Interventions For Individuals Research Articles

Dialearner: Predicting Diabetes with Machine Learning

Abstract: In the medical field, it is essential to predict diseases early to prevent them. Diabetes is one of the mostdangerous diseases all over the world. In modern lifestyles, sugar and fat are typically present in our dietary habits, which have increased the risk of diabetes. To predict the disease, it is extremely important to understandits symptoms. Currently, machine-learning (ML) algorithms are valuable for disease detection. Diabetes, in all its types, costs countries of all income levels unacceptably enormous personal, societal, and economic expenses.The proposed system can help doctors to make data-driven decisions and enhance patients’ treatment. Several machine learning algorithms that are Decision Tree, Support Vector Machine, Random Forest, Artificial NeuralNetwork, k-Nearest Neighbors, Logistic Regression, and Naive Bayes are used. Evaluation metrics such as accuracy, precision, recall, and F1-score are utilized to assess the model's predictive capability. Cross-validationtechniques are employed to ensure robustness and generalizability. The proposed model holds significant promisein facilitating early detection and intervention for individuals at risk of developing diabetes, thereby improving patient outcomes, and reducing healthcare burden. Future research directions may include incorporating additional features and exploring ensemble learning techniques to further enhance predictive accuracy and reliability

A Self-Applied Psychological Treatment for Gambling-Related Problems via The Internet: A Pilot, Feasibility Study.

The main purpose of this study was to evaluate the feasibility of an online psychological intervention for individuals with gambling-related problems, supported by ecological momentary assessments and interventions (EMAs and EMIs), along with weekly phone-calls, before conducting a randomized controlled trial. Participants were required to complete 3 of the 8 modules of the program based on cognitive-behavioral therapy (CBT) and extensions and innovations of CBT. The study measured the outcomes of feasibility (i.e., reach, appropriateness, technology literacy and technology usability, fidelity, and adherence). In terms of reach, 19.8% (n = 11) of the initial population met the inclusion criteria and completed the three modules (mean age = 41; 90.9% men). The perceived appropriateness and the technology usability after the first use were both excellent, fidelity and adherence to the online treatment (73.3%) were adequate. Adherence to the EMAs and the weekly phone calls were more modest (54.51% and 66.67%, respectively). The results of the present study show that an online treatment for gambling problems enhanced by EMA and EMI might be feasible but challenges were noted in terms of reach and adherence to these assessments and calls. These challenges are important to consider for future trials and the scalability of treatments for individuals with gambling disorders.

#1192 Impact of intradialytic exercise on all-cause mortality in frail patients undergoing hemodialysis: a three-year multicenter cohort study

Abstract Background and Aims Frailty prevalence is notably high among older hemodialysis patients, correlating with poorer prognoses. Prior smaller-scale studies have underscored the benefits of various exercise interventions in individuals with Chronic Kidney Disease and those receiving dialysis treatments. Addressing frailty in older hemodialysis patients by exercise therapy is crucial for healthcare professionals aiming to enhance patient outcomes. Despite this, a standardized exercise therapy protocol for this demographic has not been broadly implemented in clinical practice. Our study sought to evaluate the impact of intradialytic resistance exercise programs on the prognosis of frail individuals undergoing hemodialysis. Method This retrospective, multicenter, non-randomized clinical trial encompassed 2006 participants (mean age 70.1±11.7 years) from 17 outpatient clinics within the Kaikoukai Medical Group. Enrollment spanned from April to December 2018, with patients stratified according to baseline frailty levels, determined by the Japanese Frailty Criteria for the Diagnosis of Frailty in the Elderly. In this study, patients meeting the criteria for frailty or pre-frailty, as defined by the Japanese Criteria for Health and Social Services (J-CHS), were collectively classified as 'frail’. Participants were invited to join a voluntary exercise program during dialysis, which included stretching and four types of resistance exercises using elastic tubes. The cohort was divided into four groups based on their frailty status and participation in the exercise program. Patient outcomes were monitored until either death or the study's conclusion in December 2021. Kaplan-Meier and log-rank analyses were utilized to assess prognostic differences among the groups, with significance levels adjusted using the Bonferroni correction. Ethical approval was granted by the Nagoya Kyoritsu Hospital's ethical committee. Results The study comprised 112 non-frail exercising, 398 frail exercising, 205 non-frail non-exercising, and 1287 frail non-exercising patients. Over the study period (median 25 months), mortality was recorded in 338 (16.9%) patients, including 8 (7.1%) non-frail exercising, 50 (12.6%) frail exercising, 16 (7.8%) non-frail non-exercising, and 264 (20.5%) frail non-exercising participants. Prognostic analysis revealed that the frail non-exercising group had a significantly poorer prognosis than both the non-frail exercising and non-frail non-exercising groups, as well as the frail exercising group (p<0.05). Conclusion This investigation is pioneering in establishing a link between intradialytic resistance exercise interventions and prognosis in frail patients. The findings indicate that, although frail patients inherently face a more challenging prognosis, participation in intradialytic exercise can yield substantial improvements. Therefore, clinicians are encouraged to advocate for exercise therapy as a means to enhance prognosis in frail patients undergoing hemodialysis.

