesthetics, effectiveness and adverse effects, and cultural acceptability. ConclusionsOur preliminary results suggest that Whitu may be an effective app for improving multiple dimensions of young people's well-being. Modifications to the look and feel, cultural content, and onboarding have been undertaken based on the qualitative feedback, and an RCT is currently underway.

The Effects of Virtual Reality Based Rehabilitation on Upper Extremity Function in a Child with Cerebral Palsy: A Case Report

Aim This case report was designed to assess the efficacy of virtual reality (VR) rehabilitation on improving upper extremity function for a child with spastic hemiplegic cerebral palsy. Methods In addition to conventional therapies completed three times per week, the participant engaged in virtual reality rehabilitation with the Neofect Smart Kids five to seven days per week for six weeks totaling just over twelve hours of intervention time. Outcome measures were administered pre-intervention, post-intervention, and 6-weeks post-intervention. Results Varying levels of improvement in motor function, quality of movement, and functional use were observed during intervention evidenced by improved scores on the following standardized assessments: Peabody Developmental Motor Scales, Second Edition; the Quality of Upper Extremity Skills Test; and the Pediatric Evaluation and Disability Inventory—Computer Adaptive Test. The participant maintained improvements in motor skills at 6-weeks post intervention, however, the quality of his movements and overall frequency of use with his affected upper extremity decreased in the 6-weeks following termination of intervention. Conclusions Even though the results are not generalizable, the VR intervention for this child allowed for greater movement repetition and improved functional upper extremity use.

Sustained Effects From a School-Based Intervention Pilot Study for Children With Asthma and Anxiety.

Children with chronic conditions (i.e., asthma) are more likely to have anxiety or depressive symptoms. Comorbid asthma and anxiety in children leads to increased morbidity, causing children to miss instructional time and parent/caregiver (CG) work absences. Asthma educational programs and mental health interventions have been developed, though no scalable programs integrate asthma education and mental health behavioral interventions for school-aged children. This study evaluated the sustained preliminary effects of an integrated asthma education and cognitive behavioral skills-building program, Creating Opportunities for Personal Empowerment for Asthma. Thirty-two children ages 8-12 years with asthma and symptoms of anxiety received the intervention. At 6-weeks postintervention, anxiety and CG-reported behavioral symptoms were significantly reduced, there were fewer missed doses of asthma controller medications, and asthma-related self-efficacy, personal beliefs, and the children's understanding of asthma significantly increased. Most children (n = 29, 91%) reported continued use of coping skills.

Effect of supportive counseling on pregnancy-specific stress, general stress, and prenatal health behaviors: A multicenter randomized controlled trial

ObjectiveThe aim of this study was to investigate the effects of group supportive counseling (SC) on pregnancy-specific stress, general stress, and healthy behavior of pregnant women. MethodsThis randomized controlled trial study was conducted on 80 pregnant women in two groups; SC for six sessions, once a week for two hours (n = 40), and antenatal usual care (AUC) (n = 40). All Participants completed questionnaires measuring pregnancy-specific stress, state anxiety, prenatal health behaviors, perceived stress, and provided a saliva sample for measurement of cortisol at pre-intervention and 6-week post-intervention. ResultsThe post-intervention results indicated that the outcome scores decreased more significantly in group SC than in the AUC for total NuPDQ, for state-anxiety, for PSS-14, and for unhealthy behaviors with a large effect size. Also, healthy behaviors were promoted more significantly in SC group than in AUC. However, salivary cortisol levels did not differ between group SC and AUC groups. ConclusionGroup supportive counselling can promote pregnancy stress and healthy behaviors. Practice ImplicationsAddition of supportive counseling to prenatal usual care may be suggested for pregnant women with any gestational age who seek methods for improving pregnancy stress and healthy behaviors.

A Novel Mobile Phone App Intervention With Phone Coaching to Reduce Symptoms of Depression in Survivors of Women's Cancer: Pre-Post Pilot Study.

