High Attendance Research Articles

Handwriting without Tears® via Telehealth Delivery: A Case Study of Feasibility and Effectiveness for Handwriting and Spelling Outcomes

ABSTRACT In the current environment, the effects the pandemic have had on children remains unknown. Handwriting was not addressed effectively during online education, an occupation which pediatric occupational therapists are highly qualified to support with children, families, and schools. Concurrently, the use of telehealth as a service delivery method has increased, especially during the pandemic. The ease, flexibility, and satisfaction found with telehealth, time will dictate its continued use. This case study presents a preliminary investigation into the effectiveness and feasibility of the Handwriting Without Tears® (HWT) program via telehealth delivery for handwriting and spelling outcomes for a first grader. A case study pretest/posttest design was used to assess handwriting and spelling gains for a first grade female. The Print Tool and Alphabet15 were used to assess handwriting quality and handwriting speed respectively. The Test of Written Spelling-5 and the Primary Spelling Inventory were used to evaluate spelling. The participant completed 18 synchronous HWT telehealth visits over six weeks. The participant made handwriting legibility and speed gains, but the spelling results were inconclusive. The feasibility of the telehealth service delivery was confirmed with reported participant satisfaction, high attendance, and minimal accommodations required to translate the HWT program to telehealth. The high frequency visits as recommended by a previous systematic review anecdotally was deemed taxing by the participant and family. Further research is warranted to determine the effectiveness of HWT on literacy outcomes, such as handwriting and spelling, delivered via telehealth at a lower frequency of visit.

A Benefit-Cost Analysis of BackTrack, a Multi-Component, Community-Based Intervention for High-Risk Young People in a Rural Australian Setting.

BackTrack is a multi-component, community-based program designed to build capacity amongst high-risk young people. The aim of this study was to conduct a benefit-cost analysis of BackTrack, which was implemented in Armidale, a rural town in New South Wales, Australia. Costs and benefits were identified, measured and valued in 2016 Australian dollars. Costs were estimated from program financial and administrative records. Benefits were estimated using a pre-post design and conservative economic assumptions. Benefits included education attendance or completion; employment; engagement with health service providers; reduced homelessness; economic productivity; reduced vandalism to local infrastructure; reduced youth crime; reduced engagement with the justice system; and program income generated by participants. The counterfactual baseline was zero educational outcome, based on discussions with BackTrack staff and expert informants. We tested this assumption compared to the assumption that participants had a Year 8 education. There was evidence of significant quantifiable improvements in several outcomes: high school attendance or completion, vocational education attendance or completion, unskilled or vocationally qualified employment and economic productivity. Reduced homelessness, engagement with health services and acquisition of job readiness skills, as well as reduced local infrastructure vandalism and reduced crime were further quantifiable improvements. The net social benefit of BackTrack was estimated at $3,267,967 with a benefit-cost ratio of 2.03, meaning that every dollar invested in BackTrack would return $2.03 in benefits. BackTrack represents a viable funding option for a government interested in addressing the needs of high-risk young people.

Attendance in physical education classes, sedentary behavior, and different forms of physical activity among schoolchildren: a cross-sectional study

