Baseline Assessment Research Articles

The impact of a coach-guided personalized depression risk communication program on the risk of major depressive episode: study protocol for a randomized controlled trial

BackgroundDepression is a highly prevalent and disabling mental health problem. Self-help has been strongly advocated for dealing with depression. Built upon the research on risk prediction modeling and risk communication, we developed a coach-guided, personalized depression risk communication tool (PDRC) for sharing information about individualized depression risk and evidence-based self-help strategies. The primary objective of this project is to evaluate the impact of the PDRC on the 12-month risk of major depressive episode (MDE) in Canadians who are at high risk of MDE.MethodsThis is an assessor-blinded randomized controlled trial (RCT) with two arms. We will recruit 500 males and 500 females in the communities across the country. Individuals are eligible, if they: (1) are 18 years or older, (2) have not had a depressive episode in the past two months, (3) are at high risk of MDE based on the sex-specific risk predictive algorithms for MDE (predicted risk of 6.5% + for men and of 11.2% + for women), (4) can communicate in either English or French, and (5) agree to be contacted for follow-up interviews. After screening and baseline assessment, participants will be randomized by sex into intervention and control group in a 1:1 ratio. Participants in the intervention group will receive the coach-guided PDRC. The participants are assessed at baseline, 3 and 12 months via computer assisted telephone interview system, regarding the presence of MDE, depressive and anxiety symptoms, use of self-help strategies, mental health services use and self-efficacy.DiscussionThe coach-guided PDRC may empower users to actively engage in self-management, leading to reduced risk of MDE. If successful, the coach-guided PDRC will lead to a novel selective prevention program that is closely aligned with the tiered mental health services model, contributing to early prevention of depression and better mental health wellbeing.Date of trial registration: 2024-10-02.Protocol version and dateDecember 6, 2024. Version #1.Trial registration: NCT06619366.

Impact of model physiotherapy centres in reducing the burden among the caregivers of children with neurodevelopmental disorders in the rural area of Tamil Nadu: a study protocol

BackgroundApproximately 1 in 8 children under the age of 6 in Tamil Nadu are diagnosed with neurodevelopmental disorders (NDD), yet only a fraction of these children receives proper medical care. The unequal distribution of healthcare services is mainly due to the lack of accessibility, especially in rural areas, leading to a significant burden on caregivers. This research aims to alleviate caregiver burden and reduce disability in preschool children by establishing model clinics or specialized outreach centers in rural villages, supported by SRM Institute of Science and Technology under the Unnat Bharat Abhiyan Scheme.(UBA-SRMIST).MethodsThe study will commence with screening all preschool children registered in Anganwadi in the designated villages. Tailored model clinics will be set up in these villages based on the prevalence of NDD. Once established, children diagnosed with NDD will undergo rehabilitation for a year. Baseline and endline assessments will be conducted to evaluate the effectiveness of the model center on both the child's disability and the caregiver burden.DiscussionThis research will demonstrate the effectiveness of a model outreach center in rural villages in reducing disability levels in children and alleviating caregiver burden by eliminating the need for long travels to access rehabilitation services. The findings of this study will not only contribute to the objectives of UBA-SRMIST in uplifting villages but also facilitate the creation of registries and provision of data to the government for the implementation of policies that address the current disparities in healthcare access.Trial registration Trail has been registered under Clinical Trials Registry—India (CTRI/2024/06/069196).

Multifaceted concussion assessment battery: sensitivity at the expense of specificity?

ABSTRACT Objectives A multifaceted assessment battery is recommended for testing suspected concussed athletes; however, the individual tests have limitations and potentially may lead to false positive outcomes. Therefore, the purpose of this study was to psychometrically evaluate concussion assessment tools used for intercollegiate student-athletes, with a focus on the time interval between baseline and subsequent assessments. Methods 92 collegiate student-athletes matched between concussion (N = 46. F32/M14) and non-concussion (N = 46, 32F/14 M) completed the standard assessment of concussion, balance error scoring system, symptom questionnaire, and computerized neurocognitive tests at baseline and acutely (<48 hours) following a concussion. Test outcomes were compared between time points with three approaches, 1) vs baseline, 2) reliable change scores (RCI), and 3) vs American College of Rehabilitation Medicine (ACRM). Concussion assessment sensitivity, specificity, likelihood ratios, predictive values, and diagnostic odds ratio were calculated. A receiver operator characteristic compared area under the curve (AUC) for the overall battery as well as between academic years. Results The sensitivity of the battery was high (78.3 – 95.7%), but specificity was low to moderate (6.5 – 52.2%) with comparison to the RCI typically performing best. The three approaches yielded AUC values between 0.51 – 0.63 which is below the discriminatory threshold (0.70) with comparison to RCI performing best. By academic year, Juniors was the only year in which the ROC exceeded the threshold (0.75). The number of tests failed did not improve any AUC values (0.51 – 0.69) to exceed the threshold. Conclusions The outcomes of this study support the premise that concussion must be evaluated using a comprehensive clinical examination including a variety of assessments to evaluate each clinical domain. Clinicians need to recognize that the multifaceted assessment battery has high sensitivity, but the overall psychometrics do not exceed the threshold for group discrimination and caution must be used in their interpretation.

