Large Effect Sizes Research Articles

Acceptance and Commitment Therapy for Hypersexuality: A Pilot Study

Hypersexuality refers to the inability to control sexual desire. Despite it has shown serious consequences for physical, psychological and social health, the evidence of available psychological interventions is still insufficient. In this open-label pilot study, an Acceptance and Commitment Therapy (ACT) intervention was conducted with adults with clinically significant levels of hypersexuality aimed to examine its feasibility and usefulness. The intervention consisted of eight weekly online individual psychological intervention sessions. Outcome self-report measures were administered at baseline, after the intervention and a 3 months follow-up. Behavioral and subjective informed changes in sexual practices were weekly assessed through self-monitoring. Twelve participants (M age = 38.8 ± 11.5 years, 83.3% male, 66.7% homo or bisexual) completed the intervention. The feasibility was found to be good, with all the participants completing the training and high levels of satisfaction. Hypersexuality, psychological flexibility, cognitive fusion and mindfulness scores significantly improved after the ACT intervention, with large effect sizes. Clinically significant changes in hypersexuality were found for the vast majority of participants, besides reductions in the time dedicated to planning and practicing sex and the sexualized drug use. Results indicate that ACT-based interventions may be considered feasible and potentially effective therapeutic alternatives for hypersexuality.

Pathway analysis of the impact of health literacy, social support, and self-management on frailty in patients with chronic heart failure: A cross-sectional study.

Chronic heart failure (CHF) is a significant global health challenge, and frailty is common among CHF patients. Although abundant evidence has revealed significant intercorrelations among health literacy, social support, self-management, and frailty, no study has explored their associations into 1 model based on a theoretical framework. The study aimed to test the Information-Motivation-Behavioral Skills Model in a sample of Chinese CHF patients and explore the potential relationships among social support, health literacy, self-management, and frailty. A cross-sectional study was conducted on CHF patients (n = 219) at a tertiary hospital in China. The Tilburg Frailty Indicator, Heart Failure Specific Health Literacy Scale, Social Support Rating Scale, and Self-management Scale of Heart Failure Patients were used to assess frailty, health literacy, social support, and self-management, respectively. Structural equation modeling with the bootstrapping method was used to test the hypothesized relationships among the variables. The results showed that 47.9% of the CHF patients suffered from frailty. Frailty was negatively correlated with health literacy (r = -0.268, P < .01) with a moderate effect size, social support (r = -0.537, P < .01) with a large effect size, and self-management (r = -0.416, P < .01) with a moderate effect size. The structural equation modeling model showed that social support was positively associated with health literacy (β = 0.419, P < .01) and self-management (β = 0.167, P < .01) while negatively associated with frailty (β = -0.494, P < .01). Health literacy was positively associated with self-management (β = 0.565, P < .01), and self-management was negatively associated with frailty (β = -0.272, P < .01). Our study suggests the potential positive impacts of health literacy, social support, and self-management on improving frailty in CHF patients. Healthcare providers should strengthen patient health education, improve their health literacy, enhance their social support, and promote their self-management so as to reverse frailty and reduce the risk of adverse outcomes.

Short- and Long-Term Outcomes of e-Health and Internet-Based Psychological Interventions for Chronic Tinnitus: A Systematic Review and Meta-Analysis.

Objective: e-Health or web-based systems in the field of tinnitus have gained increasing interest. Cognitive behavioral therapy (CBT) delivered via the internet is currently witnessing a surge in both attention and offerings. This systematic review analyzed the efficacy and sustainability of internet-based therapies aimed at reducing tinnitus distress and comorbidities such as anxiety, depression, and sleep disorders. The review exclusively considered randomized controlled trials (RCTs) in which trained personnel were actively involved during intervention. Methods: Utilizing search terms such as tinnitus, internet-based therapy, and e-Health therapy, we identified 155 studies, from which 37 RCTs were carefully examined for data availability. Primary outcome measures included treatment effects for tinnitus distress (Tinnitus Questionnaire and other questionnaires) and handicap (Tinnitus Handicap Inventory), while secondary outcomes encompassed depression, anxiety, and sleep problems. Meta-analyses were conducted employing random-effect models. A study effect model was applied, yielding a singular effect size for each sample. The effect sizes were examined for influences of various moderators. Results: We found a statistically significant large effect size for improvement in tinnitus distress (d = 0.83; [confidence interval 0.61-1.06] with total n = 450 for the experimental group and total n = 504 or the controls), while the reduction of tinnitus handicap was smaller (moderate effect size d = 0.59; [0.44-0.73]). Less strong but still significant effects resulted for depression, anxiety, and insomnia. Most of the long-term outcomes remained stable. As moderators, the risk of bias (RoB) and the severity of tinnitus manifestations were identified. Conclusions: Internet-based therapy provides a valuable avenue for initial therapeutic contact, as supporting component in tinnitus treatment if accompanied by therapists. The heterogeneous quality with high drop-out rates or partly high RoB and the wide range of interventions (counseling, eCBT, mindfulness) might be considered as a limiting factor for a first-line management in tinnitus. So far, the use of e-Health is dependent on availability or user preferences.