BackgroundAttendance in physical education classes (PE) helps young people to achieve the physical activity recommendations and to reduce their exposure to sedentary behavior. However, the association between PE attendance and the daily frequency of specific forms of physical activity is less known. The current study analyzed the association between weekly attendance in PE and daily frequencies of different forms of physical activity (active play, non-active play, structured physical activity), and overall daily frequencies of physical activity (PA) and sedentary behaviors (SB) among schoolchildren.MethodsCross-sectional study with schoolchildren from second to fifth grade of 11 public schools (n = 2,477; 9.1 ± 1.38-y-old; 53.2% girls; 17.5 ± 3.5 kg/m2) in Feira de Santana (Northeast Brazil). PA, SB, and attendance in PE were self-reported using a previously validated on-line questionnaire based on the previous day's recall (Web-CAAFE). Multiple Binomial Negative regression modeling was carried out to analyze the association (Prevalence Rate: PR) between weekly attendance in PE (0/week, 1/week, ≥ 2/week) and frequencies of active play, non-active play, and structured physical activity, with adjustments by age, school shift, and BMI z-scores. Regression models analyzing overall PA also included adjustments by household chores.ResultsAttendance in PE ≥ 2/week was associated with higher frequencies of active play (girls: PR = 1.40, 95%CI = 1.11–1.78; boys: PR = 1.49, 95%CI = 1.15–1.94) and structured physical activity (girls: PR = 2.11, 95%CI = 1.31–3.40; boys: PR = 4.33, 95%CI = 1.63–11.52). Higher attendance in PE (≥ 2/week) was associated with high overall PA (girls: PR = 1.31, 95%CI = 1.06–1.62; boys: PR = 1.42, 95%CI = 1.14–1.77) and low SB (girls: PR = 0.80, 95%CI = 0.71–0.90; boys: PR = 0.81, 95%CI = 0.68–0.97). Attendance in PE 1/week was also associated with a lower frequency of daily SB among girls (PR = 0.73, 95%IC = 0.64–0.84)ConclusionHigher weekly attendance in PE was associated with higher frequencies of active play, structured physical activity, higher overall PA, and lower SB among both girls and boys.

Delayed high school start times and graduation and attendance rates over 4 years: the impact of race and socioeconomics.

The current study was designed to examine if improvements in high school graduation and attendance rates persist 4 years after start times later than 8:30 am. Socioeconomic status and race were accounted for in the graduation analysis. School-wide attendance and graduation records (n = 28 schools) from 1999-2017 were analyzed in August of 2021 using a repeated-measures analysis of variance at 5 points in time, 1 year predelay and 4 consecutive years postdelay start times. Graduation rates for students in grade 12 (n > 47,000) after postdelay year 4 increased from 80% to 90% (P < .001) and attendance rates in grades 9-12 (n > 80,000) improved from 90% to 93% (P = .012). Attendance and graduation rates for all students improved after 4 years following a delayed start. Economically disadvantaged students and Black students showed significant changes in graduation rates postdelay year 4 and White students significantly improved postdelay years 2, 3, and 4. Adolescent students, especially economically and racially disadvantaged students, have a vulnerability for obtaining adequate sleep. Delaying high school start times is a cost-effective intervention that could promote sufficient sleep and boost graduation and attendance rates. McKeever PM, Dodd R, O'Sullivan DM. Delayed high school start times and graduation and attendance rates over 4 years: the impact of race and socioeconomics. J Clin Sleep Med. 2022;18(11):2537-2543.

Virtual individual cognitive stimulation therapy in Hong Kong: A mixed methods feasibility study

ObjectivesWe aimed to translate and culturally adapt Virtual Individual Cognitive Stimulation Therapy (V-iCST) for the Hong Kong (HK) Chinese population, and to evaluate its feasibility and acceptability. MethodsA mixed methods case series (N=8) was used to assess the feasibility of V-iCST and changes in cognition, quality of life (QoL), mood, and communication pre and post-test. Data were analyzed with the reliable change index. Thematic analysis of post-therapy interviews and content analysis of session rating forms were used to evaluate the acceptability. ResultsV-iCST was feasible with low attrition (0%) and high attendance (100%). Participants had reliable improvements in all outcomes. Six had improved and stable cognition; four had clinically significant changes in depression. There were no reliable changes in QoL. Qualitative analyses indicated V-iCST as acceptable but required assistance. ConclusionsV-iCST can be adapted for HK Chinese with dementia and potentially improve cognition, QoL, mood, and communication.

Cancer-related fatigue mediates the relationships between physical fitness and attendance and quality of life after participation in a clinical exercise program for survivors of cancer.

