Modification Intervention Research Articles

Don't Forget the Humble Text Message: 25 Years of Text Messaging in Health.

Since the early studies exploring the use of SMS text messaging for health intervention, text messaging has played a pivotal role in the advancement of mobile health. As an intervention modality, text messaging has provided vital learnings for the design and delivery of interventions, particularly in low-resource settings. Despite the advances in technology over the last 25 years, text messaging is still being used in largely the same way to deliver health information, behavior change interventions, and support. The strong, consistent evidence for the benefits of this type of intervention has made text messaging a routine part of health interventions around the world. Key to its success is its simplicity, alongside the benefit of being arguably the most accessible form of consumer digital health intervention. Text message interventions are well suited for public health interventions due to their low cost, vast reach, frequent use, high read rates, and ability to be tailored and personalized. Furthermore, the nature of text messaging interventions makes them ideal for the delivery of multilingual, culturally tailored interventions, which is important in the context of increasing cultural diversity in many countries internationally. Indeed, studies assessing text message-based health interventions have shown them to be effective across sociodemographic and ethnic groups and have led to their adoption into national-level health promotion programs. With a growing focus on artificial intelligence, robotics, sensors, and other advances in digital health, there is an opportunity to integrate these technologies into text messaging programs. Simultaneously, it is essential that equity remains at the forefront for digital health researchers, developers, and implementers. Ensuring digital health solutions address inequities in health experienced across the world while taking action to maximize digital inclusion will ensure the true potential of digital health is realized. Text messaging has the potential to continue to play a pivotal role in the delivery of equitable digital health tools to communities around the world for many years to come. Further new technologies can build on the humble text message, leveraging its success to advance the field of digital health. This Viewpoint presents a retrospective of text messaging in health, drawing on the example of text message-based interventions for smoking cessation, and presents evidence for the continued relevance of this mobile health modality in 2025 and beyond.

Electroacupuncture promotes gastrointestinal functional recovery after radical colorectal cancer surgery: a protocol of multicenter randomized controlled trial (CORRECT trial)

IntroductionThe incidence of postoperative gastrointestinal dysfunction (POGD) is notably high among patients following colorectal cancer surgery, highlighting the urgency for the prompt development of efficacious preventive and therapeutic approaches. Electroacupuncture (EA) represents an intervention modality that holds promise for the management of POGD. However, the existing empirical evidence substantiating its efficacy remains scarce. The aim of this study is to evaluate the efficacy and safety of EA as a treatment for POGD in patients undergoing colorectal cancer surgery.MethodsThis study is a multicenter, parallel-group, randomized controlled trial, named as CORRECT. CORRECT trial will recruit 300 participants diagnosed with colorectal cancer and about to undergo radical surgery across four sub-centers. The participants will be randomly assigned to one of three groups: the EA group, sham-electroacupuncture group, or control group, with a randomization ratio of 2:2:1. All groups will follow a standardized Enhanced Recovery After Surgery (ERAS) protocol. The EA group will receive EA at acupoints LI4, SJ6, ST36, and ST37, while the SA group will undergo sham-electroacupuncture. The treatments will be administered twice daily from the day of surgery until the fourth day after the operation. The primary endpoint is the time to first flatus, while secondary endpoints encompass time to first defecation, bowel sound emergence, initial water intake, duration of postoperative hospitalization, nausea and vomiting, pain levels, and blinded evaluations. Additional outcomes include medication usage and complication rates, et al.DiscussionThe CORRECT trial aims to provide high-quality evidence for the role of EA in the treatment of POGD following colorectal cancer surgery. It will contribute data towards the integration of acupuncture into ERAS protocols. Insights from the trial could help in tailoring treatment plans based on individual patient responses to EA, optimizing care on a case-by-case basis.Trial registrationClinical Trial Registry registration was approved by the ClinicalTrials.gov committee on November 2023 with the ClinicalTrials.gov Identifier: NCT06128785. URL: https://clinicaltrials.gov/study/NCT06128785?tab=history&a=1#study-details-card.