Religious savior-centered psychotherapy for depression: a focus on women’s well-being

ABSTRACT This study explores the effectiveness of Religious Savior-Centered Psychotherapy (RSCP) in treating depression in religious women. RSCP is a therapeutic approach that integrates Islamic teachings, particularly the concept of a Savior, with cognitive and behavioral strategies to address mental health challenges. Unlike traditional therapy models, RSCP emphasizes spiritual healing by fostering a strong connection to faith and a hopeful outlook for the future. The study aims to assess RSCP’s impact on depression in women by aligning with Islamic teachings and emphasizing positive future expectations. A pretest-posttest design with a two-month follow-up was employed to evaluate the effects of RSCP. The study included 70 women aged 18–60 from five counseling clinics in Tehran, all diagnosed with mild to moderate depression, and having expressed a belief in a Savior. MANCOVA was used to analyze the data, ensuring assumptions of normality and homogeneity of variances were met. MANCOVA results indicated a significant linear correlation between the treatment and depression levels (p < .05), with a large effect size (partial η2 = .61 for posttest and .54 for follow-up). Initial findings suggest RSCP’s potential benefit on mental well-being. RSCP has the potential to be integrated into existing mental health frameworks as a culturally sensitive option, particularly for Muslim women seeking faith-based approaches to mental health care. Future research with larger samples, randomized controlled trials, and longitudinal studies is needed to explore the effectiveness of this new positive psychotherapy approach.

Known-Group Validity and Sensitivity to Change in the Sensory-Motor Dysfunction Questionnaire in Individuals with Neck Pain: A Pilot Study

Background/Objectives: Sensorimotor dysfunction is often reported in individuals experiencing neck pain, irrespective of severity and chronicity. The treatment of neck dysfunction has been found to positively impact sensorimotor integration (SMI), thereby improving sensorimotor function. However, no patient-reported outcome measure has been validated for discrimination between healthy individuals and neck pain patients with disordered SMI, nor has there been documentation of positive change in SMI following neck pain treatment.The purpose of this study was to administer the Sensory-Motor Dysfunction Questionnaire (SMD-Q), for the purposes of: (1) known-group validity between individuals without and with chronic neck pain (CNP) or subclinical neck pain (SCNP); (2) assess the questionnaire’s capacity to quantify changes in altered SMI following a tailored treatment plan. Methods: Part 1—Known Group Validity: The SMD-Q was administered to 30 neck pain (13 with CNP, and 17 with SCNP), and 30 healthy participants. Part 2—Sensitivity to Change: The SMD-Q was re-administered to neck pain participants following their tailored treatment plans (SCNP—8-weeks and CNP—12 weeks). Results: The SMD-Q can discriminate between healthy and neck pain participants (p ≤ 0.001), and may be sensitive to showing treatment effects (ηp2 = 0.162; large effect size (ES)), but the sample size was too small to determine if it can discriminate treatment effects between groups (ηp2 = 0.070; medium ES). Conclusions: Differing degrees of disordered SMI can be discriminated by the SMD-Q, but further research is needed to determine its sensitivity to treatment.

A survey of essential anatomy from the perspective of anesthesiology, emergency medicine, obstetrics and gynecology, and orthopedics resident physicians

BackgroundRecent changes in anatomy curricula in undergraduate medical education (UME), including pedagogical changes and reduced time, pose challenges for foundational learning. Consequently, it is important to ask clinicians what anatomical content is important for their clinical specialty, which when taken collectively, can inform curricular development.MethodsThis study surveyed 55 non-primary care residents in anesthesiology (AN; N = 6), emergency medicine (EM; N = 15), obstetrics and gynecology (OB; N = 13), and orthopedics (OR; N = 21) to assess the importance of 907 anatomical structures across all anatomical regions. Survey ratings by participants were converted into a post-hoc classification system to provide end-users of this data with an intuitive and useful classification system for categorizing individual anatomical structures (i.e., essential, more important, less important, not important).ResultsSignificant variability was observed in the classifications of essential anatomy: 29.1% of all structures were considered essential by OB residents, 37.6% for AN residents, 41.6% for EM residents, and 72.0% for OR residents. Significant differences (with large effect sizes) were also observed between residency groups: OR residents rated anatomy of the back, limbs, and pelvis and perineum anatomy common to both sexes significantly higher, whereas OB residents rated the pelvis and perineum anatomy common to both sexes and anatomy for individuals assigned female at birth highest. Agreement in classifications of importance among residents was observed for selected anatomical structures in the thorax, abdomen, pelvis and perineum (assigned male at birth-specific anatomy), and head and neck. As with the ratings of anatomical structures, OR residents had the highest classification across all nine tissue types (p < 0.01).ConclusionsThe present study created a database of anatomical structures assessed from a clinical perspective that may be considered when determining foundational anatomy for UME curriculum, as well as for graduate medical education.

