Individual Goal Setting Research Articles

A Randomized Controlled Trial on the Effects of a 6-Month Home-Based Physical Activity Program with Individual Goal-Setting and Volunteer Mentors on Physical Activity, Adherence, and Physical Fitness in Inactive Older Adults at Risk of Cognitive Decline: The INDIGO Study

Background: Increasing physical activity (PA) in those who have memory concerns requires innovative approaches. Objective: To compare in this randomized controlled trial (RCT) the effects on PA, adherence, and fitness of two approaches to deliver a 6-month home-based PA program in older, inactive individuals at risk of cognitive decline. Methods: Individuals (n = 52) aged 60–85 years, inactive with mild cognitive impairment or subjective cognitive decline were recruited from the community and memory clinics. Randomization was to 6 months of 150 min/week moderate intensity PA with either: goal-setting with mentor support; or education and peer contact. A subset of participants (n = 36) continued for a further 6 months. PA, moderate and vigorous PA, and secondary outcomes, fitness, goal performance/satisfaction and self-efficacy were assessed at baseline, 6 and 12 months. Modelling of primary and secondary outcomes was conducted with linear mixed models. Results: Participants were mean age (±sd) 70.1 (6.4) years. Six-month retention was 88.5%(n = 46). No significant between-group differences were observed for PA or fitness. Post-hoc combined group data showed a significant, moderate-large effect size increase in PA with time. PA increased by a mean 1,662 (943, 2383) steps/day (95%CI) and 1,320 (603, 2037) steps/day at 6 and 12 months (p < 0.001). Median (quartiles Q1-Q3) 6 and 6–12 month combined group adherence was 88.9 (74.4–95.7)%and 84.6 (73.9–95.4)%respectively. Conclusion: In this target group, no differences were detected between groups both intervention strategies were highly effective in increasing PA and fitness.

Building a culture of early mobilization in the pediatric intensive care unit-a nuts and bolts approach.

The culture of sedation and immobilization in the pediatric intensive care unit (PICU) is associated with PICU-acquired weakness, delirium, and poor functional, neurocognitive and psychosocial outcomes. A structured approach to introducing physical activity, as early as possible after PICU admission, may prevent these complications and optimize the holistic outcomes of critically ill children. Changing culture and introducing new clinical practice in PICU is complex, but can be approached systematically, using a “nuts and bolts” approach targeting the basic, practical considerations and essential required elements or components. Extending the construction analogy, this article reviews the relevant literature to describe the essential elements required to build and sustain a successful and safe early mobility program in the PICU. Effective early mobilization requires individual patient assessment and goal setting, using a collaborative inter-disciplinary, patient- and family-centered approach, to ensure mobility goals and physical activities are appropriate for the patient’s age, condition/s, premorbid function, strength, endurance and developmental level. Early mobility activities for the pediatric age spectrum include active or active-assisted range of motion exercises, neurodevelopmental play, use of mobility devices, in-bed exercises, transfers, sitting or standing tolerance, crawling, pre-gait activities, ambulation and activities of daily living, with a focus on play as function. Although there are few complete contraindications to early mobilization, appropriate precautions and preparation should be taken to mitigate potential safety concerns. Although there are many perceived barriers to early mobilization in the PICU, at the level of patient, provider, institution and knowledge translation; these are not objectively associated with increased risk during mobilization and can be overcome through an engaged process of practice change by all members of the interprofessional clinical team. Early mobility programs could be initiated in PICU as systematic quality improvement initiatives, with established processes to optimize structural, process and system elements and to provide continual feedback, measurement, benchmarking and collaboration; to ultimately impact on measurable patient outcomes. Early, graded, and individually prescribed mobilization should be considered as part of the standard PICU “package of care” for all critically ill and injured children, in order to improve their functional status and quality of life after PICU discharge.

