Engagement In Daily Activities Research Articles

Exploring the Effects of Major Depressive Disorder on Daily Occupations and the Impact of Psychotherapy: A Literature Review.

Major depressive disorder (MDD) is a prevalent psychological mood disorder that can disrupt one's functioning and result in decreased engagement in daily activities. Psychotherapy, in different approaches, is a common approach for individuals experiencing MDD. Nevertheless, a literaturereview of the research supporting the effectiveness of psychotherapeutic interventions in patients with MDD-impacted areas of their daily occupations, such as back to work, cognitive deficits, and well-being, has not been conducted. A literature review was carried out to evaluate the effectiveness of psychotherapy on daily occupations for individuals diagnosed with MDD. Due to variations in study design and outcome measures, a best evidence synthesis was carried out instead of a meta-analysis. Forty-one identified articles were fully assessed in total. These studies were conducted in various countries so that a global approach could be considered comprehensive. The findings showed strong evidence supporting the effectiveness of psychotherapy on return-to-work interventions in improving depressive symptoms. There was limited evidence for the effectiveness of psychotherapy on lifestyle interventions in reducing anxiety and suicidal ideation, as well as limited evidence for enhancing work participation. Notably, there were no studies evaluating individualized client-centered psychotherapy interactions with occupations, revealing a research gap. Challenges such as incomplete reporting within studies and study heterogeneity prevented a meta-analysis. While the overall evidence base for the effectiveness of psychotherapy for MDD in treating functionality is limited, the findings provide strong support for the efficacy of occupational therapy return-to-work interventions. This is particularly important given the economic costs associated with mental health issues and work-related absences. Further research is required to strengthen the existing evidence base.

The hidden burden of dysmenorrhea among adolescent girls in Palestine refugee camps: a focus on well-being and academic performance

BackgroundDysmenorrhea (painful menstruation) is a condition that may have a profound effect on adolescent girls’ health status and well-being. It can impede their engagement in daily activities and hamper their regular school attendance. This study aims to explore the relationship between dysmenorrhea, well-being, and academic performance among adolescent girls living in Palestine refugee camps in the West Bank and Jordan.MethodsWe conducted a household survey between June and September 2019, with a total sample of 2737 adolescent girls 15 to 18 years old. Dysmenorrhea severity was assessed using the Working Ability, Location, Intensity, Duration of pain Dysmenorrhea scale (WaLIDD). The WHO-5 scale was used to evaluate the girls’ overall well-being. Menstrual academic disruption (MAD) was measured using a self-reported scale. Multiple linear regression models were employed to evaluate the association between dysmenorrhea, well-being, and academic performance. Directed Acyclic Graphs (DAGs) were employed to identify variables for control in regression models.ResultsThe mean dysmenorrhea score was 6.6 ± 2.6, with 37.9% and 41.2% expressing moderate and severe symptoms, respectively. The mean WHO-5 score was 58.7 ± 25.1, and 34.9% reported a low well-being status. The mean MAD score was 3.1 ± 3.3. 26% reported missing school due to dysmenorrhea, 36% said dysmenorrhea impacted their ability to concentrate, and 39% were unable to study for tests, and complete homework. The first regression analysis showed a reduction of 1.45 units in WHO-5 score for each unit increase in dysmenorrhea. The second regression analysis showed a non-linear increase in MAD score for increasing dysmenorrhea. For each dysmenorrhea score less than 4 (mild) there was a modest increase in MAD scores (coefficient 0.08, p-value = 0.006), and for each dysmenorrhea score above 4 there was a stronger increase in MAD scores (coefficient 0.95, p < 0.001).ConclusionDysmenorrhea poses significant challenges to the well-being and academic performance of adolescent girls living in Palestine refugee camps. Collaborative efforts and multifaceted approaches are crucial to address dysmenorrhea effectively. This involves research, targeted interventions, culturally sensitive strategies, and fostering a supportive environment that empowers girls to thrive academically and beyond.