Panoramic view of the effects of active breaks in an educational context

In education, optimising academic achievement (AA) and promoting attention and concentration are essential elements. The main goal of this systematic review (SR) is to analyse and synthetise the scientific evidence to examine the impact that the different interventions with active breaks (AB) have on the AA, attention, and concentration of the students in educational contexts. To do this, the PRISMA protocol is followed (REG INPLASY: INPLASY202390082). The documents that comply with the inclusion criteria for this research are 29 scientific articles extracted from the databases Web of Science (WOS), SCOPUS and ERIC. The specific goals of this study are detailed through 13 research questions related to the characteristics of the works and their results, e.g. thematic and geographic diversity, variability in the research designs, inclusion of several educational levels and academic contents, as well as the presence of common intervention modalities and heterogeneous durations. The panoramic view suggested by the results presents AB as an interdisciplinary topic of international interest mainly focused on basic education, with measure instruments that are diverse and have variable duration, which might influence the comparability between studies. Even though some studies back up the positive effects of AB, the heterogeneity of approaches and results highlights the need of future research in order to unify criteria and allow a better understanding of the effects of AB and their applicability in several educational contexts.

Effects of aromatherapy on sleep quality in older adults: A meta-analysis.

Aromatherapy has been proposed as a complementary therapy to enhance sleep quality and regulate mood. However, few studies have specifically examined the efficacy of aromatherapy in managing sleep disorders in older adults. Therefore, the present study aims to systematically review the impact of aromatherapy on sleep quality among older adults. It employed a meta-analysis design. A systematic and comprehensive search was conducted across 7 databases to identify randomized controlled trials examining the effects of aromatherapy on sleep quality in older adults. Two researchers independently assessed the quality of the literature. The study adhered to the Preferred Reporting Items for Systematic Reviews and Meta-analysis checklist. Aromatherapy demonstrated effectiveness in improving sleep quality among older adults (standardized mean difference [SMD] = -1.02; 95% confidence interval [CI] = -1.38 to -0.66; P < .001). Subgroup analyses based on aroma types, intervention modalities, and treatment durations revealed enhanced efficacy with lavender as the sole aroma (SMD = -1.39; 95% CI = -2.06 to -0.72; P < .001), non-inhaled aromatherapy (SMD = -1.73; 95% CI = -2.26 to -1.2; P < .001), and aromatherapy administered for less than 4 weeks (SMD = -1.16; 95% CI = -1.68 to -0.64; P < .001). Notably, significant effects of aromatherapy on anxiety (SMD = -0.83; 95% CI = -1.24 to -0.42; P < .001) and depression (SMD = -0.85; 95% CI = -1.30 to -0.39; P < .001) in older adults were also observed. This study indicates that aromatherapy improves sleep quality in older adults, with single-use lavender, non-inhalation aromatherapy, lasting less than 4 weeks being particularly effective. Aromatherapy also alleviates depression, but its effects on anxiety require further evaluation.

La propiedad realmente existente

The article studies the land legal situation in six popular neighbourhoods in Quilmes town, in the Gran Buenos Aires, considering the complexities of the state processing of legal titles. Though the systematization of different qualitative surveys in those six neighbourhoods during nine years, it is sustained that regularization policies favour the circulation of documentation which recognizes the de facto possession of land without assimilating it to deeds. In this way, the state develops an intervention modality that displaces the boundaries between formal and informal, favouring multiple uses of this state recognized certifications. At the same time, the systematization of surveys showed changes that have occurred during the last years in regularization policies. The certificados de vivienda familiar seem to have acquired a considerable circulation, intersecting a national program in a provincial policy. However, the hybrid legal prospect, of de facto possession without deeds, persists, although with an increasing presence of public policy made documentation that certify possession.

A systematic review on career interventions for high school students.

