Greater Use Research Articles

Emotion malleability beliefs matter in emotion regulation: a comprehensive review and meta-analysis

ABSTRACT Individuals’ beliefs about the malleability of emotions have been theorised to play a role in their psychological distress by influencing emotion regulation processes, such as the use of emotion regulation strategies. We conducted a meta-analysis to test this idea across studies with a focus on the relationships between emotion malleability beliefs and five distinct emotion regulation strategies: cognitive reappraisal, suppression, avoidance, rumination, and acceptance. Further, using two-stage meta-analytic structural equation modelling (TSSEM), we examined whether the emotion regulation strategies mediate the cross-sectional relationship between emotion malleability beliefs and psychological distress across studies. Thirty-seven studies were included in the meta-analyses and 55 cross-sectional studies were included in the TSSEM. Results demonstrated that, across studies, emotion malleability beliefs were significantly associated with greater use of putatively helpful strategies (particularly with cognitive reappraisal) and less use of putatively unhelpful strategies (particularly with avoidance). The use of cognitive reappraisal and avoidance partially mediated the relationship between emotion malleability beliefs and psychological distress. These results highlight the importance of considering beliefs about the malleability of emotions in the context of emotion regulation. These findings suggest the potential role of emotion malleability beliefs in interventions for individuals with emotion regulation-related difficulties and psychological distress.

Sex Differences in Low-Density Lipoprotein Cholesterol Treatment Among Young Israeli Patients Following Premature Acute Coronary Syndrome.

Introduction: Effective management of dyslipidemias is crucial for reducing morbidity and mortality among patients after acute coronary syndrome (ACS). Sex differences in dyslipidemia management after premature ACS in Israeli patients have not been extensively studied. This study aimed to investigate potential disparities between men and women in managing dyslipidemia, considering current guidelines. Methods: This retrospective cohort study examined patients who were 55 years old or younger and admitted to Meir Medical Center for ACS from January 2018 to February 2019. The study aimed to evaluate the use of lipid-lowering therapy (LLT), measure the achievement of target low-density lipoprotein cholesterol (LDL-C) levels, and analyze the occurrence of major adverse cardiovascular and cerebrovascular events (MACCE) in both male and female patients. Results: The study included a total of 687 participants, of which 23.3% were identified as females. Upon discharge, ∼80% of the patients were prescribed high-intensity statins. After 1 year, it was observed that females had higher levels of LDL-C and lower rates of achieving target LDL-C levels (<70 and 55 mg/dL) as compared with males (45% vs. 54.6% and 30% vs. 42.2%, respectively). The use of non-statin LLT at the 1-year mark was minimal in both groups. Finally, it was found that the occurrence of MACCE was similar between males and females. Conclusion: Sex disparities in dyslipidemia management after a premature ACS were apparent, with females having higher LDL-C levels and lower rates of target achievement. Intervention is necessary to address these disparities and encourage greater use of non-statin LLT.

Affectation of COVID-19 pandemic on the use and abundance of wild resources in Tabasco, Mexico: A qualitative assessment.

Southern Mexico is particularly rich in natural resources, yet unemployment has risen to 8% during the COVID-19 pandemic. The effect of the pandemic on the use and abundance of Tabasco's wild resources was examined through personal surveys. By using Microsoft Forms® with cell phones 1,963 surveys were collected. Cronbach's alpha, Z-value, and chi2 were calculated using the MAXQDA Analytics Pro program. A higher abundance of wild resources before the pandemic than today (57% vs. 11%) was observed. During the pandemic, people referred more to a high use (28%) of resources than to a low use (20%). This caused the low abundance or scarcity of wild products to be greater during the pandemic than before the pandemic (43% vs. 4%). Wild foods and timber were the most used products. The pandemic has produced a greater use of natural resources probably due to the high unemployment rate in rural areas. Future studies of wild products should address the relevant products in the locality and their even sampling. Finding suitable respondents is highly recommended.

Metacognitive strategies mediate the association between metacognitive beliefs and perceived quality of life.