Flow experience fosters university students' well-being through psychological resilience: Alongitudinal design with cross-lagged analysis.

Existing research has linked individuals' flow experience - a positive affective and cognitive state of deep immersion and engagement in daily activities - and their well-being, particularly among university students. A growing number of longitudinal studies have further contributed to this understanding. However, limited attention has been given to exploring the dynamic interplay between these two variables and their underlying mechanisms (i.e., the mediator) of psychological resilience, specifically among university students in the context of the COVID-19 pandemic. To address this research gap, the present study draws on self-determination, flow and broaden-and-build theories. It examines the temporal dynamics and relationships between flow experience and well-being, and the mediating role of psychological resilience among Chinese university students. The study adopts a three-wave longitudinal design with a sample of 474 university students in Southwest China. Participants' flow experience, well-being and psychological resilience were measured across three time waves. The findings of this study reveal that flow experience predicts well-being across the three waves and that psychological resilience mediates this prediction. This empirical evidence emphasizes the significance of both flow experience and psychological resilience in contributing to the well-being of university students over time amid COVID-19. These findings enrich our understanding of the factors contributing to well-being in educational settings and provide highly relevant and timely insights for developing strategies to foster well-being among university students, especially in the transition into the post-pandemic era; findings also offer valuable insights not only for researchers but also for educators and policymakers.

Sensory Considerations for Emerging Textile Applications

Textiles are increasingly playing a role as a therapeutic medium in the disability field as well as in everyday life. This paper aims to review the literature on the relationship between textiles and sensory integration or sensory preferences in the general population. A brief literature review was conducted using PubMed (MEDLINE), SCOPUS, and Google Scholar. The review of the current literature highlights some key themes in the literature, including the indication that adaptive and sensory clothing design requires consideration of the textiles and fabrics being used, the functionality and appearance of garments, and affordability and access. The evidence suggests that clothing design should utilize soft fabrics which are seamless, have limited external tags, support social participation and functional engagement in daily activities, and are accessible.

Improving Health for Older Adults With Pain Through Engagement: Protocol for Tailoring and Open Pilot Testing of a Mind-Body Activity Program Delivered Within Shared Medical Visits in an Underserved Community Clinic.

Chronic musculoskeletal pain is prevalent and disabling among older adults in underserved communities. Psychosocial pain management is more effective than pharmacological treatment in older adults. However, underserved community clinics often lack psychosocial treatments, in part because of a lack of trained providers. Shared medical appointments, in which patients undergo brief medical evaluation, monitoring, counseling, and group support, are an efficacious and cost-effective method for chronic disease management in underserved clinics, reducing the need for specialized providers. However, shared medical visits are often ineffective for chronic pain, possibly owing to lack of inclusion of skills most relevant for older adults (eg, pacing to increase engagement in daily activities). We have described the protocol for the development and initial pilot effectiveness testing of the GetActive+ mind-body activity intervention for older adults with chronic pain. GetActive+ was adapted from GetActive, an evidence-based intervention that improved pain outcomes among mostly affluent White adults. We aim to establish the initial feasibility, acceptability, fidelity, and effectiveness of GetActive+ when delivered as part of shared medical appointments in a community clinic. We conducted qualitative focus groups and individual interviews with providers (n=25) and English-speaking older adults (aged ≥55 y; n=18) with chronic pain to understand the pain experience in this population, perceptions about intervention content, and barriers to and facilitators of intervention participation and implementation in this setting. Qualitative interviews with Spanish-speaking older adults are in progress and will inform a future open pilot of the intervention in Spanish. We are currently conducting an open pilot study with exit interviews in English (n=30 individuals in total). Primary outcomes are feasibility (≥75% of patients who are approached agree to participate), acceptability (≥75% of patients who enrolled complete 8 out of 10 sessions; qualitative), and fidelity (≥75% of session components are delivered as intended). Secondary outcomes include physical function-self-reported, performance based (6-minute walk test), and objective (step count)-and emotional function (depression and anxiety). Other assessments include putative mechanisms (eg, mindfulness and pain catastrophizing). We began enrolling participants for the qualitative phase in November 2022 and the open pilot phase in May 2023. We completed the qualitative phase with providers and English-speaking patients, and the results are being analyzed using a hybrid, inductive-deductive approach. We conducted rapid analysis of these data to develop GetActive+ before the open pilot in English, including increasing readability and clarity of language, reducing the number of skills taught to increase time for individual check-ins and group participation, and increasing experiential exercises for skill uptake. We provide a blueprint for the refinement of a mind-body activity intervention for older adults with chronic pain in underserved community clinics and for incorporation within shared medical visits. It will inform a future, fully powered, effectiveness-implementation trial of GetActive+ to help address the chronic pain epidemic among older adults. ClinicalTrials.gov NCT05782231; https://clinicaltrials.gov/study/NCT05782231. DERR1-10.2196/52117.