Artificial Intelligence in Participation-Focused Pediatric Rehabilitation: A Scoping Review

<h3>Objective(s)</h3> To examine how artificial intelligence (AI) is integrated into pediatric rehabilitation interventions targeting the participation of children and youth with childhood disabilities in valued activities. <h3>Data Sources</h3> For this scoping review, we conducted a systematic literature search in well-established applied health sciences and computer science databases for articles published before February 2020. <h3>Study Selection</h3> Two independent researchers screened and selected studies based on the following inclusion criteria: 1) participation was an explicit study aim or outcome, or the targeted focus of the AI application; 2) AI was applied as part of the provided and tested intervention; 3) children or youth with a childhood disability were the focus of the study and/or AI application; and 4) the article was published in English. <h3>Data Extraction</h3> Two researches mapped the data according to types of AI, mode of delivery, type of personalization, and whether the intervention addressed individual goal-setting. <h3>Data Synthesis</h3> The literature search identified 1,852 articles of which 63 met the inclusion criteria. Most included articles used multiple AI applications with the highest prevalence of robotics (87%) and human-agent/computer/robot interaction (56%). As for mode of delivery, most of the included articles described an intervention delivered in-person (89%) and only 7 (11%) were delivered remotely. Only one was customized to patients' individual needs (2%). No intervention described individual goal setting as part of their therapy process or intervention planning. <h3>Conclusions</h3> Three major gaps for further research and development were identified: 1) A lack of remotely provided participation-focused interventions using AI; 2) a lack of individual goal-setting integrated in pediatric rehabilitation interventions; and 3) a lack of rehabilitation interventions tailored to the individual needs of children, youth and/or families. <h3>Author(s) Disclosures</h3> We have no conflict of interest to declare.

A pilot feasibility study of gabapentin for managing pain in children with dystonic cerebral palsy

BackgroundGabapentin is often used to manage pain in children with dystonic cerebral palsy, however the evidence for its effectiveness in this population is limited. The primary objective of this feasibility pilot study was to assess the factors which might impact on a future randomised controlled trial including the ability to recruit and retain participants, assess adherence/compliance to the prescribed intervention, and ability to complete all outcome assessments. The secondary objective was to gather preliminary evidence for the effectiveness of gabapentin at reducing pain, improving comfort and reducing dystonia in children with dystonic cerebral palsy.MethodsThis open label pilot study recruited children aged 5–18 years with dystonic cerebral palsy and accompanying pain affecting daily activities from four centres around Australia. Children were prescribed gabapentin for 12 weeks and were assessed at baseline, 6 weeks and 12 weeks. The primary outcome was feasibility of the protocol. Secondary outcomes were pain behaviour, pain intensity, care and comfort, individualised goal setting and dystonia severity.ResultsThirteen children (mean age 10.4 years (SD 2.4yrs), 9 females) were recruited from 71 screened over 15 months. Two children withdrew while eight children experienced side effects. There were issues with adherence to medication dosage regimens and data collection. Improvements were seen in pain behaviour, comfort and pain related goals at 12 weeks. Dystonia was not significantly changed.ConclusionsWhilst gabapentin has potential to improve pain and comfort in children with dystonic CP, the feasibility of implementing a definitive randomised controlled trial is low. Alternative trials designs are required to further examine the effectiveness of gabapentin in this heterogeneous population.Trial registrationThe trial was registered with the Australian Clinical Trial Registry (ACTRN12616000366459) on 22/03/2016 and the Therapeutic Goods Administration (CT-2016-CTN-00500-1) on 22/06/2016.

EMDIA Case Series-Effective Medication Therapy Management (MTM) for Diabetes Type 2 Patients-A Proof of Concept Study.

Background: A 2016 meta-analysis of pharmaceutical care for patients with diabetes mellitus showed that the following four components were most effective: (a) individual goal setting, (b) sending feedback to the physician, (c) reviewing the medication, and (d) reviewing blood glucose measurements. Methods: To formulate a hypothesis regarding the effect of these four pharmaceutical care components on glycemic control in patients with diabetes mellitus and the feasibility of these components in practice. Ten patients with type 2 diabetes were included in the case series and received medication therapy management over four months. Results: The four care components were feasible in everyday practice and could be implemented within one patient visit. The average visits were 49 and 28 min at the beginning and end of the study, respectively. The glycated hemoglobin values did not change over the study period, though the fasting blood glucose decreased from 142 to 120 mg/dl, and the number of unsolved drug-related problems decreased from 6.9 to 1.9 per patient by the study end. Conclusions: This case series supports the hypothesis that community pharmacists can implement structured pharmaceutical care in everyday pharmacy practice for patients with type 2 diabetes mellitus.