Cancer-related fatigue (CRF) is a common and limiting symptom reported by survivors of cancer, negatively impacting health-related quality of life (HRQoL). Exercise improves CRF, HRQoL, and physical fitness in survivors. Prospective research trials have shown that exercise-associated fitness improvements effects on HRQoL are mediated by CRF; however, this has not been investigated in a pragmatic real-world setting. This study utilizes data from a large heterogenous population of survivors participating in a clinical exercise program to investigate this mediation effect, as well as effects of program attendance. Data were collected from 194 survivors completing the BfitBwell Cancer Exercise Program (July 2016-February 2020). Changes in HRQoL, CRF, and fitness were calculated and program attendance collected. Basic correlation analyses were performed. Linear regression analyses were performed to assess mediation by CRF. All measures of CRF, HRQoL, and physical fitness significantly improved following the exercise program. Improvements in physical fitness were significantly correlated with improvements in HRQoL (r = 0.15-0.18), as was program attendance (r = 0.26) and CRF (r = 0.59). The effects of physical fitness and program attendance on HRQoL were at least partially mediated by the effects of CRF. This study extends research findings on how exercise programs improve HRQoL in survivors of cancer to a real-world setting. Results indicate that clinical exercise programs should target reductions in CRF in survivors (during or after treatment) through improvements in physical fitness to improve HRQoL and that high attendance should be encouraged regardless of fitness changes.

The Feasibility of a Mindfulness Intervention for Depression in People with Mild Dementia: A Pilot Randomized Controlled Trial

ABSTRACT Objectives This preliminary study aimed to establish the feasibility of running an adapted Mindfulness Based Cognitive Therapy (MBCT) intervention for people with mild dementia and depression. It also aimed to conduct an exploratory analysis as to whether the MBCT intervention would lead to greater improvements in measures of depression, anxiety, quality of life and cognition, as compared to treatment as usual (TAU). Methods A single-blind, multisite, feasibility randomized controlled trial was used. People with dementia and depression were recruited from participating memory services. Twenty participants were randomized to either an adapted MBCT and TAU group (n = 10) or TAU (n = 10). Measures of depression, anxiety, quality of life (QOL), and cognition were assessed at baseline and follow-up. Results The intervention was feasible in terms of high attendance and low levels of attrition. It was not judged feasible to recruit enough participants within the recruitment time-frame. The MBCT group did not show significant improvements in depression, anxiety, QOL, and cognition at follow-up, as compared to TAU. Conclusion There is currently inadequate evidence to recommend this adapted MBCT intervention for people with dementia for the treatment of depression within memory services. The MBCT intervention needs redevelopment and piloting before further testing in an RCT.

Organized Breast and Cervical Cancer Screening: Attendance and Determinants in Rural China.

To evaluate the attendance and determinants of organized cervical and breast cancer (two-cancer) screening, especially higher-level factors, we conducted a cross-sectional survey in central China from June 2018 to November 2019 among 1949 women (age ≥ 35 years). We examined organizer-level factors, provider-level factors, receiver-lever factors and attendance and participation willingness of screening. The results indicate that the attendance and participation willingness of organized two-cancer screening was 61.19% and 77.15%, respectively. After adjustment for potential confounders, women who received screening notification were more likely to have greater participation willingness and higher attendance than those who received no notification (adjusted odds ratio [aOR] = 1.59, 95% confidence interval [CI]: 1.27–1.99; aOR = 98.03, 95% CI: 51.44–186.82, respectively). Compared with being notified about screening by GPs, being notified by community women’s leaders and other community leaders were more likely to lead to greater willingness to participate again (aOR = 2.86, 95% CI: 1.13–7.24; aOR = 3.27, 95% CI: 1.26–8.48, respectively) and recommending screening to others (aOR = 2.18, 95% CI: 1.02–4.65; aOR = 4.14, 95% CI: 1.84–9.30, respectively). The results suggest that notification of women about screening by community leaders is an important organizer-level factor. As a part of public health services, the design and implementation of optimal cancer screening strategies may require public-sector involvement at the organizer level instead of a one-man show by the health sector.

Influence of Class Attendance on Academic Performance of Community Senior High School Students

Academic performance is one key measure of students’ success in schools and is of much concern in Ghana just as in other sub-Sahara African countries. It is influenced by a plethora of variables but not many studies have examined the influence of class att endance on learners learning success. This article examined class attendance and its correlation with academic performance of students in community senior high schools. A stratified random sample of 354 grades 11 and 12 students from three community senior high schools had their class attendance scores and end of term examination scores used. Pearson Product Moment correlation and independent sample t-Test were the statistical tools used. The study found that there was a positive correlation between students’ class attendance and their academic performance. There was a statistically significant difference between academic performance of students who had high class attendance and those who had low class attendance. Much focus should be placed on continuous assessment t o motivate students’ attend class regularly.