CONECTAR: A MINDSET TO INCREASE HISPANIC ENGAGEMENT IN DIGITAL TECHNOLOGY RESEARCH

Abstract In-home digital technology affords the opportunity for more precise and ecologically valid assessments of daily activity engagement. However, concerns about loss of privacy can hinder recruitment, especially within communities already underrepresented in research. Literature on effective, culturally tailored recruitment strategies is limited. Herein, we describe strategies employed for an in-home digital technology study with 100% Mexican American representation. Hispanic participants were recruited from the greater San Antonio area. Direct recruitment strategies conducted in both English and Spanish included community outreach events, a participant repository, cross-enrollment with other research studies, and by word of mouth. Mass recruitment strategies included flyer dissemination, newsletters, and digital announcements through community organizations (i.e., Salud America!) and national (i.e., Research Match) and institutional websites. Between September 2022 and February 2023, 31 participants were enrolled out of 154 individuals who were contacted. Of these, 29% were recruited from community events, 22.6% from word of mouth, 19.4% from cross-enrollment, 12.9% from the research repositories, and 16.1% from mass recruitment strategies. The most common reasons for non-enrollment included lack of interest (n=49), screen failure (n=29), and privacy concerns (n=12).Direct recruitment efforts achieved higher rates of enrollment, while mass media campaigns yielded lower responses and resulted in more unsuccessful contact attempts. Understanding the relationship between social networks and research beliefs may be particularly relevant given the Hispanic culture’s collectivist and family-oriented nature. Hence, social network theories, combined with a diffusion of innovation framework, may be advantageous for increasing trust and may consequently improve representation of diverse groups in research.

Perceived Control Over Time Among College Students with and without Attention Deficits and/or Specific Learning Disorders.

Background: College students cope with a variety of activities that demand organizational skills which may increase stress. Perceived control over time is the perception of having enough time to finish one’s work meet one’s deadlines. This influences time management behaviors, satisfaction, independent engagement in daily activities, academic success and stress. Aim: To evaluate the self-perception of daily functions and control over time among college students with and without Attention Deficits and/or Specific Learning Disorders, who were seeking support, correlated with their demographic characteristics. Method: Participants: Thirty-six students (3 males, 33 females), mean age 23.42 + 4.80, who approached the college's student support center. Instruments: Behavioral Rating Inventory of Executive Functions (BRIEF- A) and Time Organization and Participation Scale (TOPS). Results: Significant correlations were found between the BRIEF - A and the TOPS subscales. Comorbidity of SLD and ADHD was associated with a lower perceived performance as measured in those scales while the demographic variables did not. Conclusions: Occupational therapists may have an important role in students' support centers and are encouraged to evaluate perceived control over time, of students, facilitate time management skills, and guide a discovery of strategies for balancing between demanding academic and extra curriculums tasks.

Pediatric strabismus is associated with increased severe functional impairment

Previous studies found children with strabismus have increased risk of physical injuries and reduced overall quality of life. However, the impact of strabismus on interpersonal relationships and engagement in daily activities is not well understood. The purpose of this study was to determine the association of strabismus with severe functional impairment and identify domains disrupted by strabismus.