Long-Term Benefits of Adding a Pedometer to Pulmonary Rehabilitation for COPD: The Randomized Controlled STAR Trial

PurposeThis Stay Active after Rehabilitation (STAR) study examined the effects of a pedometer-based behavioral intervention for individuals with COPD during three weeks of inpatient pulmonary rehabilitation (PR) on patients’ physical activity levels six weeks and six months after PR, including steps (primary outcome), moderate-intensity physical activity, and sedentary time as well as patient quality of life, symptoms, and other psychological and clinical variables.Patients and MethodsRehabilitation patients with COPD wore a triaxial accelerometer (ActiGraph wGT3X) for seven days two weeks before (T0) as well as six weeks (T3) and six months (T4) after PR. In addition to the three-week inpatient PR (control group, CG), the randomly allocated intervention group (IG) received a brief pedometer-based behavioral intervention with the application of the following behavior-change techniques: performing the behavior, individual goal-setting, self-monitoring, and feedback. The effects were analyzed using analysis of covariance with an intention-to-treat approach.ResultsA total of 327 patients (69% male, age: 58 years, FEV1 (%): 53.5, six-minute walk distance: 447.8 m) were randomly allocated to either the IG (n = 167) or CG (n = 160). Although both groups increased their daily steps after PR (IG: MT3-T0 = 1152, CG: MT3-T0 = 745; IG: MT4-T0 = 795, CG: MT4-T0 = 300), the slightly higher increases in daily steps in the IG compared to the CG at T3 (Δ388 steps, d = 0.16) and T4 (Δ458 steps, d = 0.15) were not statistically significant (p > 0.05 for all). Patients in both groups showed moderate to high pre-post-changes in terms of secondary outcomes, but no advantage favoring the IG was found.ConclusionThe results show that adding a pedometer-based behavioral intervention to standard German three-week inpatient PR for COPD patients did not result in more physical activity in terms of steps and moderate-intensity physical activity or less sedentary time. However, both groups (IG and CG) showed remarkably enhanced physical activity levels six weeks and six months after PR, as well as improvements in other secondary outcomes (eg, quality of life).

Feasibility of a Wearable-Based Physical Activity Goal-Setting Intervention Among Individuals With Anterior Cruciate Ligament Reconstruction.

Individuals with a history of anterior cruciate ligament reconstruction (ACLR) demonstrate persistent reductions in physical activity (PA) volume that are not being addressed during rehabilitation. Currently, it is challenging for clinicians to prescribe exercise interventions that extend beyond in-person rehabilitative care in a manner that is responsive and acceptable to patients. To investigate the feasibility of using a novel, technology-driven, personalized goal-setting intervention over a 2-month period among young individuals with a history of primary unilateral ACLR. Single-blinded feasibility study. University community. Ten women and 2 men (age = 22.0 ± 3.0 years, time since surgery = 56.0 ± 36.3 months) with a history of primary unilateral ACLR. All participants completed a 28-day PA observation period immediately followed by a 28-day individualized PA goal-setting intervention period delivered via a commercially available PA monitor. Primary feasibility outcomes were days of PA monitor wear compliance and days of goal achievement during the intervention period. Participants also completed the Knee Osteoarthritis Outcome Score (KOOS) at study enrollment and after the intervention period, and the individual change in the KOOS Quality of Life subscale was compared with the minimal detectable change (7.2 points). Average PA monitor wear compliance was 95.5% ± 7.3% during the observation period and 97.7% ± 2.9% during the intervention period. Median goal achievement was 31.5% ± 6.8% during the intervention period. Five participants demonstrated meaningful improvements in the KOOS Quality of Life subscale during the study period. Individualized goal setting via mobile technology appears to be a feasible approach to PA promotion. However, based on the low rate of daily goal attainment during the intervention period, continued refinement of this intervention aproach would be beneficial before broad clinical implementation.

