Adaptive Treatment Research Articles

A Complex Interrelationship of Childhood Obesity, Dental Caries and Malocclusion Amidst the COVID-19 Pandemic and Social Media Amplification: A Narrative Review

Recent research has highlighted the link between childhood obesity, dental caries, and malocclusion, and how the Coronavirus Disease - 2019 (COVID-19) pandemic and social media have worsened these health issues. Increased screentime and decreased physical activity during the pandemic have significantly contributed to these conditions among children. Studies emphasise the need to address common risk factors such as unhealthy diets, limited healthcare access, and poor public health policies to reduce their negative effects. This review explores the complex relationship between childhood obesity, dental caries, and malocclusion, with a focus on their global importance. It examines the connections and shared risk factors between these conditions, particularly in the context of the pandemic and the growing influence of social media on children. The goal is to provide insights for developing effective interventions and management strategies to improve children's health worldwide. The present review stresses the urgent need for comprehensive strategies that target both individual and collective risk factors, while also considering broader socioeconomic and digital influences on children's health behaviours. Promoting healthy lifestyles, access to nutritious foods, physical activity, and better dental care can help to alleviate these conditions. Understanding the interplay between these health issues and the digital environment is crucial to creating effective and adaptable public health interventions.

Informing climate-health adaptation options through mapping the needs and potential for integrated climate-driven early warning forecasting systems in South Asia-A scoping review.

Climate change is widely recognised to threaten human health, wellbeing and livelihoods, including through its effects on the emergence, spread and burdens of climate-and water-sensitive infectious diseases. However, the scale and mechanisms of the impacts are uncertain and it is unclear whether existing forecasting capacities will foster successful local-level adaptation planning, particularly in climate vulnerable regions in developing countries. The purpose of this scoping review was to characterise and map priority climate- and water-sensitive diseases, map existing forecasting and surveillance systems in climate and health sectors and scope out the needs and potential to develop integrated climate-driven early warning forecasting systems for long-term adaptation planning and interventions in the south Asia region. We searched Web of Science Core Collection, Scopus and PubMed using title, abstract and keywords only for papers focussing on climate-and water-sensitive diseases and explicit mention of either forecasting or surveillance systems in south Asia. We conducted further internet search of relevant national climate adaptation plans and health policies affecting disease management. We identified 187 studies reporting on climate-sensitive diseases and information systems in the south Asia context published between 1992 and 2024. We found very few robust, evidenced-based forecasting systems for climate- and water- sensitive infectious diseases, which suggests limited operationalisation of decision-support tools that could inform actions to reduce disease burdens in the region. Many of the information systems platforms identified focussed on climate-sensitive vector-borne disease systems, with limited tools for water-sensitive diseases. This reveals an opportunity to develop tools for these neglected disease groups. Of the 34 operational platforms identified across the focal countries, only 13 (representing 38.2%) are freely available online and all were developed and implemented by the human health sector. Tools are needed for other south Asian countries (Afghanistan, Sri Lanka, Bhutan) where the risks of infectious diseases are predicted to increase substantially due to climate change, drought and shifts in human demography and use of ecosystems. Altogether, the findings highlight clear opportunities to invest in the co-development and implementation of contextually relevant climate-driven early warning tools and research priorities for disease control and adaptation planning.

Understanding drought risk management in vulnerable communities in dryland farming systems: Evidence from northwest Ghana

Drought intensity and associated risks are increasing in sub-Saharan Africa (SSA) with dire implications for sustainable livelihood. Yet, there is a limited comprehensive understanding of the severity of drought risks in dryland farming systems in sub-Saharan Africa including Ghana, where climate change has multiple effects on farming operations. Monitoring episodic droughts is particularly important for developing local-based adaptive interventions to sustainably improve livelihood and food systems. Drawing evidence from Northwest Ghana, this study used a Rainfall Anomaly Index (RAI), Principal Component Analysis (PCA) and Binary Logistic Regression (BLR) to understand drought indices and risks of 40 years (1981–2020), and assess prioritized coping measures and determinants in rural farming communities. The study revealed that farmers in Northwest Ghana have been experiencing severe intermittent drought risks in the last four decades, with extreme episodes observed in 1983 and 1984. Results show that northern Ghanaian households are coping with drought risks using several strategies such as picking edible wild fruit, migration for labour work, remittances from family members and friends, livestock rearing and sale, petty trading, and basket weaving as the key coping measures by households to counteract drought risk. The BLR estimates show that socio-economic variables such as marital status, household size, market access, and farmland size are significant factors that can predict farmers’ coping interventions. The sale of livestock as a buffer to support households rebound from a climate disaster is critical. We suggest that decision-makers and policy-makers mainstream access to social safety schemes in drought-affected locations to sustain local food systems, agricultural biodiversity and livelihoods.