Quality of life may be understood as a multidimensional evaluation of life circumstances in relation to values, expectations, and perceived well-being. Quality of life is thus dependent on the subjective perception of the current life situation, not only objective circumstances. According to metacognitive theory, metacognition guides the appraisal of inner experiences (i.e., thoughts and feelings) and influences how one relates to external stressors. Hence, dysfunctional metacognitive beliefs and the cognitive attentional syndrome (CAS), which includes perseverative thinking, threat monitoring and ineffective coping strategies, may negatively influence subjective quality of life. Therefore, we aimed to investigate if metacognitive beliefs and CAS strategies were associated with quality of life. A sample of 503 participants (77.1% women, mean age 41.0, SD = 11.5) completed the metacognitions questionnaire 30 (MCQ-30), the CAS-1 and the quality of life scale (QOLS). We used structural equation modelling (SEM) to estimate associations between the variables founded in metacognitive theory. The results of the SEM showed a significant direct relationship between metacognitive beliefs and quality of life. CAS strategies mediated the effect of metacognitive beliefs on quality of life. Higher level of metacognitive beliefs was associated with greater use of CAS strategies, which in turn was associated with lower quality of life. Further, more CAS strategies were associated with lower quality of life. The results support the generic metacognitive model and suggest that stronger endorsement of dysfunctional metacognitive beliefs and corresponding CAS strategies are associated with lower quality of life. This observation held even when controlling for relevant covariates and suggests that modifying metacognitive beliefs may impact on subjective quality of life.

The Effect of Body Temperature Changes on the Course of Treatment in Patients With Pneumonia and Sepsis: Results of an Observational Study.

Traditionally, patients who are critically ill with infection and fever have been treated with antipyretics or even physically cooled. Presumed benefits of the reduction of body temperature are mostly based on decreased metabolic demands. However, it has been shown that decreasing body temperature in patients who are critically ill is not associated with improvement in treatment outcomes. Additionally, there is some data to support the use of temperature modulation (therapeutic hyperthermia) as an adjuvant treatment strategy in patients with infection. This study aims to determine the effect of body temperature on the course of intensive care unit (ICU) treatment of patients who are mechanically ventilated with pneumonia, sepsis, and positive tracheal aspirates on admission. We performed a single-center retrospective study. Core body temperature was measured in all patients. We analyzed associations between average temperatures in the first 48 hours after admission to ICU and ICU treatment parameters. Additionally, patients were divided into three groups: patients with negative tracheal aspirates 1 week after ICU admission (P-N group), patients with a different pathogen in tracheal aspirates 1 week after ICU admission (P-HAP group), and patients with a persisting pathogen in tracheal aspirates 1 week after ICU admission (P-P group). Differences in body temperature and interventions aimed at temperature modulation were determined. We observed a significantly higher average temperature in the first 48 hours after admission to ICU in patients who survived to hospital discharge compared to nonsurvivors (mean 37.2 °C, SD 1 °C vs mean 36.9 °C, SD 1.6 °C; P=.04). We observed no associations between average temperatures in the first 48 hours after ICU admission and days of mechanical ventilation in the first 7 days of treatment (ρ=-0.090; P=.30), the average maximum daily requirement for noradrenaline in the first 7 days of treatment (ρ=-0.029; P=.80), average maximum FiO2 in the first 7 days of ICU treatment (ρ=0.040; P=.70), and requirement for renal replacement therapy in the first 7 days of ICU treatment (mean 37.3 °C, SD 1.4 °C vs mean 37.0 °C, SD 1.3 °C; P=.23). In an additional analysis, we observed a significantly greater use of paracetamol in the P-N group (mean 1.0, SD 1.1 g vs mean 0.4, SD 0.7 g vs mean 0.4, SD 0.8 g; P=.009), a trend toward greater use of active cooling in the first 24 hours after ICU admission in the P-N group (n=11, 44% vs n=14, 33.3% vs n=16, 32%; P=.57), and no other significant differences in parameters of ICU treatment between patient groups. We observed better survival in patients who developed higher body temperatures in the first 48 hours after admission to the ICU; however, we observed no changes in other treatment parameters. Similarly, we observed greater use of paracetamol in patients with negative tracheal aspirates 1 week after ICU admission. Our results support the strategy of temperature tolerance in patients who are intubated with pneumonia and sepsis.

Identifying who benefits most from supportive versus expressive techniques in psychotherapy for depression: Moderators of within- versus between-individual effects.

