Generalization Of Treatment Effects Research Articles

Targeted psychological and psychosocial interventions for auditory hallucinations in persons with psychotic disorders: Protocol for a systematic review and meta-analysis.

In recent years, a growing body of evidence has demonstrated the efficacy of non-pharmacological interventions for schizophrenia spectrum disorders (SSD) including positive symptoms such as auditory hallucinations (AH). However, clinical trials predominantly examine general treatment effects for positive symptoms. Therefore, previous research is lacking in comprehensive and clear evidence about psychological and psychosocial approaches that are primarily tailored to treat AH. To overcome this knowledge gap in the current literature, we will conduct a systematic review and meta-analysis to assess the efficacy of clearly targeted psychological and psychosocial interventions for AH in persons with SSD. This study protocol has been developed according to the guidelines of the Preferred Reporting Items for Systematic Reviews and Meta-Analysis Protocols. We will include all randomized controlled trials analyzing the efficacy of targeted psychological and psychosocial interventions especially aimed at treating AH in SSD. We will include studies on adult patients with SSD experiencing AH. The primary outcome will be the change on a published rating scale measuring AH. Secondary outcomes will be delusions, overall symptoms, negative symptoms, depression, social functioning, quality of life, and acceptability (drop-out). We will search relevant databases and the reference lists of included literature. The study selection process will be conducted by two independent reviewers. We will conduct a random-effect meta-analysis to consider heterogeneity across studies. Analyses will be carried out by software packages in R. The risk of bias in each study will be evaluated using the Cochrane Risk of Bias tool. Assessment of heterogeneity and sensitivity analysis will be conducted. The proposed study will augment the existing evidence by providing an overview of effective treatment approaches and their overall efficacy at treating AH in SSD. These findings will complement existing evidence that may impact future treatment implementations in clinical practice by addressing effective strategies to treat AH and therefore improve outcomes for the addressed population. No ethical issues are foreseen. We will publish the results from this study in peer-reviewed journals and at relevant scientific conferences. PROSPERO registration number: CRD42023475704.

Causal inference of general treatment effects using neural networks with a diverging number of confounders

Semiparametric efficient estimation of various multi-valued causal effects, including quantile treatment effects, is important in economic, biomedical, and other social sciences. Under the unconfoundedness condition, adjustment for confounders requires estimating the nuisance functions relating outcome or treatment to confounders nonparametrically. This paper considers a generalized optimization framework for efficient estimation of general treatment effects using artificial neural networks (ANNs) to approximate the unknown nuisance function of growing-dimensional confounders. We establish a new approximation error bound for the ANNs to the nuisance function belonging to a mixed smoothness class without a known sparsity structure. We show that the ANNs can alleviate the “curse of dimensionality” under this circumstance. We establish the root-n consistency and asymptotic normality of the proposed general treatment effects estimators, and apply a weighted bootstrap procedure for conducting inference. The proposed methods are illustrated via simulation studies and a real data application.

Attitudes towards terrorist rehabilitation programs: psychological mediating and moderating mechanisms

ABSTRACT Rehabilitation programs for terrorists have gained notoriety. Some issues still require thorough investigation, such as the social support they receive. The present research aims to examine the attitudes towards rehabilitation programs for terrorist offenders and the mediating and moderating mechanisms underlying these attitudes. To this end, two studies were conducted: the first study evaluated the mediating mechanisms (negative feelings and threats; N = 407) and the second study analyzed the moderating mechanisms (social dominance orientation, system justification, and political orientation; N = 444). In both cases, the type of offender was manipulated (criminal vs. nationalist terrorist vs. Islamist terrorist offenders) and different attitudes were assessed (general support, incapacitation, treatment effectiveness, and mandated treatment). The results showed less support for rehabilitation programs for Islamist terrorists than for other offenders. Moreover, Islamist terrorists pose a more significant terrorist threat while criminals pose a greater realistic threat, which led to less favorable attitudes towards rehabilitation programs. Finally, individuals with more conservative ideologies had stronger negative attitudes towards programs for Islamist terrorists. We discuss these findings within the framework of integrated threat and system justification theories.