Experts' Perceived Patient Burden and Outcomes of Knee-ankle-foot-orthoses (Kafos) Vs. Microprocessor-stance-and-swing-phase-controlled-knee-ankle-foot Orthoses (Mp-sscos).

Patients with neuromuscular knee-instability assisted with orthotic devices experience problems including pain, falls, mobility issues and limited engagement in daily activities. The aim of this study was to analyse current real-life burden, needs and orthotic device outcomes in patients in need for advanced orthotic knee-ankle-foot-orthoses (KAFOs). An observer-based semi-structured telephone interview with orthotic care experts in Germany was applied. Interviews were transcribed and content-analysed. Quantitative questions were analysed descriptively. Clinical experts from eight centres which delivered an average of 49.9 KAFOs per year and 13.3 microprocessor-stance-and-swing-phase-controlled-knee-ankle-foot orthoses (MP-SSCOs) since product availability participated. Reported underlying conditions comprised incomplete paraplegia (18%), peripheral nerve lesions (20%), poliomyelitis (41%), post-traumatic lesions (8%) and other disorders (13%). The leading observed patient burdens were "restriction of mobility" (n=6), followed by "emotional strain" (n=5) and "impaired gait pattern" (n=4). Corresponding results for potential patient benefits were seen in "improved quality-of-life" (n=8) as well as "improved gait pattern" (n=8) followed by "high reliability of the orthosis" (n=7). In total, experts reported falls occurring in 71.5% of patients at a combined annual frequency of 7.0 fall events per year when using KAFOs or stance control orthoses (SCOs). In contrast, falls were observed in only 7.2 % of MPSSCO users. Advanced orthotic technology might contribute to better quality of life of patients, improved gait pattern and perceived reliability of orthosis. In terms of safety a substantial decrease in frequency of falls was observed when comparing KAFO and MP-SSCO users.

Perceived accessibility: How access to dockless bike-sharing impacts activity participation

The emergence and popularity of dockless bike-sharing systems have attracted extensive attention due to the associated environmental and health benefits. However, little consideration has been given to the potential individual social implications of dockless bike-sharing. Our knowledge about whether dockless bike-sharing systems have the ability to facilitate individuals’ engagement in daily activities is limited. The goal of this study is to gain more insight into how individuals’ personal characteristics and neighborhood environment features influence perceived access to different types of activities by dockless bike-sharing. Using survey data collected from residents in Beijing, we employed four ordinary least squares (OLS) regressions to assess the effect of individual and spatial attributes on the role dockless bike-sharing plays in users’ perceived accessibility to activities overall as well as to three different categories of activities—subsistence, maintenance and leisure. The results indicated that male users reported enjoying more benefits in accessing activities. Dockless bike-sharing users’ perceived benefits in accessing activities largely relied on their social support from their family and friends and their attitudes towards environmental and health concerns of travel. Additionally, users who agreed that dockless bike-sharing has helped them access bus stops and metro stations perceived higher benefits of dockless bike-sharing on activity participation. Our analysis also highlighted that dockless bike-sharing users in Beijing benefited most in their commuting trips, and to a lesser degree, when attending maintenance and leisure activities. The percentage of cycling paths within the home neighborhood tended to be positively associated with individuals’ perceived accessibility to subsistence activities.

Shining new light on dementia treatment: ADAS‐Cog and quantitative EEG evidence of cognitive improvement in early and mid‐stage dementia using self‐administered 1070 nm transcranial near‐infrared photobiomodulation