A recent randomized controlled trial (RCT) indicated that individuals with higher levels of attachment anxiety exhibited better treatment outcomes in supportive-expressive therapy (SET) relative to supportive therapy (ST). But to gain insight into within-patient therapeutic changes, a within-individual design is required. The present study contrasts previous findings based on theory-driven between-patient moderators with data-driven moderators of within-patient processes to investigate whether findings converge or diverge across these two approaches. We used data of 118 patients from the pilot and active phases of a recent RCT for patients with major depressive disorder, comparing ST with SET, a time-limited psychodynamic therapy. The predefined primary outcome measure was the Hamilton Rating Scale for Depression. Supportive versus expressive techniques were rated based on patients' end-of-session perspective. We compared previous findings based on moderators of between-patient effects with a data-driven approach for identifying moderators of within-patient effects of techniques on subsequent outcome. After false discovery rate corrections, of 10 preselected moderators, patients' attachment anxiety and domineering style remained significant. Of these, bootstrap resampling revealed significant differences between ST and SET techniques for the attachment anxiety moderator: Those with higher attachment anxiety benefited more from greater use of ST than SET techniques in a particular session, as evidenced by lower levels of symptoms at the subsequent session. Our within-individual findings diverge from previously published between-individual analyses. This proof-of-concept study demonstrates the importance of complementing between-individuals with within-individual analyses to achieve better understanding of who benefits most from specific treatment techniques. (PsycInfo Database Record (c) 2024 APA, all rights reserved).

The motivation to integrate and perceived discrimination as antecedents of cultural identity styles.

The research examined the motivation to integrate and perceived discrimination as antecedents of cultural identity styles, the cognitive and behavioral strategies that bicultural individuals use for decision making in managing and maintaining their ethnic and national identities. Two major cultural identity styles have been distinguished: the alternating identity style (AIS, changing cultural identities depending on the circumstances) and the hybrid identity style (HIS, blending selected aspects of these identities in a unique way). Based on earlier cross-sectional research, we tested the hypotheses that the motivation to integrate would predict greater use of both styles and that perceived discrimination would predict greater use of the AIS, but not the HIS, over time. A community sample of 493 Chinese Americans (56% female, 51.5% first generation, Mage = 53.27 years) completed an online survey at two points in time with approximately a 1-month interval. Path modeling controlling for demographic factors (age, generation) and cultural identity style (AIS and HIS at T1) was used to test our hypotheses. Analyses revealed that younger Chinese Americans made greater use of the AIS and that both the motivation to integrate and perceived discrimination were significant predictors of the AIS at T2. In contrast, only the motivation to integrate predicted the HIS at T2, confirming our hypotheses. The results demonstrate that both personal and situational factors affect the management of cultural identities. The findings are discussed in relation to research on acculturation and integration and theories of social and situated identity identities. (PsycInfo Database Record (c) 2024 APA, all rights reserved).

과학 수업에서 디지털 자료를 활용한 수업이 초등학생들의 디지털 소양에 미치는 영향과 디지털 수업에 대한 인식에 미치는 영향

The purpose of this study was to investigate the effects of classes using digital textbooks and digital materials on elementary school students' digital literacy and their perception of digital classes, focusing on the expansion of the visual data area in science classes. For the 5th and 6th graders of elementary schools in the central region, classes centered on traditional book textbooks and classes using digital textbooks were conducted to compare the degree of improvement in digital literacy. 158 5th grade students and 146 6th graders were participated in. Classes using book-type textbooks and digital textbooks were conducted 3 times a week for 3 months, for a total of 12 weeks, from October to December to research subjects with similar living conditions and economic levels, and digital literacy tests were conducted before and after. As a result, students who used digital textbooks showed a partially statistically significant change in the degree of improvement in digital literacy compared to students in the control group. As a result of analysis by dividing into five areas: collection of information, utilization and management of information, utilization and evaluation of media, utilization of smart devices, and understanding and practice of copyright and Internet ethics, Comparing the pre-test and post-tests in the experimental and control groups, each showed significant changes in digital literacy. This is a result that runs counter to the idea that digital literacy can only be improved by making greater use of digital materials. However, students who consistently use it are able to induce more changes in terms of digital literacy than students who do not. In addition, students who used digital textbooks preferred classes using audio-visual materials such as digital textbooks more than classes using general photos or book-type textbooks, and had comfort and confidence in using digital devices such as computers and tablet PCs. In addition, it was found that science classes using materials were more preferred. However, among students' individual responses or interviews, some responded that learning was more effective in traditional teaching, research through scientist interviews, and explanations through images or diagrams.