Effectiveness of Exercise Programs for Alleviation of Upper Body Pain in Patients with Spinal Cord Injury: A Systematic Review

(1) Background: Upper body pain, particularly in the limbs and shoulders, is a common symptom among patients with spinal cord injury (SCI) and wheelchair users. Despite the focus on resistance muscle training as a suitable intervention for SCI individuals, findings across different populations and conditions have been inconsistent. (2) Methods: We conducted a systematic review to elucidate the correlations among exercise interventions, muscle strength enhancement, and pain reduction. A comprehensive literature search was performed using the keywords “spinal cord injury,” “pain,” “exercise,” “disability,” “paraplegia,” and “tetraplegia” across the DBpia, EMBASE, PubMed, and Science Direct databases. (3) Results: From 191 identified articles, 13 studies (1 from Korea and 12 from other countries) were selected for analysis. The results indicate that exercise interventions are effective in reducing pain in patients with SCI, with a particular emphasis on alleviating shoulder pain. (4) Conclusion: Exercise is essential for pain reduction in patients with SCI, especially those experiencing shoulder pain. However, there is a notable lack of experimental research focusing primarily on pain. The development of appropriate measurement instruments is crucial for the prevention and relief of pain in this patient population.

Effectiveness of medication self-management, self-monitoring and a lifestyle intervention on hypertension in poorly controlled patients: The MEDICHY randomized trial

BackgroundUncontrolled hypertension is a common problem worldwide, despite the availability of many effective antihypertensive drugs and lifestyle interventions. We assessed the efficacy of a multi-component intervention in individuals with uncontrolled hypertension in a primary care setting.MethodsThis study was a randomized, multicenter, parallel, two-arm, single-blind controlled trial performed in primary healthcare centers in Mallorca (Spain). All participants were 35 to 75-years-old and had poorly controlled hypertension. Patients were randomly assigned in a 1:1 ratio to a control group (usual care) or an intervention group (self-monitoring of blood pressure, self-titration of hypertensive medications, dietary interventions, and physical activity interventions). The primary outcome was decrease in the mean SBP at 6 months relative to baseline.ResultsA total of 153 participants were randomized to an intervention group (77) or a control group (76). After 6 months, the intervention group had a significantly lower systolic blood pressure (135.1 mmHg [±14.8] vs. 142.7 mmHg [±15.0], adjusted mean difference: 8.7 mmHg [95% CI: 3.4, 13.9], p < 0.001) and a significantly lower diastolic blood pressure (83.5 mmHg [±8.8] vs. 87.00 mmHg [±9.0], adjusted mean difference: 5.4 [95% CI: 2.9, 7.8], p < 0.0001). The intervention group also had significantly more patients who achieved successful blood pressure control (<140/90 mmHg; 54.4% vs. 32.9%, p = 0.011).DiscussionSelf-monitoring of blood pressure in combination with self-management of hypertensive medications, diet, and physical activity in a primary care setting leads to significantly lower blood pressure in patients with poorly controlled hypertension.Clinical Trial Registration:ClinicalTrials.gov, identifier ISRCTN14433778.