The 6-Month Efficacy of an Intensive Lifestyle Modification Program on Type 2 Diabetes Risk Among Rural Women with Prior Gestational Diabetes Mellitus: a Cluster Randomized Controlled Trial

This study aimed to evaluate the efficacy of an intensive lifestyle modification program tailored to rural Chinese women with prior gestational diabetes mellitus compared with usual care. In a cluster randomized controlled trial, 16 towns (clusters) in two distinct rural areas in China were randomly selected (8 towns per district); and 320 women with prior gestational diabetes mellitus were recruited from these towns. With stratification for the two study districts, eight towns (160 women) were randomly assigned to the intervention group of a tailored intensive lifestyle modification program and 8 towns (160 women) to the control group. Process measures were collected on attendance, engagement, fidelity, and satisfaction. Primary efficacy outcomes included glycemic and weight-related outcomes, while secondary efficacy outcomes were behavioral outcomes and type 2 diabetes risk score, which were collected at baseline, 3-month, and 6-month follow-up. Generalized estimation equations were used to analyze the data. High attendance (72% of sessions), engagement (67% of interactive activities and group discussions), fidelity (98%), and satisfaction (92%) with the tailored intensive lifestyle modification program were achieved. There were significant reductions in fasting blood glucose, oral glucose tolerance test 2 h, waist circumference, and type 2 diabetes risk score of participants in the intervention group compared to the control group (p < .05). There was no significant intervention effect on body mass index or behavioral outcomes (p > .05). In this study, we demonstrate the successful efficacy of an Intensive Lifestyle Modification Program in reducing type 2 diabetes risk among younger women with prior gestational diabetes mellitus. This tailored program delivered by local healthcare providers is a promising approach for diabetes prevention in rural China, reducing health disparities in rural communities about diabetes prevention. Registered in the Chinese Clinical Trial Registry (ChiCTR2000037956) on 3rd Jan 2018.

Participation of children and young people with cerebral palsy in activities of daily living in rural Uganda.

To compare the participation attendance and involvement of children and young people with and without cerebral palsy (CP) in a low-resource area of Uganda. Eighty-two children and young people with CP aged 6 to 22 years (49 males, 33 females) and 81 age- and sex-matched peers without CP (6 to 22 years; 48 males, 33 females) participated in this population-based, cross-sectional study. Data on attendance and involvement in 20 home and community activities were obtained using Picture My Participation, an instrument intended to measure participation in children with disabilities, particularly in low- and middle-income countries. Non-parametric statistical methods were used to assess between-group differences. Effect size estimates were calculated. Pooled attendance across all activities was lower in children and young people with CP than in children and young people without CP (p < 0.001) and for each activity item (p=0.004 to p < 0.001). The effect sizes for each activity were 0.2 to 0.7. Between-group differences were larger for community activities than for home activities. Pooled involvement across all activities was less in the group with CP (p < 0.001) and for each activity (p=0.014 to p < 0.001). The effect sizes for each activity were 0.2 to 0.5. Children and young people in Gross Motor Function Classification System (GMFCS) levels I and II had higher attendance (p < 0.001) and involvement (p=0.023) than those in GMFCS levels III to V. Participation of young people living with CP in Uganda was restricted, especially for community activities. There is a need to identify context-specific participation barriers and develop strategies to overcome them. Children and young people with cerebral palsy (CP) attended all activities less than their peers without CP. Differences in attendance were larger for community-based activities than home activities. When attending activities, children and young people with CP were less involved than their peers. Children and young people with milder impairments attended less frequently than their peers without CP. Children and young people with milder impairments attended more frequently than their peers with severe impairments.