Second Wave Positive Psychology in the Prevention and Reduction of Parental Burnout: The CARE Intervention

Positive psychology interventions aim to enhance individuals’ resilience, mental health, and well-being. This study ( N = 34) aimed to assess whether the CARE (Coherence, Attention, Relationship, Engagement) intervention tailored to enhance parental strengths and resources may contribute to the prevention and reduction of parental burnout. We tested the hypothesis that, compared to a waiting-list control group, parents attending the intervention would present lower scores of parental burnout postintervention (T2). The results of the study showed that compared to the control group the CARE program contributed to the significant reduction of parental burnout within the intervention group, with a large effect size ( F(1, 32) = 7.74 , p = .01, η2p = 0.20). Within the CARE group, the severity of parental burnout significantly decreased ( t(32) = 3.87, Mdiff = 16.71, SEdiff = 4.32, p = .01), whereas there was no statistically significant difference in parental burnout symptoms between T1 and T2 among the participants from the control group ( t(32) = −0.07, Mdiff = −0.29, SEdiff = 4.32, p = 1.00). In conclusion, the findings of the present study suggest that the CARE intervention may significantly contribute to the reduction of parental burnout.

A Person-Based Web-Based Sleep Intervention Aimed at Adolescents (SleepWise): Randomized Controlled Feasibility Study.

Adolescents are advised to sleep 8-10 hours per night; however, most do not sleep for this recommended amount. Poor adolescent sleep is associated with detrimental health outcomes, including reduced physical activity, risk-taking behaviors, and increased depression and anxiety levels, making this an important public health concern. Existing interventions targeting adolescent sleep are often unsuccessful or their effectiveness unclear, as they are frequently noninteractive, time-consuming, and lack a strong theoretical foundation; highlighting an urgent need for innovative interventions deemed acceptable by adolescents. The main objective of this study was to determine the acceptability, feasibility, and preliminary impact of a web-based person-based sleep intervention (SleepWise) on adolescent sleep quality. Participant incentivization was also explored to understand its impact on engagement, acceptability, and sleep quality. A feasibility trial was conducted to test the feasibility, acceptability, and preliminary impact of SleepWise on adolescent sleep quality, developed based on the person-based approach to intervention development. In total, 90 participants (aged 13-17 years) from further education institutions and secondary schools were recruited for two 2-arm randomized controlled trials. One trial (trial 1) was incentivized to understand the impact of incentivization. Acceptability and sleep quality were assessed via questionnaires, and a mixed methods process evaluation was undertaken to assess participant engagement and experience with SleepWise. Engagement was automatically tracked by SleepWise, which collected data on the date and time, pages viewed, and the number of goals and sleep logs completed per participant. Semistructured interviews were carried out to gain participant feedback. Participants in both trials reported high levels of acceptability (trial 1: mean 21.00, SD 2.74; trial 2: mean 20.82, SD 2.48) and demonstrated similar levels of engagement with SleepWise. Participants in trial 1 viewed slightly more pages of the intervention, and those in trial 2 achieved their set goals more frequently. Improvements in sleep quality were found in both trials 1 and 2, with medium (trial 1) and large (trial 2) effect sizes. A larger effect size for improvement in sleep quality was found in the nonincentivized trial (d=0.87), suggesting that incentivization may not impact engagement or sleep quality. Both trials achieved acceptable recruitment (trial 1, N=48; trial 2, N=42), and retention at 5 weeks (trial 1: N=30; trial 2: N=30). Qualitative findings showed that adolescents lead busy lifestyles, which may hinder engagement; however, participants deemed SleepWise acceptable in length and content, and made attempts at behavior change. SleepWise is an acceptable and potentially efficacious web-based sleep intervention aimed at adolescents. Findings from this study showed that incentivization did not greatly impact engagement, acceptability, or sleep quality. Subject to a full trial, SleepWise has the potential to address the urgent need for innovative, personalized, and acceptable sleep interventions for adolescents. OSF Registries osf.io/yanb2; https://osf.io/yanb2.