AbstractBackgroundThe current evidence supporting nonpharmacologic treatment of dementia has focused mainly on environmental or interactive interventions, e.g., music, sensory stimulation, simulated presence, and validation therapies. Exercise and light therapy improved/maintained activities of daily living, while cognitive stimulation, exercise and reminiscence improved cognition. The strongest evidence for reducing emotional disorders so far has employed music, psychological interventions and reminiscence. PubMed lists 918 citations related to non‐pharmacological treatments for dementia with music therapy and behavioral management techniques being the most efficacious showing modest improvements at best. Non‐pharmacologic treatment interventions directed at reversing both cognitive and behavioral symptom of dementia are small, few in number and with wide variation in defining outcome measures, and little comparative data across approaches to guide further research efforts or systematic clinical applicability. Photobiomodulation using brief, daily, pulsed LED‐driven transcranial infrared light stimulation, has been shown to markedly alter both cognitive and behavioral symptoms in people with mild to moderate dementia. Improved functioning has been documented by both standard neuropsychological testing and noninvasive Quantitative electroencephalographic (QEEG) measures of functional connectivity. This presentation describes a multi‐site, randomized, placebo controlled, at‐home, self‐administered treatment protocol employing pulsed transcranial and intraocular 1068nm near‐infrared light to achieve reversal of cognitive decline, and improve dementia patient’s physical and interpersonal behavior. Study subjects (n=100) were evaluated at two locations at baseline, midpoint (30 days) and termination (60 days) using both Quantitative EEG and ADAS‐Cog and caregiver evaluation of subject’s change in ADLs. This trial was a replication of an earlier pilot trial and a recent safety/feasibility trial with no adverse events reported in any study. MMSE improved 21.0%, 4.8 points in the active treatment group and 1.6 points in the placebo group. Sleep duration increased in the active treatment group by an hour after 8 days of treatment and caregivers noted improved mood, energy, and positive engagement in daily activities. None of these functional changes were noted in the placebo arm subjects. Active group’s clock drawing improved 20% and no change in the control group. Logical memory recall improved 3.3 points (p&lt; .03) and time to completion of Trails A&amp;B decreased 23.7% (p&lt;.03).

A smart tech lever to augment caregivers' touch and foster vulnerable patient engagement and well-being

PurposeSome population groups face precarious health, reflecting their vulnerability, in terms of lack of agency or control. Smart technologies promise to transform people's lives from the enhanced connectedness, greater computational processing and more complex decision-making they can achieve. This study aims to investigate how smart technology can mitigate vulnerability and improve well-being.Design/methodology/approachThe research group, of three scholars and three managers, pursued an action research methodology with an iterative process of planning, action and learning. The authors conducted three related action studies: (1) adopting smart technologies, (2) fostering patient engagement and (3) assessing well-being.FindingsThe adoption of sensors and wearable devices had positive impacts for both patients and caregivers. Technologies highlighted their meaning as resources to support actors' (caregivers' and vulnerable patients') activities. Smart devices as resources get integrated, stimulate change and enable new practices. For caregivers, such innovative solutions help improve their knowledge of patients and their ability to act efficiently; for vulnerable patients, they fostered engagement in daily activities to improve well-being.Originality/valueThe paper delineates an overall model (SEVP) that describes how the integration of high-tech and high touch enables patient engagement to mitigate vulnerability and improve well-being.

Impact of the COVID-19 Quarantine on Young Children’s Family-Based Daily Activities in Greece

This study reports on parental perceptions of changes and continuities in young children&amp;rsquo;s home-based daily activities during the initial COVID-19 quarantine in Greece. Daily activities present significant contexts for children&amp;rsquo;s learning and development and their continuity in periods of crisis is important for children&amp;rsquo;s psychological well-being. Existing research worldwide, underscores the changes occurring in families&amp;rsquo; daily lives because of the pandemic- imposed restrictions, mostly focusing on their negative impact on family routines and functioning. On the other hand, continuities in children&amp;rsquo;s everyday activities during the quarantine have been less studied. 116 mothers and fathers, forming a convenience sample, reported on their children&amp;rsquo;s as well as their own engagement in daily activities with them, before and during the quarantine, using the CDA-PB scale. Results revealed changes in accordance with other research findings on this topic but also continuities in Greek families&amp;rsquo; daily activities, which relate to parental values and already established family routines.