Facilitative Supervision: Implementation and Contribution to Sustainability in Primary Healthcare Provision in the Upper West Region in Ghana,

Purpose –– This paper examines how Facilitative Supervision (FS) which focuses on mentoring, joint-problem solving and two-way communication between the supervisor and the supervisee has evolved to play a pivotal role in achieving the Sustainable Access to basic quality health care is a key development goal (SDG). in the Upper West Region of Ghana. Methods –– It employed semi-structured interviews, focus group discussions and observation to generate primary data to achieve its purpose. Thematic and content-of-voices analyses were adopted for the data analysis. Findings –– The study revealed improvement in maternal and child health care as facilities recorded high attendance for antenatal and child immunization in the study area. It was also discovered that, FS has helped both supervisors and supervisees become more confident and disciplined than before as they equipped themselves with latest and updated knowledge in their areas of work. Conclusion/Recommendation –– The paper recommends that FS should be adequately resourced and that stakeholders should improve road conditions and networks leading to and from health facilities to ease supervision, and organize trainer-of-trainers capacity building programmes, for adequate number of the supervisors.

Peer Group Support Intervention to Reduce Cardiovascular Disease Risk for African American Men According to Life's Simple 7 in Faith-Based Communities.

Adverse cardiovascular health disparities persist for African American men. Although changing health behaviors is perhaps one of the most effective methods to prevent cardiovascular disease (CVD)-related deaths, previous behavior change programs targeting single or multiple CVD risk factors in target groups have had mixed success. The purpose of this pilot study was to determine whether a multi-faceted peer group intervention model based on American Heart Association's Life's Simple 7 was feasible, safe, acceptable, and efficacious in producing meaningful risk reduction for African American men. A convenience sample of 24 African American men with at least one CVD risk factor participated quasi-experimental study having peer intervention vs. nonequivalent comparison groups, with pretest-posttests at two church sites in Minneapolis, MN (MPLS) and Washington, D.C. (DC). Feasibility, safety, acceptability, and potential efficacy were assessed by examining completion of peer group sessions, adverse events, attendance, attrition, within and between-group changes in measures using nonparametric statistics. All twenty-four men completed the study with no study-related adverse symptoms and medical events. The peer groups had moderate to high attendance, and the peer program evaluation was highly positive among participants. Between baseline and 6-months, there were significant differences between the intervention and the comparison group in cholesterol levels and weights (p = .041, p = .034, respectively) at one site (DC). There were no significant between-group changes at the other site (MPLS). The multi-faceted peer support intervention was feasible, acceptable, and shown to have potential efficacy to reduce CVD risk for highly motivated African American men. Future studies with a larger sample size are needed to test the effectiveness of this intervention model to reduce CVD risk among African American men.

Effects of Acceptance and Commitment Therapy on fatigue interference and health-related quality of life among patients with advanced lung cancer: A pilot randomized controlled trial

ObjectiveThe present study aimed to examine the feasibility and preliminary effects of Acceptance and Commitment Therapy (ACT) on fatigue interference and health-related quality of life in patients with advanced lung cancer. MethodsIn a single-blinded, parallel-group randomized controlled trial, 40 patients with advanced lung cancer were randomized to either the intervention group, which received the four-session individual ACT in 4 weeks, or the control group, which received usual care. The outcomes were evaluated at baseline and one week postintervention. ResultsIntervention feasibility and acceptability were established with a high attendance rate of 88.75% and a high retention rate of 75%. Approximately 95% of the participants reported satisfaction with the intervention. Despite the insignificant effects on fatigue interference, statistically significant interactions effects of ACT for health-related quality of life (P ​= ​0.001), cancer-related fatigue (P ​< ​0.001), depressive symptoms (P ​< ​0.001), anxiety (P ​< ​0.001), and distress (P ​= ​0.003) were noted. ConclusionsThis pilot trial supports the feasibility and acceptability of conducting ACT for patients with advanced lung cancer. The findings show the potential positive effects of ACT on health-related quality of life. Future studies with full-scale samples are recommended to evaluate the long-term effects of ACT on fatigue interference.

With You Until the End of the Age? A Longitudinal Study of Changes in Religiosity and Loneliness in Later Life.

With few exceptions, a vast literature on religion and well-being in later life has largely ignored outcomes of loneliness. The current study considers how changes in religiosity and formal religious participation over time associate with loneliness, and whether there are age differences in how this process unfold. Using data from the first two waves (2005-2006, 2010-2011) of the National Social Life, Health, and Aging Project (NSHAP) from the United States, results suggest that consistent religious attendance was associated with lower loneliness, while decreases in attendance were associated with higher loneliness. The association between stable high religious attendance and loneliness was stronger for older cohorts of older adults (65-74, and 75+ years of age). We found no such patterns for religious integration in daily life. We discuss the implications for church communities and family and friends of older adults and provide insights for addressing loneliness as a public health problem.