Treating narcolepsy-related nightmares with cognitive behavioural therapy and targeted lucidity reactivation: A pilot study.

Nightmares are a common symptom in narcolepsy that has not been targeted in prior clinical trials. This study investigated the efficacy of Cognitive Behavioural Therapy for Nightmares (CBT-N), adapted for narcolepsy, in a small group of adults. Given the high prevalence of lucid dreaming in narcolepsy, we added a promising adjuvant component, targeted lucidity reactivation (TLR), a procedure designed to enhance lucid dreaming and dream control. Using a multiple baseline single-case experimental design, adults with narcolepsy and frequent nightmares (≥3/week, N = 6) were randomised to a 2 or 4 week baseline and received seven treatment sessions (CBT-N or CBT-N + TLR). Across the groups, there was a large effect size (between-case standardised mean difference [BC-SMD] = -0.97, 95% CI -1.79 to -0.14, p < 0.05) for reduced nightmare frequency from baseline (M = 8.38/week, SD = 7.08) to posttreatment (M = 2.25/week, SD = 1.78). Nightmare severity improved significantly with large effect sizes on sleep diaries (BC-SMD = -1.14, 95% CI -2.03 to -0.25, p < 0.05) and the Disturbing Dream and Nightmare Severity Index (z = -2.20, p = 0.03, r = -0.64). Treatment was associated with a reduction for some participants in sleep paralysis, sleep-related hallucinations, and dream enactment. NREM parasomnia symptoms (z = -2.20, p = 0.03, r = -0.64) and self-efficacy for managing symptoms (z = -2.02, p = 0.04, r = -0.58) improved significantly with large effect sizes. Participants who underwent TLR (n = 3) all recalled dreams pertaining to their rescripted nightmare. In interviews, participants noted reduced shame and anxiety about sleep/nightmares. This study provides a proof of concept for the application of TLR as a therapeutic strategy with clinical populations, as well as preliminary evidence for the efficacy of CBT-N in treating narcolepsy-related nightmares.

Maternal Eating Disorders, Body Mass Index, and Offspring Psychiatric Diagnoses

Maternal nutrition is essential in fetal development; thus, disordered eating may influence this process and contribute to the development of offspring psychiatric disorders. To investigate the association of maternal eating disorders and prepregnancy body mass index (BMI) with offspring psychiatric diagnoses. This population-based cohort study used Finnish national registers to assess all live births from January 1, 2004, through December 31, 2014, with follow-up until December 31, 2021. The data analyses were conducted from September 1, 2023, to September 30, 2024. Maternal eating disorder and prepregnancy BMI. Primary outcomes were 9 neurodevelopmental and psychiatric offspring diagnoses. Cox proportional hazards modeling adjusted for potential risk factors in the development of the outcome disorders was applied in 2 models. Secondary analyses were stratified for adverse birth outcomes (prematurity, small size for gestational age, and low Apgar score) or comorbid offspring eating disorders. Categories of BMI (calculated as weight in kilograms divided by height in meters squared) included underweight (BMI <18.5), normal weight (18.5-24.9), overweight (25.0-29.9), obesity (30.0-34.9), and severe obesity (≥35.0). The mean (SD) age of 392 098 included mothers was 30.15 (5.38) years, 42 590 mothers (10.86%) were born outside of Finland, 6273 mothers (1.60%) had a history of an eating disorder, 23 114 mothers (5.89%) had prepregnancy underweight, and 208 335 (53.13%) mothers had overweight or obesity. Among 649 956 included offspring, 332 359 (51.14%) were male, and 106 777 (16.43%) had received a neurodevelopmental or psychiatric diagnosis. Maternal eating disorders, prepregnancy underweight, and overweight or obesity were associated with most of the studied mental diagnoses in offspring, even after adjusting for potential covariates. The largest effect sizes were observed for maternal eating disorders not otherwise specified in association with offspring sleep disorders (hazard ratio [HR], 3.34 [95% CI, 2.39-4.67]) and social functioning and tic disorders (HR, 2.79 [95% CI, 2.21-3.52]), while for maternal severe prepregnancy obesity, offspring intellectual disabilities (HR, 2.04 [95% CI, 1.83-2.28]) had the largest effect size. Adverse birth outcomes further increased the risk of offspring having other feeding disturbances of childhood and infancy (eg, HR, 4.53 [95% CI, 2.97-6.89] for maternal eating disorders) and attention-deficit/hyperactivity disorder and conduct disorder (eg, HR, 2.27 [95% CI, 1.74-2.96] for maternal anorexia nervosa). In this population-based cohort study including 392 098 mothers and 649 956 offspring, offspring from mothers with an eating disorder history or prepregnancy BMI outside normal weight were at higher risk of psychiatric disorders. The results differed somewhat between the 2 exposures with regard to which offspring diagnoses had associations, and effect sizes were typically larger for maternal eating disorders vs BMI. These findings suggest a need to consider these 2 exposures clinically to help prevent offspring mental illness.

