ANCOVA Models Research Articles

Investigating the Effectiveness of Character Empowerment Training on Primary School Teachers’ Teaching Emotions

Background: Intervention programs focused on character empowerment provide teachers with the tools to achieve personal well-being and develop resilience in challenging situations. Objectives: This study aimed to investigate the effectiveness of character empowerment training on the emotional responses of primary school teachers in Yazd city during the 2021 - 2022 academic year. Methods: The research employed a semi-experimental design with a pretest-posttest approach and a control group. The statistical population consisted of primary school teachers in Yazd, from which 30 individuals were selected using convenience sampling. These individuals were randomly assigned to either the experimental group (15 teachers) or the control group (15 teachers). Teachers were first paired based on their teaching experience, prior participation in similar courses, and educational level. One individual from each pair was then randomly allocated to the experimental group, and the other to the control group. The research instrument used was the Teachers' Emotions Questionnaire. The experimental group underwent character empowerment training over two months, comprising 12 sessions of 50 minutes each. Data were analyzed using SPSS software version 26, employing an ANCOVA model and MANCOVA test. Results: The findings revealed a significant difference between the two groups in terms of the emotions of pride (32%), anxiety (18%), and anger (47%). Specifically, character empowerment training increased the emotion of pride (P < 0.01) while reducing anger and anxiety (P < 0.05). However, there was no significant difference between the experimental and control groups regarding the emotion of enjoyment (P < 0.01). Conclusions: Enhancing awareness of character empowerment and integrating it into daily practices can help teachers experience heightened pride, reduced anger, and lower anxiety levels, while also enabling them to recognize and appreciate their positive attributes.

The Impact of Disease X on Potential Travelers’ Travel Decision

This study used ANCOVA models to investigate how pandemic characteristics—spreading speed, severity, and vaccination requirements—affect travel intentions. The results reveal that these factors explain 31.7% of the variance in travel decisions, with disease-spreading speed and severity being the most significant determinants. While vaccination requirements are relevant, they play a secondary role compared to the immediate threat of disease characteristics. The interaction effects between these factors further demonstrate their combined impact on travel reluctance. Demographic variables, such as gender and the presence of children, also influence decisions in specific contexts. These findings contribute to the understanding of risk perception during health crises, reinforcing the role of perceived severity in shaping cautious travel behavior. Practical implications for the tourism industry include the need for transparent communication, tailored health protocols, and demographic-specific marketing strategies. Future research should explore broader factors and adopt longitudinal approaches to capture evolving travel intentions during pandemics.

Do Social Media Likes Affect Food Consumption?

Social norms can affect food consumption. Although social media could be used to disseminate such norms, there is limited experimental research on the subject. The purpose of the study was to examine the effects of socially endorsed social media food posts, in the form of Instagram likes, on participants’ eating behavior of wheat food products. The survey was conducted in sensory booths where 149 participants were assigned to one of three conditions viewing three types of images: traditional Greek foods, modern foods, and home decoration as control. However, only one type was socially endorsed with likes. Participants self-reported on a series of questionnaires and were offered traditional Greek rusks (paximathia) and modern crackers as a snack reward during break time on two separate dishes. The hypothesis was that those who had paid attention to socially endorsed images of traditional foods would prefer to consumer Greek rusks, whereas those having paid attention to socially endorsed modern foods would opt for the crackers. Using the ANCOVA model, there was not identified any significant effect of condition on rusk or cracker consumption in grams after controlling the covariates. The results propose that exposure to socially endorsed images with Instagram likes, as a form of social media norm, do not incite people to consume more of either traditional rusks or modern crackers.

Blood pressure and hypertension in older adults with a history of regular cannabis use: findings from the Multi-Ethnic Study of Atherosclerosis.