The Opioid Epidemic and the State of Stigma: A Pennsylvania Statewide Survey

Background: The opioid epidemic is a public health crisis. Among initiatives surrounding treatment and prevention, opioid use disorder (OUD) stigma has emerged as a subject for intervention. Objectives: This study examines overall results and demographic differences of three subscales of a public stigma survey instrument: general attitudes, social distance, and treatment availability and effectiveness. Methods: A statewide sample of Pennsylvanian adults (N = 1033) completed an online survey about the opioid epidemic. Weighted percentage level of agreement was reported for each item. To determine significant differences in responding across demographic groups (gender, race, and urban/rural status), multiple one-way ANOVAs were analyzed. Significant differences in the level of agreement and disagreement (p < .05) were reported. Results: The majority of respondents agreed that the opioid epidemic is a problem and that anyone can become addicted to opioids; however, many Pennsylvanians still disagree that OUD is a medical disorder and continue to endorse social distance beliefs of people with OUD. Most participants agreed that there are effective treatments available, and that recovery was possible; however, a large portion of participants were unsure whether specific treatments are effective. Subscale mean differences were significant for gender and age. Conclusions/Importance: Findings highlight that stigmatized attitudes, behaviors, and beliefs about individuals who use opioids are still prevalent and that uncertainty remains about the effectiveness of OUD treatment. OUD interventions should use targeted messaging in order to impact the ongoing opioid crisis.

The Link between Fibromyalgia Syndrome and Anger: A Systematic Review Revealing Research Gaps.

Anger has been associated with increased pain perception, but its specific connection with Fibromyalgia Syndrome (FMS) has not yet been established in an integrated approach. Therefore, the present systematic review focuses on exploring this connection, and based on this connection, delimiting possible gaps in the research, altogether aimed at improving FMS clinical intervention and guiding future research lines. Anger is considered a basic negative emotion that can be divided into two dimensions: anger-in (the tendency to repress anger when it is experienced) and anger-out (the leaning to express anger through verbal or physical means). The current systematic review was performed based on the guidelines of the PRISMA and Cochrane Collaborations. The Prospective Register of Systematic Reviews (PROSPERO) international database was forehand used to register the review protocol. The quality of chosen articles was assessed and the main limitations and research gaps resulting from each scientific article were discussed. The search included PubMed, Scopus, and Web of Science databases. The literature search identified 13 studies eligible for the systematic review. Levels of anger-in have been shown to be higher in FMS patients compared to healthy participants, as well as patients suffering from other pain conditions (e.g., rheumatoid arthritis). FMS patients had also showed higher levels of state and trait anxiety, worry and angry rumination than other chronic pain patients. Anger seems to amplify pain especially in women regardless FMS condition but with a particularly greater health-related quality of life´s impact in FMS patients. In spite of the relevance of emotions in the treatment of chronic pain, including FMS, only two studies have proposed intervention programs focus on anger treatment. These two studies have observed a positive reduction in anger levels through mindfulness and a strength training program. In conclusion, anger might be a meaningful therapeutic target in the attenuation of pain sensitivity, and the improvement of the general treatment effects and health-related quality of life in FMS patients. More intervention programs directed to reduce anger and contribute to improve well-being in FMS patients are needed.

EVALUATING THE EFFECTIVENESS OF SUPPORTIVE TREATMENT BY MOXA ROLLER ON SOME TRADITIONAL WIND-COLD DISEASES

Background: According to traditional medicine, the wind-cold agent is a common clinical cause, may appear in such diseases as: lumbar pain, neck shoulder pain, and flu… The wind-cold agent enters the meridian and collateral system, skin and hair on the body, lead to blood stasis due to qi stagnation cause pain and affect the patient’s quality of life. The moxa roller method is a form of moxibustion, which based on the use of a warm heat. The use of moxa roller is a new method in clinical to make moxibustion in patients more convenient and effective. Materials and method: 30 patients were diagnosed with lumbar pain and neck shoulder pain according to wind-cold traditional disease, treatment at Thua Thien Hue Traditional Medicine Hospital with supportive of moxa roller. The study was designed by method of prospective study, assessed the results before and after treatment. Results: Neck shoulder treatment: the rate good and very good accounts for 78.6%, lumbar pain treatment: the rate good and very good accounts for 87.6%. The general treatment effect is good and very good accounting for 83.4%. The change compared to before treatment was statistically significant with p &lt; 0.05. Conclusion: Practising moxibustion by moxa roller supportive treatment of some diseases by wind-cold results in high clinical effectiveness. Key words: lumbar pain, neck shoulder pain, moxa roller, wind-cold.