BackgroundPsychological distress is a major issue among survivors of women’s cancer who face numerous barriers to accessing in-person mental health treatments. Mobile phone app–based interventions are scalable and have the potential to increase access to mental health care among survivors of women’s cancer worldwide.ObjectiveThis study aimed to evaluate the acceptability and preliminary efficacy of a novel app-based intervention with phone coaching in a sample of survivors of women’s cancer.MethodsIn a single-group, pre-post, 6-week pilot study in the United States, 28 survivors of women’s cancer used iCanThrive, a novel app intervention that teaches skills for coping with stress and enhancing well-being, with added phone coaching. The primary outcome was self-reported symptoms of depression (Center for Epidemiologic Studies Depression Scale). Emotional self-efficacy and sleep disruption were also assessed at baseline, 6-week postintervention, and 4 weeks after the intervention period. Feedback obtained at the end of the study focused on user experience of the intervention.ResultsThere were significant decreases in symptoms of depression and sleep disruption from baseline to postintervention. Sleep disruption remained significantly lower at 4-week postintervention compared with baseline. The iCanThrive app was launched a median of 20.5 times over the intervention period. The median length of use was 2.1 min. Of the individuals who initiated the intervention, 87% (20/23) completed the 6-week intervention.ConclusionsThis pilot study provides support for the acceptability and preliminary efficacy of the iCanThrive intervention. Future work should validate the intervention in a larger randomized controlled study. It is important to develop scalable interventions that meet the psychosocial needs of different cancer populations. The modular structure of the iCanThrive app and phone coaching could impact a large population of survivors of women’s cancer.

The Acceptability and Effectiveness of an Online Intervention for Youth With Parents With a Mental Illness and/or Substance Use Issue

PurposeThere is a paucity of interventions for young adults who have parents with a mental health or substance use issue. The 6-week mi.spot (supportive, preventive, online, and targeted) professionally moderated, online intervention fills this gap. The purpose of this study was to present evidence of the acceptability, safety, and preliminary effectiveness of this intervention. MethodsIn response to social media advertising, 31 young people aged 18–25 years participated in mi.spot. Intervention effectiveness was examined via a single-group pre, post, and 6-week follow-up study design, measuring primary changes in depression, anxiety, stress, and psychological well-being and secondary changes in coping, self-efficacy, social connectedness, attribution of responsibility, help-seeking, and mental health literacy. Acceptability and safety were determined by system use and participants' self-reports. ResultsOver the 6 weeks of the intervention, 28 (90.3%) of 31 participants used one or more components of the mi.spot intervention. Significant improvements were reported in depression and stress from preintervention to 6-week postintervention. Trend improvements were evident in well-being, social connection, and coping. No change was reported in general help-seeking, social connectedness, mental health literacy, self-efficacy, or attribution. No safety violations were reported. Participants reported mi.spot to be safe and acceptable. Conclusionsmi.spot appears to be safe and acceptable and shows promise as an effective online intervention to improve the mental health and well-being of young adults with parents with mental health and/or substance use issues.

Dynamic Surface Exercise Training in Improving Trunk Control and Gross Motor Functions among Children with Quadriplegic Cerebral Palsy: A Single Center, Randomized Controlled Trial.

ABSTRACTBackground:Dynamic surface provides proprioceptive and vestibular feedback with optimal level of arousal. The activities on unstable environment have greater sensorimotor experiences. There is a lack of evidence examining the benefits of dynamic surface exercise training (DSET) among the children with spastic quadriplegic cerebral palsy (CP).Aim:The aim of the study was to analyze the effect of dynamic surface exercises on trunk control and gross motor functions in children with quadriplegic CP.Materials and Methods:A total of 30 children with spastic quadriplegic CP with Gross Motor Function Classification System of levels III and IV were recruited by the simple random sampling method (random number generator) to participate in this randomized controlled study. Recruited children were randomly divided into two groups, DSET group and standard physiotherapy training group. Both the groups received active training program lasting for 60 min, 4 days/week for 6 weeks. Gross Motor Function Measure (GMFM)-88 and Pediatric Balance Scale (PBS) scores were recorded at baseline, and at the end of 6-week post-intervention.Results:Total 30 children with quadriplegic CP with mean age 6.64 ± 2.15 years in experimental group and 6.50 ±1.59 years in control group participated in the study. Experimental group showed a significant difference for GMFM and PBS scores between pre- and post-intervention with P < 0.005. A significant difference was observed in GMFM scores between experimental and control group with P < 0.005.Conclusion:Six-week dynamic surface exercise therapy along with standard physiotherapy was effective in improving trunk control and gross motor function performance among children with spastic quadriplegic CP aged 6–12 years.