Factors influencing length of survival in ambulatory palliative care - a cross sectional study based on secondary data

BackgroundQuality of life and patient self-determination are key elements in successful palliative care. To achieve these goals, a robust prediction of the remaining survival time is useful as it can provide patients and their relatives with information for individual goal setting including appropriate priorities. The Aim of our study was to assess factors that influence survival after enrollment into ambulatory palliative care.MethodsIn this cross-sectional, multicenter study (n = 14 study centers) clinical records of all palliative care patients who were treated in 2017 were extracted and underwent statistical analysis. The main outcome criterion was the association of survival time with clinical characteristics such as age, type of disease, symptoms and performance status.ResultsA total of 6282 cases were evaluated. Median time of survival was 26 days (95 % CI: 25–27 days). The strongest association for an increased hazard ratio was found for the following characteristics: moderate/severe weakness (aHR: 1.91; 95 % CI: 1.27–2.86) Karnofsky score 10–30 (aHR: 1.80; 95 % CI: 1.67–1.95), and age > 85 (aHR: 1.50; 95 % CI: 1.37–1.64). Surprisingly, type of disease (cancer vs. non-cancer) was not associated with a change in survival time (aHR: 1.03; 95 % CI: 0.96–1.10).ConclusionsIn this cross-sectional study, the most relevant predictor for a short survival time in specialized ambulatory palliative care was the performance status while type of disease was irrelevant to survival.

Digital Learning Support for Makers: Integrating Technical Development and Educational Design

Makerspaces have gained momentum, not only due to novel manufacturing technologies but also the need for qualified workforce in production industries. Capacity building should not follow ad hoc procedures or arbitrary project designs to qualify for digital production, but rather should still leave room for creativity. As such, the quest has arisen for structured while empowering guidance of additive manufacturing. This can be of benefit for timely education, not only for qualifying existing workforce in production industries but also to attract students in production-related domains. In this paper, we aim to develop an integrated understanding of technical development and capacity-building support activities. We exemplify the proposed design science approach with a regional makerspace. This provides us with the user-centered evaluation of structuring additive manufacturing along an individualized education scheme. Thereby, additive manufacturing capacity building starts with individual goal setting and structuring requirements for an envisioned solution, which becomes part of a learning contract of a specific project. Learning steps are framed by design science and its stages and cycles, since artifacts can be of various kinds, stemming either from construction, modeling, material selection, or manufacturing. The evaluation study revealed essential benefits in terms of structured planning and individualization of capacity-building processes.

The development of PAT-HD: A co-designed tool to promote physical activity in people with Huntington's disease.

BackgroundHuntington's disease (HD) is a genetic condition resulting in movement, behavioural and cognitive impairments. People with HD have low levels of physical activity which may be compounded by insufficient support from health‐care professionals.ObjectiveTo evaluate the initial acceptability of a co‐designed tool used within a HD clinic to promote physical activity.DesignCo‐design of a physical activity tool; acceptability evaluation.Setting and participantsCo‐design included people with HD and health‐care professionals. Acceptability was evaluated in a HD clinic in the UK.Main variables studiedA physical activity tool was co‐designed and used within a HD clinic.Main outcome measureAcceptability as assessed by semi‐structured interviews with members of the HD clinic.ResultsForty people visited the HD clinic; 19 were given physical activity advice. Themes around who, where and how promotion of physical activity could take place were identified; concepts of benefits and barriers were threads through each theme.DiscussionWe describe for the first time the co‐design of a HD specific physical activity tool. Our associated acceptability study emphasizes the importance of individualized planning of physical activities in complex neurodegenerative conditions. Perceived barriers were time and lack of knowledge of local resources.ConclusionsA simple tool can support conversations about physical activity with people with HD and is an aid to individualized goal setting. Exploring the use of PAT‐HD within a community setting and development of support systems for health‐care professionals and support workers who are in regular contact with people with HD is required.

Self-Determination Through Technology: Understanding Physical Activity Engagement for Older Adults

Despite the known health benefits of exercise, only 30% of older adults (65-75 years) and 18.5% (85 years+) meet the recommendations for exercise. Barriers include difficulty accessing facilities, and lack of motivation and social support. Research results indicate that exercise adoption and adherence is higher among older adults when basic psychological needs are met. Technologies (e.g., exergames, activity trackers) have the potential to satisfy the three basic needs as indicated by the Self-Determination Theory. Technology may satisfy a user’s need for autonomy by offering different activities to choose from (biking versus resistance training) or intensity and duration options. They may promote competence by allowing for individualized goal setting and tracking. Technologies have the potential to promote relatedness through virtual instruction, subsequently removing the accessibility barrier. The application of this theory provides design guidelines for exercise technologies and a greater understanding of how technology may motivate exercise behavior for older adults

Developing an Innovative Tablet-Based Walking Program to Improve Arthritis Fatigue.