The Role of Attention Modulation and Its Neurophysiological Mechanisms in Tinnitus Management: A Review

Background and Aim: Tinnitus, characterized by the perception of sound without the presence of an external auditory stimulus, can profoundly affect the quality of life. This review study aims to assess the role of attention modulation in tinnitus management and investigate the neurophysiological mechanism of attention and its interaction with emotional processing in patients with tinnitus. Recent Findings: The studies revealed differences in the function of attentional networks among individuals with tinnitus. The studies showed the positive impact of various techniques for attention modulation through direct attention training or indirect mechanisms influencing attention. These techniques could modify attentional biases, enhance attention control, and alleviate tinnitus-related distress. Conclusion: The results of studies suggest the potential role of attention modulation in tinnitus management. By targeting attentional processes, researchers and clinicians can provide more effective interventions for individuals with tinnitus. However, there is a need for further investigation to optimize the intervention protocols by collaboration between researchers, clinicians, and individuals with tinnitus to achieve success in tinnitus management. Background and Aim: Tinnitus, characterized by the perception of sound without the presence of an external auditory stimulus, can profoundly affect the quality of life. This review study aims to assess the role of attention modulation in tinnitus management and investigate the neurophysiological mechanism of attention and its interaction with emotional processing in patients with tinnitus. Recent Findings: The studies revealed differences in the function of attentional networks among individuals with tinnitus. The studies showed the positive impact of various techniques for attention modulation through direct attention training or indirect mechanisms influencing attention. These techniques could modify attentional biases, enhance attention control, and alleviate tinnitus-related distress. Conclusion: The results of studies suggest the potential role of attention modulation in tinnitus management. By targeting attentional processes, researchers and clinicians can provide more effective interventions for individuals with tinnitus. However, there is a need for further investigation to optimize the intervention protocols by collaboration between researchers, clinicians, and individuals with tinnitus to achieve success in tinnitus management. Keywords: Tinnitus; attention; tinnitus management; neurophysiological mechanism; attention training

Long-term Health Outcomes of New Persistent Opioid Use After Gastrointestinal Cancer Surgery.

New persistent opioid use (NPOU) after surgery has been identified as a common complication. This study sought to assess the long-term health outcomes among patients who experienced NPOU after gastrointestinal (GI) cancer surgery. Patients who underwent surgery for hepato-pancreato-biliary and colorectal cancer between 2007 and 2019 were identified using the Surveillance, Epidemiology, and End Results (SEER)-Medicare-linked database. Mixed-effect multivariable logistic regression and Cox proportional hazard models were used to estimate the risk of mortality and hospital visits related to falls, respiratory events, or pain symptoms. Among 15,456 patients who underwent GI cancer surgery, 967(6.6%) experienced NPOU. Notably, the patients at risk for the development of NPOU were those with a history of substance abuse (odds ratio [OR], 1.45; 95% confidence interval [CI], 1.14-1.84), moderate social vulnerability (OR, 1.26; 95% CI, 1.06-1.50), an advanced disease stage (OR, 4.42; 95% CI, 3.51-5.82), or perioperative opioid use (OR, 3.07; 95% CI, 2.59-3.63. After control for competing risk factors, patients who experienced NPOU were more likely to visit a hospital for falls, respiratory events, or pain symptoms (OR, 1.45, 95% CI 1.18-1.78). Moreover, patients who experienced NPOU had a greater risk of death at 1year (hazard ratio [HR], 2.15; 95% CI, 1.74-2.66). Approximately 1 in 15 patients experienced NPOU after GI cancer surgery. NPOU was associated with an increased risk of subsequent hospital visits and higher mortality. Targeted interventions for individuals at higher risk for NPOU after surgery should be used to help mitigate the harmful effects of NPOU.

Targeting Therapeutic Windows for Rheumatoid Arthritis Prevention.