This study presents a systematic literature review of career interventions for high school students, exploring the theoretical framework, intervention modality, evaluation and outcomes of the intervention. Five keywords, three databases and five inclusion criteria were defined. Of the 419 documents collected, 25 remained for meta-synthesis. The results showed that (1) the theoretical framework mainly consisted of career construct theory, social cognitive career theory, and cognitive information processing theory. (2) The intervention modality was mainly group counseling (8 sessions, 45 min). (3) The evaluation system mainly consisted of a pre-and post-test for the experimental and control group, and (4) the intervention outcomes were mainly focused on the positive development of career adaptability and career decision-making. The discussion offers recommendations for future research and practice in high school career interventions. (1) Social cognitive career theory should be given attention. (2) A three-tiered high school career development guidance model of career curriculum, career group counseling and individual counseling could be developed. (3) Career interventions should be shifted to mixed quantitative and qualitative studies, tracer studies, and special groups. (4) Outcome expectations should be given equal attention.

A comprehensive study on the bioactive flavonoids in Paulownia flowers: Uncovering metabolic pathways, effective components, and regulatory genes for industrial applications

The study explores Paulownia flowers as an emerging resource in medicine, food, health supplements, cosmetics, and animal feed, despite a lack of characterization of their secondary metabolite accumulation mechanisms. We conducted a comprehensive investigation into the biological activities, metabolite profiles, and gene expression patterns of flavonoids in Paulownia flowers. Our results, obtained using ABTS/FRAP/DPPH assays, MTT assays, and colorimetric analyses, demonstrate the potent antioxidant, antibacterial, hypolipidemic, and antiproliferative activities of Paulownia flower flavonoid (PFF) extracts. Notably, the Paulownia elongata tetraploid (M4) exhibited particularly notable effects. HPLC fingerprinting, molecular docking, and density functional theory calculations led to the identification of rhoifolin and luteolin as key bioactive flavonoids. UV-Vis, fluorescence, and circular dichroism spectroscopy confirmed PFF's role as a reversible and mixed inhibitor of xanthine oxidase (XOD). Transcriptome and metabolomic analyses further revealed substantial enrichment in phenylpropanoid, flavonol, and flavonoid biosynthetic pathways, with PfPP2C, PfPYR, PfPYL, PfNPR1, PfMYBs, and PfbHLHs identified as crucial regulators. This work provides a foundational understanding of flavonoid biosynthesis in Paulownia flowers, paving the way for targeted genetic modification and biotechnological interventions aimed at enhancing flavonoid accumulation for industrial applications.

Predicting Early Dropout in a Digital Tobacco Cessation Intervention: Replication and Extension Study.

Detecting early dropout from digital interventions is crucial for developing strategies to enhance user retention and improve health-related behavioral outcomes. Bricker and colleagues proposed a single metric that accurately predicted early dropout from 4 digital tobacco cessation interventions based on log-in data in the initial week after registration. Generalization of this method to additional interventions and modalities would strengthen confidence in the approach and facilitate additional research drawing on it to increase user retention. This study had two research questions (RQ): RQ1-can the study by Bricker and colleagues be replicated using data from a large-scale observational, multimodal intervention to predict early dropout? and RQ2-can first-week engagement patterns identify users at the greatest risk for early dropout, to inform development of potential "rescue" interventions? Data from web users were drawn from EX, a freely available, multimodal digital intervention for tobacco cessation (N=70,265). First-week engagement was operationalized as any website page views or SMS text message responses within 1 week after registration. Early dropout was defined as having no subsequent engagement after that initial week through 1 year. First, a multivariate regression model was used to predict early dropout. Model predictors were dichotomous measures of engagement in each of the initial 6 days (days 2-7) following registration (day 1). Next, 6 univariate regression models were compared in terms of their discrimination ability to predict early dropout. The sole predictor of each model was a dichotomous measure of whether users had reengaged with the intervention by a particular day of the first week (calculated separately for each of 2-7 days). For RQ1, the area under the receiver operating characteristic curve (AUC) of the multivariate model in predicting dropout after 1 week was 0.72 (95% CI 0.71-0.73), which was within the range of AUC metrics found in the study by Bricker and colleagues. For RQ2, the AUCs of the univariate models increased with each successive day until day 4 (0.66, 95% CI 0.65-0.67). The sensitivity of the models decreased (range 0.79-0.59) and the specificity increased (range 0.48-0.73) with each successive day. This study provides independent validation of the use of first-week engagement to predict early dropout, demonstrating that the method generalizes across intervention modalities and engagement metrics. As digital intervention researchers continue to address the challenges of low engagement and early dropout, these results suggest that first-week engagement is a useful construct with predictive validity that is robust across interventions and definitions. Future research should explore the applicability and efficiency of this model to develop interventions to increase retention and improve health behavioral outcomes.