Different Trends of World &amp; Ethiopian Local Soybean Based Recipes and Their Health Benefits: A Review

Soybean (Glycine max L.) accounts for 25% of global vegetable oil production. It is a high-protein, high-nutritional-value food that is beneficial for chronic disease prevention and treatment, alleviates depressive symptoms, and improves skin health, fiber, high in calcium and magnesium, essential amino acids, anthocyanin, saponins, lipids, and oligosaccharides. According to epidemiological studies, consumption of soybean based foods provides the advantages of lowering the prevalence of heart disease, reducing the chance of an ischemic stroke, and lowering cholesterol, which reduces the likelihood of atherosclerosis. It is effective against a wide range of malignancies, including breast, prostate, colorectal, ovarian, and endometrial cancers. Soybean recipe have antioxidant properties and helps to ease menopausal symptoms in women as well as lower the risk of type 2 diabetes. Isoflavones, a phytochemical present in soybeans, have numerous health benefits. Soybean recipes (dishes) are created in varied ways and composite ratios in different countries. Soy milk, bread, enjera, tofu and kukis are a few examples in Ethiopia. In all types of the recipes prepared, their nutritional compositions are outstanding and delicious in their tastes. The large population of Ethiopian Orthodoxy Christianity followers are not allowed during seasons of fasting, to consume proteins derived from animals. Hence soybean foods are good alternatives during those fasting days for the problem of protein malnutrition and vitamin A absorption. Ethiopian traditional unique foods like enjera, bread, wot, kitta, biscuit, kukis etc. can be prepared from soybean mixed flour. Owing to its superior nutritional value as a well-balanced diet and several health advantages, we advise making greater use of soybean-based recipes, oils, and products.

Temporal and region-specific tau hyperphosphorylation in the medulla and forebrain coincides with development of functional changes in male obese Zucker rats.

Metabolic syndrome (MetS) is associated with development of tauopathies that contribute to cognitive decline. Without functional leptin receptors, male obese Zucker rats (OZRs) develop MetS, and they have increased phosphorylated tau (ptau) with impaired cognitive function. In addition to regulating energy balance, leptin enhances activation of the hippocampus, which is essential for spatial learning and memory. Whether spatial learning and memory are always impaired in OZRs or develop with MetS is unknown. We hypothesized that male OZRs develop MetS traits that promote regional increases in ptau and functional deficits associated with those brain regions. In the medulla and cortex, tau-pSer199,202 and tau-pSer396 were comparable in juvenile (7-8 wk old) lean Zucker rats (LZRs) and OZRs but increased in 18- to 19-wk-old OZRs. Elevated tau-pSer396 was concentrated in the dorsal vagal complex of the medulla, and by this age OZRs had hypertension with increased arterial pressure variability. In the hippocampus, tau-pSer199,202 and tau-pSer396 were still comparable in 18- to 19-wk-old OZRs and LZRs but elevated in 28- to 29-wk-old OZRs, with emergence of deficits in Morris water maze performance. Comparable escape latencies observed during acquisition in 18- to 19-wk-old OZRs and LZRs were increased in 28- to 29-wk-old OZRs, with greater use of nonspatial search strategies. Increased ptau developed with changes in the insulin/phosphatidylinositol 3-kinase (PI3K)/Akt signaling pathway in the hippocampus and cortex but not medulla, suggesting different underlying mechanisms. These data demonstrate that leptin is not required for spatial learning and memory in male OZRs. Furthermore, early development of MetS-associated autonomic dysfunction by the medulla may be predictive of later hippocampal dysfunction and cognitive impairment.NEW & NOTEWORTHY Male obese Zucker rats (OZRs) lack functional leptin receptors and develop metabolic syndrome (MetS). At 16-19 wk, OZRs are insulin resistant, with increased ptau in dorsal medulla and impaired autonomic regulation of AP. At 28-29 wk OZRs develop increased ptau in hippocampus with deficits in spatial learning and memory. Juvenile OZRs lack elevated ptau and these deficits, demonstrating that leptin is not essential for normal function. Elevated ptau and deficits emerge before the onset of diabetes in insulin-resistant OZRs.