A New and Tidier Setting: How Does Environmental Clutter Affect People With Dementia's Ability to Perform Activities of Daily Living?

The relationship between the physical environment and the person with dementia's (PwD) activities of daily living (ADLs) task performance is controversial. Although the general assumption is that this population benefits from their home environment when performing ADLs, very few experimental studies have been conducted to date. The aim was to investigate the influence of the environment (home vs. Research-lab) and the role of clutter on ADL performance. Sixty-five PwD were evaluated with a performance-based ADL assessment (at home and clutter-free Research-lab). Paired t tests compared ADL performance and level of clutter in both environments. Multiple regression analysis investigated factors associated with better ADL performance. Overall, PwD performed better at home even though clutter was significantly lower in the Research-lab. When stratified by dementia stage, PwD in the moderate stage of the disease performed better at home. Absence of clutter in the Research-Lab did not appear to play a beneficial role in ADLs. When stratified by dementia stage, only PwD in the moderate stage appeared to benefit from their home environment when performing ADL tasks. Future studies are required to elucidate the wider role of the environment in supporting engagement in daily activities in different dementia stages.

Use of digital health technologies to examine subjective and objective sleep with next-day cognition and daily indicators of health in persons with and without HIV

Most previous studies investigating sleep’s association with health outcomes have relied on averaged sleep quality and laboratory-based health measures. This study examines the dynamic within-person relationships between subjective (Ecological Momentary Assessment) and objective sleep (actigraphy) on next-day cognition (subjective and objective), mood, and engagement in daily activities using linear mixed-effects regression modeling. Participants included 94 individuals (59 people with HIV, 35 HIV-) aged 50–74, assessed daily for 14 consecutive days/nights. Subjective and objective sleep were well correlated and were both associated with subjective ratings of cognition, but not objective cognition. Worse subjective sleep was associated with next-day lower happiness and higher depressed mood, and more pain, but was not related to next-day daily activities. Objective sleep was associated with next-day depressed mood and feelings of worry, and was positively associated with next-day television watching. Results provide evidence to support the utility of real-time assessment for sleep and functional outcomes that may lead to potential personalized interventions for individuals with and without HIV.

Prompting Play for Preschoolers: Virtual Workshops for Educators

Abstract Date Presented 04/13/21 To support preschool students with intellectual and developmental disabilities (IDD), the educators working closely with them must be equipped with appropriate strategies. As OTs, it is our responsibility to ensure that any deficits in play are managed to increase engagement in daily activities. Through engagement in virtual workshops detailing two prompting strategies, participants' knowledge and self-efficacy regarding these techniques to support play in the classroom was increased. Primary Author and Speaker: Katherine Gammer Contributing Authors: Mor Nahum, Chen Makranz, Afik Hoba, Tamar Peretz, Nechama Silbermen, and Shai Netanel Nagary

Comparison on Well-Being, Engagement and Perceived School Climate in Secondary School Students with Learning Difficulties and Specific Learning Disorders: An Exploratory Study.

Reading and writing skills influence the social status of students, exerting effects not only on learning, but also on wellbeing. This study aimed to assess the impact of diagnosis of specific learning disorder on well-being in secondary-school students, comparing students with a diagnosis of specific learning disorder (SLD-group), students showing learning difficulties without diagnosis (LD-group) and students without learning difficulties (control-group). Students were tested with neuropsychological screening tests in order to identify learning difficulties and were further assessed by means of psychological and school well-being questionnaires. The results show that LD group perceive themselves as having a low sense of mastery and autonomy, less interest and engagement in daily activities and low peer social support than their schoolmates. This result highlights, for the LD group, a low well-being experience, which is not observed in the SLD and control groups. On the contrary, SLD group students do not differ from control group students in any dimensions except for the perceived parents’ support and involvement in school life, in which the SLD group show the highest scores. This work underlines the importance of having a diagnosis as it seems to work as a protective factor for both the psychological and school well-being of the student.