Observational evidence investigating associations between cannabis use and blood pressure and hypertension is inconsistent. Cross-sectional data from 3,255 participants at Exam 6 (2016-2018) of the Multi-Ethnic Study of Atherosclerosis (MESA) were analyzed, including self-reported cannabis smoking patterns, standardized measures of systolic blood pressure (SBP), diastolic blood pressure (DBP), pulse pressure (PP; BP collectively), and hypertension. ANCOVA and multivariable relative risk regression models were used to calculate adjusted means for BP and adjusted prevalence ratios (PRs) for prevalent hypertension. In fully adjusted ANCOVA models, a history of regular cannabis smoking, when compared to no history, was not significantly associated with increased SBP [mean difference: 0.1 mmHg (95% CI: -1.6-1.9)], DBP [mean difference: 0.5 mmHg (95% CI: -0.3-1.4)], PP [mean difference: -0.5 mmHg (95% CI: -1.8-0.9)], or prevalent hypertension [PR: 1.01 (95% CI: 0.93-1.10)]. Furthermore, no associations were observed for either the duration or recency (in the past month) of cannabis smoking or number of joint/pipe years. Models exploring potential interactions between a history of regular cannabis smoking and age, sex, race/ethnicity, and cigarette smoking status were not significant for either BP or hypertension. In a cohort of racially and ethnically diverse older adults with a high prevalence of hypertension, no evidence of increased risk due to regular cannabis smoking was found for either blood pressure or hypertension.

Semaglutide for the treatment of resistant hypertension

Abstract Background Treatment options for resistant hypertension (RH) are often limited by medication intolerance and adverse effects. Novel approaches to treatment are required. The disease of obesity affects 70% of patients with RH. Purpose To determine if a weight centric approach using semaglutide improved BP control in patients with RH. Methods Individual participant data from three randomised placebo-controlled trials (STEP 1, 3 and 4) examining the effect of semaglutide 2.4mg on body weight over 68 weeks were included. Participants on >4 anti-hypertensive medications or those with systolic BP (SBP) >130mmHg at baseline and 3 anti-hypertensive medications including a diuretic were considered to have RH. Firstly, the change in SBP comparing those on semaglutide to placebo was analysed with baseline systolic BP as a covariate in an ANCOVA model. Then, the RH group was subdivided into those with SBP above or below 130mmHg at baseline and BP response to semaglutide assessed. Analyses were performed using R Software version 4.0.3. Results In the pooled analysis of 3136 trial participants, 111 met the criteria for RH. Compared to placebo, participants on semaglutide had a SBP reduction of -4.93mmHg, adjusted for SBP baseline to -3.16mmHg (95%CI -8.69 to 2.37). For those with RH and a baseline SBP > 130mmHg on semaglutide, the SBP change was -10.94mmHg. This change was 4.54mmHg for those with a SBP < 130mmHg. The diastolic BP changes were -3.62 and 2.79mmHg respectively (Figure 1). At trial completion, 36% of those on semaglutide did not meet the criteria for RH. Conclusions The effect of semaglutide on BP for patients with RH is modest. A greater BP reduction is evident for those with a higher baseline SBP. Targeting excess body weight with semaglutide is a viable treatment option for patients with RH and uncontrolled BP.

What are the changes in mothers' diets after the birth of a child: results from the NutriNet-Santé cohort.

Childbirth is a major life-changing event, this period is an opportunity to improve eating habits. The aim of this longitudinal study was to identify and characterise dietary changes in women according to their parity status. Dietary intake data from 4194 women of childbearing age included in the NutriNet-Santé cohort were derived using a FFQ, administered in 2014 and 2018, distinguishing between organic and conventional food consumption. Women were classified into four groups: ‘previous children’, ‘multiparous’, ‘primiparous’ and ‘nulliparous’. Multi-adjusted ANCOVA models were used to estimate the changes according to the parity group. Changes in food consumption towards a more plant-based, healthier and organic diet were observed in all four groups of women, although to various degrees. In multivariable models, ‘Nulliparous’ women showed a greater improvement in terms of ‘sustainable’ food consumption than ‘previous children’ women. ‘Primiparous’ women significantly increased their energy intake (+349 (269–429) kcal/d) and their consumption of dairy products (+30 (3–56) g/d), and they significantly decreased their consumption of alcohol (–23 (–32–15) g/d), coffee and tea (–107 (–155–60) g/d). Regarding organic food, ‘nulliparous’ women increased their consumption more than ‘previous children’ and ‘primiparous’ women were those who were most frequently in the top quintile of organic food increase. Although there were dietary changes in all groups of women according to their parity, childless women have a shift moving towards a more sustainable diet. Women who had a first child reduced their alcohol and caffeine consumption.