Efficacy of Horticultural Therapy on Positive, Negative, and Affective Symptoms in Individuals with Schizophrenia: A Systematic Review and Meta-Analysis of Randomized Controlled Trials

Background/Objectives: Positive symptoms, negative symptoms, and emotional disturbances are core features of schizophrenia. Although horticultural therapy (HT) has shown promise as an adjunctive treatment, evidence supporting its effectiveness remains limited. This systematic review and meta-analysis aimed to assess the impact of HT on total symptoms, positive symptoms, negative symptoms, and emotional disturbances in individuals with schizophrenia. Methods: We conducted a search for randomized controlled trials (RCTs) published up to March 2024 across multiple databases, including PubMed, Embase, Cochrane Library, CINAHL, CEPS, CNKI, Wanfang, and Yiigle. A random-effects model was employed to calculate the standardized mean difference (SMD). Results: A total of 35 studies enrolling 2899 participants were included. Our results indicated that, in the short term (≦3 months), HT has moderate to large effect sizes on total symptoms (SMD = 0.690, 95% CI 0.463 to 0.916), positive symptoms (SMD = 0.695, 95% CI 0.038 to 1.351), negative symptoms (SMD = 0.681, 95% CI 0.395 to 0.967), depression (SMD = 0.646, 95% CI 0.334 to 0.959), and anxiety (SMD = 0.627, 95% CI 0.364 to 0.890), with more pronounced benefits for anxiety symptoms in patients with a shorter duration of illness. In the long term (&gt;3 months), HT shows large effect sizes for total symptoms (SMD = 1.393, 95% CI 0.858 to 1.928), negative symptoms (SMD = 1.389, 95% CI 0.935 to 1.842), anxiety (SMD = 1.541, 95% CI 1.042 to 2.040), and moderate to large effect sizes for positive symptoms (SMD = 0.667, 95% CI 0.077 to 1.258) and depression (SMD = 0.707, 95% CI 0.198 to 1.217). Additionally, longer weekly treatment durations are associated with better outcomes for total symptoms and negative symptoms. Schizophrenia patients with more severe initial symptoms may be potential responders to HT. Conclusions: These findings support the efficacy of HT in improving symptoms and emotional well-being in schizophrenia patients. Further trials with more rigorous designs are warranted to confirm these benefits.

The effects of hands-on content-language integrated learning on fourth graders’ acquisition of target vocabulary and procedural knowledge in Taiwan

Despite the widespread use of multimodal pedagogies in Content and Language Integrated Learning (CLIL) contexts, empirical studies specifically focusing on the impact of hands-on learning on target vocabulary and procedural knowledge acquisition in CLIL Social Studies, particularly in Taiwan, are relatively uncommon. Grounded in embodied learning theories, this study investigated the comparative impact of hands-on learning versus worksheet-based instruction on fourth graders’ target vocabulary acquisition and procedural knowledge within a CLIL Social Studies setting in Taiwan. The study also explored students’ perceptions of their learning experiences with these instructional methods. This quasi-experimental study involved four intact fourth-grade CLIL Social Studies classes from three elementary schools in Taiwan, comprising 40 students in the Experimental Group (EG), who engaged in hands-on learning, and 34 students in the Control Group (CG), who engaged in worksheet-based learning. Activities included Chinese dumpling making, bird’s nest building, and designing a pot of succulents. Data were collected through pre- and post-tests to assess target vocabulary acquisition and procedural knowledge, followed by learner experience surveys to evaluate students’ perceptions of their learning experiences. The analysis included paired-samples t-tests, independent-samples t-tests, and thematic analysis of open-ended survey responses. Results revealed that the EG significantly outperformed the CG in both target vocabulary acquisition and procedural knowledge across all three activities, with large effect sizes (d = 1.05–1.51 for target vocabulary and 0.95–2.89 for procedural knowledge), demonstrating the effectiveness of hands-on learning. However, while significant differences were observed in memory retention of target vocabulary and procedural knowledge from the survey results, no significant differences were found between the EG and CG in terms of perceived ease of learning. These findings suggest that hands-on learning offers substantial benefits over traditional worksheet-based instruction in CLIL settings, though the transition to hands-on methods may require additional support. Practical implications include the strategic selection of relevant vocabulary, the implementation of structured hands-on approaches, and the emphasis on behavioral reinforcement to enhance learning outcomes.