A pilot study of a gratitude journaling intervention to enhance spiritual well-being and exercise self-efficacy in Black breast cancer survivors

BackgroundBreast cancer (BC) survivorship presents significant health disparities, particularly affecting Black women, who experience a 40% higher BC death rate compared to White women. These disparities are exacerbated by comorbidities, which contribute to poorer overall health outcomes. Additionally, Black BC survivors often face psychosocial challenges, including increased stress and lower well-being, which can lead to adverse physical health effects. This pilot study aims to assess the feasibility and efficacy of a culturally sensitive gratitude journaling intervention designed to enhance spiritual well-being, exercise self-efficacy, and reduce inflammation among Black BC survivors.MethodsThis pilot study employed a two-group, parallel random-assignment experimental design to compare a gratitude journaling intervention with a general memory journaling control group. Twenty-six Black women aged 40 to 70 years with a history of BC were randomly assigned to either the gratitude journaling intervention group (n = 13) or the control group (n = 13). The gratitude intervention group engaged in gratitude journaling twice weekly for eight weeks, while the control group documented daily memories. Outcomes measured included Gratitude Questionnaire-6, FACIT-Spiritual Well-Being 12 Item Scale, Perceived Stress Scale, Giscombe Superwoman Schema Questionnaire, and the Stage of Motivational Readiness for Physical Activity questionnaire and inflammatory biomarkers. Statistical analyses included the Wilcoxon rank sum test and Fisher’s exact test.ResultsTwenty-six participants were enrolled, with 73% completing baseline and post-intervention assessments. The intervention group showed a significant improvement in spiritual well-being (p = 0.014) with a large effect size (ES = 0.57). Marginal improvements in exercise self-efficacy were also observed (ES = 0.39). Although there were no significant differences in dispositional gratitude and perceived stress between groups, the intervention group exhibited trends toward increased gratitude and reduced stress. Inflammatory biomarker analysis indicated non-significant changes, though IL-6 levels increased in the intervention group.ConclusionThis study demonstrates the feasibility and acceptability of a gratitude journaling intervention among Black BC survivors. The intervention significantly enhanced spiritual well-being and showed promise in improving exercise self-efficacy, suggesting its potential for promoting holistic wellness in this population. These findings provide a foundation for future larger-scale randomized controlled trials to further evaluate the efficacy of gratitude-based interventions for Black BC survivors.Trial registrationThis study was registered prospectively at ClinicalTrials.gov (NCT05473026) on 07-13-2022.

Evaluating the 3-month post-intervention impact of a supportive text message program on mental health outcomes during the 2023 wildfires in Alberta and Nova Scotia, Canada