Contribution of provisioning ecosystem services of homestead trees to rural livelihoods in Kashmir Himalaya, India

Aim: To quantify provisioning ecosystem services (PES) derived from homestead trees, estimate their economic value and contribution to rural livelihoods, and ascertain socio-economic determinants of household PES income from homestead trees in district Budgam of Kashmir. Methodology: In this study 106 homesteads were selected across 12 sample villages using multi-stage random sampling. Data were gathered through structured interviews, focus group discussions, homestead inventories, non-participant observations, and rapid market assessments. The data were analyzed through descriptive and analytical statistics. Results: The mean value of PES of homestead trees was ₹ 14349.27 per household per year, which was composed of fruits (45.54%), fuel wood (20.50%), tree browse (18.15%), timber (8.06%), and wicker (7.75%). PES of homestead trees constituted 4th important component of rural economy, accounting 16.23% of the average household's income. ANCOVA indicated that social membership, family size, family labour, farm size, livestock holding, main occupation, wealth status and annual income were potent predictors of household PES income from homestead trees. The R2 (0.872) of the ANCOVA model indicated that socio-economic determinants accounted for 87.20% of the variation in homestead trees' domestic PES revenue. Interpretation: Findings suggested that PES income from homestead trees is a vital intervention for socio-economic development, livelihood diversification, and forest conservation; hence, policy must be implicated towards a sustainable supply of PES from homestead trees by promoting homestead tree holdings. Key words: Homestead trees, Kashmir Himalaya, Livelihood, Provisioning ecosystem services

Guided bone regeneration improves defect fill and reconstructive outcomes in 3-wall peri-implantitis defects.

This multi-center, randomized clinical trial compared the long-term outcomes of guided bone regeneration (GBR) with open flap debridement (OFD) in treating peri-implantitis-related bony defects with ≥3 osseous walls over 36 months. The study aimed to evaluate the healing potential of GBR using a deproteinized bovine bone mineral (DBBM) graft and native bilayer collagen membrane (NBCM) compared to OFD without the use of graft materials. Sixty-six individuals diagnosed with peri-implantitis were randomly assigned to either GBR (34 patients) or OFD (32 patients). The OFD group served as the control, where inflamed tissue was removed and the implant surface decontaminated using 3% hydrogen peroxide, but no bone graft was placed. The GBR group received DBBM and NBCM for defect reconstruction. Radiographic defect fill (RDF), probing pocket depth (PPD), bleeding on probing (BOP), suppuration (SUP), mucosal recession (MREC), and patient-reported outcomes (PROs) were assessed over the study duration. Post-surgical care included azithromycin, ibuprofen, and chlorhexidine rinses. The study involved baseline assessments, surgical interventions, and follow-ups at 6, 12, and 36 months. Supportive peri-implant therapy was provided every 3 months during the additional 24-month follow-up. Primary outcome was RDF at 36 months. Secondary outcomes included PPD, BOP, SUP, MREC, and PROs. Descriptive statistics and ANCOVA models were used for analysis. At 36 months, GBR resulted in a mean RDF of 2.13 ± 1.26 mm, compared to 1.64 ± 1.54 mm with OFD (p = .18). No significant differences were found in PPD, BOP, SUP, REC, or PROs between the groups. Treatment success (defined as no additional bone loss, PPD ≤ 5 mm, no BOP, and no SUP) was achieved in 46.2% of GBR cases and 20% of OFD cases (p = 0.053). GBR provided improved short-term defect fill and higher treatment success compared to OFD, although the differences were not statistically significant. Both procedures maintained clinical parameters over 36 months, with similar patient satisfaction (PROs) observed for GBR and OFD. The adjunct use of DBBM and NBCM may offer clinical benefits for peri-implantitis cases with specific bony defect morphology.