Game, guide or website for financial education improvement: Evidence from an experiment in Colombian schools

This paper evaluates the impact of a financial education program consisting of three different learning tools, for children (6–18) in Bogota, Colombia, in 2018. This randomized experiment offers the opportunity to examine the impact of those three learning tools (Game, Guide, Website) on students’ financial knowledge and literacy on a sample of 1337 students from four Colombian schools, and four academic grades. We did not find a significant general treatment effect; however, we did find an improvement in treated public school students. Regarding the efficacy of the tools, we found several heterogeneous effects among the types of schools and grades. The type of school (public/private) is relevant in terms of knowledge improvement and still represents a pre-existing condition that leads to differences in children’s performance, but implementing a program can help mitigate these differences. We found that differentiated instruction in the learning process can be effective even if significant pre-existing differences still prevail. This study contributes to creating a framework for the current situation of Colombian children’s financial literacy and serves as insight for future programs.

Cognitive Change and Relaxation as Key Mechanisms of Treatment Outcome in Chronic Pain: Evidence From Routine Care.

Despite effective treatment approaches within the cognitive behavioral framework general treatment effects for chronic pain are rather small to very small. Translation from efficacy trials to naturalistic settings is questionable. There is an urgent need to improve the effectiveness of well-established treatments, such as cognitive-behavior therapy (CBT) and the investigation of mechanisms of change is a promising opportunity. We performed secondary data analysis from routine data of 1,440 chronic pain patients. Patients received CBT in a multidisciplinary setting in two inpatient clinics. Effect sizes and reliable change indices were computed for pain-related disability and depression. The associations between changes in the use of different pain coping skills (cognitive restructuring, activity despite pain, relaxation techniques and mental distraction) and changes in clinical outcomes were analyzed in structural equation models. Pre–post effect sizes range from g = 0.47 (disability) to g = 0.89 (depression). Changes in the use of cognitive restructuring, relaxation and to a lesser degree mental distraction were associated with changes in disability and depression. Effects from randomized trials can be translated to naturalistic settings. The results complement experimental research on mechanisms of change in the treatment of chronic pain and indicate an important role of cognitive change and relaxation as mechanisms of change. Our findings cautiously suggest that clinicians should optimize these processes in chronic pain patients to reduce their physical and emotional disability.

Treatment Effect of Mammary Duct Exploration Combined with Focal Resection on Granulomatous Lobular Mastitis.

ObjectiveThis study aims to summarize the treatment of granulomatous lobular mastitis with a low recurrence rate and high satisfaction rate.MethodsIn this study, the epidemiology and treatment effect was analyzed based on the general data and treatment effects. Patients treated for granulomatous lobular mastitis at the Dongzhimen Hospital, Beijing University of Chinese Medicine, and Beijing Contemporary Hospital from October 24, 2016, to May 8, 2019, were selected as subjects for the study.ResultsThe results revealed that the common features of granulomatous lobular mastitis were nipple retraction, history of induced abortion, nipple discharge, history of thyroid disease, history of lactation mastitis, and mental illness. The cure rate of the disease was 100%, the recurrence rate was 0.38%, and the patient satisfaction rate was 97.71%.ConclusionThe combination of mammary duct exploration and focal resection has a positive effect on the treatment of this disease and is worthy of clinical popularization.

Assessment and Treatment of Selective Mutism in a Child With Autism Spectrum Disorder

Over 60% of children diagnosed with selective mutism are also diagnosed with Autism Spectrum Disorder. Previous research established that behavioral interventions are effective at increasing speech in children with both diagnoses. However, few studies conducted assessments to determine environmental variables that inhibit speech, and such assessments are necessary for the development of effective and efficient treatments. This case study describes an assessment that evaluated the function(s) of selective mutism. The results confirmed that the participant did not talk to avoid social interaction and that mutism occurred primarily in the presence of multiple, unfamiliar people. Our first treatment focused on increasing tolerance for social interaction, demonstrated by an increase in speech production in the presence of unfamiliar people. Our second treatment focused on increasing qualitative aspects of the participant’s speech (i.e., both responses and initiations). Finally, we taught the participant’s parents to implement the treatment in naturalistic settings, and the participant demonstrated generalization of treatment effects across people and settings. Implications for clinical practice and future research are discussed.