Identification of osteoporosis genes using family studies.

Osteoporosis is a multifactorial bone disease characterised by reduced bone mass and increased fracture risk. Family studies have made significant contribution in unravelling the genetics of osteoporosis. Yet, most of the underlying molecular and biological mechanisms remain unknown prompting the need for further studies. This review outlines the proper phenotyping and advanced genetic techniques in the form of high-throughput DNA sequencing used to identify genetic factors underlying monogenic osteoporosis in a family-based setting. The steps related to variant filtering prioritisation and curation are also described. From an evolutionary perspective, deleterious risk variants with higher penetrance tend to be rare as a result of negative selection. High-throughput sequencing (HTS) can identify rare variants with large effect sizes which are likely to be missed by candidate gene analysis or genome-wide association studies (GWAS) wherein common variants with small to moderate effect sizes are identified. We also describe the importance of replicating implicated genes, and possibly variants, identified following HTS to confirm their causality. Replication of the gene in other families, singletons or independent cohorts confirms that the shortlisted genes and/or variants are indeed causal. Furthermore, novel genes and/or variants implicated in monogenic osteoporosis require a thorough validation by means of in vitro and in vivo assessment. Therefore, analyses of families can continue to elucidate the genetic architecture of osteoporosis, paving the way for improved diagnostic and therapeutic strategies.

NAMAH—An Innovative Tele-ECHO Mentoring Program to Foster Well-being Among Physicians

Background: The current study aimed to develop and implement the National Assistance in Mental Health for Health Care Providers (NAMAH) module, which focused on wellness and building resilience for a cohort of physicians. Methods: The NAMAH module is a 12-week tele-mentoring program leveraging videoconference technology that uses the ECHO (Extension of Community Healthcare Outcome) HUB and SPOKE and consists of real-life case discussions and a brief didactic. The module’s content was developed after iterative feedback from experts and incorporated suggestions from healthcare providers (HCPs) following a needs assessment. A pre and post-design was used to assess the impact of the module on psychological distress using the self-reported Kessler Psychological Distress Scale (K10) and burnout using the Maslach Burnout—Inventory-Human Services Survey (MBI-HSS) among the 32 physicians who participated. Results: There was a significant decrease in the mean scores before (19.5 ± 6.27) and after (17.38 ± 6.23) the NAMAH module ( p &lt; .05) in the psychological distress as measured by K 10 with a Cohen’s d of 0.41 (95% CI: 0.05–0.77). There was also a significant decrease in the mean scores after the intervention in the emotional exhaustion and depersonalization domain of the MBI-HSS with a medium effect size (Cohen’s d of 0.65) and large effect size (Cohen’s d of 0.94), respectively. Conclusion: The findings from this pilot study lay a foundational framework, encouraging further exploration, research, and scaling-up of such interventions to enhance mental health among physicians and HCPs.

What matters most to the perception of community resilience in Romania?

We aim to measure and explain the perception of community resilience in Romania. We use survey data from a country-representative sample of 1500 respondents. We rely on factor-based partial least squares path modeling to measure five reflective latent constructs from a CCRAM-type questionnaire. We use these constructs to extract a second-order formative latent construct representing an overall measure of community resilience. Next, we use three sub-dimensions of family resilience, along with individual resilience and several control variables to explain community resilience. Among the five sub-dimensions of the overall measure of community resilience, social trust exerts the highest contribution, followed by place attachment. The predictors of community resilience with the largest effect sizes are the three sub-dimensions of family resilience. The policies geared towards increasing community resilience might not be able to address the most important factors, at least in the case of Romania, because they pertain to informal group interaction, and lie outside the reach of formal administrative authority.

Psilocybin-assisted neurofeedback for the improvement of executive functions: a randomized semi-naturalistic-lab feasibility study.