Fatigue associated with arthritis is highly prevalent and interferes with patients' daily routines. An interdisciplinary research team developed the Tablet-based Cognitive Behavioral Intervention (Tab-CBI) for older adults with arthritis fatigue. The goal of the Tab-CBI is to alleviate fatigue by promoting a simple walking activity. The Tab-CBI application used off-the-shelf technologies and was implemented on a mini-tablet computer. The four key components of Tab-CBI are: (a) multimedia cognitive-behavioral therapy (CBT)-based educational modules; (b) videoconferencing communication; (c) individualized goal setting; and (d) electronic data submission. Experts perceived that the Tab-CBI was engaging and user friendly, and effective in improving simple walking routines and alleviating fatigue. Experts' feedback was incorporated into refining the Tab-CBI. The current study demonstrated that the Tab-CBI has potential to be a useful innovation for fatigue management in older adults. [Journal of Gerontological Nursing, 46(10), 13-18.].

Promotion of Healthy Aging Within a Community Center Through Behavior Change: Health and Fitness Findings From the AgeWell Pilot Randomized Controlled Trial.

The purpose of this randomized controlled trial was to determine if behavior change through individual goal setting (GS) could promote healthy aging, including health and fitness benefits in older adults who attended a community "AgeWell" Center for 12 months. Seventy-five older adults were randomly allocated to either a control or a GS group. Health outcomes were measured at baseline and after 12 months of the participants' having access to the exception of Agewell Center facilities. The findings demonstrate that participation in the Center in itself was beneficial, with improved body composition and reduced cardiovascular risk in both groups (p < .05), and that this kind of community-based resource offers valuable potential for promoting protective behaviors and reducing health risk. However, a specific focus on identifying individual behavior change goals was required in order to achieve increased activity engagement (p < .05) and to bring about more substantial improvements in a range of health, diet, and physical function measures (p < .05).

Healthy Aging Project-Brain: A Psychoeducational and Motivational Group for Older Veterans

Positive health behaviors can promote brain health with age. Although healthy lifestyle factors are often encouraged by health care providers, many older adults experience difficulty incorporating these into their daily life. To address this gap, we developed a novel health education and implementation group for older veterans (aged > 50 years). The primary objectives of this group were to provide psychoeducation about the link between behaviors and brain health, increase personal awareness of specific health behaviors, and promote behavior change through individualized goal setting, monitoring, and support. Based on input from medical providers, group content targeted behaviors known to support cognitive functioning: physical activity, sleep, cognitive stimulation, and social engagement. Thirty-one veterans participated in six 90-minute weekly classes and attended 5 of the 6 groups on average. The average age for the predominantly male (90%) and white (70%) group was 71 years. Qualitative feedback indicated high satisfaction and increased awareness of health behaviors. Results of paired samples t tests comparing baseline to posttreatment self-report measures revealed a significant decline in depressive symptoms (P = .01) and increases in satisfaction with life (P = .003) and self-efficacy (P = .008). This development project showed evidence of increased awareness of health behaviors and improved mood. Expanded data collection will strengthen power and generalizability of results (increase sample diversity). It will also allow us to examine moderating factors, such as perceived self-efficacy, on outcomes.