Clinical Observation of Zhuang Medicine Crystal Sugar Ye’An Decoction in Treating Senile Skin Pruritus and Its Effects on Serum IgE

Objective: To discuss the specific application of Zhuang Medicine Crystal Sugar Ye’An Decoction in senile skin pruritus and its effects on serum IgE detection level. Methods: 90 patients with senile skin pruritus admitted to our hospital from February 2019 to April 2020 were randomly grouped. The general treatment effect, itching, secondary skin lesion severity, serum IL-6, IgE level and adverse reactions between 45 patients treated with Chlorcyclizine Hydrochloride Tablets (The control group) and 45 patients treated with Crystal Sugar Ye’An Decoction were compared. Results: The total effective rate of the treatment in the observation group was 93.33%, much higher than that in the control group, 75.56%. The difference was verified and statistically significant (P&lt;0.05). Before the treatment, the itching area, frequency, duration and severity of secondary skin lesions were at the same level (P&gt;0.05). After the treatment, the above data were all reduced, and the reduction of the observation group was more significant than that of the control group, indicating the difference was statistically significant (P&lt;0.05). Before the treatment, there was no difference in serum IL-6 and IgE test data between the two groups (P&gt;0.05). After the treatment, the tendency all declined, and that of the observation group was more obvious, indicating the difference was statistically significant (P&lt;0.05). During the experiment, no obvious adverse reactions were observed in both groups. Conclusion: In the treatment of patients with senile pruritus, the application of Zhuang Medicine Crystal Sugar Ye’An Decoction is not only safe and reliable, but can promote the improvement of patients’ symptoms, adjust the level of inflammatory factors, and enhance clinical efficacy.

Parent‐implemented multiple schedules

AbstractMultiple schedules are compound schedules that alternate, and each schedule corresponds with a stimulus. They are effective at establishing stimulus control over behavior. Thus, they are sometimes implemented as schedule thinning procedures within the context of functional communication training (FCT) to reduce high rates of appropriate responses while maintaining problem behavior at low rates. To date, researchers have continued to evaluate the practicality of multiple schedules in clinical cases. However, there is a paucity of research on the generalization of treatment effects across settings and implementers. Thus, the purpose of this study was to (1) extend previous research by experimentally evaluating caregiver training on the implementation of multiple schedules within the context of FCT as a treatment for their children's problem behavior in their homes, and (2) assess the social validity of the multiple schedule with the parents. Three parent–child dyads participated in the study. All parents successfully learned to implement the multiple schedules in their home with their children. In addition, all parents reported that the treatment was highly acceptable.

Cross-modal generalization of anomia treatment to reading in aphasia

ABSTRACT Background: Generalization of treatment effects is the ultimate goal of therapy. However, treatment generalization across language modalities is not well understood in the aphasia literature and requires further investigation. This work examined the generalization effects of two word retrieval therapies, Phonomotor Treatment (PMT) and Semantic Feature Analysis (SFA), to reading performance in individuals with aphasia. Aims: This cross-modal generalization investigation was motivated by the Primary Systems Hypothesis, which proposes reading ability is related to and dependent upon underlying phonological and semantic abilities. Therefore, this study sought to determine if enhanced phonological or semantic knowledge following anomia treatment could influence reading ability. Methods & Procedures: Reading data collected in a randomized control trial for anomia treatment were retrospectively analyzed. Fifty-eight participants with chronic aphasia were randomly assigned to receive intensive PMT (n = 28) or SFA (n = 30) treatment for 56–60 hours over 6–7 weeks. Reading measures were administered pre-, post- and 3 months after treatment. To identify and compare the extent of treatment generalization to reading, within-group and between-group analyses of variance were performed. Outcomes & Results: On average, participants in both groups showed positive changes in reading. The PMT group demonstrated significantly improved reading of regularly and irregularly spelled words. The SFA group showed significant gains in reading of regularly spelled words and sentence-level reading comprehension. No statistically significant differences in oral reading or reading comprehension were found between the groups before or after therapy. Conclusions: These preliminary findings support the Primary Systems Hypothesis and suggest a link between reading ability and phonological and semantic abilities. Results show that one anomia treatment was not superior to the other and the positive influence of both PMT and SFA suggests that reading might be enhanced via intensively delivered treatments that focus on the underlying phonological or semantic impairment. Further investigations of cross-modal treatment generalization are needed to help better understand this relationship between word retrieval and reading and its implication for aphasia treatment.