BackgroundIndividuals exposed to wildfires are at risk of developing adverse mental health conditions in the months following the event. Receiving supportive text interventions during and after a wildfire event can have a significant impact on reducing mental health conditions over time.ObjectivesThe study aimed to assess the effectiveness of a supportive text message intervention service in reducing the severity and prevalence of psychological conditions 3 months following the 2023 wildfires in Alberta and Nova Scotia, two regions heavily affected by these natural disasters.MethodsIn this longitudinal study, participants voluntarily subscribed to the Text4Hope-AB and Text4Hope-NS services, receiving supportive text interventions for 3 months. On enrolment and at 3 months post-enrolment, participants completed online surveys. The severity and prevalence of mental wellbeing, resilience, depression, anxiety, and post-traumatic stress were measured using the World Health Organization- Five Well-Being Index (WHO-5), Brief Resilience Scale (BRS), Patient Health Questionnaire 9 (PHQ-9), Generalized Anxiety Disorder - 7 scale (GAD-7), and Post-Traumatic Stress Disorder Checklist for Civilians (PCL-C) respectively. Data analysis involved using McNemar’s chi-square test and paired sample t-tests.ResultsA total of 150 subscribers partially or fully completed both the baseline and 3-month assessments. The results show a statistically significant change in the mean scores on the WHO-5 Wellbeing Index (+ 24.6%), PHQ-9 (−17.0%), GAD-7 scale (−17.6%), PCL-C (−6.0%), and BRS (+3.2%) from baseline to 3 months. Similarly, there was a reduction, although not statistically significant, in the prevalence of low resilience (55.1 vs. 53.4%), poor mental well-being (71.6 vs. 48.3%), likely MDD (71.4 vs. 40.7%), likely GAD (42.1 vs. 33.3%), and likely PTSD (42.0 vs. 38.4%).ConclusionThe study’s findings underscore the potential of the supportive text intervention program in effectively aiding individuals who have endured natural disasters such as wildfires. Providing supportive text messages during wildfire events is a promising strategy for mitigating mental health conditions over time.

Structured tailored rehabilitation after hip fragility fracture: The 'Stratify' feasibility and pilot randomised controlled trial protocol.

Rehabilitation in hospital is effective in reducing mortality after hip fracture. However, there is uncertainty over optimal in-hospital rehabilitation treatment ingredients, and the generalizability of trial findings to subgroups of patients systematically excluded from previous trials. The aim of this study is to determine the feasibility of a randomized controlled trial which aims to assess the clinical- and cost-effectiveness of adding a stratified care intervention to usual care designed to improve outcomes of acute rehabilitation for all older adults after hip fracture. This is a protocol for a single site, feasibility and pilot, pragmatic, parallel group (allocation ratio 1:1) randomised controlled assessor-blind STRATIFY trial (Structured Tailored Rehabilitation AfTer HIp FragilitY Fracture). Adults aged 60 years or more, surgically treated for hip fracture following low energy trauma (fragility fracture), who are willing to provide consent or by consultee declaration (depending on capacity), are eligible. Individuals who experienced in-hospital hip fracture will be excluded. Screening, consent/assent, baseline assessment (demographics, patient reported outcome measures or PROMs [health related quality of life, activities of daily living, pain, falls related self-efficacy], and resource use), and randomization will take place within the first four days post-admission. Participants will then be offered usual care, or usual care plus STRATIFY intervention during their hospital stay. The STRATIFY intervention includes 1) a web-based algorithm to allocate participants to low- medium- or high-risk subgroups; and 2) matched interventions depending on subgroup allocation. The low-risk subgroup will be offered a self-management review, training in advocacy, and a self-managed exercise programme with support for progression, in addition to usual care (1-hour 40 minutes therapist time above usual care). The medium-risk subgroup will be offered education, a goal-orientated mobility programme (with carer training, as available and following carer consent), and early enhanced discharge planning, in addition to usual care (estimated 2-hours 15 minutes therapist time above usual care). The high-risk subgroup will be offered education, enhanced assessment, orientation, and a goal-orientated activities of daily living programme (with carer training, as available and following carer consent), in addition to usual care (estimated 2-hours 45minutes therapist time above usual care). All STRATIFY subgroup treatment interventions are specified using the Rehabilitation Treatment Specification System (RTSS) for treatment theory development and replication. Follow-up PROM data collection, RESOURCE USE alongside readmissions and mortality, will be collected on discharge and 12-weeks post-randomisation. Intervention acceptability will be determined by semi-structured interviews with participants, carers, and therapists at the end of the intervention. The trial findings will be disseminated to patients and the public, health professionals and researchers through publications, presentations and social media channels. The trial has been registered at clinicaltrials.gov (NCT06014554).

Longitudinal blood immune-inflammatory and radiomic profiling to decode different patterns of acquired resistance to immunotherapy in patients with NSCLC.