Closeness to friends explains age differences in positive emotional experience during the lockdown period of COVID-19 pandemic

BackgroundStudies on age differences in emotional states during the COVID-19 pandemic showed that older adults experienced greater emotional wellbeing compared to younger adults. We hypothesized these age differences to be related to the perception of closeness to family/friends or the engagement in daily activities during the pandemic.AimTo investigate age differences in positive and negative emotional experiences and whether the perception of closeness to family/friends and the engagement in daily activities during pandemic explained such age-related differences.MethodsThrough a cross-sectional study, 1,457 adults aged 18–87 years old completed an online survey assessing positive and negative emotional experiences, the perception of more closeness to family/friends, and daily activities that participants started/re-started during the pandemic.ResultsIncreasing age was associated with more positive and less negative emotional experiences. Age differences in positive emotional experience were explained by the perception of more closeness to friends and not by the engagement in daily activities. For negative emotional experience age, differences remained significant even after accounting for the perception of closeness to family/friends and engagements in daily activities.DiscussionOlder adults’ greater overall level of positive emotional experience was explained by their greater perception of more closeness to friends. We speculate that social closeness provides a coping mechanism to increase emotional wellbeing employed especially in older adults.ConclusionOur findings reinforce the link between perceived social closeness and emotional wellbeing especially in older adults. To cope with stressful situation, it is important to encourage older adults to increase the closeness to their social network.

The Effects of Child Support Payment Factors on Satisfaction With Levels of Parental Involvement by Noncustodial Fathers

Purpose: Research on the influences of child support on the parental involvement of non-custodial father is mixed. Method: This study uses one-way multivariate analysis of variance (MANOVA) to examine non-custodial fathers’ satisfaction with levels of accessibility to his child, degree of engagement in daily activities, level of responsibility for child’s wellbeing and custodial parents parenting practices. These variables were measured against child support payment related behaviors to include income levels, monthly child support obligation, view of fairness of payment, maintaining a current status, and the number of additional child support cases. Results: Results indicated significant mean differences in the combined parental satisfaction variable and specifically within custodial parent parenting practices. Mean differences in parental satisfaction with reference to degree of responsibility for the child were also effected by monthly child support payment amounts. No significance differences in parental satisfaction were found regarding fairness of child support payment amount or having multiple child support cases. However, small differences were noted concerning payment status of current or behind. Discussion: Implications for future study of fatherless families are explored.

Acceptance and commitment therapy for fatigue interference in advanced gastrointestinal cancer and caregiver burden: protocol of a pilot randomized controlled trial

BackgroundFatigue interference with activities, mood, and cognition is one of the most prevalent and bothersome concerns of advanced gastrointestinal (GI) cancer patients. As fatigue interferes with patient functioning, family caregivers often report feeling burdened by increasing responsibilities. Evidence-based interventions jointly addressing cancer patient fatigue interference and caregiver burden are lacking. In pilot studies, acceptance and commitment therapy (ACT) has shown promise for addressing symptom-related suffering in cancer patients. The current pilot trial seeks to test a novel, dyadic ACT intervention for both advanced GI cancer patients with moderate-to-severe fatigue interference and their family caregivers with significant caregiving burden or distress.MethodsA minimum of 40 patient-caregiver dyads will be randomly assigned to either the ACT intervention or an education/support control condition. Dyads in both conditions attend six weekly 50-min telephone sessions. Outcomes are assessed at baseline as well as 2 weeks and 3 months post-intervention. We will evaluate the feasibility, acceptability, and preliminary efficacy of ACT for improving patient fatigue interference and caregiver burden. Secondary outcomes include patient sleep interference and patient and caregiver engagement in daily activities, psychological flexibility, and quality of life. We will also explore the effects of ACT on patient and caregiver physical and mental health service use.DiscussionFindings will inform a large-scale trial of intervention efficacy. Results will also lay the groundwork for further novel applications of ACT to symptom interference with functioning and caregiver burden in advanced cancer.Trial RegistrationClinicalTrials.gov, NCT04010227. Registered 8 July 2019.