Correction: Sensitivity analysis for an unobserved moderator in RCT-to-target-population generalization of treatment effects

Correction: Sensitivity analysis for an unobserved moderator in RCT-to-target-population generalization of treatment effects

Time heals all wounds? A 2-year longitudinal diffusion tensor imaging study in major depressive disorder

Cross-sectional studies have repeatedly shown impaired white matter integrity in patients with major depressive disorder. Longitudinal analyses are missing from the current research and are crucial to elucidating the impact of disease trajectories on white matter impairment in major depressive disorder. Fifty-nine patients with major depressive disorder receiving inpatient treatment, as well as 49 healthy controls, took part in a prospective study. Participants were scanned twice (baseline and follow-up), approximately 2.25 years apart, using diffusion tensor imaging. We analyzed diffusion metrics using tract-based spatial statistics. At baseline, patients had higher mean diffusivity in a large bilateral frontal cluster comprising the body and genu of the corpus callosum, the anterior and superior corona radiata, and the superior longitudinal fasciculus. A significant group × time interaction revealed a decrease of mean diffusivity in patients with major depressive disorder over time, abolishing group differences at follow-up. This effect was observed irrespective of disease course in the follow-up period. Analyzing the course of illness is challenging because of recollection biases in patients with major depressive disorder. This study reports follow-up diffusion tensor imaging data in patients with major depressive disorder after an acute depressive episode. We demonstrated impaired prefrontal white matter microstructure (higher mean diffusivity) at baseline in patients with major depressive disorder, which normalized at follow-up after 2 years, irrespective of disease course. This might have been due to a general treatment effect and might have reflected recovery of white matter integrity.

Complications of HIV infection

HIV-infected patients often develop various complications and comorbidities including opportunistic diseases that worsen patient’s general state and decrease antiretroviral treatment effectiveness. On the other hand, the diagnosis of HIV infection often begins with the identification of complications, and only then, the main disease is diagnosed. Early detection of these complications and comorbidities is essential for timely and effective treatment of patients with HIV infection. In addition, an important issue is the differential diagnosis of complications caused directly by HIV, opportunistic infections and antiretroviral therapy, since each of these groups of complications needs its own approach to treatment. The literature review of PubMed resource performed in this work allowed us to present the main complications of HIV infection and to separate them by the location of the lesion and the cause of occurrence, which facilitates the perception of information. Neurological, cardiopulmonary and gastrointestinal complications are described in detail, since the violation of these systems occurs in HIV-infected patients most often. The main causing factors, the features of clinical manifestations, detection and diagnosis by visualization, serological, microbiological, histological and other methods are described in the study. The main directions of HIV infection complications treatment, the features of the patient’s condition in which it is advisable to use certain methods of treatment, a plan for further patients monitoring are also described. Other rare lesions, such as urogenital, musculoskeletal, metabolic and endocrine complications, are also described. It has been found that the manifestations of HIV infection are variable and depend on the stage of HIV infection, the level of CD4+ cells, viral load, the presence of opportunistic diseases and the antiretroviral therapy regimen used. The features of the etiology, pathogenesis, clinical manifestations and treatment of HIV infection complications described in the article can help doctors of all specialties in early detection, treatment and prevention.