5120 Contribution Of Proximal Femur Geometry And Bone Density Distribution To Hip Fragility In Adults ≥ 50yrs With Longstanding Type 1 Diabetes

Abstract Disclosure: F. Johannesdottir: None. C. D’Mello: None. A.B. Murthy: None. B. Zahedi: None. K. Engelke: None. M.L. Bouxsein: None. E.W. Yu: Grant Recipient; Self; Amgen Inc. Introduction: Adults with type 1 diabetes (T1D) have a 6-fold increased risk of hip fracture, which is explained only in part by lower areal bone mineral density (aBMD) by DXA. We hypothesize that femoral geometry and regional bone deficits at the proximal femur contribute to higher hip fracture risk in older adults with T1D. Further, we determine the influence of age at T1D diagnosis on femoral bone density and structure. Methods: We enrolled 97 individuals with T1D and 53 non-diabetic controls (CON) as part of the T1D Bone Health Connection (BEACON) Study, an ongoing prospective study of adults aged ≥50 years. We obtained computed tomography (CT) scans of the proximal femur (in-plane pixel size 0.98x0.98 mm, 1.25 mm slice thickness) to measure total (Tt), trabecular (Tb) and cortical (Ct) volumetric BMD (vBMD); and volume (Vol) and Ct thickness (Th) in several regions, including total hip, femoral neck (FN), trochanter (TR) and intertrochanter (IT) (Medical Image Analysis Framework, University of Erlangen, Germany). We also assessed total hip and FN aBMD by DXA. We employed ANCOVA models to compare bone outcomes between T1D and controls with adjustment for age, height, and weight, stratified by sex. When comparing bone outcomes within T1D, we adjusted for age, height, weight, and sex. Differences are reported as % difference between the least-square means for the groups. Results: The average age of participants was 64±7 yrs, and similar between T1D and CON (p=0.21). Male T1D were shorter than male CON (173 cm vs 176 cm, p=0.05), but with similar weight (p=0.73). Female T1D were heavier than female CON (71 kg vs 64 kg, p=0.03). The T1D cohort included 50 men and 47 women with mean diabetes duration of 46±10 yrs, mean A1c 7.1±1.0%, and median age at onset 17 yrs (IQR:10-25). Among T1D, 31 (52% female) were diagnosed ≤ age 12. Among men, total hip and FN aBMD did not differ by group, but T1D had smaller FN Tt.Vol (9%) and FN width (8%) (p<0.05 for all). In contrast, there were no differences between T1D and CON in the female cohort, neither by DXA nor CT (p≥0.13). Of note, T1D men appeared to have more poorly controlled diabetes than women (29% of men vs 11% women had A1c ≥8%, p=0.03). Within T1D, those who were diagnosed ≤ age 12 had lower Tb.vBMD (16-18%) at the total hip, TR and IT regions (p<0.05) and tended to have lower Tb.vBMD (16%, p=0.06) at the neck compared to those diagnosed at a later age, but no differences in DXA aBMD (p>0.31). Conclusion: In sum, older men, but not women, with T1D showed some deficits in bone structure at the proximal femur. Adults with T1D who were diagnosed ≤ age 12 had trabecular bone deficits within the proximal femur. Additional studies are needed to identify mechanisms underlying the high hip fracture risk in T1D. Presentation: 6/1/2024

Can Productive Aptitude and Age Affect Circulating Serotonin, Total Thyroid Hormones, and Cortisol Patterns in Cows?

Cattle productivity, whether in terms of meat yield or milk production, is intricately regulated by a multitude of factors. Among them, hormone concentrations play a significant role, reflecting the complex interplay between endocrine regulation and physiological processes that ultimately determine the efficiency and yield of production. High concentrations of 5-hydroxytriptamine (5-HT) are associated with a reduced metabolic load at the onset of lactation and a lower milk yield. Thyroid hormones (THs) and cortisol also affect several metabolic pathways, including carbohydrate, protein, and lipid metabolism. The aim of this study was to assess if milk or meat aptitudes and age influence circulating 5-HT, THs, and cortisol concentrations, investigating the possible interactions among these parameters. The research was performed on 46 healthy cows of three different breeds. Enzyme-linked immunosorbent assay (ELISA) methods were used to quantify circulating 5-HT and cortisol concentrations, and an immunochemiluminescent analyzer was used for THs. For parameters exhibiting non-normal distributions, an ANCOVA model using age, aptitude, and their interaction as fixed factors was applied. Significant lower T3 concentrations were recorded in dairy cows than in meat cows. Moreover, T4 significantly decreased with advancing age both in cows aimed at milk and meat production. Lastly, T4 was positively correlated with T3 and 5-HT in meat production-oriented cows.

