Long-term Behavioral Changes Research Articles

Ethical challenges of telepsychiatry

Telepsychiatry is shifting the focus of psychiatry and psychotherapy from personal interaction and relationship building to communication with technological mediators in the form of telecommunication, virtual reality (VR), social robots or artificial intelligence (AI). This article discusses the opportunities and risks of new technologies in psychiatric treatment, taking into account the principles of medical ethics. Telepsychiatric treatments can promote self-determination in the home environment as opposed to institutionalisation but carry the risk of uncontrolled data sharing. They harbour risks of potential harm such as social isolation, negative effects on the doctor-patient relationship and long-term changes in patient behaviour through, for example, VR. In terms of justice, demographic and psychopathological factors could result in unequal access to telepsychiatry, with questionable sustainability effects. The anonymity of telepsychiatry threatens alienation, while moral considerations cannot be replaced by AI for the time being. It is obligatory to carefully weigh up the benefits and risks of telepsychiatry, but especially in rural areas they could optimise care.Precisely because of ethical concerns, further intensive research is necessary to weigh up the risks and benefits. The development of telepsychiatric systems requires transdisciplinary co-operation. At a societal level, the significance of technologies as a supplement or replacement for the doctor-patient relationship needs to be discussed.

Fundamentals of leadership development: a randomized pilot study to evaluate implementation of a leadership curriculum for diversity, equity, and inclusion.

The Fundamentals of Leadership Development (FLD) Curriculum was created to increase integration of diversity, equity, and inclusion (DEI) in leadership skills. The pilot FLD course was utilized 1) evaluate short-term impact of the curriculum, and 2) evaluate optimal delivery methods of curricular interventions on diversity in a leadership context in a randomized fashion. After IRB approval, the pilot FLD course was opened to all SAGES Committee members for enrollment. All participants had access to the same online modules and discussion forum, but were randomized either to a 4-week longitudinal or 2-day intensive didactic session. Participants were asked to assess the curricular content after each online module and provide overall course feedback on all sessions. This data was collected along with leadership experience, course participation, and course completion data. A total of 79 participants registered for the FLD course, with 55 (69.7%) of participants completing the course. Of those that registered, 46 (58.2%) self-identified as underrepresented in medicine, 32 (40.5%) self-identified with she/her/hers pronouns, and 45 (57.0%) held an institutional leadership position. Fifty-nine (74.6%) participants were willing to be randomized. Course engagement was higher in the intensive course with 64.1% and 48.7% participation over days 1 and 2, respectively. In the longitudinal course, participation dropped off every week from 70%, 47.5%, 35%, and 27.5%, throughout the 4-week course. Participants who accessed the online modules spent a median time of 3h and 34min.User confidence after completion of each individual module were "somewhat confident" and "completely confident" for almost all survey respondents on a 5-tier Likert scale. The pilot FLD course appealed to SAGES members in leadership roles and who identified as. URiM. Course engagement was higher in the intensive course. Long-term behavior changes after course completion will need to be assessed with additional qualitative interviews. (300/300 words).

Long-Term Physical Activity Behavior Change in Pulmonary Rehabilitation: Promoting Motivation.

Long-Term Physical Activity Behavior Change in Pulmonary Rehabilitation: Promoting Motivation.

Considering the 24-Hour Activity Cycle in Older Adults.

Older adults are often advised to engage in more moderate-to-vigorous physical activity (MVPA). Although MVPA offers significant health benefits, focusing solely on MVPA may be difficult for many in this population due to their typically higher levels of sedentary behavior (SB). Increasing light-intensity physical activity (LIPA) can offer similar health benefits and be a more achievable starting point for inactive older adults. The 24-hour activity cycle provides a conceptual model that can assist healthcare providers in promoting physical activity. This model emphasizes the interaction between four key behaviors (i.e., sleep, sedentary behavior, LIPA, and MVPA) and presents a holistic approach to optimizing the balance of these activity behaviors. This article outlines strategies to help older adults increase their physical activity and reduce sedentary time within the 24-hour activity cycle, promoting sustainable, long-term behavior change in this population.