Rights of an Individual and Care for the Future of the Ancestry: Possibilities and Boundaries of Axiomatics Construction in the Context of the Legal Regulation of Bioengineering

The paper analyzes the possibility to predict and even retrospectively trace all socio-historical consequences of scientific discoveries, as well as their impact on the deep layers of human existence. On the example of the studies that led to the discovery of antibiotics, the boundaries and capabilities of those who claim to be experts in the field of futurology are demonstrated. The paper elucidates the role of social institutions and practices through which the control is exercised over the processes of using the latest achievements of science and insufficient level of competence in managing the development of technical systems. The author highlights the intuition of philosophers and representatives of the humanitarian intelligentsia regarding such significant effects of modernity as “cultural and ethnic redistribution” and other similar results of the development of the scientific thought. The paper provides for the outlines of axiological uncertainty in which Russian legislators find themselves seeking to rely in their activities on the Russian tradition, which includes pre-revolutionary, revolutionary and post-revolutionary periods. These periods are very different from the axiological point of view. At the same time, value gaps arose, were smoothed and overcome, and the whole system of values is in the process of searching for their own identity. The author has investigated the conceptual possibilities of presentation in the content area of the legal thought of the phenomenon of somatic human rights in the context of their legislative protection. Discussions among lawyers of integrity of the individual and means of its legal protection are analyzed. The paper deals with the correlation of individual and collective goal-setting in the Society of Knowledge and within the framework of the modern system of social relations. The current principles of bioethics as the basis of legal regulation and as implication of the system of humanitarian values and human rights are subject to philosophical and critical reflection.

Study protocol of a single-arm pre-post study to assess the preliminary effectiveness and feasibility of a home-based bimodal prehabilitation program on preoperative aerobic fitness in high-risk patients scheduled for liver or pancreatic resection

&lt;p class="abstract"&gt;&lt;strong&gt;Background:&lt;/strong&gt; Controversial evidence currently exists regarding the feasibility and effectiveness to improve preoperative aerobic fitness during home-based prehabilitation in patients scheduled for liver or pancreatic resection, whereas morbidity rates are high following these resections. The primary aim of this study is to evaluate the preoperative oxygen uptake (VO&lt;sub&gt;2&lt;/sub&gt;) at the ventilatory anaerobic threshold before and after a four-week home-based preoperative training program with nutritional supplementation in high-risk patients scheduled for elective liver or pancreatic resection. Secondary aims are to evaluate program feasibility, immune system function, cardiopulmonary exercise test responses, individual progression profiles on training responses, quality of life, and postoperative course.&lt;/p&gt;&lt;p class="abstract"&gt;&lt;strong&gt;Methods:&lt;/strong&gt; In this multicenter study with a pretest-posttest design, patients with a liver or pancreatic tumor scheduled for elective resection will be recruited. To select the high-risk fraction of this surgical population, their VO&lt;sub&gt;2&lt;/sub&gt; at the ventilatory anaerobic threshold should be &amp;lt;11 ml/kg/min for final inclusion. A planned total of 24 high-risk patients will participate in a four-week (three sessions per week) home-based bimodal prehabilitation program. The partly supervised home-based preoperative training program consists of individualized goal setting followed by titration of interval and endurance training on an advanced cycle ergometer, combined with functional task exercises. Additionally, patients will be given protein and vitamin/mineral supplementation.&lt;/p&gt;&lt;p class="abstract"&gt;&lt;strong&gt;Discussion: &lt;/strong&gt;Effects of a partly supervised home-based bimodal prehabilitation regimen are unknown in high-risk patients opting for liver or pancreatic resection. Improved preoperative aerobic fitness might translate into improved postoperative outcomes and a reduced demand on care resources.&lt;/p&gt;&lt;p class="abstract"&gt;&lt;strong&gt;Trial Registration:&lt;/strong&gt; The study is registered in the Netherlands Trial Registry (NL6151) and was approved by the Institutional Ethics Committee, Twente, Enschede, the Netherlands (P17-08).&lt;/p&gt;

Belief formation – A driving force for brain evolution

The topic of belief has been neglected in the natural sciences for a long period of time. Recent neuroscience research in non-human primates and humans, however, has shown that beliefs are the neuropsychic product of fundamental brain processes that attribute affective meaning to concrete objects and events, enabling individual goal setting, decision making and maneuvering in the environment. With regard to the involved neural processes they can be categorized as empirical, relational, and conceptual beliefs. Empirical beliefs are about objects and relational beliefs are about events as in tool use and in interactions between subjects that develop below the level of awareness and are up-dated dynamically. Conceptual beliefs are more complex being based on narratives and participation in ritual acts. As neural processes are known to require computational space in the brain, the formation of inceasingly complex beliefs demands extra neural resources. Here, we argue that the evolution of human beliefs is related to the phylogenetic enlargement of the brain including the parietal and medial frontal cortex in humans.

