Long-term Behavioral Changes Research Articles

O.3.2-6 A computer-tailored physical activity intervention for prostate and colorectal cancer patients and survivors: long-term efficacy and behavior change maintenance of OncoActive

Abstract Purpose To improve the long-term physical and psychological health of prostate and colorectal cancer survivors, physical activity (PA) interventions aimed at maintaining PA are necessary. OncoActive is a print- and web-based intervention that was was able to increase PA of prostate and colorectal cancer patients and survirors shortly after the intervention ended. This study evaluated the long-term efficacy (12-month follow-up) comparing OncoActive and a control group. Furthermore, we explored whether the increased PA was maintained after an 8 month non-intervention follow-up period. Methods Prostate or colorectal cancer patients were randomly assigned to OncoActive (N = 249) or a usual care control group (N = 229). OncoActive participants received 3 times PA advice and a pedometer. PA outcomes (i.e., ActiGraph and self-report MVPA min/week and days with ≥ 30 min PA) and health-related outcomes (i.e., fatigue, depression, physical functioning) that were significantly changed by the intervention at 6-month follow-up, were included. Differences between groups and changes over time were assessed with multilevel linear regressions. Results At 12 months, OncoActive participants did not perform better than control group participants at ActiGraph MVPA min/week, self-report MVPA min/week or ActiGraph days with PA. Only self-report days with PA were significantly higher in OncoActive compared to the control group. Fatigue was the only health-related outcome that was significantly lower in OncoActive compared to the control group at 12-month follow-up. When exploratively looking within the OncoActive group, the previously found PA increase shortly after the intervention (6 months follow-up) was maintained at 12 months and PA improved significantly from baseline to 12 months. The control group showed small but non-significant improvements from 6 to 12 resulting in a decline of differences between groups. Conclusion At long-term follow-up (i.e., 12-months), most significant differences between OncoActive and the control group at short-term follow-up (i.e., 6 months) were no longer significant. Natural improvements in the control group may have contributed to this. Fatigue was significantly lower in OncoActive compared to control group participants at 12 months. Computer-tailored PA advice may give participants an early start to recovery and potentially contributes to improving long-term health. Funding KWF Kankerbestrijding (Dutch cancer society) NOU2012-5585

O.2.3-3 Are we working (too) comfortably?: developing and testing an evidence-informed toolkit to reduce sedentary behaviour when working at home

Abstract Covid-19 permanently changed how desk-based workers spend their day, with many working at home (W@H) some/all of the working week. W@H is associated with increased levels of sedentary behaviour (SB), when compared to office sitting. There are adverse mental and physical health outcomes associated with prolonged SB. A solution is needed to support those who W@H to move more across the day, reducing the negative effects of SB. Informed by a rapid review and focus groups with desk-based workers, we developed a ‘Toolkit’ comprising educational information about SB, suggestions for reducing SB, and action planning resources. ‘Toolkit’ components were grouped into themes and delivered over 4-weeks by e-newsletter: 1) Move During Meetings; 2) Active Breaks; 3) Home-to-Home Commute; 4) DIY Tech. Scottish Government employees tested the ‘Toolkit’ and provided feedback to allow us to refine ahead of wider rollout. Staff reported enjoying using the ‘Toolkit’ and found the weekly e-newsletters were a useful reminder to move more when W@H. Suggestions were considered practical, low-cost, and didn’t require additional resource (e.g. buying equipment) to engage with. In terms of refinements, staff felt it would be useful to have organisational support for permission to take breaks when W@H and that there were occasions when it could be difficult to implement suggestions, e.g. during meetings, when busy, and limitations of job requirements. Each participant had their own favourite strategy. The ‘Toolkit’ could be further enhanced through options to personalise. The Active Break week was the favourite theme with 39% of final evaluation respondents indicating preference for this. DIY Tech week was the least favourite (11%). W@H employees are aware of the risks of prolonged SB, and want to reduce this behaviour without impacting on job role. Validation from employers will nurture a culture of permission to move, however resources providing employees with individualised suggestions of when to move and what to do will be imperative to encourage long-term behaviour change. Through our research, we have developed and tested an intervention ‘Toolkit’ for supporting those W@H to reduce SB. The next stage is to explore AI-based opportunities for personalisation and rolling out more widely.