To uncover the underpinnings of acquired resistance (AR) to immunotherapy (IO), we determined whether distinctive clinico-pathological, radiomic and peripheral blood (PB) immune-inflammatory features reflect oligo- and systemic (sys)-AR in advanced NSCLC patients undergoing immune checkpoints inhibitors. On 105 consecutive IO-treated advanced NSCLC, PB immunophenotypes, cytokines and CT-derived radiomic features (RFs), extracted from primary and merged metastatic lesions, were prospectively collected at baseline (T0) and first disease assessment (T1, 9-12 weeks), and their delta (Δ) variation [(T1-T0)/T0] computed. AR, defined as progression after initial response (complete/partial) or stable disease ≥ 6 months, was subdivided according to the number of new and/or progressive lesions in oligoAR (≤3) and sysAR (>3). Clinico-pathological, PB and radiomic parameters and survival outcome were statistically correlated to AR patterns. OligoAR and sysAR involved 24% and 12.4% of cases, respectively. While baseline PB immune profiles were comparable, a Δpos cytotoxic (NK, CD8+GnzB+) and Δneg immunosuppressive (CD14+ monocytes) dynamic coupled with different modulation of IL-6, TGF-β1, TNFα and sPD-L1 represented distinctive features of oligoAR vs sysAR (P<0.05). Significantly longer post-progression survival characterized oligoAR vs sysAR (median 20.3 vs 5.6 months;HR:0.22,P<0.001). The number and sites of oligoAR involvement appeared to condition blood immune background (P<0.05) and survival. Delta radiomic outperformed baseline RFs, with 15 ΔRFs sharply discriminating oligoAR from sysAR (P range:<0.001-0.04). ROC analysis confirmed the optimal performance of top-ranked ΔRFs (AUC range:0.88-0.99). Longitudinal analysis of blood immune hallmarks and radiomic descriptors may decipher distinct patterns of AR to IO in advanced NSCLC patients.

Perceived Psychological and Physical Health as Predictors of Mortality and Quality of Life in Patients with Lymphedema: A Prospective Study Spanning Almost Two Decades.

How does living with a chronic disease of the lymphatic system affect quality of life and mortality? Lymphedema is a chronic disease mostly affecting women and research is sparse. To this date, longitudinal studies evaluating biopsychosocial predictors for mortality and quality of life in lymphedema are largely missing. This study aims to identify possible predictors and could open innovative ways for treatment options. Two hundred ninety-two patients with lymphedema partaking in a rehabilitation program in a lymphedema clinic were longitudinally assessed. The sample consisted of 86.2% women, aged between 18 and 83years (M = 53.42, SD = 12.54), with a mean BMI (kg/m2) of 31.64 (SD = 8.26). Beginning with baseline assessment in 2002-2006, follow-up was evaluated 15-19years later (N = 91). We assessed a variety of potential biopsychosocial predictors of mortality and quality of life (i.e., depression, anxiety, cancer). At follow-up, 19.5% of participants were deceased. Age, gender, and cancer significantly predicted mortality (R2 = .27) and quality of life (R2 = .29). Anxiety and depression significantly predicted both quality of life and mortality when entered simultaneously. However, further analyses indicated suppressor effects and when entered separately, effects solely for depression or anxiety did not reach significance level. Age, gender, and cancer were the main predictors of mortality and quality of life in patients with lymphedema. Psychological predictors of mortality and quality of life were mainly due to suppressor effects, thus calling for caution when analyzing the contribution of mental health indicators for clinical outcomes. This study was preregistered with the German Clinical Trials Register (Identifier DRKS00024450) and Open Science Framework ( https://doi.org/10.17605/OSF.IO/RHXQJ ).

Seroepidemiology of trachoma in a low prevalence region receiving annual mass azithromycin distribution in Maradi, Niger.

Trachoma programs use the indicator trachomatous inflammation--follicular (TF) to monitor indication for and response to treatment for trachoma at the district level. Alternative indicators, including serologic markers, are increasingly being evaluated for trachoma surveillance. We evaluated seroprevalence of IgG antibodies to the Pgp3 antigen in two districts in Maradi, Niger thought to have low TF prevalence. Data were collected as part of the baseline assessment of the Azithromycin Reduction to Reach Elimination of Trachoma (ARRET) trial in September 2021. A random sample of 80 communities was selected from Mayahi and Guidan Roumdji districts, both of which had TF prevalence <20% at their most recent trachoma impact survey in 2018. A random sample of 50 children per community was sampled. We collected field grades, conjunctival swabs for processing PCR for ocular Chlamydia trachomatis, and dried blood spots for serologic assessment. Of 3,994 children sampled in 80 communities, 49% were female and median age was 4 years. Overall TF prevalence was 4.6% (95% CI 3.5 to 5.8%) and trachomatous inflammation-intense (TI) prevalence was 0.6% (95% 0.3 to 0.9%). The prevalence of ocular chlamydia was 0.03% (95% CI 0.08%). Seroprevalence for Pgp3 antibodies was 6.3% (95% CI 5.5 to 7.1%) in 1-9-year-olds and 3.7% (95% CI 2.9 to 4.4%) in 1-5-year-olds. TF and Pgp3 seroprevalence were better correlated in 1-5-year-olds (correlation coefficient 0.29) compared to 1-9-year-olds (correlation coefficient 0.09). In this low trachoma prevalence setting in Niger, seroprevalence of antibodies to Pgp3 were consistent with little ongoing transmission of C. trachomatis.