Gender Perceptions of Small Holder Farmers on the Impact of Climate Change in Communal Areas of Zimbabwe

Climate change has caused severe havoc to social, economic, environmental and physical repercussions to development. The world has encountered the unprecedented natural catastrophes which encompass climate induced calamities such as hurricanes, floods, volcanoes, droughts and cyclones. The study was aimed at unpacking the gender dimensions of small holder farmer on the impact of climate change, vulnerability, adaptation in communal areas. Quantitative primary data was collected from a sample of 244 selected smallholder communal famers, in which stratified random sampling was used to select the respondents to this study. A self-administered structured questionnaire was used to solicit quantitative data from smallholder communal farmers, Bikita rural district council (department of environment) and from Agriculture Extension department. A total of 188 questionnaires were responded to and used for data analysis. Using SPSS version 16.0 quantitative data were analysed using a mix of descriptive statistics, correlation analysis and regression analysis. The study established that the negative effects of climate change and variability are mitigated through growing of drought resistant small grains, growing early maturity seed varieties, adjusting crop planting times, application of lower levels of fertilizers, winter ploughing and ridging and pot-holing. Participation of smallholder farmers in climate change adaptation interventions in Bikita district is subject to socio-political, resources and physical systems and processes barriers. It also established a negative relationship between resource availability and female smallholder farmers’ participation in climate change adaptation practices and the study concluded that availability of resources is a key factor to female small holder farmers’ participation in climate change intervention. There is also need to avail agricultural research results relevant to the small holder farmers and train them on how to use the results to make informed on-farm investment decisions.

Exploring preference for delivery methods for a psychosocial intervention for prenatal anxiety: A qualitative study from a tertiary care hospital in Pakistan.

This qualitative study explores therapists' and participants' preferences for delivery methods (face-to-face and phone sessions) of a cognitive behavioral therapy-based psychosocial intervention for prenatal anxiety delivered in a tertiary care hospital. The research was conducted in a randomized controlled trial in Pakistan, where a shift from face-to-face to phone-based therapy occurred during the coronavirus disease-2019 (COVID-19) pandemic. Twenty in-depth interviews and a focus group discussion were conducted with participants and therapists, respectively. Transcripts were analyzed using thematic analysis. Participants generally preferred face-to-face sessions for rapport building, communication, and comprehension. However, barriers like venue accessibility, childcare, and lack of family support hindered engagement. Telephone sessions were favored for easy scheduling and the comfort of receiving the session at home, but there were challenges associated with phone use, distractions at home, and family members' limited mental health awareness. A mix of face-to-face and telephone sessions was preferred, with rapport from in-person sessions carrying over to telephone interactions. This study underscores the need for adaptable intervention delivery strategies that consider cultural norms, logistical challenges, and individual family dynamics. By combining the benefits of both delivery methods, mental health interventions can be optimized to effectively address prenatal anxiety and promote well-being in resource-constrained settings like Pakistan.

Do Adaptation Interventions Reduce Vulnerability and Disaster Risk and Strengthen Socio-Ecological Resilience?: Lessons from Coastal Odisha, India

Do Adaptation Interventions Reduce Vulnerability and Disaster Risk and Strengthen Socio-Ecological Resilience?: Lessons from Coastal Odisha, India

Advanced biomechanical analytics: Wearable technologies for precision health monitoring in sports performance.