Older Veterans' Experiences of a Multicomponent Telehealth Program: Qualitative Program Evaluation Study.

There are 8.8 million American veterans aged >65 years. Older veterans often have multiple health conditions that increase their risk of social isolation and loneliness, disability, adverse health events (eg, hospitalization and death), mental illness, and heavy health care use. This population also exhibits low levels of physical function and daily physical activity, which are factors that can negatively influence health. Importantly, these are modifiable risk factors that are amenable to physical therapy intervention. We used a working model based on the dynamic biopsychosocial framework and social cognitive theory to conceptualize the multifactorial needs of older veterans with multiple health conditions and develop a novel, 4-component telehealth program to address their complex needs. This study aims to describe veterans' experiences of a multicomponent telehealth program and identify opportunities for quality and process improvement. We conducted qualitative interviews with telehealth program participants to collect their feedback on this novel program; explore their experience of program components; and document perceived outcomes and the impact on their daily life, relationships, and quality of life. As part of a multimethod program evaluation, semistructured interviews were conducted with key informants who completed ≥8 weeks of the 12-week multicomponent telehealth program for veterans aged ≥50 years with at least 3 medical comorbidities. Interviews were audio recorded and transcribed. Data were analyzed by a team of 2 coders using a directed content analysis approach and Dedoose software was used to assist with data analysis. Of the 21 individuals enrolled in the program, 15 (71%) met the inclusion criteria for interviews. All 15 individuals completed 1-hour interviews. A total of 6 main conceptual domains were identified: technology, social networks, therapeutic relationship, patient attributes, access, and feasibility. Themes associated with each domain detail participant experiences of the telehealth program. Key informants also provided feedback related to different components of the program, leading to adaptations for the biobehavioral intervention, group sessions (transition from individual to group sessions and group session dynamics), and technology supports. Findings from this program evaluation identified quality and process improvements, which were made before rigorously testing the intervention in a larger population through a randomized controlled trial. The findings may inform adaptations of similar programs in different contexts. Further research is needed to develop a deeper understanding of how program components influence social health and longer-term behavior change.

The Lifespan of Human Activity Recognition Systems for Smart Homes.

With the growing interest in smart home environments and in providing seamless interactions with various smart devices, robust and reliable human activity recognition (HAR) systems are becoming essential. Such systems provide automated assistance to residents or to longitudinally monitor their daily activities for health and well-being assessments, as well as for tracking (long-term) behavior changes. These systems thus contribute towards an understanding of the health and continued well-being of residents. Smart homes are personalized settings where residents engage in everyday activities in their very own idiosyncratic ways. In order to provide a fully functional HAR system that requires minimal supervision, we provide a systematic analysis and a technical definition of the lifespan of activity recognition systems for smart homes. Such a designed lifespan provides for the different phases of building the HAR system, where these different phases are motivated by an application scenario that is typically observed in the home setting. Through the aforementioned phases, we detail the technical solutions that are required to be developed for each phase such that it becomes possible to derive and continuously improve the HAR system through data-driven procedures. The detailed lifespan can be used as a framework for the design of state-of-the-art procedures corresponding to the different phases.

A mild stressor induces short-term anxiety and long-term phenotypic changes in trauma-related behavior in female rats.

Anxiety and anxiety-influenced disorders are sexually dimorphic with women being disproportionately affected compared to men. Given the increased prevalence in women and the documented differences in anxiety and trauma behavior between male and female rats this paper sought to examine the link between stress, anxiety, and fear learning and extinction in female rats. We tested the hypothesis that a mild stressor will induce short-and long-term increases in anxiety and produce long term effects on subsequent fear learning and extinction behavior. We induced anxiety in female Sprague- Dawley rats with a short (3 min) exposure to a ball of cat hair infused with 150 μl of cat urine (mild stressor) that elicits innate fear but does not cause fear conditioning. The control group was exposed to fake cat hair. Anxiety was assessed in the Light-Dark Open Field (LDOF) or Elevated Plus Maze (EPM) before, immediately after and 4 days after stimulus exposure. Two weeks later, all animals were subject to Contextual Fear Conditioning (CFC) in the Shock Arm of a Y-maze, blocked off from the rest of the maze. Memory and fear extinction (learning of safety) was assessed in the following four days by placing each rat in one of the Safe Arms and measuring avoidance extinction (time spent and number of entries in the Shock Arm). Cat hair exposure induced changes in anxiety-like behavior in the short-term that appeared resolved 4 days later. However, the cat-hair exposed rats had long-term (2 weeks) phenotypic changes expressed as altered exploratory behavior in an emotionally neutral novel place. Fear learning and extinction were not impaired. Yet, using avoidance extinction, we demonstrated that the phenotypic difference induced by the mild stressor could be documented and dissociated from learning and memory. These findings demonstrate that the history of stress, even mild stress, has subtle long-term effects on behavior even when short-term anxiety appears resolved.