Ectoine lozenges in the treatment of acute viral pharyngitis: a prospective, active-controlled clinical study

PurposeAcute pharyngitis is an uncomfortable disorder mostly caused by viruses and for which antibiotics are unwarranted. This study compared lozenges containing ectoine, a natural extremolyte, with hyaluronic acid lozenges and hypertonic saline gargle for symptomatic treatment of acute viral pharyngitis.MethodsThis prospective, controlled clinical study, recruited 90 patients with moderate-to-severe pharyngitis symptoms who chose to use either ectoine (n = 35), hyaluronic acid (n = 35), or saline gargle (n = 20). Patients applied their 7-day treatment from the inclusion visit (V1) until the end-of-study visit (V2). Patients’ pharyngitis symptoms, general health, general treatment effectiveness and tolerability, and patient compliance were assessed by investigators and patients.ResultsThe sum score for three primary symptoms (pain on swallowing, urge to cough, and hoarseness) decreased by 79.5% (ectoine), 72.2% (hyaluronic acid), and 44.8% (saline gargle). Both lozenges were significantly superior to saline gargle (P < 0.05). Regarding general health improvement, ectoine was significantly superior to saline gargle (72.5% vs. 45.2%, P < 0.05), but hyaluronic acid (63.3%) was not. At V2, 65.7% of patients receiving ectoine reported “very good” general health vs. 48.6% of those receiving hyaluronic acid and 20.0% using saline gargle. Ectoine was significantly superior (P < 0.05) to both hyaluronic acid and saline gargle in terms of tolerability and patient compliance. No patients taking ectoine reported unpleasant sensations while applying their treatment, whereas almost half of patients using hyaluronic acid lozenges and saline gargle did.ConclusionTreatment with ectoine lozenges significantly relieves moderate-to-severe symptoms of acute viral pharyngitis and is more effective and tolerable than treatments with hyaluronic acid lozenges and hypertonic saline gargle.

Virtual humans as co-workers: A novel methodology to study peer effects

We introduce a novel methodology to study peer effects. Using virtual reality technology, we create a naturalistic work setting in an immersive virtual environment where we embed a computer-generated virtual human as the co-worker of a human subject, both performing a sorting task at a conveyor belt. In our setup, subjects observe the virtual peer, while the virtual human is not observing them. In two treatments, human subjects observe either a low productive or a highly productive virtual peer. We find that human subjects rate their presence feeling of “being there” in the immersive virtual environment as natural. Subjects also recognize that virtual peers in our two treatments showed different productivities. We do not find a general treatment effect on productivity. However, we find that competitive subjects display higher performance when they are in the presence of a highly productive peer - compared to when they observe a low productive peer. We use tracking data to learn about the subjects’ body movements. Analyzing hand and head data, we show that competitive subjects are more careful in the sorting task than non-competitive subjects. We also discuss some VR related methodological issues.

Phase II trial design with growth modulation index as the primary endpoint.

Molecularly targeted, genomic-driven, and immunotherapy-based clinical trials continue to be advanced for the treatment of relapse or refractory cancer patients, where the growth modulation index (GMI) is often considered a primary endpoint of treatment efficacy. However, there little literature is available that considers the trial design with GMI as the primary endpoint. In this article, we derived a sample size formula for the score test under a log-linear model of the GMI. Study designs using the derived sample size formula are illustrated under a bivariate exponential model, the Weibull frailty model, and the generalized treatment effect size. The proposed designs provide sound statistical methods for a single-arm phase II trial with GMI as the primary endpoint.

Which interventions work for dementia family carers?: an updated systematic review of randomized controlled trials of carer interventions.

A meta-analysis was carried out of randomized controlled trials of carer interventions using MEDLINE, PsycINFO, Scopus, and Cochrane Central Register of Controlled Trials. The majority of studies were conducted in Western and Southern Europe or the United States and recruited carers of people with Alzheimer's disease or dementia grouped as a whole. The most commonly used outcome measures were depression and burden across studies. The updated evidence suggested that psychoeducation-skill building interventions delivered face-to-face can better impact on burden. Psychotherapeutic interventions underpinned by Cognitive Behavior Therapy (CBT) models demonstrated strong empirical support for treating anxiety and depression and these effects were not affected by the mode of delivery (i.e. face-to-face vs. technology). A modern CBT approach, Acceptance and Commitment Therapy (ACT), seemed to be particularly beneficial for carers experiencing high levels of anxiety. Future research needs to explore the efficacy of interventions on multiple clinical outcomes and which combination of interventions (components) would have the most significant effects when using CBT. The generalization of treatment effects in different countries and carers of different types of dementia also need to be addressed. More research is needed to test the efficacy of modern forms of CBT, such as ACT.