Linguistic analysis of health anxiety during the COVID-19 pandemic.

Health anxiety, which is defined as fear of having or contracting serious physical illness, is particularly salient in light of the COVID-19 pandemic. We conducted a mixed methods study in which 578 narrative samples were analyzed using Linguistic Inquiry and Word Count (LIWC) software to determine linguistic markers from six LIWC categories relevant to cognitive-behavioral features of health anxiety. Broad linguistic predictors were analyzed through three backward elimination regression models in order to inform subcategory predictors of each area of health anxiety. Thus, both broad and specific linguistic predictors of general health anxiety, virus-relevant body vigilance, and fears of viral contamination were examined. Greater use of affective category words in written narratives predicted general health anxiety, as well as body vigilance and viral contamination fears. These findings represent the first direct demonstration of linguistic analysis of health anxiety and provide nuanced information about the nature and etiology of health anxiety.

DETERMINING FACTORS IN THE ADOPTION OF PRECISION AGRICULTURE TECHNOLOGIES BY GRAIN PRODUCERS

The adoption of precision agriculture technologies (PAT) has contributed significantly to the development of a more sustainable agriculture with a greater use of inputs, cost reduction, and increased productivity. Also, information arising from reports generated using these technologies allows farmers to manage their property more efficiently. Despite the benefits to the management of production and use of inputs, many farmers still do not use precision agriculture technologies on their property or use them only partially. The objective of this study is to investigate the farmers' perception about the use of PAT and determine which factors influence adoption of PAT. To this end, 133 soy producers from different states of Brazil were interviewed. Multiple logistic regression was used to build the estimated model (MA2). Education level, producer experience, planted area with maize, and government agencies as a source of information have a statistically significant influence on the adoption of PAT.

‘Go-No-Go’: Anticommons and Inter-ministerial conflict in India’s Forest and Mineral Governance

India’s forests, particularly in coal and other mineral-bearing regions, have been at the centre of many social and environmental conflicts. Such conflicts will likely remain salient over the next decade as India appears to be moving towards greater use of coal instead of transitioning away from it. The current governance architecture in mineral-bearing forested areas is characterized by fragmentation of rights across different stakeholders and a pluralistic institutional regime – a situation often characterized as ‘anticommons.’ ‘Anticommons’ lead to the resource getting gridlocked and underused. The Indian government undertook a critical and ambitious policy design exercise – the ‘Go-No-Go’ or Inviolate Forest Policy (IFP) policy – to address the resource dilemmas by ‘objectively’ demarcating forests for mining and conservation. This paper traces the conflict around the policy formulation as it manifested in the corridors and ministries of the government. We use a novel data source of government records of formal policy deliberations – obtained through India’s transparency law, Right to Information (RTI) – supported by conversations with senior bureaucrats, policymakers, and expert observers. We find that the quest for ‘objective’ demarcation of ‘pristine’ forests for conservation was marked by inter-ministerial conflict, laden with asymmetric power balances and involving the careful deployment of discursive frames and tactical maneuvers. We argue that the multiplicity of use-values that get valued differently a) by different individuals/groups of individuals and b) at different scales inscribe the possibility of conflict at the heart of any attempt to resolve anticommons, as can be seen in the IFP. In the process, we expose the problems in prioritizing amongst competing resource-uses, using ‘efficiency’-based approaches. Further, our analysis presents an implicit critique of the monolithic understanding of the State in the supply of property rights.

Disciplinary welfare and the punitive turn in criminal justice: Parallel trends or communicating vessels?