Rheumatoid arthritis (RA) is a worldwide public health problem. Interventions to delay or prevent the onset of RA have attracted much attention in recent years, and researchers are now exploring various prevention strategies. At present, there is still no unified consensus for RA prevention, but targeting therapeutic windows and implementing interventions for at-risk individuals are extremely important. Due to the limited number of clinical trials on pharmacologic interventions, further studies are needed to explore and establish optimal intervention regimens and effective measures to prevent progression to RA. In this review, we introduce the RA disease process and risk factors, and present research on the use of both Western and Chinese medicine from clinical perspectives regarding RA prevention. Furthermore, we describe several complete and ongoing clinical studies on the use of Chinese herbal formulae for the prevention of RA.

Can Stem Cell Therapy be an Effective Therapeutic Option for Complex and Neurological Conditions?

This article explores the feasibility and potential benefits of stem cell therapy as a promising therapeutic intervention for individuals facing severe behavioral and cognitive impairments, targeting underlying neurological mechanisms to offer potential symptom improvement and function restoration, thereby enhancing the quality of life for patients and potentially alleviating stress and burnout among caregivers. The aims of the study include investigating the efficacy of stem cell therapy in addressing these impairments and evaluating its potential to alleviate caregiver burden. Through a comprehensive review of existing literature, clinical trials, and studies, this research synthesizes the mechanisms of stem cell therapy, potential applications, clinical trial outcomes, caregiver experiences, and economic implications. The methods employed involve analyzing diverse data sources to provide a holistic understanding of the possibilities and challenges associated with stem cell therapy. Key outcomes of the study include highlighting promising results from clinical trials targeting conditions such as autism spectrum disorder, Parkinson's disease, and Crohn's disease, which underscore the transformative potential of stem cell therapy in patient care. Additionally, economic implications suggest potential reductions in healthcare costs and alleviation of financial strain on individuals, families, and healthcare providers. Stem cell therapy represents a paradigm shift in healthcare, promising to redefine treatment approaches and alleviate broader societal burdens associated with complex neurological conditions. The relevance of the study lies in emphasizing the need for continued research, ethical considerations, and multidisciplinary collaboration to ensure the safe and effective integration of stem cell therapy into clinical practice, ultimately offering new hope and improved care for patients, caregivers, and healthcare systems worldwide.

Oxytocin-Augmented Modular-Based Group Intervention for Loneliness: A Proof-Of-Concept Randomized Controlled Trial

Introduction: Loneliness poses a significant health problem and existing psychological interventions have shown only limited positive effects on loneliness. Based on preliminary evidence for impaired oxytocin signaling in trait-like loneliness, the current proof-of-concept study used a randomized, double-blind, placebo-controlled design to probe intranasal oxytocin (OT) as an adjunct to a short-term modular-based group intervention for individuals suffering from high trait-like loneliness (HL, UCLA Loneliness Scale ≥55). Methods: Seventy-eight healthy HL adults (56 women) received five weekly group psychotherapy sessions. HL participants received OT or placebo before the intervention sessions. Primary outcomes were trait-like loneliness measured at baseline, after the intervention, and again at two follow-up time points (3 weeks and 3 months), and, assessed at each session, state loneliness (visual analog scale), perceived stress (Perceived Stress Scale, PSS-10), quality of life (World Health Organization Five Well-Being Index, WHO-5), and the therapeutic relationship (Group Questionnaire, GQ-D). Results: The psychological intervention was associated with significantly reduced perceived stress and improved trait-like loneliness across treatment groups, which was still evident at the 3-month follow-up. OT had no significant effect on trait-like loneliness, quality of life, or perceived stress. However, compared to placebo, OT significantly facilitated the decrease in state loneliness within sessions and significantly improved positive bonding between the group members. Conclusion: Despite significantly improved trait-like loneliness after the intervention, OT did not significantly augment this effect. Further studies are needed to determine optimal intervention designs to translate the observed acute effects of OT into long-term benefits.