Evaluating the effect of a virtual reality digital therapeutic on maternal stress among expectant and postpartum Black and Latina mothers: a protocol paper

BackgroundMaternal mental health is vital to overall well-being, particularly among expectant and postpartum Black and Latina women who experience higher stress levels and mental health challenges. Traditional healthcare systems often fail to meet these needs, underscoring the need for innovative and accessible interventions. NurtureVR, a digital maternal mental health and educational program, leverages virtual reality to offer mindfulness, relaxation, and guided imagery to support these women.ObjectivesThis protocol aims to evaluate whether NurtureVR, a digital therapeutic, can reduce stress levels and mental health symptoms in pregnant and postpartum Black and Latina women, improve sleep, enhance pregnancy and childbirth experiences, and increase pregnancy and postpartum health literacy.MethodsThe Nurturing Moms study uses a pre- and post-intervention design with a 5-week NurtureVR program. Fifty participants, 25 expectant and 25 postpartum Black and Latina women, will be recruited through clinics, community organizations, and online platforms. The study involves three phases: baseline assessments of stress, mood, self-efficacy, demographics, and health history; daily use of NurtureVR for 15 minutes during the third trimester and six weeks postpartum; and follow-up assessments at six weeks postpartum. The program includes 49 modules on labor and delivery, stress during pregnancy, nutrition, breastfeeding, hormonal changes, 3D VR representations of fetal development, pain management simulations, and mindfulness exercises for labor. Participants will report stress, anxiety, mood, and pain levels following each VR session. Additional qualitative insights will be gathered through focus groups, and an optional survey will be administered one-year post-intervention to evaluate long-term effects.ConclusionsThe Nurturing Moms study seeks to create a more inclusive and equitable healthcare landscape, demonstrating that digital interventions like NurtureVR are essential for providing high-quality maternal care. By democratizing access to clinical research and healthcare, this decentralized trial promotes equity, improves the generalizability of findings, and accelerates the development of new treatments. The study’s innovative approach has the potential to improve maternal experiences of stress, sleep, and overall health outcomes for Black and Latina mothers and children, despite limitations such as sample size, language barriers, and the preliminary nature of a pilot and feasibility study.

Development of a model predicting falls in older emergency department patients using smartphone-based mobility measures.

While emergency departments (EDs) are crucial for identifying patients at risk for falls, existing fall risk measures are often inaccurate. This study aimed to assess whether iPhone sensor-based mobility measures collected after ED discharge can improve fall prediction compared with traditional ED-based screening measures. This single-center, observational cohort study recruited ED patients aged 60 or older who owned an iPhone. Participants completed baseline assessments, downloaded a custom app to track mobility measures from the iPhone, and were followed for 90 days post-discharge. Fall outcomes were self-reported via the app or follow-up phone calls. Logistic regression and the LASSO technique were employed to identify significant predictors. The discriminative ability of the models was assessed by comparing the C-statistics. Of the 149 participants enrolled, 76.5% (N = 114) provided at least 7 days of post-discharge iPhone sensor-based mobility data. The cohort had a mean age of 73 years, with 16.7% (N = 19) experiencing a fall. Participants who fell showed a significantly greater increase in daily steps over time compared with those who did not (p = 0.002). The extended logistic regression model, by incorporating mean gait asymmetry and change in step count, demonstrated a higher but nonsignificant improvement in discriminative ability (C-statistic = 0.84) compared with the base model (C-statistic = 0.79). This study demonstrates that iPhone mobility measures collected after ED discharge can enhance fall prediction relative to self-reported fall risk screening questions in older adults. The strongest mobility predictors were gait asymmetry and changes in step count. While the findings suggest that post-discharge mobility monitoring could improve fall prevention strategies, further validation in diverse populations is necessary.