When it comes to the relationship between social policy and penal policy, existing scholarship often focuses on the penal–welfare tradeoff, according to which countries with large and generous welfare states tend to have lower incarceration rates and less harsh treatment of offenders. We know much less about the relationship between the punitive turn in criminal justice and the use of discipline within social policy. Has there been a parallel trend of law-and-order policies and stricter benefit conditionality, a kind of ‘criminalization’ of welfare beneficiaries, as critical scholarship suggests? We test this idea for the first time with quantitative data, using public spending on public order and safety and unemployment benefit conditionality data for 18 rich democracies between 1990 and 2012, that is, the period when a punitive turn as well as the rise of activation and workfare is said to have taken place. Contrary to the critical literature, we do not find evidence of parallel trends toward more discipline in both areas, but rather a negative relationship of ‘communicating vessels’, where a greater use of disciplinary tools in social policy is associated with stagnating or even shrinking spending on police and prisons. Moreover, this pattern tends to emerge under conditions of higher welfare state generosity. These findings have important implications about the role of state ‘discipline’ in contemporary policymaking.

The dark side of Artificial Intelligence – Risks arising in dating applications

Key digested messageHiding behind a smartphone screen, online dating applications provide a playground of opportunity for fraudsters and scammers. With ease of access to artificial intelligence, the technological capabilities of nefarious individuals are quickly growing. From sophisticated chatbots designed to engage in conversations and extract personal data, to deepfake technology used to create convincing false personas. This article summarises the current and upcoming risks which artificial intelligence poses to dating application and social media users. Deepfake technology is a key risk; the world is experiencing greater use of attractive deepfake images to convince dating app users into involvement in a romance scam, face-swaps to target and blackmail social media users with their intimate images, and instant generation of child sexual abuse material. Other risks include stalkers tracking their victims with greater ease, and individuals downloading nefarious dating applications which utilise chatbots to gather information and get paid. Gaps in empirical research are identified and discussed.

Burden and quality of life of family caregivers of Alzheimer’s disease patients: the role of forgiveness as a coping strategy

Objectives This study aimed to evaluate the variables that  were associated, contributed and moderated quality of life (QoL) and burden in family caregivers. Methods A total of 130 participants were evaluated using the following instruments: Depression, Anxiety and Distress Scale; Index of Family Relations; Heartland Forgiveness Scale; Burden Interview Scale; Short Form Health Survey. Results Being a younger caregiver, less distress, better family relationships and greater use of forgiveness were associated with more QoL. Also, family caregivers who chosethe caregiving role, less distress, better family relationships and greater use of forgiveness showed lower levels of burden. Age, distress and forgiveness contributed to QoL. In turn, the choice to become a family caregiver, distress, and forgiveness contributed to burden. Forgiveness played a moderating role in the relationship between family relationships and burden. Conclusion Based on the results, there is a need to intervene in older family caregivers, particularly those who did not choose to become a caregiver, who report greater distress, have worse family relationships, and display less use of forgiveness, in order to decrease their burden and promote QoL.

Emotion Regulation Use Varies Across Socioecological Levels of Pandemic Stress in Older Adults

ABSTRACT Objectives COVID-19 escalated stress within family/neighborhood (local) and national/cultural (global) levels. However, the impact of socioecological levels of stress on pandemic emotion regulation remains largely unexplored. Methods Thirty older adults from the Northeast US (63–92 years) reported on pandemic stress and emotion regulation in semi-structured interviews. Responses were coded into socioecological sources of local and global stress, and associated use of cognitive emotion regulation strategies from the Cognitive Emotion Regulation Questionnaire was explored. Results Older adults experienced significant distress at global levels, and perception of lacking top-down safety governance may have exacerbated local distress of engaging in daily activities during the COVID-19 pandemic. Participants endorsed coping with local stressors via perspective-taking, acceptance, and other adaptive strategies, while global sources of stress were associated with greater use of maladaptive strategies, including other-blame and rumination. Conclusion Quantitative assessments may underestimate significant older adult distress and maladaptive coping toward global stressors. Findings should be replicated with more diverse populations beyond the COVID-19 context.

Differential relations between breathing retraining, in vivo exposure, and imaginal exposure homework completion and treatment outcomes in veterans receiving prolonged exposure for PTSD.