The Look After Yourself (LAY) intervention to improve self-management in stroke survivors: Results from a quasi-experimental study

ObjectiveTo test the efficacy of a self-management intervention for stroke survivors vs. usual care. MethodsUsing a quasi-experimental study, participants were recruited from three public Italian hospitals. Questionnaires assessing self-efficacy (SSEQ), quality of life (SF-12), physical performance (SPPB), depression (GDS) and activities of daily living (MBI) were administered at baseline, discharge and two months after discharge. Mixed models with a propensity score were used between experimental group (EG) and control group (CG). Logistic models were used to compare the use of health services. ResultsEighty-two stroke survivors were enrolled in the EG and 103 in the CG. Self-efficacy in self-management improved in the EG compared to the CG during hospitalization. Improvements from baseline to discharge were found in the EG in the mental component of SF-12 and in MBI. The EG were 8.9 times more likely to contact general practitioners after discharge and 2.9 times to do regular exercise than CG. Notably, EG with higher education benefitted more from the intervention. ConclusionThe intervention was efficacious in improving self-efficacy, mental health and activities of daily living. Practice implicationsStructured educational interventions based on problem-solving and individual goal setting may improve self-management skills in stroke survivors.

The impact of the environmental crisis on the purchasing power of consumers

The subject of the article is purpose of consumer behavior and its direct connection and interaction with ecological situation in the world. Several examples show that consumption which exceeds the normal level is determined by irrational goals and motives. These motives have essentially the nature of public ritual. They are supported by the social imitation instinct rather than by conscious individual goal setting. The irrationality and arbitrariness of consumption purposes therefore means also the irrationality of the goals and meaning of the production. The conclusion is that an economic system which is based on another alternative ultimate goals and meanings may be more effective in the face of a growing environmental crisis.

Clinical Outcomes and Satisfaction following Neuropsychological Assessment for Adults: A Community Hospital Prospective Quasi-Experimental Study.

Patients and other stakeholders generally report high satisfaction with neuropsychological evaluations (NPEs), but no research has examined effects of cognitive, emotional, and other factors that often prompt evaluations. A prospective, quasi-experimental study was conducted to examine self-reported cognitive and psychiatric symptoms, self-efficacy, motivation, and satisfaction following a NPE. Participants from a neuropsychology clinic who were diagnosed with AD/HD and/or a DSM-IV mood disorder based on a NPE were included, and excluded if diagnosed with dementia or failure on performance validity tests. To examine whether a NPE with an interventional feedback session was associated with outcomes, changes from baseline to post-feedback session were examined with repeated-measures analysis of variance. Pearson correlations determined whether changes in hypothesized mechanisms (i.e., self-efficacy, goal importance and confidence ratings, and use of cognitive strategies) were related to changes in cognitive or psychiatric symptom severity. At follow-up, participants reported reductions in psychiatric (change in Brief Symptom Inventory depression: M=-2.8, SD=4.4, range=-11 to 8, ${\eta}_p^2$=.30; anxiety: M=3.2, SD=6.6, range=-21 to 10, ${\eta}_p^2$=.20) and cognitive symptoms (change in Multiple Ability Self-Report Questionnaire attention: M=-0.3, SD=0.5, range=-1.6 to 0.5, ${\eta}_p^2$=.31; verbal memory: M=-0.3, SD=0.5, range=-1.1 to 0.5, ${\eta}_p^2$=.24; language: M=-0.4, SD=0.4, range=-1.3 to 0.4, ${\eta}_p^2$=.48), and improved cognition (change in Meta-Memory Questionnaire ability: M=4.4,SD=6.2, range=-10 to 16, ${\eta}_p^2$=.35; contentment: M=4.3, SD=4.5, range=-7 to 14, ${\eta}_p^2$=.49). Participants reported increased self-efficacy for general and evaluation-specific goals. Increased goal-specific self-efficacy was associated with large reductions in psychiatric symptoms. Participants reported high levels of satisfaction with the NPE. Results support the clinical utility of NPE and feedback, and underscore the importance of individualized goal setting as part of the evaluation process.