Behavioral Changes and Long-Term Cortical Thickness Alterations in Women with Fibromyalgia

ObjectivesThe purpose of this study was to examine long-term brain and behavioral changes in patients with fibromyalgia (FM) compared to healthy individuals. MethodsData from 33 female volunteers with FM and 33 healthy controls women paired by age and school degree were used to analyze the cortical thickness from high-resolution T1-weighted magnetic resonance imaging (MRI) obtained through a 3T-MRI scanner. Additionally, the Toronto Alexithymia Scale, the Positive and Negative Affect Scale, the emotion regulation questionnaire (ERQ), and the Hamilton Depression and Anxiety rating scales were used to evaluate the behavioral changes. ResultsThe findings indicate significant cortical structure differences in the right cerebral hemisphere between groups in the insular anterior cortex precentral and postcentral gyrus (P < .001). The FM group scored higher for alexithymia (P < .01), negative affect (P < .01), anxiety (P < .01), and depression (P < .01) symptoms, on the other hand, scored lower for positive affect (P < .01). No differences were found on the left cerebral hemisphere. Furthermore, there was a negative correlation between the right insular anterior cortex and Toronto Alexithymia Scale (P < .001). ConclusionThis study showed long-term brain and behavioral changes in patients with FM, suggesting notable neurophysiological alterations associated with this chronic pain condition. It provides new insights into how FM may affect brain health and potential biomarkers for the condition.

Maternal low-dose caffeine intake during the perinatal period promotes short- and long-term sex-dependent hormonal and behavior changes in the offspring.

Maternal caffeine crosses the placenta and mammary barriers, reaching the baby and, because his/her caffeine metabolism is immature, our hypothesis is that even a low caffeine intake (250 mg/day), lower than the dose limit recommended by the World Health Organization, can promote caffeine overexposure in the offspring, leading to short- and long-term changes. Pregnant Wistar rats received intragastric caffeine (CAF) (25 mg/Kg/day) or vehicle during the gestation and lactation periods. We evaluated morphometrical, metabolic, hormonal, and behavioral parameters of male and female offspring at different ages. Even a low caffeine intake promoted lower maternal body mass and adiposity, higher plasma cholesterol and lower plasma T3, without changes in plasma corticosterone. Female CAF offspring exhibited lower birth weight, body mass gain and food intake throughout life, and hyperinsulinemia at weaning, while male CAF offspring showed reduced food intake and lower plasma T3 at weaning. At puberty and adulthood, male CAF showed higher preference for palatable food, aversion to caffeine intake and higher locomotor activity, while female CAF only showed lower preference for high fat diet (HFD) and lower anxiety-like behavior. At adulthood, both male and female offspring showed higher plasma T3. Male CAF showed hypertestosteronemia, while female CAF showed hypoinsulinemia without effect on glucose tolerance. A low caffeine intake during the perinatal period affects rat's offspring development, promoting sex-dependent hormonal and behavior changes. Current data suggest the need to review caffeine recommendations during the perinatal period.

Revolutionizing cancer survivorship: Using human-centered design to build an innovative model for whole-person healing.

355 Background: The cancer care system has struggled for decades to deliver meaningful post-tx survivorship care, relying on patient uptake of clinical guidelines for surveillance, and SCPs for health promotion and managing late effects. On paper, we know how to support survivors. However, there is a lack of “comprehensive guidance on patient-centered practices that specifically address how cancer patients experience their care or how to personalize survivorship so that it meets patients’ unique needs” (Mead et al, 2020). Tofill this gap, we developed an evidence-based, community-delivered model for whole-person healing throughout acute and extended survivorship. Methods: We co-designed a new care model with 24 survivors, shaped by their lived experience &amp; unmet needs. The pilot comprised: A) 2-day in-person retreat to evaluate healing modalities (incl. yoga, journaling, group discussion, nutrition coaching, songwriting); B) a 3-hour human-centered design workshop defining “thriving,” mapping survivorship challenges/gaps &amp; crafting an ideal care map; C) 8-12 weeks of facilitated organic social engagement with their retreat cohort. We conducted the intervention 3x (6/2003-3/2024) with 7-9 participants aged 29-60. Pre-intervention &amp; 4-month post-intervention surveys measured QOL, symptoms &amp; self-efficacy. Participants also did a qualitative survey post-intervention, sharing preferences &amp; activity impact. Results: The model addresses cancer's proximal/distal psychological, emotional, physical &amp; existential impacts. It builds a connected survivor community &amp; drives long-term behavior change with group accountability. The intervention: A) reduced fears of recurrence &amp; preoccupation with functional concerns &amp; indicated positive changes in self-concept; B) improved social connectedness. 86% agreed/strongly agreed they felt seen &amp; understood; 100% strongly agreed that they can implement 1+ new wellness/healing tool in daily life; 80% increase in confidence keeping emotional distress from interfering with life; 40% reduction in perception of cancer/Tx causing negative changes in self-concept; 60% increase in confidence keeping fatigue from interfering with life. Conclusions: A new model of post-treatment survivorship care is needed that aligns with oncology and primary care delivery, builds on the modern wellness movement, and is able to be sustained in daily life. Survivorship can be delivered in the community leveraging in-person/virtual retreats, workshops, apps and social networks. This intervention shows potential to transform survivorship care delivery &amp; radically improve outcomes.