Combining internet-delivered cognitive behavioural therapy and attention bias modification for reducing depressive symptoms in firefighters: a randomized controlled trial.

Firefighters are frequently exposed to traumatic events and stressful environments and are at particularly high risk of depressive symptoms. The present study aimed to examine the impact of a combined internet-delivered cognitive behavioral therapy (iCBT) and attention bias modification (ABM) intervention to reduce depressive symptoms in firefighters. The study was a randomized controlled trial carried out in Kunming, China, and involved the recruitment of 138 active firefighters as participants. The intervention lasted for an 8-week duration, during which participants participated in ABM exercises on alternating days and concurrently underwent eight modules of iCBT courses delivered through a smartphone application. Baseline and post-intervention assessments were conducted to evaluate the effects of the intervention. Results indicated that the combined iCBT and ABM intervention was significantly effective in reducing symptoms of depression compared with the no intervention control group (U=1644, p<0.001, Wilcoxon r=0.280). No significant change was observed in attention bias post-intervention (U=2460, p=0.737, Wilcoxon r=0.039), while a significant increase was observed in attention-bias variability (U=3172, p<0.001, Wilcoxon r=-0.287). This study provides evidence for the effectiveness of the combined iCBT and ABM intervention in reducing depressive symptoms among firefighters. This study provides conceptual support and preliminary evidence for the effectiveness of the combined iCBT and ABM intervention in reducing depressive symptoms among firefighters.

Foreign Aid, Identities and Interests: Qatar and the UAE in Sudan

ABSTRACT The entanglement of domestic and geopolitical dynamics with the evolution of the aid strategies of the Gulf States is particularly evident in the Horn of Africa (HOA), where the regional competition for exercising influence has affected the modalities of humanitarian and development interventions. A comparison of the foreign aid given by Qatar and the United Arab Emirates (UAE) to Sudan in the context of its political and humanitarian crisis during three different periods (2014-17; 2017-19; and post-2019) allows a better understanding of these dynamics. By adopting a neoclassical realist and constructivist approach, it highlights similarities and differences in the domestic factors at play, including the ideological and security dimension, in both donor and recipient countries, as well as their overlapping with the regional and international spheres, which determine aid strategies in terms of the geographical, channel and sectoral allocation of aid resources.

Efficacy of Acceptance and Commitment Therapy in Social Anxiety Disorder: A Systematic Review and Meta-analysis

Background: Acceptance and commitment therapy (ACT) is a novel third-wave therapy becoming popular in the management of various anxiety disorders. In this systematic review, we wish to gather the data that have been studied to determine the effectiveness of ACT in treating social anxiety disorder (SAD). Methods: This study followed standard systematic review guidelines and was registered with PROSPERO prior to undertaking the review. Databases, namely PubMed, PsycINFO, Ovid MEDLINE, and gray literature (ClinicalTrials.gov, BASE) with relevant keywords, were searched from inception to February 2024. Randomized controlled trials encompassing both clinical and nonclinical populations aged more than 10 years diagnosed with SAD were included. These trials compared ACT with wait list controls (n = 6) and cognitive behavioral therapy (n = 3). The primary outcome focused on the reduction of symptoms associated with social anxiety, while quality of life served as a secondary outcome. Measures of effect were determined through pre-test and post-test mean values, alongside their respective standard deviations. The random effect model was used to calculate pooled effect size. The quality of the included papers was assessed using Cochrane RoB-1. Covidence software was used for the initial selection of studies, and meta-analyses were performed using RevMan software. Results: From the initial 442 study records that were searched, finally 9 studies were included for the systematic review, of which 6 studies were found suitable for meta-analysis. The pooled estimate for studies comparing ACT with wait list found that the overall effect size for social anxiety symptoms was g = −1.28 (95% confidence interval of -1.88, -0.69) favoring ACT intervention significantly. Conclusion: This review found that ACT is efficacious in treating SAD. Most of the studies included were conducted in adolescent females. Varying ACT intervention modalities were incorporated, with the primary outcome assessed using a range of scales. The results of our meta-analysis should be interpreted with caution because of heterogeneity and smaller number of studies being included. ACT can be considered a psychotherapeutic option for the management of SAD.