Biomass smoke inhalation promotes neuroinflammatory and metabolomic temporal changes in the hippocampus of female mice

Smoke from wildland fires has been shown to produce neuroinflammation in preclinical models, characterized by neural infiltrations of neutrophils and monocytes, as well as altered neurovascular endothelial phenotypes. To address the longevity of such outcomes, the present study examined the temporal dynamics of neuroinflammation and metabolomics after inhalation exposures from biomass-derived smoke. 2-month-old female C57BL/6 J mice were exposed to wood smoke every other day for 2 weeks at an average exposure concentration of 0.5 mg/m3. Subsequent serial euthanasia occurred at 1-, 3-, 7-, 14-, and 28-day post-exposure. Flow cytometry of right hemispheres revealed two endothelial populations of CD31Hi and CD31Med expressors, with wood smoke inhalation causing an increased proportion of CD31Hi. These populations of CD31Hi and CD31Med were associated with an anti-inflammatory and pro-inflammatory response, respectively, and their inflammatory profiles were largely resolved by the 28-day mark. However, activated microglial populations (CD11b+/CD45low) remained higher in wood smoke-exposed mice than controls at day 28. Infiltrating neutrophil populations decreased to levels below controls by day 28. However, the MHC-II expression of the peripheral immune infiltrate remained high, and the population of neutrophils retained an increased expression of CD45, Ly6C, and MHC-II. Utilizing an unbiased approach examining the metabolomic alterations, we observed notable hippocampal perturbations in neurotransmitter and signaling molecules, such as glutamate, quinolinic acid, and 5-α-dihydroprogesterone. Utilizing a targeted panel designed to explore the aging-associated NAD+ metabolic pathway, wood smoke exposure drove fluctuations and compensations across the 28-day time course, ending with decreased hippocampal NAD+ abundance on day 28. Summarily, these results indicate a highly dynamic neuroinflammatory environment, with potential resolution extending past 28 days, the implications of which may include long-term behavioral changes, systemic and neurological sequalae directly associated with wildfire smoke exposure.

Sustainable consumer choices – critical reflection on hospitality and tourism

PurposeStrategies to promote more sustainable consumer choices have been gaining interest among tourism and hospitality scholars. In particular, behavioral economic theories of decision-making have gained popularity in the past decade, led by behavioral interventions (BIs) such as the nudge movement. This paper aims to present a critical reflection on this recent trend, with a specific focus on whether these BI approaches are an adequate tool to contribute to long-term behavioral changes, one crucial aim of the promotion of sustainable consumption.Design/methodology/approachBased on a critical review of recent significant academic works in the field, this paper reflects on how nudge principles are applied in the hospitality and tourism sectors, as well as the usual justifications given for their use. This paper then discusses the potential limitations, both theoretical and practical, of using these short-term focused approaches to decisions that intend to have long-term outcomes and aims.FindingsBIs in hospitality and tourism have the potential to create long-term sustainable changes through a more comprehensive view of behavioral factors influencing decisions; however, such approaches would need to be strongly embedded in theoretical arguments that question “how” and “why” behavior change could be sustainable in the long term. This paper proposes a conceptual framework to address these concerns for future research.Research limitations/implicationsThis critical reflection proposes a comprehensive framework that will help guide stronger theoretically motivated identification, design and empirical testing of BIs and nudges. Industry can eventually benefit from theoretically stronger interventions that provide a balance between the short-term and long-term influence of BIs to attain customer loyalty and eventually greater value for business stakeholders.Originality/valueThis reflection paper critically reviews the basis of BIs and recommends a framework to strengthen their theoretical arguments. This reflection focuses on the theoretical critique of BIs and nudges to ensure long-term behavior changes are sustainable. The paper also proposes a comprehensive framework that incorporates well-founded theoretical models to enhance BIs and nudge literature.