Mind the intention-behavior gap: a qualitative study of post-myocardial infarction patients’ beliefs and experiences with long-term supervised and self-monitored physical exercise

BackgroundMany post-myocardial infarction (MI) patients struggle with physical activity behavior change (BC) for life-long secondary prevention. There is limited knowledge about factors influencing long-term physical activity BC among post-MI patients. This qualitative study aimed to explore the beliefs and experiences related to post-MI patients’ physical activity BC process following a year’s participation in a supervised and self-monitored exercise program: the Norwegian Trial of Physical Exercise After MI (NorEx).MethodsWe conducted a qualitative study, performing in-depth semi-structured interviews with a randomly selected sample of NorEx participants when they were scheduled for cardiopulmonary exercise testing after one year of participation. Interviews were transcribed verbatim and the data was analyzed by applying reflexive thematic analysis.ResultsSeventeen participants (n = 4 female [24%]; median age, 61 years; median time since index MI, 4 years) were recruited and interviewed once. Analysis resulted in four main themes (nine sub-themes): (1) Personal responsibility to exercise (Exercise is safe, Health benefits, Habitual exercise); (2) Peer social support for a sense of safety and belonging (Social exercise, Supervision is preferred); (3) Research participation transformed exercise beliefs (High-intensity exercise is superior, Personal Activity Intelligence (PAI) promotes exercise adherence); and (4) Mind the intention-behavior gap (Initial anxiety, Lack of continued follow-up).ConclusionsSeveral participants reported that they were able to maintain exercise BC during a year’s participation in NorEx. Nevertheless, a perceived lack of continued and individualized follow-up made some participants struggle with motivation and self-regulation, leading to an intention-behavior gap. Therefore, our findings suggest there is a need for individualized and continued social support and supervision from health and exercise professionals to maintain long-term exercise BC for secondary prevention among post-MI patients.Trial registrationThe NorEx study has been registered at ClinicalTrials.gov (NCT04617639, registration date 2020-10-21).

Designing for Sustained Motivation: A Review of Self-Determination Theory in Behaviour Change Technologies

Abstract Recent years have seen a surge in applications and technologies aimed at motivating users to achieve personal goals and improve their wellbeing. However, these often fail to promote long-term behaviour change, and sometimes even backfire. We consider how self-determination theory (SDT), a metatheory of human motivation and wellbeing, can help explain why such technologies fail, and how they may better help users internalize the motivation behind their goals and make enduring changes in their behaviour. In this work, we systematically reviewed 15 papers in the ACM Digital Library that apply SDT to the design of behaviour change technologies (BCTs). We identified 50 suggestions for design features in BCTs, grounded in SDT, that researchers have applied to enhance user motivation. However, we find that SDT is often leveraged to optimize engagement with the technology itself rather than with the targeted behaviour change per se. When interpreted through the lens of SDT, the implication is that BCTs may fail to cultivate sustained changes in behaviour, as users’ motivation depends on their enjoyment of the intervention, which may wane over time. An underexplored opportunity remains for designers to leverage SDT to support users to internalize the ultimate goals and value of certain behaviour changes, enhancing their motivation to sustain these changes in the long term.

A single exposure to brivaracetam or perampanel does not cause cell death in neonatal rats.