Evaluating the co-designed “kalmer” relaxation intervention for people with aphasia: a feasibility case series

ABSTRACT Background People with aphasia are at increased risk of developing anxiety and depression. There is a need for accessible psychological interventions to be evaluated for this clinical group. Relaxation is a promising treatment option. Aims This case series study aimed to assess the feasibility of the “Kalmer” relaxation intervention. Methods and Procedures Twelve participants with aphasia were recruited via online social media/websites for people with aphasia. After 4 weeks of baseline assessment which included for mood the Behavioural Outcomes of Anxiety Scale (BOA) and Stroke Aphasic Depression Questionnaire − 10 item (SADQ-10), participants accessed the relaxation intervention on Vimeo© for 5 weeks. Participants were encouraged to practice relaxation 5 times a week. Vimeo© analytics were collected to measure participants’ preferences and use of the intervention. Immediately post intervention and at 3- and 6-month follow up time points, BOA and SADQ-10 scores were collected again. The Reliable Change Index was used to determine the impact of the intervention. Outcomes and Results Whilst recruitment was slow, once participants were enrolled the trial appeared feasible. Vimeo© analytics demonstrated participants engaged well in the treatment and preferred imagery-based relaxation recordings. Anxiety symptoms improved for 5/12 participants (42%) immediately post intervention and 7/11 participants (63%) at 3 and 6 month follow-up time points. Depressive symptoms improved for 6/12 participants (50%) immediately post intervention, 4/11 participants (36.3%) at 3-month follow-up and 5/11 participants (45.5%) at 6-month follow-up. Conclusions The Kalmer relaxation intervention appears feasible and shows potential to reduce anxiety and depressive symptoms in people with aphasia. Considerations for future trials include the need for expanding both recruitment (e.g. community and hospital rehabilitation services) and methods of delivery for the intervention (e.g. DVD and in person groups).

Emotional variability and late adolescent suicidal ideation: Buffering role of parent-youth connectedness.

Emotional variability has been identified as a risk factor for adolescent psychopathology. This study explored the cross-sectional and prospective associations between emotional variability and suicidal ideation and examined the moderating role of parent-adolescent connectedness. Participants included 108 Taiwanese late adolescents (Mage = 18.53, SDage = 0.39; 64% female) who completed ecological momentary assessment (EMA) over 14 days, and baseline and follow-up assessments over 6 months. Results indicated that while negative emotional (NE) and positive emotional (PE) variability were not associated with suicidal ideation at baseline, both predicted increased suicidal ideation 6 months later. Furthermore, parent-adolescent connectedness moderated the relationship between NE variability and suicidal ideation, with high connectedness mitigating the adverse effects of NE variability. These findings suggest that emotional variability is a key predictor for the development of suicidal ideation and highlight the protective role of parent-adolescent connectedness. Interventions promoting family connectedness may be effective in reducing suicidal risk among emotionally variable youth.

A randomized controlled trial of the effect of a psychoeducational intervention program on quality of life of patients with gynecological cancers

ABSTRACT Background Women diagnosed with gynecological cancer often suffer from physical, psychological, and social challenges as well as sexuality-related concerns and hence poor life quality. This study attempted to evaluate the effect of psychoeducational intervention program on quality of life among patients with gynecological cancers. Methods A randomized controlled trial design was used where the eligible gynecological cancer women (n = 100) were allocated randomly into the intervention group receiving a four‐session, 8‐week-long psychoeducational program (n = 50) or the control group receiving routine care (n = 50). Allocation concealment was used to avoid selection bias. A structured interview questionnaire was used at baseline assessment to obtain data regarding the socio-demographics as well as clinical traits of studied women. Additionally, data on quality of life at baseline and after implementation of the program were collected using the Arabic version of Functional Assessment of Cancer Therapy-General version 4 (FACT-G). Results The study revealed that gynecological cancer women receiving psychoeducational intervention program experienced a significantly greater improvement in their total life quality in addition to significant improvements across different domains as measured by FACT-G. Conclusion The psychoeducational intervention program contributed positively in improving the life quality among patients with gynecological cancers.

Sexual Assault-Related Interactions and Social Reactions in the Initial Months Following Assault: A Daily Diary Study.