This study investigated the impact of wearable technologies, particularly advanced biomechanical analytics and machine learning, on sports performance monitoring and intervention strategies within the realm of physiotherapy. The primary aims were to evaluate key performance metrics, individual athlete variations and the efficacy of machine learning-driven adaptive interventions. The research employed an observational cross-sectional design, focusing on the collection and analysis of real-world biomechanical data from athletes engaged in sports physiotherapy. A representative sample of athletes from Bahawalpur participated, utilizing Dring Stadium as the primary data collection venue. Wearable devices, including inertial sensors (MPU6050, MPU9250), electromyography (EMG) sensors (MyoWare Muscle Sensor), pressure sensors (FlexiForce sensor) and haptic feedback sensors, were strategically chosen for their ability to capture diverse biomechanical parameters. Key performance metrics, such as heart rate (mean: 76.5 bpm, SD: 3.2, min: 72, max: 80), joint angles (mean: 112.3 degrees, SD: 6.8, min: 105, max: 120), muscle activation (mean: 43.2%, SD: 4.5, min: 38, max: 48) and stress and strain features (mean: [112.3 ], SD: [6.5 ]), were analyzed and presented in summary tables. Individual athlete analyses highlighted variations in performance metrics, emphasizing the need for personalized monitoring and intervention strategies. The impact of wearable technologies on athletic performance was quantified through a comparison of metrics recorded with and without sensors. Results consistently demonstrated improvements in monitored parameters, affirming the significance of wearable technologies. The study suggests that wearable technologies, when combined with advanced biomechanical analytics and machine learning, can enhance athletic performance in sports physiotherapy. Real-time monitoring allows for precise intervention adjustments, demonstrating the potential of machine learning-driven adaptive interventions.

Lessons Learned About Trauma Related to Racial Discrimination During COVID-19 in the United States.

Race scholars have discussed how the pandemic has disproportionately burdened marginalized communities and exacerbated pre-existing inequities, particularly for Black Indigenous People of Color (BIPOC) in the United States (U.S.). One glaring social determinant during the time of the COVID-19 is racial discrimination. This chapter will discuss lessons learned regarding the negative impact of discrimination on BIPOC, especially as it pertains to their experiences of trauma. Some of these lessons include (1) the need for clinical psychologist to improve access to treatment through increased research on culturally adaptive interventions, (2) increased research on the effects of race-based trauma on mental health symptomatology, (3) policy and institutional changes that reduce disparities in access to care, and (4) increased education for psychologists around billing procedures for individuals with race-based stress.

An adaptive text message intervention to promote psychological well-being and reduce cardiac risk: The Text4Health controlled clinical pilot trial

ObjectiveIn a two-arm pilot trial, we examined the feasibility, acceptability, and preliminary efficacy of a 12-week, adaptive text message intervention (TMI) to promote health behaviors and psychological well-being in 60 individuals with multiple cardiac risk conditions (i.e., hypertension, hyperlipidemia, and/or type 2 diabetes) and suboptimal adherence to exercise or dietary guidance. MethodsParticipants were allocated to receive the TMI or enhanced usual care (eUC). The TMI included daily adaptive text messages promoting health behaviors, twice-weekly messages to set goals and monitor progress, and monthly phone check-ins. Feasibility (primary outcome) and acceptability were measured by rates of successful text message delivery and daily participant ratings of message utility (0–10 Likert scale). We also assessed impact on health behavior adherence, psychological health, and functional outcomes. ResultsThe TMI was feasible (99.3% of messages successfully sent) and well-accepted (mean utility = 7.4/10 [SD 2.6]). At 12 weeks, the TMI led to small-sized greater improvements in moderate to vigorous physical activity (d = 0.37), overall physical activity (d = 0.23), optimism (d = 0.20), anxiety (d = −0.36), self-efficacy (d = 0.22), and physical function (d = 0.20), compared to eUC. It did not impact other outcomes substantially at this time point. ConclusionThis 12-week, adaptive TMI was feasible, well-accepted, and associated with small-sized greater improvements in health behavior and psychological outcomes. Though larger studies are needed, it has the potential to be a scalable, low-intensity program that could be used in clinical practice.ClinicalTrials.govregistration:NCT04382521

Dissecting climate change risk and financial market instability: Implications for ecological risk management.