Psychological Interventions for Insomnia in Patients with Cancer: A Scoping Review.

Insomnia is a frequent and distressing symptom with limited treatment in patients with cancer. Among the available treatments for insomnia, psychological interventions are some of the most assessed. While studies and reviews show promise of interventions improving insomnia in patients with cancer, inconsistent approaches to operationalizing and measuring insomnia combined with the heterogeneity of available treatments render comparisons and synthetization difficult. This review sought to rigorously synthesize psychological interventions for patients with cancer and insomnia by describing current therapies, identifying gaps in the literature, and offering supportive interventions. A comprehensive search of five databases-Ovid MEDLINE, Ovid Embase, Ovid PsycInfo, EBSCO CINAHL Plus with Full Text, and Cochrane Library-was conducted through 1 August 2024. The review included randomized trials and non-inferiority trials evaluating psychological interventions for patients with various types of cancers. Twenty-one studies were included, and study quality ranged from good to excellent, according to the PEDro scale. The current evidence supports the use of cognitive behavioral therapy (CBT) to treat insomnia over and above psychoeducation alone, mindfulness-based stress reduction, Brief Behavioral Therapy, the Benson Relaxation Technique, progressive muscle relaxation, mindfulness meditation, mind-body bridging, and home-based psychological nursing. Digital, minimal, and internet-based intervention modalities are effective, though professional-delivered CBT proved most effective. CBT remains the most effective psychological intervention for insomnia in this population. Challenges exist regarding the implementation of CBT, so further research is warranted to identify the best psychological interventions for specific settings and subsets of patients with cancer.

Abstract 4135206: Patterns of Lifestyle Risk Behaviors for Cardiovascular Disease in Family Caregivers: A Latent Class Analysis

Introduction: Lifestyle risk behaviors for cardiovascular disease (CVD) often co-occur. However, little is known about their behavioral patterns among family caregivers, a population at high risk for CVD. Aims: To identify distinct latent classes of caregivers of lifestyle risk behaviors for CVD and to examine the individual characteristics associated with membership in the identified latent classes. Methods: This study included 643 unpaid family caregivers from the 2019 Health Information National Trends Survey 5 Cycle 3. The assessed lifestyle risk behaviors included cigarette use, non-abstinence from alcohol, low physical activity, long sedentary time, and low fruit and vegetable consumption. These behaviors were dichotomized based on established guidelines or cut-off points. Latent class analysis was performed to identify latent classes based on these lifestyle risk behaviors among caregivers. Subsequently, multinomial logistic regression was used to investigate socio-demographic, health-related, and caregiving characteristics associated with the latent class membership. Results: Three distinct classes were identified (mean age = 55±16 years; 59.3% female; 57.1% non-Hispanic white): “overall healthy, but non-abstainer” (Class 1, 17.1%; reference), “overall unhealthy” (Class 2, 64.1%), and “inactive, but healthy eaters” (Class 3, 18.8%). In unadjusted multinomial logistic regression models, caregivers reporting greater financial hardship (relative risk ratio [95% CI] = 2.5 [1.0-5.9]), higher psychological distress (3.7 [1.9-7.3]), poorer sleep quality (3.3 [1.6-6.8]), longer caregiving hours (2.1 [1.1-3.9]), and providing dementia care (2.3 [1.3-4.3]) were more likely to belong to Class 2, relative to Class 1. In the adjusted model including the significant characteristics above and controlling for age and gender, psychological distress (2.7 [1.2-5.9]) remained significant. No characteristics were significantly associated with membership in Class 3, relative to Class 1. Conclusions: Lifestyle risk behaviors for CVD among caregivers may cluster in distinct patterns that vary by individual characteristics. Caregivers experiencing psychological distress may be particularly at risk for engaging in lifestyle risk behaviors. Our novel findings underscore the importance of adaptive lifestyle modification interventions that target caregiver subgroups with different patterns of health behaviors to promote their cardiovascular health.