Exposure to a range of anti-seizure medications (ASMs) during early brain development adversely impacts neurodevelopmental outcomes in both animal models and in clinical studies. Many ASMs, including phenobarbital, phenytoin, valproate (VPA), and benzodiazepines, are associated with acute neurotoxicity (cell death), impaired synaptic development, and long-term behavioral changes following gestational or neonatal exposure in animals. This is mirrored in clinical studies which show lasting neurodevelopmental deficits following early-life or gestational exposure to these drugs. Brivaracetam (BRV) and perampanel (PER) are two newer generation anti-seizure medications and are of interest based on their mechanisms of action (SV2A modulator, AMPA antagonist, respectively), as other drugs with these mechanisms of action do not trigger acute neurotoxicity. Both BRV and PER show anti-seizure efficacy in developing animals, but potential neurotoxicity of these drugs is unexplored. To address this gap, we treated postnatal day (P)7 Sprague-Dawley rats with BRV (20, 40, 80 mg/kg) and PER (0.1, 0.9, 2.7 mg/kg), and assessed the induction of cell death across a range of vulnerable brain regions 24 h after exposure. Cell death was assessed using pathogreen staining. In each of the regions examined (dorsal striatum, nucleus accumbens, motor cortex, cingulate cortex, lateral thalamus, septum, hippocampus), VPA, which served as a positive control, significantly increased cell death as measured by the numer of pathogreen positive cells. By contrast, neither BRV nor PER increased the number of pathogreen positive cells in any region examined. Our results suggest that BRV and PER may have a positive safety profile-at least with respect to acute induction of cell death - and therefore may offer a safer option for the treatment of early life seizures.

Together we win! Narratives of couples pursuing a healthy diet and physical activity: A qualitative study.

Metabolic syndrome (MetS) is a major risk factor for non-communicable diseases, including type 2 diabetes mellitus, cardiovascular disease, and cancer. The risk of MetS can be transmitted via epigenetic processes from both the mother and the father. Therefore, it is essential that both members of a couple are targeted in pre-conception nutrition and physical activity-based lifestyle programs. However, lifestyle interventions targeting both members of a couple are scarce in the literature. This study, therefore, aimed to explore the barriers and facilitators of a couples-based lifestyle intervention. Nulliparous couples who had an interest in having children in the future were recruited to the study and each member interviewed separately to gain insight into to gain insight into designing future couples-based lifestyle interventions. Interviews were conducted between June and October 2021. Reflexive thematic analysis (RTA) was applied to conduct and analyse semi-structured, in-depth interviews with nulliparous couples who had an interest in having children in the future. Four major themes were identified in nine couples aged 25-34 years (here referred to as "millennials"): Millennials are committed to preparation for their future offspring; millennials know features of a good program likely to have high adherence and long-term behavior change; millennials acknowledge the importance of couples-based programs; and millennials appreciate that future global emergencies may require lifestyle modifications. This study found that millennial couples showed a strong intention to create optimal emotional, financial, and health conditions for their children. They supported couples-based approach (CBA) lifestyle interventions to mitigate potential epigenetic risks. Couples believed that participating together in these programs would enhance adherence to healthy habits, promoting long-term well-being. The findings advocate for exploring and testing CBA interventions that target both partners, as joint participation not only aids in healthy conception and reduces metabolic syndrome risks but also establishes a foundation for family health. These insights highlight the potential of CBA interventions to positively impact future generations.

MHealth learning strategies to support behaviour change in individuals using wheelchairs and/or scooters: a systematic review.

The purpose of this systematic review of the literature is to build understanding of the key elements and recommendations for the design of mHealth technology for individuals using wheelchairs and/or scooters and identify key features associated with the use of mHealth to support healthy behaviour changes for this population. Eight major electronic databases were systematically searched to identify mobile health (mHealth) interventions, which targeted adult WC/S users. Independent reviewers used Endnote and Covidence to manage articles meeting review criteria and to exclude duplicates. A quality assessment was conducted on each included article. Nine articles describing studies with diverse study designs met criteria to be included in this review. Several interactive application intervention features, such as participant collaboration and goal setting, and key technical features to support mHealth app development and utilisation were identified. Results found intuitive and simple designs of mHealth apps, with the ability to customise to support learning styles and preferences, support usability and acceptability by participants. More research is needed to evaluate best practices to support initial training of end-users, mHealth apps' ability to support long-term behaviour change and maintenance, and the understanding of active ingredients in complex interventions that include mHealth apps. Both interactive mHealth application intervention and technical features support healthy behaviour change among individuals using wheelchairs and scooters.