An Adaptive Behavioral Intervention for Weight Loss Management

Lifestyle interventions for weight loss are difficult to implement in clinical practice. Self-managed mobile health implementations without or with added support after unsuccessful weight loss attempts could offer effective population-level obesity management. To test whether a wireless feedback system (WFS) yields noninferior weight loss vs WFS plus telephone coaching and whether participants who do not respond to initial treatment achieve greater weight loss with more vs less vigorous step-up interventions. In this noninferiority randomized trial, 400 adults aged 18 to 60 years with a body mass index of 27 to 45 were randomized in a 1:1 ratio to undergo 3 months of treatment initially with WFS or WFS plus coaching at a US academic medical center between June 2017 and March 2021. Participants attaining suboptimal weight loss were rerandomized to undergo modest or vigorous step-up intervention. The WFS included a Wi-Fi activity tracker and scale transmitting data to a smartphone app to provide daily feedback on progress in lifestyle change and weight loss, and WFS plus coaching added 12 weekly 10- to 15-minute supportive coaching calls delivered by bachelor's degree-level health promotionists viewing participants' self-monitoring data on a dashboard; step-up interventions included supportive messaging via mobile device screen notifications (app-based screen alerts) without or with coaching or powdered meal replacement. Participants and staff were unblinded and outcome assessors were blinded to treatment randomization. The primary outcome was the between-group difference in 6-month weight change, with the noninferiority margin defined as a difference in weight change of -2.5 kg; secondary outcomes included between-group differences for all participants in weight change at 3 and 12 months and between-group 6-month weight change difference among nonresponders exposed to modest vs vigorous step-up interventions. Among 400 participants (mean [SD] age, 40.5 [11.2] years; 305 [76.3%] women; 81 participants were Black and 266 were White; mean [SD] body mass index, 34.4 [4.3]) randomized to undergo WFS (n = 199) vs WFS plus coaching (n = 201), outcome data were available for 342 participants (85.5%) at 6 months. Six-month weight loss was -2.8 kg (95% CI, -3.5 to -2.0) for the WFS group and -4.8 kg (95% CI, -5.5 to -4.1) for participants in the WFS plus coaching group (difference in weight change, -2.0 kg [90% CI, -2.9 to -1.1]; P < .001); the 90% CI included the noninferiority margin of -2.5 kg. Weight change differences were comparable at 3 and 12 months and, among nonresponders, at 6 months, with no difference by step-up therapy. A wireless feedback system (Wi-Fi activity tracker and scale with smartphone app to provide daily feedback) was not noninferior to the same system with added coaching. Continued efforts are needed to identify strategies for weight loss management and to accurately select interventions for different individuals to achieve weight loss goals. ClinicalTrials.gov Identifier: NCT02997943.

Understanding reliability of the observer-reported communication ability measure within Angelman syndrome through the lens of generalizability theory

AimsCaregivers rate improved communication ability as one of the most desired outcomes for successful interventions for individuals with Angelman syndrome (AS). When measuring communication ability in clinical trials, the reliability of such measures is critical for detecting significant changes over time. This study examined the reliability of the Observed-Reported Communication Ability (ORCA) measure completed by caregivers of individuals with AS.MethodsThe ORCA measure was completed by 249 caregivers with 170 caregivers completing the ORCA measure again after 5–12 days. Generalizability theory was used to examine the following sources of measurement error in ORCA scores: concepts, subdomains, assessment points, and the interactions among those facets and the object of measurement: communication ability. Three generalizability studies were conducted to understand the reliability of the ORCA measure for different measurement designs. Decision studies were carried out to demonstrate the optimization of measurement procedures of the ORCA measure.ResultsG and Phi coefficients of the original measurement design exceeded the 0.80 threshold considered sufficiently reliable to make relative and absolute decisions about the communication ability of individuals with AS based on their caregivers’ observed scores. The optimization procedures indicated that increasing the number of communication concepts and/or assessment points leads to more reliable estimates of communication.ConclusionThe ORCA measure was able to reliably distinguish different levels of communication ability among individuals with AS. Multiple assessment points and or more concepts would provide more precise estimates of an individual’s communication ability but at the cost of survey fatigue.

Can social adversity alter the epigenome, trigger oral disease, and affect future generations?