Mindfulness and Understanding of Self-Care for Leaders of Extension: Promoting Well-Being for Health Educators and Their Clients.

BackgroundMindfulness and self-care, practiced through a variety of methods like meditation and exercise, can improve overall sense of holistic well-being (i.e., flourishing). Increasing mindfulness and self-care may lead to increased flourishing and job satisfaction among the nation-wide Cooperative Extension system delivery personnel (agents) through a theory-based online program and an extended experiential program.MethodsCooperative Extension agents from two states were invited to participate in MUSCLE via statewide listservs. Participants were invited to attend sessions and complete competency checks and between-session assignments each week. The study was conducted using Zoom. Pre- and post- program surveys included validated scales for flourishing and physical activity status. Due to high demand for mindfulness programing during the onset of the COVID-19 pandemic, experiential “Mindful Meet-up” 30-minute sessions were held on Zoom. Dissemination and implementation of the two differing interventions (i.e., MUSCLE and Mindful Meet-ups) were examined.ResultsMUSCLE (more intensive program with assignments and competency checks) had lower reach, and did not show statistically increased flourishing or physical activity. Mindful Meet-ups had higher attendance and proportional reach during the beginning of the pandemic, but no practical measure of flourishing or physical activity behaviors. Unsolicited qualitative feedback was encouraging because the interventions were well-received and participants felt as though they were more mindful.ConclusionsWhile agents anecdotally reported personal improvements, capturing data on outcomes was challenging. Complementing outcome data with implementation and dissemination outcomes allowed for a richer picture to inform intervention decision-making (i.e., offering the same or new programming depending on participant needs).

Developing a novel treatment for patients with chronic pain and Opioid User Disorder

BackgroundIt is critical to develop empirically based, community-treatment friendly, psychotherapy interventions to improve treatment for patients with comorbid chronic pain and Opioid Use Disorder. Understanding factors that increase patient adherence and attendance is important, along with strategies targeted to address those issues.MethodsBased on initial psychophysiology research on adults with OUD and chronic pain, we created an integrated cognitive-behavioral, 12-week outpatient group therapy called STOP (Self-regulation Therapy for Opioid addiction and Pain). In this study, we pilot tested STOP in a Stage 1a feasibility and acceptability study to identify unique treatment needs and factors that increased session attendance, adherence to treatment, and improved outcomes. Fourteen individuals on medication for OUD with co-occurring chronic pain participated.ResultsSTOP had high attendance rates (80%; and active patient engagement). Urine toxicology showed no illicit drug use after week 8. Data analysis from pre-intervention to a 3-month follow-up showed significant functional improvement (F(1,12) = 45.82;p < 0.001) and decreased pain severity levels (F(1,12) = 37.62;p < 0.01). Participants reported appreciation of the unique tools to counteract physiological activation during a pain flare or craving. Participants also reported benefit from in-session visual aids, applicable pain psychology information, take-home worksheets, tools for relaxation practice, learning to apply the therapy tools.DiscussionSTOP is a 90-min 12-week rolling-entry group therapy based on previous research identifying psychophysiological needs of pain and OUD patients that can be seamlessly incorporated into community addiction treatment clinics.ConclusionPreliminary results of STOP are promising with high patient engagement and adherence and significant reductions in drug use and pain.Trial registrationClinicalTrials.Gov NCT03363243, Registered Dec 6, 2017.

Positive Outcomes in a Virtual Partial Hospitalization Program.