Travel behaviour transformations in Indonesia: Assessing the long-term impact of COVID-19 on mobility patterns

This study examined the long-term impacts of the COVID-19 pandemic on mobility patterns in Indonesia, focusing on the transition from pre-pandemic norms to the endemic phase. Using quantitative methods and retrospective data analysis, we explored changes in travel behaviour, including mode choice, trip frequency, and travel time. We identified travel behaviour in three phases: pre-pandemic, pandemic (March 2020 to the end of January 2022), and transition to endemic (the data collection period: July – August 2022). Our investigation of the shifts in travel behaviour across these periods enabled us to distinguish between temporary fluctuations and enduring, potentially long-term changes in behaviour. The empirical investigation revealed significant alterations in trip frequency that persisted during the endemic phase, suggesting that these changes in mobility are likely to continue. Factors influencing these shifts include socioeconomic characteristics, work modalities, and attitudes toward health protocols. This study contributes to the understanding of pandemic-induced travel behaviour transformations and provides insights for policymakers and transportation planners to adapt to these changes in the Southeast Asian context.

The effect of anhedonic traits on snack food consumption and interoception of food-related pleasure and bodily sensations

Human eating behaviour is driven by the need to secure energy demands and the desire for pleasure. Signals from the body guide this behaviour, relying on the ability to sense internal sensations. Impaired interoception has been linked to unhealthy eating habits. However, the impact of anhedonia (reduced ability to experience pleasure) on interoception and eating behaviour has not yet been studied and could enhance our understanding of eating behaviour. We conducted a cross-sectional study using self-report measures on 309 Chinese consumers with high (n = 150) and low (n = 159) anhedonic traits to explore differences in interoceptive experiences of snack food consumption. Specifically, we investigated interoceptive awareness, intuitive eating, and food-related pleasure using validated questionnaires. Additionally, we examined snack intake frequency, drivers of snack food consumption and post-ingestive sensations using self-developed questionnaires. We hypothesised that individuals with high anhedonic traits would exhibit low interoceptive awareness and lower intensity of interoceptive sensations linked to snack food consumption. Consistent with our hypotheses, low interoceptive awareness and intuitive eating were observed in individuals with high anhedonic traits. Furthermore, individuals with high anhedonic traits reported lower food-related pleasure, lower healthy snack intake frequency, and lower intensity of post-ingestive sensations for healthy snacks compared to the group with low anhedonic traits. Differences detected between groups were mainly detected for healthy snacking and not unhealthy snacking. Understanding how anhedonic traits relate to food pleasure and bodily sensations related snack consumption can provide novel insights and clarify focus areas for developing strategies supporting interoceptive awareness for long-term dietary behaviour changes.

Evaluating campaign concepts aimed at replacing sugar-sweetened beverages with water.

The study addresses the global health concern of sugar overconsumption, particularly focusing on the prevalence of sugar-sweetened beverage consumption among young people. The study tested three different health promotion campaign concepts, designed to reduce sugar-sweetened beverage intake and promote water consumption as a healthier alternative. A total of 402 young adults (18-29) were recruited from a university campus and an online panel. Participants were randomly assigned to view one of three campaign images: one advocating for substituting sugar-sweetened beverages with water, and two exclusively promoting water consumption. These images were assessed through an online survey, which included questions on emotional response, salience, attitudes and intentions towards various beverages. Participants exposed to the campaign emphasising the benefits of water showed a greater intention to increase water consumption and reduce both sugar- and non-sugar-sweetened beverages compared with the other groups. There were no significant differences observed for the beverage choice task across the campaigns. The findings suggest that messaging focusing on the benefits of water holds promise in encouraging healthier beverage consumption intentions among young adults. The lack of significant differences in the beverage choice task across the campaigns indicates a need for further research to explore long-term behaviour change effects. SO WHAT?: By highlighting the benefits of water consumption, campaigns may have the potential to positively influence beverage choices and promote healthier habits. Continued research in this area can provide valuable insights for developing more impactful interventions aimed at reducing sugar-sweetened beverage consumption.