The nature versus nurture debate has intrigued scientific circles for decades. Although extensive research has established a clear relationship between genetics and disease development, recent evidence has highlighted the insufficiency of attributing adverse health outcomes to genetic factors alone. In fact, it has been suggested that environmental influences, such as socioeconomic position (SEP), may play a much larger role in the development of disease than previously thought, with extensive research suggesting that low SEP is associated with adverse health conditions. In relation to oral health, a higher prevalence of caries (tooth decay) exists among those of low SEP. Although little is known about the biological mechanisms underlying this relationship, epigenetic modifications resulting from environmental influences have been suggested to play an important role. This review explores the intersection of health inequalities and epigenetics, the role of early-life social adversity and its long-term epigenetic impacts, and how those living within the lower hierarchies of the socioeconomic pyramid are indeed at higher risk of developing diseases, particularly in relation to oral health. A deeper understanding of these mechanisms could lead to the development of targeted interventions for individuals of low SEP to improve oral health or identify those who are at higher risk of developing oral disease.

Brief admission by self-referral for individuals with self-harm and suicidal ideation: a qualitative study based on focus groups exploring relatives’ experiences

ABSTRACT Purpose Brief Admission by self-referral (BA) is a standardized crisis-management intervention for individuals with self-harm and risk for suicide. This study explored relatives’ experiences of BA. Relatives’ perspectives may contribute to an increased understanding of the effects of BA given the relatives’ role as support and informal caregivers as well as being co-sufferers. Methods Fourteen relatives to adults with access to BA within one Swedish region participated in focus groups analysed with reflexive thematic analysis. Results We generated themes evolving around three meaning-based concepts: access (A low threshold to a safe back-up is crucial and obstacles may easily break faith), independence (Trust in their ability with care and respect), and recovery (The rest and relational recovery we all get are needed and invaluable). Conclusions BA brings considerable value to users and relatives, by supporting them to take care of themselves and each other. Communication and involvement of relatives may enhance users’ ability to overcome obstacles to accessing BA. Implementation and adherence may be strengthened by supervision of BA staff and education of emergency care staff. Resources are needed to improve access. Mapping hurdles to BA, support through peers and targeted psychoeducation may improve recovery for BA users and their relatives.

Deep learning imaging phenotype can classify metabolic syndrome and is predictive of cardiometabolic disorders

BackgroundCardiometabolic disorders pose significant health risks globally. Metabolic syndrome, characterized by a cluster of potentially reversible metabolic abnormalities, is a known risk factor for these disorders. Early detection and intervention for individuals with metabolic abnormalities can help mitigate the risk of developing more serious cardiometabolic conditions. This study aimed to develop an image-derived phenotype (IDP) for metabolic abnormality from unenhanced abdominal computed tomography (CT) scans using deep learning. We used this IDP to classify individuals with metabolic syndrome and predict future occurrence of cardiometabolic disorders.MethodsA multi-stage deep learning approach was used to extract the IDP from the liver region of unenhanced abdominal CT scans. In a cohort of over 2,000 individuals the IDP was used to classify individuals with metabolic syndrome. In a subset of over 1,300 individuals, the IDP was used to predict future occurrence of hypertension, type II diabetes, and fatty liver disease.ResultsFor metabolic syndrome (MetS) classification, we compared the performance of the proposed IDP to liver attenuation and visceral adipose tissue area (VAT). The proposed IDP showed the strongest performance (AUC 0.82) compared to attenuation (AUC 0.70) and VAT (AUC 0.80). For disease prediction, we compared the performance of the IDP to baseline MetS diagnosis. The models including the IDP outperformed MetS for type II diabetes (AUCs 0.91 and 0.90) and fatty liver disease (AUCs 0.67 and 0.62) prediction and performed comparably for hypertension prediction (AUCs of 0.77).ConclusionsThis study demonstrated the superior performance of a deep learning IDP compared to traditional radiomic features to classify individuals with metabolic syndrome. Additionally, the IDP outperformed the clinical definition of metabolic syndrome in predicting future morbidities. Our findings underscore the utility of data-driven imaging phenotypes as valuable tools in the assessment and management of metabolic syndrome and cardiometabolic disorders.