Lifestyle intervention improves cardiometabolic profiles among children with metabolically healthy and metabolically unhealthy obesity

BackgroundIn recent years, there has been a surge of interest in the metabolic phenotype among children with obesity characterized by the absence of associated cardiometabolic risk factors (CRFs), known as metabolically healthy obesity (MHO), as opposed to those with metabolically unhealthy obesity (MUO). This study investigated the effect of lifestyle intervention on CRFs among children with MHO and MUO.MethodsA total of 102 school-aged children with obesity (54 girls and 48 boys) aged 8–16 years completed a 16-week school-based lifestyle modification intervention program, MyBFF@school Phase I. The intervention consisted of physical activity, healthy eating promotion, and psychological empowerment. MHO and MUO statuses were defined based on the 2018 consensus-based criteria. Fasting venous blood collection, body composition measurement, clinical assessment and physical fitness testing were conducted at baseline and at the end of week 16.ResultsAfter the intervention, the CRFs of the children with MUO improved with significant decreases in systolic (p < 0.001) and diastolic (p = 0.01) blood pressure and a significant increase in high-density lipoprotein cholesterol (HDL-C) (p = 0.005), while the CRFs of the children with MHO had a significant decrease in uric acid (p = 0.04). Additionally, 51.6% of the children with MHO transitioned to the MUO, while 26.8% of the children with MUO crossed over to the MHO at the end of the intervention. Furthermore, the odds of having high systolic blood pressure among children with MUO were 59% lower at week-16 than at baseline (OR = 0.41 (95% CI = 0.18, 0.92), p = 0.03).ConclusionsOur findings demonstrated that CRFs improved more prominently among children with MUO following the intervention. More importantly, our findings indicate that MHO in children is transient, hence, strategies to protect children against MUO are warranted.Trial registration: ClinicalTrials.gov NCT02212873.

The role of intervention timing and treatment modality in visual recovery following pituitary apoplexy: a systematic review and meta-analysis.