Limited Bedding and Nesting as a Model for Early-Life Adversity in Mice.

Early-life adversity (ELA), such as abuse, neglect, lack of resources, and an unpredictable home environment, is a known risk factor for developing neuropsychiatric disorders such as depression. Animal models for ELA have been used to study the impact of chronic stress on brain development, and typically rely on manipulating the quality and/or quantity of maternal care, as this is the major source of early-life experiences in mammals, including humans. Here, a detailed protocol for employing the Limited Bedding and Nesting (LBN) model in mice is provided. This model mimics a low-resource environment, which provokes fragmented and unpredictable patterns of maternal care during a critical developmental window (postnatal days 2-9) by limiting the amount of nesting materials given to the dam to build a nest for her pups and separating the mice from the bedding via a mesh platform in the cage. Representative data are provided to illustrate the changes in maternal behavior, as well as the diminished pup weights and long-term changes in basal corticosterone levels, that result from the LBN model. As adults, offspring rearedin the LBN environment have been shown to exhibit an aberrant stress response, cognitive deficits, and anhedonia-like behavior. Therefore, this model is an important tool to define how the maturation of stress-sensitive brain circuits is altered by ELA and results in long-term behavioral changes that confer vulnerability to mental disorders.

Tympanostomy Tubes Under Local Versus General Anesthesia for Children: A Prospective Long-Term Study.

Tympanostomy tube insertion (TTI) under local anesthesia (LA) is gaining popularity but literature comparing long-term outcomes for children undergoing TTI under LA versus general anesthesia (GA) is limited. This study compares the long-term quality of life (QoL) between LA and GA in children undergoing TTI. Secondary objectives included long-term behavioral changes, parental satisfaction, tube durability, and postoperative complications. We prospectively followed children aged under 6 who underwent TTI, under LA or GA, 2 years prior. We assessed QoL using validated scales (OM6, PedsQL), analyzed behavioral changes and parental satisfaction through qualitative scales, and retrieved data on tube durability and non-immediate complications. A total of 84 children (LA = 42; GA = 42) had complete data and a minimum of 1 year of follow-up. Demographic data were similar, except for younger patients in the LA group (1.4 vs. 1.9 years, p = 0.02). LA group exhibited increased fear of health care professionals following TTI (LA: Likert scale 2.1/5, GA: 1.5/5, p = 0.04). Tube retention rate was shorter in the LA group (at 15 months: GA:72%, LA:50%, p = 0.039). Two years post-TTI, there were no differences regarding QoL (OM-6 score; LA: 15.2/100, GA: 21.4/100, p = 0.18, and PedsQL score; LA: 84.3/100, GA: 83.8/100, p = 0.90), parental satisfaction with anesthesia (GA: 4.5/5, LA: 4.6/5, p = 0.56), and postoperative complications (GA: 3/42, LA: 7/42, p = 0.18). TTI under LA in children is associated with an increased fear of health care professionals and shorter functionality of tympanostomy tubes as compared to GA. No difference was observed in long-term QoL, parental satisfaction, and complications rate. Level 3 Laryngoscope, 2024.

Is companion animal loss cat-astrophic? Responses of domestic cats to the loss of another companion animal