MENUMBUHKAN DISIPLIN DIRI MELALUI DISIPLIN POSITIF RESTITUSI

The method of giving punishment in creating self-discipline in students is not effective. The punishment given will stimulate bullying in schools. The impact of punishment not only hurts physically but also mentally. They will grow into someone who is inferior and anti-social. In learning they become passive because they only focus on avoiding punishment. Likewise, giving rewards is not effective in fostering self-discipline in learners. This method actually makes learners dependent on rewards for good behavior and is counter-productive to the goal of self-discipline. Rewards do not foster internal motivation, responsibility and resilience in learners. This research uses the literature review method where data is obtained from various sources such as journals, e-books, and relevant references according to the topic raised. Positive discipline guides learners in fostering internal motivation so as to create long-term self-discipline. Positive discipline gives learners the freedom to correct and learn from their mistakes. Restitution is part of positive discipline with three steps, namely; 1) Stabilizing Identity; 2) Validating wrong actions; 3) Questioning class beliefs. The end result of the application of restitution positive discipline is the birth of self-discipline in students which is characterized by long-term good behavior. Schools that implement restitution positive discipline successfully reduce the number of offenses, learners are more likely to respect school rules and consider the consequences of their actions before violating. This indicates that restitution is successful in reducing negative behavior and bringing about long-term changes in learners' behavior.

Promoting physical activity through supervised vs motivational behavior change interventions in breast cancer survivors on aromatase inhibitors (PAC-WOMAN): protocol for a 3-arm pragmatic randomized controlled trial

BackgroundAromatase inhibitors (AI) are frequently used to treat hormone-receptor-positive breast cancer, but they have multiple adverse effects (e.g., osteoporosis, arthralgia), resulting in premature therapy discontinuation/switch. Physical activity (PA) can attenuate these negative effects and improve quality of life (QoL). However, most cancer survivors fail to perform/sustain adequate PA levels, especially in the long-term. Theory-based interventions, using evidence-based behavior change techniques, aimed at promoting long-term behavior change in breast cancer survivors are effective, but remain scarce and fail to promote self-regulatory skills and better-quality motivations associated with sustained PA adoption. This paper describes the design of the PAC-WOMAN trial, which will test the long-term effectiveness and cost-effectiveness of two state of the art, group-based interventions encouraging sustained changes in PA, sedentary behavior, and QoL. Additional aims include examining the impact of both interventions on secondary outcomes (e.g., body composition, physical function), and key moderators/mediators of short and long-term changes in primary outcomes.MethodsA 3-arm pragmatic randomized controlled trial, involving a 4-month intervention and a 12-month follow-up, will be implemented, in a real exercise setting, to compare: 1) brief PA counseling/motivational intervention; 2) structured exercise program vs. waiting-list control group. Study recruitment goal is 122 hormone-receptor-positive breast cancer survivors (stage I-III), on AI therapy (post-primary treatment completion) ≥ 1 month, ECOG 0–1. Outcome measures will be obtained at baseline, 4 months (i.e., post-intervention), 10 and 16 months. Process evaluation, analyzing implementation determinants, will also be conducted.DiscussionPAC-WOMAN is expected to have a relevant impact on participants PA and QoL and provide insights for the improvement of interventions designed to promote sustained adherence to active lifestyle behaviors, facilitating its translation to community settings.Trial registrationApril 20, 2023 – NCT05860621.April 21, 2023 – https://doi.org/10.17605/OSF.IO/ZAQ9NApril 27, 2023 – UMIN000050945.