The Cognitive Profile of Older Adults With Treatment-Resistant Depression: An Analysis of the OPTIMUM Randomized Controlled Trial

ObjectiveMajor depressive disorder in older adults (late-life depression; LLD) is frequently associated with cognitive impairment, and some deficits (e.g., executive function) have been associated with a higher level of treatment resistance. However, the cognitive profile of treatment-resistant LLD (TR-LLD) has not been characterized. We hypothesized that patients with TR-LLD would show deficits in cognitive function, especially executive function, and that executive function deficits would predict poorer response to pharmacotherapy. DesignSecondary analysis of baseline cognitive data from OPTIMUM, a multicenter RCT evaluating pharmacotherapy strategies for TR-LLD. SettingFive outpatient academic medical centers (4 US, 1 Canada). ParticipantsAbout 369 participants aged 60 and older from the OPTIMUM study. MeasurementsBaseline scores on individual tasks and composite scores from the NIH Toolbox-Cognition Battery were transformed into demographically-adjusted T-scores and compared to published norms. Impairments in the set shifting and inhibitory control tasks were investigated as predictors of depressive symptom change following treatment using ANCOVA models. ResultsParticipants had low performance on tasks evaluating inhibitory control, processing speed, verbal/nonverbal memory, and the fluid composite, but normative performance on working memory and set shifting. Participants had high estimated premorbid IQ (superior Performance on oral reading recognition). Age and physical comorbidity negatively associated with processing speed. Impairments in set shifting predicted less improvement in depressive symptoms; impairments in inhibitory control did not. ConclusionsParticipants with TR-LLD presented with broad cognitive deficits relative to healthy norms. Given poorer outcomes following standard pharmacotherapy associated with impaired set shifting, future research needs to identify alternative treatment strategies.

How to detect affect recognition alterations in amyotrophic lateral sclerosis.

To define the clinical usability of an affect recognition (AR) battery-the Comprehensive Affect Testing System (CATS)-in an Italian sample of patients with amyotrophic lateral sclerosis (ALS). 96 ALS patients and 116 healthy controls underwent a neuropsychological assessment including the AR subtests of the abbreviated version of the CATS (CATS-A). CATS-A AR subtests and their global score (CATS-A AR Quotient, ARQ) were assessed for their factorial, convergent, and divergent validity. The diagnostic accuracy of each CATS-A AR measure in discriminating ALS patients with cognitive impairment from cognitively normal controls and patients was tested via receiver-operating characteristics analyses. Optimal cut-offs were identified for CATS-A AR measures yielding an acceptable AUC value (≥ .70). The ability of CATS-A ARQ to discriminate between different ALS cognitive phenotypes was also tested. Gray-matter (GM) volumes of controls, ALS with normal (ALS-nARQ), and impaired ARQ score (ALS-iARQ) were compared using ANCOVA models. CATS-A AR subtests and ARQ proved to have moderate-to-strong convergent and divergent validity. Almost all considered CATS-A measures reached acceptable accuracy and diagnostic power (AUC range = .79-.83). ARQ showed to be the best diagnostic measure (sensitivity = .80; specificity = .75) and discriminated between different ALS cognitive phenotypes. Compared to ALS-nARQ, ALS-iARQ patients showed reduced GM volumes in the right anterior cingulate, right middle frontal, left inferior temporal, and superior occipital regions. The AR subtests of the CATS-A, and in particular the CATS-A ARQ, are sound measures of AR in ALS. AR deficits may be a valid marker of frontotemporal involvement in these patients.

Infant Temperament Is Associated With Milk Cortisol but Not With Maternal Childhood Trauma.