Executive function deficits, common in psychiatric disorders, hinder daily activities and may be linked to diminished neural plasticity, affecting treatment and training responsiveness. In this pioneering study, we evaluated the feasibility and preliminary efficacy of psilocybin-assisted frontal-midline theta neurofeedback (NF), a neuromodulation technique leveraging neuroplasticity, to improve executive functions (EFs). Thirty-seven eligible participants were randomized into an experimental group (n = 18) and a passive control group (n = 19). The experimental group underwent three microdose sessions and then three psilocybin-assisted NF sessions, without requiring psychological support, demonstrating the approach's feasibility. NF learning showed a statistical trend for increases in frontal-midline theta from session to session with a large effect size and non-significant but medium effect size dynamical changes within sessions. Placebo effects were consistent across groups, with no tasks-based EF improvements, but significant self-reported gains in daily EFs-working memory, shifting, monitoring and inhibition-showing medium and high effect sizes. The experimental group's significant gains in their key training goals underscored the approach's external relevance. A thorough study with regular sessions and an active control group is crucial to evaluate EFs improvement and their specificity in future. Psilocybin-enhanced NF could offer significant, lasting benefits across diagnoses, improving daily functioning. This article is part of the theme issue 'Neurofeedback: new territories and neurocognitive mechanisms of endogenous neuromodulation'.

Development and Validation of a Patient-Reported Outcome Measure of the Impact of Chronic Hand Eczema on Health-Related Quality of Life: the Hand Eczema Impact Scale (HEIS).

Chronic Hand Eczema (CHE) is an inflammatory skin disease that causes significant impact on health-related quality of life (HRQoL). The Hand Eczema Impact Scale (HEIS) is a new patient-reported outcome(PRO) measure designed to assess the impact of CHE on key domains of HRQoL. This study aimed to develop and evaluate content and psychometric validity of the HEIS. The HEIS was initially developed on the basis of a literature review and concept elicitation interviews. Qualitative cognitive debriefing interviews (n = 20) were conducted with patients with CHE to assess relevance and understanding of items, response options, and recall period. Psychometric properties (item performance, dimensionality, reliability, validity, responsiveness, and estimation of meaningful change thresholds) were then assessed using data (n = 258) from a phase 2b trial (NCT03683719). Cognitive debriefing confirmed all items were understood and relevant to patients. Inter-item correlations (all > 0.50) and confirmatory factor analysis (factor loadings ≥ 0.80) supported unidimensionality of the HEIS score, and mostly provided support for the HEIS Proximal Daily Activity Limitations (PDAL) score, with only one item loading below the prespecified threshold. Item properties and previous qualitative work supported retaining this item in the total score but removed from the HEIS PDAL domain. Internal consistency (Cronbach's alpha ≥ 0.89) and test-retest reliability (intra-class correlation coefficient ≥ 0.79) results were very strong. Strong correlations with concurrent measures (0.66-0.87) and significant differences between severity groups (p < 0.001) supported construct validity. Large effect sizes for mean change scores in participants that improved and significant differences between groups indicated ability to detect change. Anchor-based analyses supported within-individual responder definitions of ≥ 1.3 points for improvements in both HEIS score and HEIS PDAL score (covering three items) and of ≥ 1.5 points for HEIS embarrassment with the appearance of hands (Emb) score (covering two items). The 9-item HEIS is the first CHE-specific PROmeasure developed and validated according to regulatory guidance for assessment of the impact of CHE on key domains of HRQoL. This article provides evidence of strong content and psychometric validity and shows improvements of ≥ 1.3 points in HEIS score and HEIS PDAL score, and improvements of ≥ 1.5 points in HEIS Emb score represent clinically meaningful, important changes. NCT03683719.

The relations between impulsivity, opioid use, and nonmedical prescription opioid use motives: An examination within three large urban emergency departments.

Impulsivity is a transdiagnostic risk factor for multiple disorders, including opioid use disorders (OUDs). However, scant work has examined if impulsivity facets distinguish individuals reporting nonmedical opioid use from those who use opioids as prescribed, particularly in important settings such as emergency departments (EDs). Further, no studies, to our knowledge, have examined the relations between impulsivity facets and motives for nonmedical prescription opioid use (NMPOU). Using data from EDs, this study examined if impulsivity facets (assessed via the [negative] urgency, premeditation, perseverance, sensation seeking, and positive urgency) related to nonmedical opioid use and if these facets related to OUD severity among individuals reporting past-year opioid use. Among patients reporting past 3-month NMPOU, the relation between motives for use and impulsivity was examined. Results indicated all facets (except lack of perseverance) distinguished patients reporting nonmedical opioid use from individuals abstaining from opioid use and those who used opioids as prescribed, with particularly large effect sizes for positive and negative urgency. Similarly, among patients reporting past 12-month opioid use, all facets (except lack of perseverance) significantly distinguished individuals who were OUD negative from those with severe OUD, with positive and negative urgency showing the strongest relations. Multiple motives were associated with certain UPPS-P facets, particularly positive urgency, negative urgency, and sensation-seeking. Results suggest that the relation between impulsivity and opioid use characteristics varies across facets of impulsivity, with emotion-based impulsivity being the most relevant. Implications for screening and interventions are discussed. (PsycInfo Database Record (c) 2024 APA, all rights reserved).