Review on Role of Yoga in Chittodvega w.s.r. to Generalized Anxiety Disorder

Mental health disorders are mentioned as 3rd health burden in India according to WHO survey. Generalized anxiety disorders are a chronic anxiety disorder characterized by excessive and uncontrollable worry and anxiety about everyday life events and situations. In Ayurveda many psychological disorders are mentioned in Samhitas. Terms like Asvastha Chitta, Chittavimbhramsa, Chittodvega etc. seems similar to Generalized anxiety disorder, however Chittodvega seems to be nearest correlation for this disease entity. Acharya Charaka has listed Chittodvega as Manas Dosha Vikara. People with symptoms of Generalized anxiety disorder always tend to expect failure and can't stop worrying, Clinical trials have shown that anxiolytic drugs alone have limited long-term efficacy. Moreover, they often have adverse side effects including dependency, drowsiness, impaired cognition and memory and sexual dysfunction. Being an alarming disease GAD needs an effective management. Nowadays Yoga is considered as a popular approach to improve emotional health. Yoga, a form of holistic mind–body medicine, that includes the use of physical postures (Asanas), breathing practices (Pranayamas), meditations, relaxation techniques and lifestyle changes based on ancient yogic philosophy. Pranayama should be practiced to remove the blockages and to lift you out of the Tamasik and Rajasik states. Asanas empathizes physical strength and helps to maintain balance between mind and body. Yoga helps to restraint unnecessary mental fluctuations and thus helps in stabilizing and calming the mind. Thus it might be an effective and safe intervention for individuals with GAD.

Support after return to alcohol use: a mixed-methods study on how abstinence motivation and app use change after return to alcohol use in an app-based aftercare intervention for individuals with alcohol use disorder

BackgroundAs the return to alcohol use in individuals with alcohol use disorder (AUD) is common during treatment and recovery, it is important that abstinence motivation is maintained after such critical incidences. Our study aims to explore how individuals with AUD participating in an app-based intervention with telephone coaching after inpatient treatment perceived their abstinence motivation after the return to alcohol use, whether their app use behavior was affected and to identify helpful factors to maintain abstinence motivation.MethodsUsing a mixed-methods approach, ten participants from the intervention group of the randomized controlled trial SmartAssistEntz who returned to alcohol use and recorded this in the app Appstinence, a smartphone application with telephone coaching designed for individuals with AUD, were interviewed about their experiences. The interviews were recorded, transcribed and coded using qualitative content analysis. App use behavior was additionally examined by using log data.ResultsOf the ten interviewees, seven reported their abstinence motivation increased after the return to alcohol use. Reasons included the reminder of negative consequences of drinking, the desire to regain control of their situation as well as the perceived support provided by the app. App data showed that app use remained stable after the return to alcohol use with an average of 58.70 days of active app use (SD = 25.96, Mdn = 58.50, range = 24–96, IQR = 44.25) after the return to alcohol use which was also indicated by the participants’ reported use behavior.ConclusionsThe findings of the study tentatively suggest that the app can provide support to individuals after the return to alcohol use to maintain and increase motivation after the incidence. Future research should (1) focus on specifically enhancing identification of high risk situations and reach during such critical incidences, (2) actively integrate the experience of the return to alcohol use into app-based interventions to better support individuals in achieving their personal AUD behavior change goals, and (3) investigate what type of support individuals might need who drop out of the study and intervention and discontinue app use altogether.Trial registrationThe primary evaluation study is registered in the German Clinical Trials Register (DRKS, registration number DRKS00017700) and received approval of the ethical committee of the Friedrich-Alexander University Erlangen-Nuremberg (193_19 B).

Physical activity should be the primary intervention for individuals living with chronic pain A position paper from the European Pain Federation (EFIC) 'On the Move' Task Force.