The examination of grief in nonhuman animals has historically been limited to anecdotal evidence. Recent investigations suggest that the psychological experience of loss may be widespread within the animal kingdom. Many studies have examined caregiver grief following the death of a companion animal but few have examined how other companion animals respond to these deaths. We sought to examine predictors related to the response of surviving domestic cats, following the death of a companion animal within the same household. A total of 412 cat caregivers were surveyed regarding both caregivers’ and surviving cats’ (n = 452) relationship with the deceased pet as well as possible immediate and long-term behavioral changes following the loss of a companion animal within the household. Amount of time spent engaging in activities together in a typical day predicted caregiver reports of increases in grief-like behaviors and fearfulness in surviving cats. More positive relationships between the deceased animal and surviving cat predicted decreases in sleeping, eating, and playing. The longer the cat had lived with the deceased animal, the more the caregivers reported increases in attention-seeking following the death. However, higher levels of caregiver attachment also predicted reports of increases in attention seeking behavior, which may reflect anthropomorphism in the projection of caregiver grief onto surviving companion animals. Consistent with this hypothesis, caregivers who experienced greater grief were more likely to report increases in their surviving cats’ sleep, spending time alone and hiding following the death. If caregivers reported avoidant attachment with the deceased cat, they reported greater decreases in grief-like behaviors in surviving cats following the death, suggesting that caregivers without strong, secure attachment binds were less likely to perceive that their surviving animals experienced grief. This is only the second known exploration of domestic cats’ responses to the death of another companion animal and reveals that cats exhibit similar grief-like behavioral changes following such deaths compared to dogs examined in previous work. That is, they engaged less in sleeping, eating and playing but more in seeking attention from humans and other pets, hiding, spending time alone and appearing to look for their lost companions. Future work is needed to determine whether these results reflect caregivers projecting their own grief onto surviving animal companions or whether cats may also experience grief following companion loss.

Which components of behavioral weight management programs are essential for weight loss in people living with obesity? A rapid review of systematic reviews.

The optimal treatment and organization of care for people with obesity is one of the greatest challenges facing today's health services. While surgery and pharmacotherapy offer effective treatment options for some people with obesity, behavioral interventions are important to support long-term behavioral change. However, little is known about the most effective components of behavioral interventions, and this is especially the case for people with complex or severe obesity (i.e. body mass index [BMI] > 35 kg/m2). Accordingly, the current rapid review aimed to identify which behavior change techniques (BCTs) are effective for weight loss in adults with (severe) obesity. A secondary aim was to review the effects of BCTs on dietary behaviors and physical activity, and psychological outcomes, recognizing that behavioral interventions commonly target these. A search of Scopus, Ovid Medline, and Web of Science resulted in 1227 results, with 22 reviews eligible for inclusion. The most commonly reported BCTs were self-monitoring and goal setting, but these had variable effects on weight in adults with obesity. Combining these BCTs with other self-regulatory techniques led to increased weight loss. Further, for adults with severe obesity, so-called 'nudge' techniques and self-regulatory techniques were associated with greater weight loss. Three reviews also found that while self-monitoring increased physical activity, behavioral commitments increased changes to dietary behaviors. BCTs were not associated with psychological well-being. The review confirms that behavioral interventions have an impact in weight management, including for individuals with more complex or severe obesity, but highlights the need for further investigation of their use within clinical settings.

UK horse owners and veterinary practitioners' experiences of decision-making for critical cases of colic.

The survival of horses diagnosed with critical colic (requiring referral or euthanasia) relies on rapid and effective decision-making by the owner and veterinary practitioner. To explore UK horse owners' and veterinary practitioners' experiences of decision-making for critical cases of equine colic. Qualitative study using a phenomenological approach. Individual, semi-structured telephone interviews were conducted with 14 horse owners and 13 veterinary practitioners (vets) who had experienced a critical decision (referral or euthanasia) for a horse with colic. A purposive, convenience sample of participants was recruited. Sessions explored participant's experience of colic, including recognition, help-seeking behaviour, and challenges. Thematic analysis was performed on collected data. Four over-arching themes were identified; 'head', 'heart', 'practicalities' and 'impact'. Owners acknowledged responsibility for their horse's welfare but had different perspectives than vets on the importance of finance ('head'). Both vets and owners described how the horse-human relationship ('heart') often led to conflict during decision-making. The vet-client relationship was influential on decision-making for both owners and vets; involving other people in decision-making was described both positively and negatively by participants ('heart'). 'Practicalities', such as lack of preparedness, transport issues and adverse weather conditions, were identified by both owners and vets as barriers. Owners described a 'rollercoaster' of emotions after a critical decision, with profound impacts on their mental wellbeing, feelings of guilt, and long-term changes in behaviour ('impact'), and a lack of support to manage these feelings. Small sample size. This study describes stakeholder decision-making during critical cases of equine colic. Factors that commonly influenced decisions included an owner's previous knowledge and beliefs, social pressures, logistics and the relationship between the owner and vet. The study highlighted long-term impacts on the owner, including their management and decisions for subsequent horses. These factors should be considered in shared decision-making.