Temporal variations in and predictive values of ABG results prior to in-hospital cardiac arrest

In-hospital cardiac arrest (IHCA) has been understudied relative to out-of-hospital cardiac arrest. Further, studies of IHCA have mainly focused on a limited number of pre-arrest patient characteristics (e.g., demographics, number and types of comorbidities). Arterial blood gas (ABG) analysis, one of the most common diagnostic tests for assessing and managing critically or acutely ill hospitalized patients, reflects pathophysiological changes associated with adverse events or complications, including IHCA. Yet the predictive and prognostic values of patterns of pre-arrest ABG parameters for IHCA have not been fully studied. The purpose of this retrospective pilot cohort study was to investigate temporal variations in and predictive values of pre-IHCA ABG values among patients with a history of cardiopulmonary diseases. Eligible patients had a history of structural heart disease, heart failure, or pulmonary diseases. Patients were excluded if their IHCA was due to trauma, drug overdose, hypothermia, drowning, chronic terminal illness such as cancer or human immunodeficiency virus, or bleeding not caused by hemorrhage in the brain or heart. Also collected were dates, times, and causes of mechanical intubation prior to IHCA and causes of mortality. Co-primary outcomes were initial rhythms of IHCA and return of spontaneous circulation (ROSC). We conducted a pilot study and the ABG results (pH, partial pressure of carbon dioxide [PaCO2], partial pressure of oxygen [PaO2], bicarbonate [HCO3-] , and lactate) from each of the 3 days prior to IHCA were extracted from the electronic health records (EHRs) of patients (N = 44) who had experienced IHCA at a single medical center. To characterize differences in ABG parameters among study days, coefficients of variation (CVs) were compared using the modified likelihood ratio test (MLRT) using the worst ABG values. Linear regression models were run for the continuous ABG parameters and logistic regression models for the dichotomous ABG variables. Overall model effect and least squares means, SDs, mean differences within and between days (with 95 % confidence intervals), p-values and effect sizes were reported for continuous variables. For categorical variables, estimates and standard errors, 95 % confidence intervals, Wald X2 variables and p-values were presented. The CVs for pH, PaCO2, and HCO3- differed significant between study days (p <.05). The least squares means with 95 % confidence intervals for pH and lactate differed significantly in days (p <.01). Moderate to large effect sizes were obtained for all ABG parameters. Arterial lactate predicted initial rhythm (shockable versus non-shockable) and ROSC, while pH and HCO3- predicted ROSC. Results demonstrate, for the first time, the presence of significant variability in ABG parameters across 72 h prior to IHCA and the predictive potential of these parameters for initial rhythms of IHCA and ROSC. While validation in a larger sample is necessary, this study confirms the feasibility and potential value of exploring temporal patterns of pre-arrest ABG values from the EHRs. Findings of future larger studies on pre-arrest patterns of ABG parameters and other laboratory values may be used to design models that better predict risk for IHCA and guide patient care in the pre and intra-arrest periods.

A Development of Online Problem-Based Learning Model to Promote Self-Regulated Learning among Undergraduates

This research aimed to develop and evaluate an online problem-based learning (PBL) model to enhance undergraduates&amp;#39; self-regulated learning (SRL). The Research and Development method was used in two phases: the first was to develop and validate the model. It began with a literature review to identify core features of effective PBL and SRL within an online environment, then set a concept framework and create the model manually. Seven experts were reviewed following the model, and it was piloted for further optimization. Second, the model will be implemented and evaluated with a sample of 52 students at Thailand National Sports University, Chumphon Campus. The main instruments used were the developed model, the model quality questionnaire, SRL assessments (pre- and post-), and after-action review forms. The results showed that (1) a developed model consisting of four sections: orientation of the model, the model of instruction, application, and student outcomes. Six core components: authentic problems, online collaborative learning, self-regulated learning, instructional scaffolding, online learning resources, and authentic assessments, which are organized through three main processes: preparation, implementation of SRL strategies, and summative assessment, and all activities using an iterative learning three stages: meeting the problem and planning, doing and checking, and presenting the result and reflecting. Experts agreed on the quality of this model, which was excellent. (M= 4.61, SD=0.52). (2) Average SRL score was significantly higher after learning with this model compared to prior us (p&amp;lt;0.01, large effect size; d=1.03). The findings of this study support the developed model that can improve the students&amp;#39; SRL effectiveness. Overall, the students agreed that an instructor plays a critical role in developing their SRL and problem-solving skills. The students demonstrated more self-assurance and were apt to use this method to learn other subjects.