Most sexual assault survivors disclose to informal supporters and receive both negative and positive social reactions. Converging evidence suggests that the first months after sexual assault are a period of increased support-seeking that may be uniquely important to survivors' recovery, especially among survivors at risk of chronic post-traumatic stress and alcohol misuse. However, no research has examined when and how often survivors talk about their assault and what social reactions they receive during this time. As such, the goal of this study was to characterize the day-to-day assault-related interactions and social reactions received by a high-risk group of survivors during the first months following sexual assault. Adult female survivors of past-10-week sexual assault with elevated assault-related post-traumatic stress and alcohol use (N = 41) completed a baseline assessment and daily diaries over 21 days as part of a larger mHealth clinical trial. Results demonstrated that assault-related interactions occurred on an average of 24.4% of days (range: 1-14 days), were more likely to occur earlier in the daily dairy period, and decreased in frequency over time. Across days, most survivors (75%) received both positive and negative reactions in these interactions, whereas fewer (20%) received only positive reactions and no one received only negative reactions. These findings suggest that survivors commonly have assault-related interactions with their supporters in the initial aftermath of the assault and that receiving both positive and negative social reactions is typical. Findings could inform future early interventions aiming to improve supporter reactions and better support survivors' recovery.

Testing family-of-origin sensitization: Parent-adolescent conflict, emotional reactivity, and adolescent internalizing psychopathology.

Building on the sensitization hypothesis, the present work aimed to examine how parent-adolescent conflict might be associated with heightened emotional reactivity to peer conflicts, which in turn shape the development of adolescent internalizing psychopathology. Participants were 108 Taiwanese adolescents between the ages of 18 and 19 (Mage = 18.53, SDage = 0.39; 64% female) who completed baseline assessments, 14-day daily surveys, and 6-month follow-up assessments. Emotional reactivity was measured by calculating the daily association between peer conflict and positive and negative emotions. Results indicated that greater baseline parent-adolescent conflict was associated with higher negative emotional reactivity to peer conflicts, which then predicted increased depressive symptoms and anxiety symptoms 6 months later. Moreover, greater positive emotional reactivity to peer conflicts (i.e., more declines in positive emotions in response to peer conflicts) predicted increased depressive symptoms. Thus, the findings of the current study support and extend the sensitization hypothesis and suggest that parent-adolescent conflict may contribute to family-of-origin sensitization in non-familial, interpersonal contexts. The results have key implications for understanding adolescent developmental psychopathology associated with family conflicts and emotional reactivity.

A structured simulation-based mastery learning curriculum in chest tube insertion results in superior skills compared to traditional training programs.

Chest tube insertions (CTI) have a high complication rate, warranting a dedicated Simulation-Based Mastery Learning (SBML) curriculum to acquire technical skills. This randomized controlled trial compares residents' skills in CTI after completing a SBML curriculum with those enrolled in a traditional residency program. Junior residents were baseline tested on cognitive and technical skills (Thiel bodies) before randomization into an intervention and control group. The former deliberately trained CTI on a porcine rib model until passing a predefined pass/fail score and were then summatively tested on Thiel bodies. The latter had no additional training opportunities and was evaluated 3months later. Seventeen residents were recruited and randomized. Following the per-protocol principle, a significant interaction effect for Group×Procedure (F(1,14)=6.2, p=0.026) was observed. Between baseline and summative assessment, both the control group (28.0±8.2 vs. 43.6±8.1, p<0.001) and the intervention group (33.2±7.7 vs. 57.6±5.7, p<0.001) significantly increased their scores. The intervention group outperformed the control group at summative assessment (43.6±8.1 vs. 57.6±5.7, p<0.001). All participants in the intervention group and one resident in the control group achieved the pass/fail score. This SBML curriculum enabled quicker and superior skill acquisition. Skills trained on a porcine model are transferred to the highly realistic Thiel bodies and reach expert level, potentially increasing resident skill in clinical practice.