Pituitary apoplexy has historically been considered an emergent condition that necessitates surgical intervention when there is acute symptomatic onset. This potentially serious condition often occurs in the setting of an underlying adenoma, cystic lesion, or other sellar mass. When these mass lesions hemorrhage within the confined space of the sella turcica, the pituitary gland is subjected to hemorrhagic ischemia. Furthermore, critical neurovasculature in close proximity to the sella can sustain collateral damage. In the present study, we investigate whether early versus delayed surgical intervention (in terms of three timelines: before versus after 48h, 72h, and 7days, respectively) results in differences in visual outcomes for patients experiencing pituitary apoplexy with acute onset neurological and/or neuro-opthalmic symptoms. Furthermore, we compare the efficacy of surgical decompression versus expectant management of this condition. Accordingly, we queried the PubMed, Scopus, and Embase databases in adherence to PRISMA guidelines. Quantitative meta-analysis was performed according to the Mantel-Haenszel method and forest plots were generated using Review Manager v5.4. P-values < 0.05 were defined as the threshold for statistical significance. Twenty-nine studies remained eligible for review following initial search and screen, including 16 studies describing the role of intervention timing and 15 studies comparing intervention modality. Most patients presented with a visual deficit, and all patients underwent surgery - most commonly via the endoscopic endonasal (EEA) approach. Two hundred and twenty patients were included in the sub-analysis for the 7-day cutoff point. Furthermore, 81 patients underwent surgical decompression of the sella prior to 48h, and 32 patients underwent surgical decompression between 48-72h following presentation. Almost all patients exhibited improved vision post-decompression, including 19/19 patients (100%) in the post-72-h cohort. On meta-analysis using the Mantel-Haenszel method, there was a significant difference in vision outcomes in favor of patients who underwent surgical decompression before 7days as compared to after seven days (OR 5.88, 95% CI [1.77, 19.60], I2 = 0%, p < 0.01). In a separate sub-analysis, there was a total of 288 patients across 15 studies comparing surgical versus conservative management of pituitary apoplexy. These management options proved equivocal on meta-analysis (p > 0.05). In the present study, timing of surgical intervention for pituitary apoplexy was predictive of visual function recovery only at the 7-day timepoint, as has been reported by previous studies. Ultimately, this suggests that pituitary apoplexy involving severe visual deficits or altered mental status is best addressed within the first seven days post-presentation, and that both surgery and conservative management can offer similar outcomes. When apoplexy is suspected, IV corticosteroids should be administered independent of acuity or severity to prevent secondary adrenal crisis. Subsequently, for patients presenting without severe visual or other neurological deficits, expectant management is recommended. Management should be patient-specific and dependent upon the severity of symptoms present at onset.

Risk Score for Hepatocellular Cancer in Adults Without Viral Hepatitis or Cirrhosis

Hepatocellular carcinoma (HCC) is typically detected only at advanced stages when treatment options are limited. Most of the current HCC risk models focus on patients with viral hepatitis or diagnosed cirrhosis or require variables not routinely available in clinical care. To identify modifiable HCC risk factors in the general population and to develop a risk score to inform HCC screening and risk-factor modification interventions for high-risk individuals without viral hepatitis or decompensated cirrhosis. This cohort study analyzed demographic, clinical, laboratory, and diagnostic data from the US Department of Veterans Affairs (VA) electronic health records. Data were divided into development and validation samples. Veterans aged 30 to 95 years were included, and those with hepatitis B or C virus infection, hepatic decompensation, or prevalent HCC were excluded. Patients were followed up until the occurrence of HCC diagnosis, death, or December 31, 2021. A Cox proportional hazards regression model for 10-year risk of HCC was developed and used to create an HCC risk score, and performance in development and validation samples and in patient subgroups was evaluated. One outpatient visit date per person at least 18 months after VA entry, between October 1, 2007, and March 31, 2020, was randomly selected and used as the index date for the start of follow-up. Analyses were performed from March 2023 to May 2024. Age, sex, race and ethnicity, body mass index, liver fibrosis (detected with Fibrosis-4 Index [FIB-4]), diabetes status, smoking status, and alcohol use. First HCC diagnosis during follow-up. This information was ascertained from VA national cancer registry topography and histology codes and from International Classification of Diseases, Ninth Revision and International Statistical Classification of Diseases, Tenth Revision, Clinical Modification diagnosis codes for the inpatient or outpatient visits. This study of 6 509 288 veterans included 6 048 917 males (92.9%), with a median (IQR) age of 65 (54-74) years, who identified as being of Hispanic (5.3%), non-Hispanic Black (15.0%), non-Hispanic White (68.9%), or other (4.6%) race and ethnicity. Overall, 15 142 patients (0.2%) developed HCC, 69.5% of whom had FIB-4 of 3.25 or lower at baseline. While FIB-4 was the most important variable, age, sex, race and ethnicity, body mass index, diabetes, smoking, and alcohol use were also informative. Discrimination in the development sample was better than FIB-4 alone (C statistic, 0.83 [95% CI, 0.82-0.85] vs 0.79 [95% CI, 0.77-0.80]). The HCC risk score performed consistently well in the validation sample and in all subgroups. A FIB-4 threshold of 3.25 would screen 5.0% of the cohort at a cost of 28 false-positives for every true-positive; a model risk score of 58 would screen 4.7% of the cohort at a cost of 23 false-positives for every true-positive. Results of this study suggest that a multivariable risk score that uses routinely available clinical data outperforms FIB-4 alone in identifying patients at risk of HCC who do not have viral hepatitis or hepatic decompensation at baseline.