Smartphone Applications (Apps) for Nutrition Education: A Qualitative Analysis of Outpatient Dietitian Perspectives

ObjectiveTo explore how outpatient dietitians select and use applications (apps) to support nutrition education. MethodsQualitative analysis of 20 dietitians who participated in semistructured interviews investigating their app use and recommendation processes. Transcripts were analyzed using thematic analysis. ResultsFour themes described how dietitians perceive apps for nutrition education: (1) nutrition education goals focus on long-term lifestyle behavior change while protecting patients’ relationship with food, (2) attitudes toward tracking apps influence app selection, (3) dietitians differentiate among patients who will benefit from tracking vs information apps, and (4) barriers to optimal app use result in adaptations by dietitians. Conclusions and ImplicationsBarriers exist to optimal app use for nutrition education. However, accessible app design, app selection guides, and research expounding the effects of apps and their use by dietitians may improve how practitioners incorporate apps into nutrition education.

943-P: Improved Glycemic Outcomes after One Year among Level 2 Members

Background: Level2’s virtual specialty clinic, offered across the United States to people with type 2 diabetes on participating insurance plans, combines providers, coaches, continuous glucose monitors (CGM), and fitness trackers to help members gain insight, and focus on long-term behavior change. We retrospectively assessed differences in glycemic outcomes following one year of participation in Level2. Methods: People joining Level2 between 01/01/21 and 07/31/21 with 15 months of Level2 participation and 3 prior months of continuous enrollment in a participating commercial health plan were included in the analysis. We used CGM-derived GMI and A1c values available from a database of de-identified administrative claims to determine baseline and 12-month follow-up glycemic outcomes. Wilcoxon signed-rank tests were used to test for pair-wise improvements in glycemic measures between baseline and follow-up overall and stratified by baseline A1c. Results: Of the 3,440 people identified for the analysis, a subset (N = 200) had both baseline A1c and valid GMIs during follow-up. This subset was 53% (N = 106) male with mean age of 55.4 (SD = 8.5) years and had mean baseline A1c of 7.97% (SD = 1.02). The median difference between baseline A1c and follow-up GMI was -0.83% (p < 0.001) overall, with significant differences of -0.82% (p < 0.001) and -2.41% (p < 0.001) in those with baseline 7% < A1c < 9% and A1c > 9%, respectively. Over 50% of people had a decrease in glycemic outcome of more than 0.5%, with 67% and 95% of people improving by more than 0.5% in the 7-9% and > 9% groups respectively. There were 87 people that also had an A1c at 12-month follow-up; the median difference in A1c was -0.65% (p < 0.001), 50% had a decrease of more than 0.5%, and median difference between GMI/A1c follow up values was 0.13 (p = 0.11). Conclusion: Level2 members with baseline A1c and follow-up GMI saw significant improvements in glycemic control over one year of engagement. These improvements were observed for measures of both follow-up A1c and GMI. Disclosure S.Bacon: Employee; Optum Labs, Research Support; Level2. N.Thompson: Employee; Level2, Stock/Shareholder; UnitedHealth Group. D.Ferrell: Stock/Shareholder; Level2, Medexpress Urgent Care. J.Fung: Employee; Level2.

The value of pre-symptomatic genetic risk assessment for age-related macular degeneration: the Moran AMD Genetic Testing Assessment (MAGENTA) study—a study protocol for a randomized controlled trial

BackgroundAge-related macular degeneration (AMD) is an irreversible blinding eye condition with complex genetic and environmental etiologies. Genetic testing for AMD for previously identified multiple-risk single nucleotide polymorphisms can help determine an individual’s future susceptibility. However, such testing has been discouraged until evidence shows that providing such information to symptomatic or pre-symptomatic individuals will alter their disease course. Therefore, we designed this study to investigate whether knowledge of AMD risk could stimulate the adoption of a healthier lifestyle that could lower the incidence of AMD later in life. We hypothesize that pre-symptomatic individuals informed of a high genetic risk of AMD are more likely to make quantifiable, positive lifestyle changes relative to participants informed of lower genetic risk or randomized to deferred disclosure of genetic testing results.MethodsThe Moran AMD Genetic Testing Assessment (MAGENTA) study is a phase 2, single-center, prospective, double-masked, randomized controlled trial conducted at the John A. Moran Eye Center, University of Utah, Salt Lake City, Utah, USA. Participants are randomized by a 3:1 allocation ratio to immediate and deferred disclosure groups and followed for 12 months. Skin, ocular, and serum carotenoid status, as well as nutritional and social surveys, are assessed at study visits. Skin carotenoid assessment is by resonance Raman spectroscopy and reflectance spectroscopy, ocular carotenoids are measured with Heidelberg Spectralis autofluorescence imaging and fluorescence lifetime imaging ophthalmoscopy (FLIO), and serum carotenoids are quantified using high-performance liquid chromatography. The primary outcome evaluates changes in skin carotenoid status in response to genetic risk disclosure. The secondary outcomes examine changes in ocular and serum carotenoid status in response to genetic risk disclosure. Also, we will correlate AMD genetic risk with baseline ocular and systemic carotenoid status and FLIO.DiscussionMAGENTA will provide much-needed evidence on whether pre-symptomatic testing for AMD risk can lead to quantifiable long-term changes in behavior and lifestyle associated with a lower incidence of AMD later in life. Findings from the MAGENTA trial will facilitate the design of a future larger, longer-term, multicenter phase 3 trial that could feature subgroup analysis, expanded measures of lifestyle modification, and potential active nutritional interventions.Trial registrationClinicalTrials.gov NCT05265624. Registered on March 3, 2022.