This research investigates the impact of climate challenges on financial markets by introducing an innovative approach to measure climate risk, specifically the aggregate climate change concern (ACCC) index. The study aims to assess and quantify the potential influence of climate change and risk-related factors on the performance and dynamics of financial markets. In this paper, concern is defined as the attention paid to the risk of climate change and the associated negative consequences. The findings demonstrate that the aggregate index exhibits robust predictability of market risk premiums, both within the sample and out-of-sample. By comparison, the index contains additional information beyond 14 economic predictors and 12 risk/uncertainty indexes in forecasting stock market return. In addition, the index proves valuable for mean-variance investors in asset allocation, leading to significant economic gains. The study identifies the index's ability to capture the reversal of temporary price crashes caused by overreactions to climate change risk. Furthermore, it exhibits stronger return forecasting capability for green stocks, non-state-owned enterprise (non-SOE) stocks, and stocks in regions with low air pollution. Particularly during periods of low air pollution and relaxed regulation, the index displays an enhanced ability to forecast returns. The study's findings provide valuable insights for policymakers and financial institutions as they address 21st-century environmental challenges. Moreover, these findings can inform the design of adaptive measures and interventions aimed at mitigating ecological risks and promoting sustainable economicgrowth.

Teachers Retention and Recruitment in Rural Areas in Tanzania: A Narrative Review Based on the Chinese Experience

A narrative review of the literature on the practices of teacher recruitment and retention in rural China, with an emphasis on identifying the tactics employed to do so, served as the basis for this qualitative study. It then showed Tanzania how similar strategies may be applied to guarantee the successful recruitment and retention of Math and Science teachers in rural areas. The study found that while China's position is not as dire as Tanzania's, especially for teachers of science and math, both countries struggle with teacher recruitment and retention in rural areas. This results from the several strategies China has implemented to ensure successful teacher recruitment and retention in both rural and urban areas. Nonetheless, the study has demonstrated that Tanzania, like other Sub-Saharan African nations, lacks a strong framework for teacher policies that connects teacher recruitment and retention. Additionally, Science and Math teachers in Tanzania are not motivated, which leads to a teacher shortage in rural and remote areas. The study, thus, recommends that Tanzania should learn from China through the following; - Firstly, development of policies related to rewards and incentives and, an increase in salary and promotions for science and mathematics teachers recruited in rural areas. Secondly, creating huge investments in urbanizing rural areas to attract and retain afresh employed science and mathematics teachers. Thirdly, the development of teacher exchange and rotation policy. Fourthly, encouraging more gifted form six graduates in science and mathematics to work as teachers in remote regions and providing them with free access to both online and offline higher education. In this regard Tanzania will be able to comprehend the 2030 World Education for Sustainable Development, the SDGs of the UN, the African Union objectives of 2063, and Tanzania Vision 2025. Ultimately, the study concludes that, despite Tanzania's potential to learn from China, several challenges and considerations must be taken into account. These include the need for robust data collection and monitoring systems to assess the impact of adaptive interventions, as well as the importance of engaging local communities and stakeholders in the design and implementation of relevant strategies. Additionally, is essential to recognize the cultural and contextual differences between China and Tanzania, and to adapt strategies in a way that aligns with the unique needs and realities of the Tanzanian education system. This may include considering factors such as community engagement, and local governance structures in the development of adaptive interventions. To carry out frequent orientations for recently employed science and math teachers in rural schools. To establish science and technology centers, agricultural research facilities and environmental conservation projects in rural areas that encourage teachers to engage and advance knowledge in their profession. Resources that are currently spent to train more arts teachers could instead be allocated to training more math and science teachers. Creation of an online learning environment for math and science teachers that links teachers in rural and urban schools for knowledge sharing.

Scale-up Integrated Care for Chronic Diseases in Belgium: a process evaluation of policy dialogues and roadmap interventions