Previous studies have suggested that maternal childhood trauma (MCT) may influence infant temperament, but the underlying physiological mechanisms remain unclear. This study sought to confirm the involvement of breast milk cortisol in the link between MCT and infant temperament. The study sample included 90 mother-infant dyads recruited from the urban Polish population. MCT was assessed based on the Early Life Stress Questionnaire (ELSQ) and infant temperamental factors (surgency/extraversion, negative affectivity, and orienting/regulation) using the Infant Behavior Questionnaire-Revised at 12 months of life. Cortisol was assayed in milk samples collected at 5 months of life using the ELISA method. Based on the ELSQ median, the sample was divided into low and high MCT groups. The ANCOVA models with milk cortisol as a covariant were run to check the effect of low versus high MCT on infant temperament. We found a positive association between milk cortisol and orienting/regulation. Surprisingly, the low and high MCT groups did not significantly differ in milk cortisol. Furthermore, we found that MCT was unrelated to any infant temperamental factor. While recent literature on the association between milk cortisol and infant temperament is inconsistent, our results suggest that high orienting/regulation might be an adaptation to adverse environments such as stress. Moreover, the infant's temperament appears to be more responsive to the current exposition to maternal stress than her experience of traumatic stress.

Tillage and land use management effects on soil organic matter and soil microbial biomass in a field network of practical farms in France, Romania, and Sweden

A reduction in tillage intensity, organic farming, and introduction of ley-grass periods into the crop rotation are means to improve the sustainable use of arable soils. The current study uses an on-farm approach to investigate soils from different practical farms in Northern France, Central Sweden, and Romania in comparison with previously published results from randomized field-experiments nearby. No-tillage generally increased the mean SOC and total N contents of arable fields in comparison with ploughing. However, this increase was only significant for the 70 % increase at 0–10 cm depth in France. No-tillage had no general effects on MBC or MBN and increased the ergosterol content at 0–10 cm depth in France and Sweden but not in Romania. Averaging depths and tillage systems, median MBC significantly increased in the order France (220 μg g−1 soil), Romania (324 μg g−1 soil), and Sweden (384 μg g−1 soil), whereas the median MB-C/N ratios followed the order France (5.6), Sweden (8.3), and Romania (10.4). The study region-specific changes in soil pH significantly affected covariate MBC and MBN in the regression equations for equal slopes ANCOVA models. In Northern France, organic farming and ley-grass implementation into the crop rotation increased SOC and total N contents to the level of the no-tillage fields. On-farm research gives similar results to long-term field experiments in France, Romania, and Sweden. For this reason, on-farm research on practical fields is an important, less expensive alternative to randomized field experiments, with a high potential for investigating actual and relevant research objectives. This will intensify exchange in knowledge between scientists and farmers.

Quantitative Susceptibility Mapping in Adults with Persistent-Post Concussion Symptoms after Mild Traumatic Brain Injury: An Exploratory Study.

It is estimated that 18-30% of concussion sufferers experience symptoms lasting more than 1 month, known as persistent post-concussion symptoms (PPCS). Symptoms can be debilitating, and include headache, dizziness, nausea, problems with memory and concentration, sleep and mood disruption, and exercise intolerance. Previous studies have used quantitative susceptibility mapping (QSM) to show altered tissue susceptibility levels in adults acutely following concussion, however this finding has yet to be investigated in participants with PPCS. In this exploratory case-controlled study, we measured tissue susceptibility using quantitative susceptibility mapping (QSM) in 24 participants with PPCS following mild traumatic brain injury (mTBI) and 23 healthy controls with no history of concussion. We compute tissue susceptibility for seven white matter tracts and three deep grey matter regions and compare tissue susceptibility between groups using ANCOVA models controlling for age and sex. We also assess the relationship between regional tissue susceptibility and symptoms. There were no significant differences between tissue susceptibility in participants with PPCS compared to control subjects in any of the evaluated regions. However, we show lower tissue susceptibility across four white matter tracts was generally associated with worse symptoms in the PPCS group. Specifically, we saw relationships between white matter susceptibility and headache (p=0.006), time since injury (p=0.03), depressive symptoms (p=0.021) and daytime fatigue (p=0.01) in participants with PPCS. These results provide evidence in support of persistent changes in the brain months-to-years following injury and highlight the need to further understand the pathophysiology of PPCS, to determine effective prevention and treatment options. ATR: Anterior Thalamic Radiation; Caud: Caudate; CCB: Corpus Callosum Body; CCG: Corpus Callosum Genus; CCS: Corpus Callosum Splenium; CH: Cingulum; DHI: Dizziness Handicap Inventory; ESS: Epworth Sleepiness Scale; FM: Forceps Minor; FSS: Fatigue Severity Scale; GAD: Generalized Anxiety Disorder; HIT-6: Headache Impact Test 6; IFOF: Inferior Fronto-Occipital Fasciculus; ILF: Inferior Longitudinal Fasciculus; mTBI: mild traumatic brain injury; Pal: Pallidum; PPCS: Persistent Post-Concussive Symptoms; PCSC: Postconcussional Syndrone Checklist; PHQ: Patient Health Questionnaire; Put: Putamen; RPQ: Rivermead Post Concussion Symptoms Questionnaire; SLF: Superior Longitudinal Fasciculus; QSM: Quantitative Susceptibility Mapping.