BackgroundPartial hospitalization programs (PHPs) are intensive outpatient mental health programs. During the COVID-19 pandemic, our PHP was converted from an in-person service to a completely virtual telehealth service. This study compared the outcomes of care between these two versions of our PHP.MethodsIn the live version of the program, care was provided to patients aged 18 to 65 years in person, five days a week, with five groups per day and additional services, such as family work. In the telehealth version, we attempted to provide the same services by HIPAA–secure videoconferencing and telephone, after educating staff and patients. The attendance at clinic, the hospitalization rate, and patient satisfaction with care were compared between the two program versions in the 12 months prior to and after the transition to virtual care.ResultsThere were 4,821 patient visits in the in-person program, and 4,371 in the telehealth program. Compared to the in-person program, the telehealth program was associated with a higher attendance (84.5% vs. 89.5%, p = 0.0168), a lower hospitalization rate (16.5% vs. 8.9%, p = 0.02), without a difference in the patient satisfaction rate, and with 74.3% of patients reporting improvement in their condition.ConclusionsA PHP completely delivered via telehealth was feasible to implement, and some outcomes with such a program were superior to those of a live PHP. Because this was a nonexperimental study, factors other than the method of service provision may have been responsible for the observed results.

Online Mindfulness-Based Cognitive Therapy for People with Parkinson's Disease and Their Caregivers: a Pilot Study.

Anxiety and depression are common non-motor symptoms of Parkinson’s disease (PD). Caregivers of people with PD may experience severe caregiver burden. This study explored the feasibility and potential benefits of an online mindfulness-based cognitive therapy (MBCT) intervention for improving anxiety and depressive symptoms in people with PD and their caregivers (ClinicalTrials.gov NCT04469049, 7/8/2020). People with PD or parkinsonism and anxiety and/or depressive symptoms and caregivers of people with PD participated in one of three online MBCT groups. Demographic variables, pre- and post-MBCT behavioral measures (GAD-7, PHQ-9, Five Facet Mindfulness Questionnaire — FFMQ-15, Caregiver Self-Assessment Questionnaire — CSAQ), and satisfaction surveys were collected. Descriptive statistics were used to summarize data. Pre- and post-MBCT behavioral scores were compared using mixed-effect models. Fifty-six potential participants were assessed for eligibility. Twenty-eight entered MBCT groups; all but one completed the intervention. The overall sample analyzed (22 people with PD, 4 caregivers) showed significant GAD-7 and PHQ-9 score reductions and FFMQ-15 total and observing and non-reactivity subscale score increases (all p’s < 0.05). Participants with PD and anxiety symptoms (n = 14) had a significant GAD-7 score reduction; those with PD and depressive symptoms (n = 12) had a significant PHQ-9 score reduction (both p’s < 0.05). Participants with PD also had a significant FFMQ-15 observing subscale score increase (p < 0.05). The caregiver sample was too small to be analyzed separately. Online MBCT is feasible (as measured by high attendance, completion rate, and participant satisfaction) and may be effective in improving anxiety and depressive symptoms in people with PD.

Selection for male stamina can help explain costly displays with cost-minimizing female choice

In many species, male lifespan is shorter than that of females, often attributed to sexual selection favouring costly expression of traits preferred by females. Coevolutionary models of female preferences and male traits predict that males can be selected to have such life histories; however, this typically requires that females also pay some costs to express their preferences. Here we show that this problem diminishes when we link coevolutionary models of costly mate choice with the idea of stamina. In our model, the most successful males are those who can combine high attendance time on a lek — or, more generally, tenacious effort in their display time budgets — with high viability such that they are not too strongly compromised in terms of lifespan. We find that an opportunistic female strategy, that minimizes its costs by mating with highly visible (displaying) males, often beats other alternatives. It typically resists invasion attempts of genotypes that mate randomly in the population genetic sense, as well as invasion of stricter ways of being choosy (which are potentially costly if choice requires e.g. active rejection of all males who do not presently display, or risky travel to lekking sites). Our model can produce a wide range of male time budgets (display vs. self-maintenance). This includes cases of alternative mating tactics where males in good condition spend much time displaying, while those in poor condition never display yet, importantly, gain some mating success due to females not engaging in rejection behaviours should these be very costly to express.Significance statementIn many species, males spend much time and energy on displaying to attract females, but it is not always clear what females gain from paying attention to male displays. The tradition in mathematical models attempting to understand the situation is to assume that random mating is the least costly option for females. However, random mating in the population genetic sense requires females to behave in a manner that equalizes mating success between displaying and non-displaying males, and here we point out that this is biologically unlikely. Opportunistically mating females can cause males to spend much of their time budgets displaying and will shorten male lifespans in a quality-dependent manner.