Background. The goal of more integrated care has been on the Belgium health care policy agenda since 2007 with the start of disease specific care trajectories, reports on chronic care and pilot projects at local level. While there is consensus on what needs to be done, the process of how it should be done is much more uncertain. Scale-up of integrated care is complex, because it requires multi-stakeholder action and intersectoral coordination at individual healthcare practice, organizational, and political/system levels, and tailoring to the context in which it is delivered. There is little research on how to scale-up such complex and adaptive interventions.
 The SCUBY project aimed to contribute to scale-up of integrated care through development of evidence-based roadmaps and policy dialogues. This evaluation study examines the SCUBY scale-up intervention, by looking at its implementation outcomes, mechanisms of impact and the interaction with the political, policy and societal circumstances in the Belgium context.
 Methods. The ‘process evaluation for complex interventions’ by the MRC was the evaluation framework. Policy dialogues were defined as the SCUBY-team engagements with key stakeholders to develop and implement roadmaps. They comprised structured formal events, one-to-one interactions with key stakeholders, workshops, consultations, and joining ongoing dialogues of stakeholder networks. The roadmap was a scale-up strategy and included activities, a timeline and a description of the evidence base and key partners/stakeholders involved (change team). Data collection tools included policy dialogue reporting forms and surveys, key informant interviews, policy document review and a project diary. Descriptive and thematic analyses are conducted, together with a policy mapping. 
 Results. The SCUBY team conducted 79 meetings classified as policy dialogues, most of them being small group meetings or network meetings organized by partners. SCUBY organized 6 major policy dialogues and invited a mix of beneficiaries, health system administration representatives, policy makers (from federal and regional level), health care providers and their representative organizations, people involved in organization and coordination of care, care users, and scientific stakeholders. Three themes emerged as being the most important areas for the roadmap: A) primary care practice organization (change management and advocating for primary care nurses); B) data and monitoring (chronic care indicators at primary care practice level and for population health management in Primary Care Zones); and C) healthcare financing (budget for chronic care that stimulates quality and new provider payment models). The roadmap comprised subthemes, with internal objectives (to be reached with our project resources) and external objectives (beyond out sphere of control) and activities. 
 Discussion. Our findings emphasize the importance of adopting a collaborative, networking approach via the organization of various small-size and bigger-size policy dialogues, in order to create real-world impact, by building synergies and coalitions and our researcher team generating boundary spanning skills, as more proximal outcomes. The variation in progress made per roadmap theme was anticipated because of our level of involvement, expertise and resources available. The change team had to find the right balance in the trade-off between relevance and feasibility of certain scale-up strategies.

Perceptions of Older Immigrants About Health Care in the Host Countries: A Narrative Review

Older immigrants may have different needs regarding health and care services compared to other age groups. There are suggestions for adapting health services to the elderly and even immigrant elderly in order to provide equal service to everyone. There are studies indicating that with advancing age chronic diseases increase and functional capacity decreases, resulting in poorer physical and psychosocial health in immigrant elderly than in the general elderly population. It is stated that immigrants’ use of health services is lower than that of general population. Cultural and social factors influence health behaviors, opportunities, wishes and barriers for patients to access and use health and care services. Studies stated that elderly immigrants not knowing how to apply for health services, having language problems and being ineffective in communication with healthcare professionals, and experiencing lack of/insufficient social, community and family support, are lead to isolation and inadequate use of health services. In the narrative review, it is aimed to explore the existing research which was conducted on the experiences and perspectives of older immigrants, formal and informal caregivers and healthcare workers regarding health and care services and as well as interventions for better adaptation of health and care services among older immigrants.

An exploration of status of chronic diseases and its influencing factors of older people in Chinese home care and long-term care facilities: a cross-sectional study.

As the population ages, the proportion of chronic diseases becomes more prevalent. This study aimed to investigate the current status of chronic diseases among the older people in home care (HC) and long-term care facilities (LTCFs) in China and to analyze its influencing factors. This cross-sectional study was conducted between 2021 and 2022. A multi-stage stratified random sampling and census sampling approach was used in this survey of the health of 389 older people in HC and 202 older people in LTCFs from Western Hunan, respectively. The following instruments were included in the survey "International Resident Assessment Instrument for Home Care (interRAI-HC)" and the "International Resident Assessment Instrument for Long-Term Care Facilities (interRAI-LTCF)." Univariate analysis was used to examine the prevalence of chronic diseases among older people with different characteristics. Data were analyzed by IBM SPSS version 25.0 software. A p-value of <0.05 was considered statistically significant. The survey results showed that the prevalence of chronic diseases among older people in HC was 73.26% (95% CI, 68.85-77.68), and the top five chronic diseases were hypertension (26.36%), bone and joint disease (23.36%), gastrointestinal and gallbladder disease (11.78%), heart disease (11.21%), and diabetes (8.97%). The prevalence of chronic diseases among older people in LTCFs was 77.23% (95% CI, 77.23-83.06), and the top five chronic diseases were hypertension (33.11%), bone and joint disease (13.25%), cerebrovascular disease (12.91%), diabetes (11.26%), and heart disease (10.26%). The results showed that long time spent alone, having sleep disorders, and self-rated health status significantly increased HC in older people with the prevalence of chronic diseases (p < 0.05). Having marital status, non-healthy BMI, having sleep disorder, walking with the use of assistive devices, and self-rated health status significantly increased older people in LTCFs with the prevalence of chronic diseases (p < 0.05). There are differences in the prevalence and distribution of chronic diseases among older people in two different aged care models in China, and there are various risk factors for chronic diseases. Therefore, chronic disease healthcare strategies should be tailored to two different aged care models for older people. Further summary found that older people in HC spend a lot of time alone and suffer from loneliness, which ultimately causes psychological disorders. Thus, psychological adaptation interventions are needed for older people in HC. Besides, older people in LTCFs lack social support from their families (divorced/widowed) and have activity disorders (walking with the use of assistive devices). Thus, social adaptation interventions are needed for older people in LTCFs. This study provides a theoretical basis for the distribution of healthcare and the prevention and treatment of chronic diseases in Chinese older people.