Effects of a staff physical activity professional development intervention on preschoolers' mental health and self-regulation: The active learning Norwegian Preschool(er)s (ACTNOW) cluster randomised controlled trial

Background and aimPhysical activity may have positive effects on preschoolers' mental health and self-regulation. The preschool setting provides children with opportunities to meet physical activity guidelines and could improve with staff training in delivering physical activity. This study examined the effect of physical activity professional development for preschool staff on preschoolers' proxy-measured mental health and self-regulation. MethodsIn total, 1265 children from 46 preschools were cluster randomised to either the intervention or the control group. The intervention was nested within two levels implemented concurrently: the preschool level, formed as a professional development where preschools conducted development work, and the child level, with whom the staff implemented physical activity with four core components. Data were analysed using an ANCOVA model through structural equation modelling with latent outcome factors of: emotional problems, peer problems, hyperactivity, and prosocial behaviour from the Strength and Difficulties Questionnaire; and cognitive, emotional, and behavioural self-regulation from the Child Self-regulation and Behaviour Questionnaire. ResultsNo effects of the intervention (standardised effect sizes -0.195–0.145, p-values 0.118–0.893) were observed. Secondary analysis showed that children with initially high prosocial behaviour and behavioural self-regulation positively benefited from the intervention (p = 0.035 and p = 0.047, respectively). ConclusionThe ACTNOW intervention had no effects on preschoolers' mental health or self-regulation after 18 months, besides effects for children with initially the highest prosocial behaviour and behavioural self-regulation. Although the professional development was more extensive than previous studies it may have been insufficient to change the preschools physical activity practices. Clinical trial registrationwww.ClinicalTrials.gov identifier NCT04048967.

The effects of a digital lifestyle intervention in patients with hypertension: Results of a pilot randomized controlled trial.

In this pilot study, the authors investigated the preliminary effectiveness of the digital lifestyle intervention, actensio (mementor DE GmbH), in treating arterial hypertension. Adults with arterial hypertension were randomly assigned to an intervention group (actensio+standard care) or a control group (waiting list+standard care) in a 1:1 ratio. Primary and secondary endpoints were assessed at baseline (t0) and 3months post-randomization (t1). The primary endpoint was average systolic blood pressure, measured at home for 1week. Secondary endpoints included patient engagement (measured using the "patient activation measure"; PAM-13), average diastolic blood pressure, and heart rate. All endpoints were analyzed using ANCOVA models, following an intention-to-treat approach, while adjusting for baseline values. Missing data were estimated using multiple imputation models. A total of N=102 participants (f=59, age=52.94±9.01) were randomized to either the intervention (IG; N=52) or the control group (CG; N=50), of which N=80 completed the blood pressure diary, and N=81 the PAM-13 at t1. Between-group comparisons showed an average group difference in systolic blood pressure of -5.06mm Hg (95% CI=-8.71 to -1.41, p=.013) between the intervention group (M=137.37±10.13) and the control group (M=142.35±11.23). Average group difference for patient engagement was 3.35 points with a trend towards statistical significance (95% CI=-018 to 6.89, p=.064), favoring the intervention group (MIG=79.38±9.44vs. MCG=75.45±10.62). There were no group differences in diastolic blood pressure (-1.78mm Hg; 95% CI=-4.50 to 0.95, p=.402) and heart rate (-0.684; 95% CI=-3.73 to 2.36, p=0.683). The results of the present pilot study confirm the preliminary effectiveness of the digital lifestyle intervention, actensio, in reducing high blood pressure in patients with hypertension.