Assessing the effectiveness of an educational workshop designed to improve caring behaviors of Midwives at Public Hospitals in Jordan

Background: Despite caring being an important aspect of health-care providers' work, there is a growing concern about the lack of suitable caring behaviors in childbirth settings in developing countries. Objective: The objective is to design, implement, and evaluate an educational workshop to improve the caring behavior of midwives working in the labor ward of a large Jordanian public hospital. Methods: This is a pre- and post-interventional study. A workshop focused on teaching specific caring behaviors was held for 20 midwives who worked in the labor ward at one public hospital in Jordan and evaluated against women's ratings of midwives' caring behaviors and satisfaction with care after the intervention and 3 years later. Results: Significant increases were observed in the overall scores of midwives caring behaviors and women' satisfaction 6 weeks and 3 years after the intervention compared with prior scores. Women postintervention perceived midwives to be more caring than women before the intervention (P = 0.001). There were significant positive changes from preintervention scores at 6-week postintervention and 3-year postintervention on seven out of eight items of the “caring behavior scale.” Increased overall satisfaction scores were observed 6 weeks and 3 years after the intervention compared with the scores before the intervention (P Conclusion: The study can inform midwifery educators on the importance of teaching and learning of caring behaviors to future midwives in their preservice preparation. The program that was developed can be used with some modification, as part of midwifery students' educational program or as an in-service program for employed midwives.

Mindfulness-Based Intervention for Educators: Effects of a School-Based Cluster Randomized Controlled Study

The present study investigates the effectiveness of an 8-week mindfulness-based intervention designed to improve educator wellbeing and implemented concurrently in multiple school sites. Using a cluster (school) randomized controlled design, 185 educators working in 20 Australian schools were randomized to an intervention group (10 schools, number = 85, mean age = 42.34 years) or a control group (10 schools, number = 100, mean age = 43.7 years). Multiple regression analysis was performed to examine effects of intervention on wellbeing and teaching-related outcomes and students’ sense of connectedness to teachers measured post intervention after controlling for the baseline. The intervention predicted lower levels of perceived stress (β = − 0.196, p < 0.01, 95% CI [− 4.00, − 0.92]) and sleep difficulty (β = − 0.175, p < 0.05, 95% CI [− 7.54, − 0.46]) and higher levels of mindfulness (β = 0.252, p < 0.001, 95% CI [2.60, 6.12]), self-compassion (β = 0.207, p < 0.001, 95% CI [0.14, 0.43]) and cognitive reappraisal in emotion regulation (β = 0.152, p < 0.05, 95% CI [0.19, 4.03]) at immediate post-intervention, with medium to large effect sizes, after controlling for effects of corresponding variables at baseline. These effects largely remained significant at 6-week post-intervention. Improved educator wellbeing did not accompany improvements in teaching but students’ sense of connectedness to teachers. The findings suggest that mindfulness-based interventions may contribute to the overall educator wellbeing and this may increase students’ sense of connectedness to teachers without themselves undergoing any intervention.

Confident body, confident child: Evaluation of a universal parenting resource promoting healthy body image and eating patterns in early childhood-6- and 12-month outcomes from a randomized controlled trial.

To evaluate Confident Body, Confident Child (CBCC), a universal parenting resource designed to promote positive body image and healthy eating patterns in children aged 2-6 years, at 6- and 12-months follow-up. A four-arm randomized controlled trial with 345 parents was conducted. Group (A) received the CBCC resource pack + workshop, (B) received the CBCC resource pack only, (C) received a nutrition booklet and (D) received no interventions until all questionnaires were completed (i.e., waitlist control). Measures of parenting variables relevant to child body image and eating patterns, and parent-report of child weight, were administered at baseline, 6-weeks post-intervention (results reported previously), and 6- and 12-months follow-up. Mixed effects modeling comparing group averages over time revealed that significant group differences on measures of knowledge, parenting intentions and the parental feeding practice of weight restriction were still present at 12-months follow-up, though the remaining measures showed no significant differences between groups over time. The two CBCC groups reported more positive and less negative outcomes than the nutrition booklet active control. The CBCC program achieved sustained improvements in some parenting variables at 12-months, suggesting its value as an effective parenting intervention. Changes to the intervention design, such as the addition of a follow-up parent workshop, however, would likely increase its efficacy.