Unlocking the Potential of Participatory Planning: How Flexible and Adaptive Governance Interventions Can Work in Practice

AbstractThe past two decades have witnessed the rapid diffusion of participatory planning models, including Community-Driven Development and Participatory Budgeting. Despite enormous funding outlays, studies paint a mixed picture about whether and when these programs “work” to improve welfare, governance, or social change. To better understand these questions, our paper takes an in-depth approach to understanding the sub-national application of a single participatory planning intervention implemented across Northern Kenya, using qualitative process tracing to understand the mechanisms operating across five counties. Our findings suggest the potential for participatory planning interventions to succeed is contingent on three factors which are insufficiently understood by both practitioners and academics. (1) At the institutional level, participatory planning interventions need to address genuine governance gaps by fulfilling functions that are not met by formal or informal institutions. (2) The rule-based design of participatory institutions often requires adaptation at the sub-national level in response to contextual factors, and the success of this adaptation mediates whether rules function as intended. (3) Ground-level implementers exercise far more discretion than officially recognized during implementation, suggesting they function as a poorly understood source of variation between and within programs.

Who Responds to an Adaptive Intervention for Adolescents With Anorexia Nervosa Being Treated With Family-Based Treatment? Outcomes From a Randomized Clinical Trial

Anorexia nervosa (AN) is a serious psychiatric disorder with high morbidity and mortality. The current evidence supports the use of family-based treatment (FBT), but recovery rates are only about 40%. Improving treatment outcomes among adolescents with AN will save lives, improve health, and prevent chronicity. This study examined the relative efficacy of adding intensive parental coaching (IPC) to standard FBT for patients who do not respond by weight gain of 2.4 kg by session 4, a clinical predictor of outcome at the end of treatment, to improve remission rates (>94% of expected mean body mass index). The study recruited 107 participants and their families from across the United States; 69 participants failed to respond early and were randomly assigned to continue with standard FBT or to receive 3 sessions of IPC. Participants were adolescents (ages 12-18) meeting DSM-5 criteria for AN; 6.5% were male, and 11% were Hispanic. Main outcomes were mean body mass index >94% expected for age, height, and sex. Secondary outcomes included change in eating-related cognitions. Adding IPC to early nonresponders did not improve outcomes except for participants whose parents demonstrated low parental self-efficacy at baseline (moderator). Early weight gain of 2.4 kg by session 4 was replicated as a predictor of end of treatment remission. Parental self-efficacy moderates IPC as an adaptive treatment for adolescents with AN. Baseline parental self-efficacy assessment can be used to identify families most likely to benefit from adding IPC to FBT. Future studies should consider earlier interventions to improve early response rates. Anorexia nervosa is a serious psychiatric disorder. While family-based treatment (FBT) has the largest evidence base for adolescents with anorexia, recovery rates are only about 40%. This study investigated the addition of 3 sessions of intensive parental coaching intervention (IPC) to FBT among youth with anorexia who did not gain adequate weight early in treatment, a predictor of recovery by the end of treatment. Youth with inadequate weight gain were randomized to either receive FBT with IPC or FBT as usual. Overall, adding IPC did not improve outcomes among youth with anorexia. However among those whose parents demonstrated low parental self-efficacy at baseline, youth who received FBT with IPC had higher remission rates than youth who received FBT alone. Intensive parental coaching shows promise for improving outcomes among youth with anorexia whose parents report low parental self-efficacy. Adaptive Treatment for Adolescent Anorexia Nervosa; https://clinicaltrials.gov/; NCT03097874.