Limited research exists that outlines the predictive relevance of the treatment components of prolonged exposure (PE) for post-traumatic stress disorder (PTSD) on PTSD and depression symptom outcomes. The goal of the present study was to investigate relations between participant completion of breathing retraining, in vivo exposure, and imaginal exposure exercises and symptom outcomes. A total of 58 participants completed a trial of PE as part of a larger trial on peer involvement and treatment adherence. Diagnostic and self-report measures were completed throughout treatment. Participants also recorded weekly completion of breathing retraining, in vivo exposure, and imaginal exposure exercises. Pearson correlations and hierarchical regression analyses were used to investigate relations between average weekly treatment component completion and treatment outcomes, controlling for relevant variables. Although breathing retraining and in vivo exposures were associated with PTSD outcomes in the correlational findings, use of breathing retraining, in vivo exposures, and imaginal exposures were not reliably associated with PTSD symptom outcomes when controlling for other variables in the regression analysis. However, when investigating changes in comorbid symptoms of depression, greater use of breathing retraining was associated with decreased symptoms of depression at posttreatment. Present findings demonstrate the differential relations between participation in various PE treatment components and posttreatment symptom outcomes. The importance of breathing retraining in addressing comorbid depressive symptoms is discussed, with emphasis on potentially increasing relaxation and positive activities more broadly to encourage further treatment benefits.

Group sequential designs for pragmatic clinical trials with early outcomes: methods and guidance for planning and implementation

BackgroundGroup sequential designs are one of the most widely used methodologies for adaptive design in randomized clinical trials. In settings where early outcomes are available, they offer large gains in efficiency compared to a fixed design. However, such designs are underused and used predominantly in therapeutic areas where there is expertise and experience in implementation. One barrier to their greater use is the requirement to undertake simulation studies at the planning stage that require considerable knowledge, coding experience and additional costs. Based on some modest assumptions about the likely patterns of recruitment and the covariance structure of the outcomes, some simple analytic expressions are presented that negate the need to undertake simulations.MethodsA model for longitudinal outcomes with an assumed approximate multivariate normal distribution and three contrasting simple recruitment models are described, based on fixed, increasing and decreasing rates. For assumed uniform and exponential correlation models, analytic expressions for the variance of the treatment effect and the effects of the early outcomes on reducing this variance at the primary outcome time-point are presented. Expressions for the minimum and maximum values show how the correlations and timing of the early outcomes affect design efficiency.ResultsSimulations showed how patterns of information accrual varied between correlation and recruitment models, and consequentially to some general guidance for planning a trial. Using a previously reported group sequential trial as an exemplar, it is shown how the analytic expressions given here could have been used as a quick and flexible planning tool, avoiding the need for extensive simulation studies based on individual participant data.ConclusionsThe analytic expressions described can be routinely used at the planning stage of a putative trial, based on some modest assumptions about the likely number of outcomes and when they might occur and the expected recruitment patterns. Numerical simulations showed that these models behaved sensibly and allowed a range of design options to be explored in a way that would have been difficult and time-consuming if the previously described method of simulating individual trial participant data had been used.

Clinical and Economic Burden of Antibiotic Use Among Pediatric Patients With Varicella Infection in the Outpatient Setting: A Retrospective Cohort Analysis of Real-world Data in France.

Varicella infects 90% of children before age 9. Though varicella is self-limiting, its complications may require antibiotics, though how antibiotics are utilized for varicella in France is not well known. This study assessed antibiotic use and costs associated with varicella and its complications in pediatric patients managed in the outpatient setting in France. A retrospective cohort study using the Cegedim Strategic Data-Longitudinal Patient Database, an electronic medical record database from general practitioners and office-based specialists in France, was conducted. Children <18 years old diagnosed with varicella between January 2014 and December 2018 with 3-month follow-up available were included. We used descriptive analysis to assess varicella-related complications, medication use, healthcare resource utilization and costs. Overall, 48,027 patients were diagnosed with varicella; 15.3% (n = 7369) had ≥1 varicella-related complication. Antibiotics were prescribed in up to 25.1% (n = 12,045/48,027) of cases with greater use in patients with complications (68.1%, n = 5018/7369) compared with those without (17.3%, n = 7027/40,658). Mean medication and outpatient varicella-related costs were €32.82 per patient with medications costing a mean of €5.84 per patient; antibiotics contributed ~23% to total costs annually. This study showed high antibiotic use for the management of varicella and its complications. A universal varicella vaccination program could be considered to alleviate complications and associated costs in France.