The Effects of Lock-down 2020 on the Behaviour and Mood of Children Aged Three to Six in Italy

The aim of this research was to trace an association between the lock-down caused by the Covid-19 pandemic in Itlay (March-May 2020) and possible short- and long-term behavioral and mood changes in 1,000 children aged three to six years. With the data collected through the administration of two questionnaires, an account of the psychoattitudinal performance of the subjects examined during the aforementioned period was obtained. The results showed that during the lock-down nearly 60% of the sample exhibited negative feelings; 11.2% of the sample also exhibited symptoms attributable to situational depression. With the return to normalcy, the percentage of negative feelings recorded in the sample decreased to 11%; a significant association was also found between the mood state and temperament of the subjects. Behavioral changes such as increased onychophagy and eating changes during lock-down were recorded, which can be associated with stress. It was possible to reveal problems in the long term, such as difficulty in modulating anxiety, controlling aggression, and social adjustment.

Understanding long-term behaviour change techniques: a mixed methods study

Long-term behaviour change is essential to many societal and personal challenges, ranging from maintaining sustainable lifestyles to adherence to medical treatment. However, prior research has generally focused on interventions dealing with bounded, present-tense, and discretely measurable behaviour change problems, evaluated via relatively short-term trials. This has led to a skewed prioritisation of behaviour change techniques and left a critical gap in design guidance. Hence, there is an urgent need to (i) examine how behaviour change techniques can be abstractly prioritised and (ii) related to contextual, embodied interventions during long-term behavioural design. We address this need using a Delphi survey method with 12 international experts on behavioural intervention complemented by a reanalysis of over 100 real-world cases. This provides the basis for examining how experts prioritise the Behaviour Change Technique Taxonomy (BCTT) for the long-term, as well as how this corresponds to real-world long-term interventions. Based on this we provide essential, and as a first, guidance for long-term behavioural design as well as contributing to wider research on how to deal with the demands of long-term behaviour change.

Prior exposure to stress exacerbates neuroinflammation and causes long-term behavior changes in sepsis

BackgroundNeuroinflammation can occur during sepsis and is now regarded as the main mechanism underlying various related central nervous system (CNS) disorders. Another well-known factor causing neuroinflammation is psychological stress. In the current study, we examined the effects of prior exposure to stress on sepsis-induced neuroinflammation and CNS symptoms. Experimental procedureBalb/c mice were subjected to wet bedding stress for 2 days, then lipopolysaccharide (LPS) was intraperitoneally administered. For examining the neuroinflammation, the expression of proinflammatory cytokines and NF-κB activity in the brain was analyzed by RT-PCR and ELISA-based assay. Additionally, immunohistochemical study using Iba-1 was performed. Finally, behavior tests were examined one month after LPS treatment. Result and conclusionStress exposure induced the upregulation of IL-1β, IL-6 and TNFα mRNA in the cerebral cortex 4 h after LPS administration. Suggesting an underlying mechanism, LPS-induced NF-κB activation was significantly upregulated with stress in the brain. Histologically, microglia in the cerebral cortex were reactive and became more abundant with stress, while these effects were further increased with LPS injection. Behavioral analysis conducted showed a significant increase of anxiety-like behaviors in the stressed mice. These results suggest that prior exposure to stress exacerbates neuroinflammation during sepsis and induces long-term behavior changes.