Effects of probiotics on clinical manifestations and inflammatory markers in HTLV-1-associated myelopathy/tropical spastic paraparesis: A triple blind randomized, placebo controlled trial

Human T-lymphotropic virus type 1 (HTLV-1), leads to adult T-cell lymphoma/leukemia (ATL) and HTLV-1-associated myelopathy/tropical spastic paraparesis (HAM/TSP) in a minority of infected individuals. The virus promotes inflammation, a major factor in chronic disease progression. Probiotics' immune modulation and anti-inflammatory effects present a potential therapeutic intervention for HTLV-1-related conditions. This study investigates the impact of probiotics on both clinical manifestations and inflammatory markers in HAM/TSP patients.Conducted at the HTLV-1 clinic of Ghaem Hospital (Mashhad, Iran) between 2019 and 2020, this study randomized 40 HAM/TSP patients into two groups: an intervention group receiving 500 mg LactoCare capsules twice daily and a control group receiving placebo capsules of identical appearance for 12 weeks. Baseline and follow-up assessments included muscle strength, spasticity, motor disability, urinary disturbance, and serum levels of IL-10, IL-4, and IFN-γ (measured by ELISA). Post-intervention analysis revealed no significant differences between intervention and control groups in muscle strength, spasticity, and motor disability. However, significant improvement was observed in the intervention group regarding urinary symptoms after 12 weeks of initiation of intervention (P = 0.003). No significant changes were detected in serum levels of IL-10, IL-4, and IFN-γ between the two groups. The probiotics showed positive effects on urinary symptoms in HTLV-1-associated myelopathy/tropical spastic paraparesis patients but did not significantly impact other clinical or paraclinical parameters within the 12-week study period. These findings suggest that probiotics may offer symptomatic relief for some symptoms of HTLV-1-associated myelopathy/tropical spastic paraparesis patients.

Engagement in the community-based going-out programs and the association with physical frailty assessed by the Kihon Checklist: A cohort study.

In efforts to address the public health concern of physical frailty prevention, community-based programs without supervision are anticipated, yet efficacy has not been shown. We aimed to investigate the association of engaging in an unsupervised, community-based going-out program on the incidence of physical frailty among older adults. A cohort observational study was employed. Following a baseline assessment during 2015 and 2017 in Japan, we observed 1,350 older adults engage in a community-based going-out program for 12 months. Participants were categorized into either a non-engaged or engaged group via propensity score matching. A follow-up survey (mean period = 920 ± 76 days) was conducted to investigate the occurrence of physical frailty using the Kihon Checklist. The incidence of frailty, absolute risk reduction, and number needed to treat for program engagement were calculated. The odds ratio (OR) in engaged group compared with the non-engaged group was determined in a logistic regression model. Incidence of frailty was 15.1% in non-engaged group (n = 107 out of 628) and 8.3% in the engaged group (n = 53 out of 628). The number needed to treat and its 95% confidence interval were 21 (12-63) after matching. Compared with matched non-engaged group (OR 1.0), the OR and 95% confidence interval of matched engaged group for occurrence of physical frailty were 0.61 (0.42-0.87). Engaging in the unsupervised community-based going-out program could prevent one incidence of physical frailty in every 21 participants and may thus contribute to preventing physical frailty at the population level.

Effect of Corticosteroid Phobia on Treatment Adherence and Outcome in Women With Lichen Sclerosus: A Prospective Study.

The phenomenon of topical corticosteroid (TC) phobia (TCP) poses a challenge to the adherence of patients requiring prolonged treatments, particularly those with conditions like atopic dermatitis. Nonadherence to treatment significantly contributes to the inadequate control of diseases. This study aimed to evaluate TCP among women suffering from vulvar lichen sclerosus (VLS) and its potential impact on treatment adherence and therapeutic outcomes. This observational, prospective study involved adult patients who received their first histological diagnosis of VLS and underwent a 12-week corticosteroid treatment regimen at our Vulva Unit between June 2022 and September 2023. All participants completed the validated TOPICOP questionnaire, which assesses concerns, worries, and beliefs regarding TC usage. Baseline and 12-week control visit assessments were conducted to evaluate subjective and objective parameters of VLS. Patient adherence to treatment was monitored through diary entries. Among the 50 patients included (with a mean age of 64.9 ± 13.5 years), more than half (58%) had prior experience with TC treatments and 10.3% had used corticosteroids for vulvar symptoms without a precise diagnosis. The median global TOPICOP score was 19.4% (interquartile range = 5.6-36.1), with a corresponding median value of 7.0 (interquartile range = 2.0-13.0). A total of 41 patients (82.2%) adhered to the study treatment, which proved highly effective in alleviating symptoms and improving signs of VLS. Multivariate analysis revealed that neither treatment adherence nor effectiveness were significantly associated with the level of TCP. Among our VLS patients, TCP was relatively low and did not negatively impact treatment adherence to corticosteroids. Moreover, TCP did not influence the effectiveness of TC therapy, as it did not affect adherence.