Guide to Conducting Adaptive Interventions to Increase Intervention Effectiveness

Social intervention is a program designed to address social issues or achieve specific goals within society. Interventions are typically carried out by implementing the same program for all participant groups, known as a single intervention approach. However, this approach does not take into account the variations in participants' responses to the intervention. Consequently, participants may receive interventions that are not suitable for them, hence affecting the effectiveness of the intervention itself. Adaptive intervention is an approach needed to overcome such limitation. In adaptive intervention, the intervention is delivered in sequence and adjusted based on participants' responses to the initial intervention. Interventionist can modify the program through alternative interventions to tailor it to participants' needs. Compared to single intervention, adaptive intervention have the advantage of ensuring that participants only receive intervention that are suitable for their responses. However, adaptive interventions are still not widely implemented in Indonesia. This article aims to provide guidance on designing and evaluating adaptive intervention to enhance the effectiveness of social intervention in achieving desired goals. As an illustration, we use two interventions at each stage of adaptive intervention design.Intervensi sosial merupakan program yang dilakukan untuk menangani permasalahan sosial atau mencapai suatu tujuan tertentu dalam masyarakat. Intervensi umumnya dilakukan dengan memberikan program yang sama pada seluruh kelompok partisipan, atau dikenal dengan intervensi tunggal. Akan tetapi, pendekatan tersebut tidak mempertimbangkan variasi respons partisipan terhadap intervensi. Akibatnya, partisipan dapat menerima intervensi yang tidak sesuai dan pada akhirnya memengaruhi efektivitas intervensi. Intervensi adaptif adalah pendekatan yang dibutuhkan untuk mengatasi limitasi tersebut. Pada intervensi adaptif, intervensi diberikan secara berurutan dan disesuaikan berdasarkan respons partisipan terhadap intervensi awal. Intervensionis dapat memodifikasi program melalui intervensi alternatif untuk menyesuaikannya dengan kebutuhan partisipan. Dibandingkan dengan intervensi tunggal, intervensi adaptif memiliki keunggulan dalam memastikan partisipan hanya menerima intervensi yang sesuai dengan responsnya. Akan tetapi, intervensi adaptif masih belum banyak dilakukan di Indonesia. Artikel ini bertujuan memberi panduan dalam merancang dan mengevaluasi intervensi adaptif agar meningkatkan efektivitas intervensi sosial dalam mencapai tujuan yang diinginkan. Sebagai ilustrasi, kami menggunakan dua intervensi pada setiap tahap perancangan intervensi adaptif.

Video chat therapist assistance in an adaptive digital intervention for anxiety and depression: Reflections from participants and therapists.

Video chat therapist assistance in an adaptive digital intervention for anxiety and depression: Reflections from participants and therapists.

Prediction of Physical Activity Patterns in Older Patients Rehabilitating After Hip Fracture Surgery: Exploratory Study.

Building up physical activity is a highly important aspect in an older patient's rehabilitation process after hip fracture surgery. The patterns of physical activity during rehabilitation are associated with the duration of rehabilitation stay. Predicting physical activity patterns early in the rehabilitation phase can provide patients and health care professionals an early indication of the duration of rehabilitation stay as well as insight into the degree of patients' recovery for timely adaptive interventions. This study aims to explore the early prediction of physical activity patterns in older patients rehabilitating after hip fracture surgery at a skilled nursing home. The physical activity of patients aged ≥70 years with surgically treated hip fracture was continuously monitored using an accelerometer during rehabilitation at a skilled nursing home. Physical activity patterns were described in our previous study, and the 2 most common patterns were used in this study for pattern prediction: the upward linear pattern (n=15) and the S-shape pattern (n=23). Features from the intensity of physical activity were calculated for time windows with different window sizes of the first 5, 6, 7, and 8 days to assess the early rehabilitation moment in which the patterns could be predicted most accurately. Those features were statistical features, amplitude features, and morphological features. Furthermore, the Barthel Index, Fracture Mobility Score, Functional Ambulation Categories, and the Montreal Cognitive Assessment score were used as clinical features. With the correlation-based feature selection method, relevant features were selected that were highly correlated with the physical activity patterns and uncorrelated with other features. Multiple classifiers were used: decision trees, discriminant analysis, logistic regression, support vector machines, nearest neighbors, and ensemble classifiers. The performance of the prediction models was assessed by calculating precision, recall, and F1-score (accuracy measure) for each individual physical activity pattern. Furthermore, the overall performance of the prediction model was calculated by calculating the F1-score for all physical activity patterns together. The amplitude feature describing the overall intensity of physical activity on the first day of rehabilitation and the morphological features describing the shape of the patterns were selected as relevant features for all time windows. Relevant features extracted from the first 7 days with a cosine k-nearest neighbor model reached the highest overall prediction performance (micro F1-score=1) and a 100% correct classification of the 2 most common physical activity patterns. Continuous monitoring of the physical activity of older patients in the first week of hip fracture rehabilitation results in an early physical activity pattern prediction. In the future, continuous physical activity monitoring can offer the possibility to predict the duration of rehabilitation stay, assess the recovery progress during hip fracture rehabilitation, and benefit health care organizations, health care professionals, and patients themselves.