Prenatal Stress Induces Long-Term Behavioral Sex-Dependent Changes in Rats Offspring: the Role of the HPA Axis and Epigenetics.

Preclinical genetic studies have related stress early exposures with changes in gene regulatory mechanisms, including epigenetic alterations, such as modifications of DNA methylation, histone deacetylation, and histones acetylation. This study evaluates the effects of prenatal stress on the behavior, hypothalamus-pituitary-adrenal (HPA)-axis, and epigenetic parameters in stressed dams and their offspring. The rats were subjected to a protocol of chronic unpredictable mild stress on the fourteenth day of pregnancy until the birth of offspring. After birth, maternal care was evaluated for six days. Following weaning, the locomotor and depressive-like behaviors of the dams and their offspring (60 days old) were assessed. The HPA axis parameters were evaluated in serum from dams and offspring, and epigenetic parameters (histone acetyltransferase (HAT), histone deacetylase (HDAC), DNA methyltransferase (DNMT) activities, and the levels of histone H3 acetylated at lysine residue 9 (H3K9ac) and histone 3 acetylated at lysine residue 14 (H3K14ac)) were assessed in dams' and offspring' brains. Prenatal stress did not significantly influence maternal care; however, it induced manic behavior in female offspring. These behavioral alterations in the offspring were accompanied by hyperactivity of the HPA-axis, epigenetic adaptations in the activity of HDAC and DNMT, and acetylation in the histones H3K9 and H3K14. In addition, the prenatal stressed female offspring showed increased levels of ACTH compared to their male counterpart. Our findings reinforce the impact of prenatal stress on behavior, stress response, and epigenetic profile of offspring.

Intra-hippocampal cis-P tau microinjection induces long-term changes in behavior and synaptic plasticity in mice

BackgroundAlzheimer's disease is accompanied by an abnormal high accumulation of cis-P tau. However, the long-term changes in behavior following tau accumulation remains under debate. The present study investigated the long-term effects of tauopathy on learning and memory, synaptic plasticity, and hippocampal cell numbers.ResultsCis-P tau was microinjected into the dorsal hippocampus to generate Alzheimer’s like-disease model in C57BL/6 mice. Cis-P tau injected animals showed a significant impairment in learning and memory in Y-maze and Barnes maze tests. In another group of animals, the generation of long-term potentiation (LTP) was evaluated in hippocampal slices 7 months after cis-P tau injection. LTP induction was disrupted only in the dorsal but not ventral hippocampal slices. The basal synaptic transmission was also reduced in dorsal hippocampal slices. In addition, hippocampal sampling was done, and the number of cells was assessed by Nissl staining. Obtained results indicated that the number of survived cells was significantly reduced in the dorsal and ventral hippocampus of cis P-tau injected animals compared to the animals in control group. However, the decrement of cell number was higher in the dorsal compared to the ventral hippocampus.ConclusionsIn conclusion, intra-hippocampal cis-P tau injection produced learning and memory impairment at 7 months after its injection. This impairment might result from LTP disruption and a significant decrease in the number of neurons in the dorsal hippocampus.Graphical

Fitterfly Diabetes CGM Digital Therapeutics Program for Glycemic Control and Weight Management in People With Type 2 Diabetes Mellitus: Real-world Effectiveness Evaluation.