There is clear evidence demonstrating the benefits of physical activity (PA) on pain and overall health, however, PA is challenging for many individuals living with chronic pain. Even non-exercise specialists can (cost) effectively promote PA, but many health professionals report a number of barriers in providing guidance on PA, suggesting that it is not consistently promoted. This expert position paper summarizes the evidence and provides five recommendations for health professionals to assess, advise and support individuals living with any chronic pain condition with a long life expectancy in adopting and sustaining physically active lifestyles. This position paper was prepared by the 'On The Move' Task Force of the European Pain Federation EFIC. Final recommendations were endorsed by the European Pain Forum, Pain Alliance Europe and the Executive Board of EFIC. We recommend that all health professionals (1) Take a history of the persons' PA levels, and put PA on the agenda, (2) Advise that PA is important and safe for individuals living with chronic pain, (3) Deliver a brief PA intervention and support individuals living with chronic pain in becoming physically active, (4) Discuss acceptable levels of PA-related soreness and pain and (5) Provide ongoing support in staying physically active. Physical activity is safe and offers several advantages, including general health benefits, low risk of side effects, low cost and not requiring access to healthcare. Adoption of these recommendations can improve the quality of care and life of individuals living with chronic pain and reduce their overall health risks.

Qualitative Study of Food Insecurity in Hospitalized Pediatric Patients during the COVID-19 Pandemic.

Food insecurity (FI) is defined as limited or uncertain access to sufficient food for a healthy and active lifestyle. Our objective was to explore how the coronavirus disease 2019 (COVID-19) pandemic affected the FI status of pediatric patients and their families through interviewing caregivers who screen positive for FI. Caregivers of all hospitalized patients at a tertiary children's hospital who screen positive for FI with a two-question screening tool were approached about enrolling in the study. Those who consented completed a presurvey and participated in a semistructured individual interview. Interviews were audio recorded, transcribed, and analyzed according to the guidelines of thematic analysis using NVivo 12. Interviews were conducted with 15 caregivers between July 2021 and January 2022. Caregivers were 100% female and 80% Black, 13% White, and 7% Hispanic/Latinx, with a mean age of 33 years. Seventy-three percent did not experience FI until the COVID-19 pandemic. Themes include lost wages, mothers forced out of the workforce due to childcare limitations, inflation and shortages of goods, increased stress/anxiety for caregivers and children, the centrality of extended family support, and the necessity/inadequacy of federal food programs. The COVID-19 pandemic impacted unemployment and poverty and consequently exacerbated FI. Our findings point to the need to focus on proximal societal solutions, such as federal policies aimed at food assistance and childcare. Understanding the challenges related to FI that caregivers and patients experience can improve screening, support, and treatment of patients presenting for care and inform the design of necessary interventions for individuals and communities beyond COVID-19.

Inhibition of PARP1 improves cardiac function after myocardial infarction via up-regulated NLRC5

The incidence and mortality rate of myocardial infarction are increasing per year in China. The polarization of macrophages towards the classically activated macrophages (M1) phenotype is of utmost importance in the progression of inflammatory stress subsequent to myocardial infarction. Poly(ADP-ribose) polymerase 1(PARP1) is the ubiquitous and best characterized member of the PARP family, which has been reported to support macrophage polarization towards the pro-inflammatory phenotype. Yet, the role of PARP1 in myocardial ischemic injury remains to be elucidated. Here, we demonstrated that a myocardial infarction mouse model induced cardiac damage characterized by cardiac dysfunction and increased PARP1 expression in cardiac macrophages. Inhibition of PARP1 by the PJ34 inhibitors could effectively alleviate M1 macrophage polarization, reduce infarction size, decrease inflammation and rescue the cardiac function post-MI in mice. Mechanistically, the suppression of PARP1 increase NLRC5 gene expression, and thus inhibits the NF-κB pathway, thereby decreasing the production of inflammatory cytokines such as IL-1β and TNF-α. Inhibition of NLRC5 promote infection by effectively abolishing the influence of this mechanism discussed above. Interestingly, inhibition of NLRC5 promotes cardiac macrophage polarization toward an M1 phenotype but without having major effects on M2 macrophages. Our results demonstrate that inhibition of PARP1 increased NLRC5 gene expression, thereby suppressing M1 polarization, improving cardiac function, decreasing infarct area and attenuating inflammatory injury. The aforementioned findings provide new insights into the proinflammatory mechanisms that drive macrophage polarization following myocardial infarction, thereby introducing novel potential targets for future therapeutic interventions in individuals affected by myocardial infarction.