QOL-24. TREATMENT- AND TIME-RELATED IMPACT ON LONG-TERM NEUROCOGNITIVE OUTCOMES IN ADULT SURVIVORS OF A PEDIATRIC BRAIN TUMOR

Abstract Treatment for pediatric brain tumors has been associated with the risk of developing long-term neurocognitive impairment. However, it is not well understood which neurocognitive profiles exist within this population. We investigated neurocognitive functioning (NF) in survivors in early adulthood and aimed to assess the impact of radiotherapy dose (RTD) and time since treatment (TxT) on NF. Forty-six survivors of pediatric brain tumors (mean age 23.99±4.71, mean age at diagnosis 9.29±4.54) performed an extensive neurocognitive test battery resulting in intelligence (n=5), memory (n=2), and language (n=3) scores. NF in long-term survivors was compared to sex-, age-, and education-matched controls, and between the different treatment strategies (surgery-only n=19, chemotherapy n=8, radiotherapy n=11, or chemo-radiotherapy n=8). Furthermore, relation between max-RTD (range 40.28 – 61.61 Gy) as well as TxT and NF was assessed. Three ANCOVA models were tested, and false discovery rate (FDR) was applied. For all scales and domain scores, survivors scored lower compared to controls. Scores were significant lower on full scale intelligence (pfdr< 0.001), verbal comprehension (pfdr< 0.001), working memory (pfdr= 0.003), perceptual reasoning (pfdr< 0.001), processing speed (pfdr< 0.001), spoken word comprehension (pfdr= 0.001), and semantic word generation (pfdr= 0.036) compared to controls. NF was not significantly different between the different treatments, nor did the association with max-RTD reach significance. TxT was associated with verbal comprehension and spoken word comprehension; albeit significance was not retained after FDR correction. In this study, the overall survivor cohort scored lower on multiple cognitive outcomes. More detailed analysis of various risk factors might further elucidate the different neurocognitive profiles for this population. Furthermore, more detailed analysis of RTD distributions and affected brain structures may provide greater insight on the impact of radiotherapy on NF.

Tests under simple order in one‐way ANCOVA

AbstractAnalysis of covariance (ANCOVA) models are used when apart from the main treatments, some covariates also affect the response variable. In this article, the problem of testing the homogeneity of treatment effects against ordered alternatives is addressed in a fixed effects one‐way ANCOVA model when error variances are heterogeneous. The likelihood ratio test (LRT) and two approximate tests based on the asymptotic distributions of some union‐intersection type test statistics are proposed. A parametric bootstrap technique has been used to implement the LRT and its asymptotic validity is proved. A method to construct simultaneous confidence intervals is proposed. All the test procedures are further extended to the case of more than one covariate. The robustness of tests is also studied under departure from normality. Extensive simulation studies show that the proposed test procedures perform well in terms of achieving the nominal size value and good power values.

Stepped, evidence-based and integrated care service model vs. usual care for mental disorders: A randomized controlled trial (RECOVER)

Stepped, evidence-based and integrated care service models have the potential to be used as a reference for mental health services. RECOVER aimed to evaluate cost savings, effectiveness, and cost-effectiveness of such a model within a two arm, assessor- and data analysist-blinded RCT in Hamburg, Germany. Participants aged 16–79 years with mental disorders were randomly assigned either to RECOVER or treatment as usual (TAU). Primary outcomes comprised costs, effectiveness (combined symptoms, functioning, quality of life), and cost-effectiveness, hierarchically ordered. Outcomes were evaluated according to the ITT principle, group differences regarding costs with adjusted generalized linear models, effectiveness with ANCOVA models, and cost-effectiveness with the incremental cost-effectiveness ratio (ICER) and cost-effectiveness acceptability curves (CEACs). Between 1/1/2018 and 12/31/2020, n = 891 were finally included (n = 477 in RECOVER, n = 444 in TAU). RECOVER was associated with significantly lower annual total costs (-22 %), health and social care costs (-25 %) and hospital costs (-50 %). Effectiveness analyses showed a significantly better outcome for RECOVER with the fully imputed data . The CEACs descriptively demonstrated that RECOVER was cost-effective with a probability of >95 %. Treatment in RECOVER resulted in substantial cost reductions with better cost-effectiveness. RECOVER can be recommended as a reference model for comprehensive and integrated mental health services.