Digital therapeutic platforms facilitate health care through patient-centered strategies based on multidisciplinary teams and shared decision-making. Such platforms can be used for developing a dynamic model of diabetes care delivery, which can help in improving glycemic control by promoting long-term behavior changes in people with diabetes. This study aims to evaluate the real-world effectiveness of the Fitterfly Diabetes CGM digital therapeutics program for improving glycemic control in people with type 2 diabetes mellitus (T2DM) after the completion of 90 days in the program. We analyzed deidentified data of 109 participants in the Fitterfly Diabetes CGM program. This program was delivered through the Fitterfly mobile app coupled with continuous glucose monitoring (CGM) technology. This program consists of 3 phases: the first phase is observation, wherein the patient's CGM readings are observed for 7 days (week 1); the second phase is the intervention; and the third phase aims at sustaining the lifestyle modification introduced during the second phase. The primary outcome of our study was the change in the participants' hemoglobin A1c (HbA1c) levels after program completion. We also evaluated the changes in participant weight and BMI after the program, changes in the CGM metrics in the initial 2 weeks of the program, and the effects of participant engagement in the program on improving their clinical outcomes. At the end of the 90 days of the program, the mean HbA1c levels, weight, and BMI of the participants were significantly reduced by 1.2% (SD 1.6%), 2.05 (SD 2.84) kg, and 0.74 (SD 1.02) kg/m2 from baseline values of 8.4% (SD 1.7%), 74.45 (SD 14.96) kg, and 27.44 (SD 4.69) kg/m2 in week 1, respectively (P<.001). The average blood glucose levels and time above range values showed a significant mean reduction by 16.44 (SD 32.05) mg/dL and 8.7% (SD 17.1%) in week 2 from week 1 baseline values of 152.90 (SD 51.63) mg/dL and 36.7% (SD 28.4%), respectively (P<.001 for both). Time in range values significantly improved by 7.1% (SD 16.7%) from a baseline value of 57.5% (SD 25%) in week 1 (P<.001). Of all the participants, 46.9% (50/109) showed HbA1c reduction ≥1% and 38.5% (42/109) showed weight loss ≥4%. The average number of times the mobile app was opened by each participant during the program was 108.80 (SD 127.91) times. Our study shows that participants in the Fitterfly Diabetes CGM program showed a significant improvement in their glycemic control and reduction in weight and BMI. They also showed a high level of engagement with the program. Weight reduction was significantly associated with higher participant engagement with the program. Thus, this digital therapeutic program can be considered as an effective tool for improving glycemic control in people with T2DM.

Coconstruction of adjunct behavioral interventions to bariatric surgery: The INTER-Change program.

The INTER-Change program aims to use systematic frameworks to develop adjunct behavioral interventions to enhance long-term behavior change and improve outcomes in patients undergoing bariatric surgery (BS). This paper details the program strategies and how engagement of interested parties is shaping the research. The core elements of this work include: (a) A living systematic review of behavioral weight management (BWM) interventions adjunct to BS; (b) Focus groups of interested parties, including patients, healthcare professionals, and administrators, on different aspects of designing and implementing adjunct behavioral interventions; (c) A patient-generated survey to assess needs for behavioral interventions to support BWM; (d) An international eDelphi study involving interested parties to prioritize intervention components and delivery structures; and (e) An international consensus meeting to construct testing intervention protocol(s). The systematic review revealed that delivering BWM interventions during the postoperative period resulted in better weight maintenance; however, most interventions reviewed were poorly developed, and none included interested parties. Initial themes from ongoing focus groups highlighted nonweight-related outcomes as being key goals of adjunct behavior change interventions, with a strong emphasis on psychological well-being and health-related behaviors. The patient survey will add patients' feedback on current interventions and expectations. Finally, the eDelphi process and international consensus meeting will integrate all the findings to develop more efficient behavioral interventions and appropriate testing protocol(s). This integrated knowledge translation approach will help ensure that the behavioral adjunct interventions are relevant to interested parties' needs, well-designed, effective, and more likely to be implemented successfully. (PsycInfo Database Record (c) 2023 APA, all rights reserved).

Hospitality internships and green leaders: analysing the engagement of interns with hotel sustainable development practices

PurposeThe aim is to provide insights on the inclusion of sustainability training during internship and the engagement of interns in the sustainability practices of the hotel. The paper investigates how aspects of knowledge and participation in sustainable practices can bring about a positive change in the industry's future and also aid in the creation of smart green leaders.Design/methodology/approachThe paper utilizes qualitative research methodology and draws on in-depth interviews with students and learning and development managers using multiple sources of evidence to derive a holistic picture.FindingsThe paper aims to highlight the importance of incorporating sustainability training as an indispensable part of hotel internships. It also reveals the positive impact and long-term behavioural changes of students along with presenting strategies to create student stewards for sustainability.Research limitations/implicationsThe limitations of the study arise from its small sample size, which nonetheless generated some rich insights.Originality/valueThere has been much research in the area of hospitality internships, however, it has not been considered from the perspective of sustainability development or green internships. In this sense, the paper is novel as it challenges the traditional expectations of hospitality internships.