Transdiagnostic Ecological Momentary Intervention for Improving Self-Esteem in Youth Exposed to Childhood Adversity

Targeting low self-esteem in youth exposed to childhood adversity is a promising strategy for preventing adult mental disorders. Ecological momentary interventions (EMIs) allow for the delivery of youth-friendly, adaptive interventions for improving self-esteem, but robust trial-based evidence is pending. To examine the efficacy of SELFIE, a novel transdiagnostic, blended EMI for improving self-esteem plus care as usual (CAU) compared with CAU only. This was a 2-arm, parallel-group, assessor-blinded, randomized clinical trial conducted from December 2018 to December 2022. The study took place at Dutch secondary mental health services and within the general population and included youth (aged 12-26 years) with low self-esteem (Rosenberg Self-Esteem Scale [RSES] <26) exposed to childhood adversity. A novel blended EMI (3 face-to-face sessions, email contacts, app-based, adaptive EMI) plus CAU or CAU only. The primary outcome was RSES self-esteem at postintervention and 6-month follow-up. Secondary outcomes included positive and negative self-esteem, schematic self-beliefs, momentary self-esteem and affect, general psychopathology, quality of life, observer-rated symptoms, and functioning. A total of 174 participants (mean [SD] age, 20.7 [3.1] years; 154 female [89%]) were included in the intention-to-treat sample, who were primarily exposed to childhood emotional abuse or neglect, verbal or indirect bullying, and/or parental conflict. At postintervention, 153 participants (87.9%) and, at follow-up, 140 participants (80.5%), provided primary outcome data. RSES self-esteem was, on average, higher in the experimental condition (blended EMI + CAU) than in the control condition (CAU) across both postintervention and follow-up as a primary outcome (B = 2.32; 95% CI, 1.14-3.50; P < .001; Cohen d-type effect size [hereafter, Cohen d] = 0.54). Small to moderate effect sizes were observed suggestive of beneficial effects on positive (B = 3.85; 95% CI, 1.83-5.88; P < .001; Cohen d = 0.53) and negative (B = -3.78; 95% CI, -6.59 to -0.98; P = .008; Cohen d = -0.38) self-esteem, positive (B = 1.58; 95% CI, 0.41-2.75; P = .008; Cohen d = 0.38) and negative (B = -1.71; 95% CI, -2.93 to -0.48; P = .006; Cohen d = -0.39) schematic self-beliefs, momentary self-esteem (B = 0.29; 95% CI, 0.01-0.57; P = .04; Cohen d = 0.24), momentary positive affect (B = 0.23; 95% CI, 0.01-0.45; P = .04; Cohen d = 0.20), momentary negative affect (B = -0.33; 95% CI, -0.59 to -0.03, P = .01, Cohen d = -0.27), general psychopathology (B = -17.62; 95% CI, -33.03 to -2.21; P = .03; Cohen d = -0.34), and quality of life (B = 1.16; 95% CI, 0.18-2.13; P = .02; Cohen d = 0.33) across postintervention and follow-up. No beneficial effects on symptoms and functioning were observed. A transdiagnostic, blended EMI demonstrated efficacy on the primary outcome of self-esteem and signaled beneficial effects on several secondary outcomes. Further work should focus on implementing this novel EMI in routine public mental health provision. Dutch Trial Register Identifier:NL7129(NTR7475).