Interventions for improving health literacy among older people: a systematic review

BackgroundHealth literacy(HL) is defined as the degree to which individuals have the capacity to obtain process and understand basic health information and services required for making appropriate health decisions. Effective interventions to improve older people’s HL have become increasingly important. The purpose of this study is to conduct a review of interventions aimed at enhancing the HL of older people.MethodologyRelevant information was gathered from various databases including PubMed, Scopus, Cochrane Library, Science Direct, and Web of Science. Additionally, a manual search of related journals and Google Scholar, a search of the reference lists of selected articles, and a search of unpublished sources were also conducted up to 30 August 2024. Reporting quality assessment was performed using CONSORT: 2010, JBI Critical Appraisal Checklist for Quasi-Experimental Studies, and “Quality Assessment Criteria for Survey Research Reports”.ResultsA total of 21 articles were included in this study. The interventions conducted in high-income countries were found to be more effective compared to those conducted in middle and low-income countries. Furthermore, interventions carried out at the community level were more effective than those performed in nursing homes. Educational interventions were more effective than lifestyle modification interventions, and interventions carried out in a single dimension were more effective than multidimensional interventions. Additionally, interventions that utilized technology were found to be more effective.ConclusionBased on the findings, community-based interventions that encompass a one-dimensional approach, incorporating the use of technology and considering the duration of the intervention, are more recommended.

The efficacy of cognitive stimulation, cognitive training, and cognitive rehabilitation for people living with dementia: a systematic review and meta-analysis.

Cognition-oriented treatments (COTs) are a group of non-pharmacological treatments aimed at maintaining or improving cognitive functioning. Specific recommendations on the use of these interventions in people living with dementia (PLwD) are included in the Italian Guideline on the Diagnosis and Treatment of Dementia and Mild Cognitive Impairment, developed by the Italian National Institute of Health. This systematic review and meta-analysis, based on the GRADE methodology, is part of the guideline. Considered outcomes included the cognitive functions, quality of life, and functional abilities of PLwD, taking into account disease severity, modality and system of delivery, and form of the intervention. The effectiveness of these interventions on caregivers' outcomes was also assessed. Both group and individual cognitive stimulation were reported as effective in supporting cognitive functions in PLwD at any degree of severity. Individual cognitive training and group cognitive training were reported as effective in improving global cognitive functions in people with mild dementia. Cognitive rehabilitation appeared to be effective only in improving the functional abilities of people with mild dementia. Cognitive rehabilitation appeared to be the most effective in improving caregivers' outcomes, with results suggesting a reduction in care burden. The observed differences in the effectiveness of these interventions in people with different disease severity can be explained by the intrinsic characteristics of each intervention. Despite the large number of available studies, a high clinical, statistical, and methodological heterogeneity was observed. More methodologically rigorous studies are needed to clarify the effectiveness of each protocol and modality of intervention.

Perceptual filters: Exploring disability and ableism’s cognitive framework

ABSTRACT Ableism, akin to other forms of discrimination such as sexism and racism, is increasingly recognized as a pervasive societal concern directed towards individuals with disabilities. This scholarly inquiry delineates the operational definition, manifestations, and ramifications of ableism, with a specific focus on its manifestations within healthcare settings. It underscores the critical need for targeted interventions aimed at mitigating biases among healthcare professionals and promoting inclusivity within healthcare delivery systems. Utilizing insights from cognitive psychology, the study conceptualizes ableism as a cognitive distortion, explicating the mechanisms through which biases shape perceptions and recommending Cognitive Behavioral Therapy (CBT) as a promising intervention modality. The paper advocates for exploration of intersectional analyses, utilization of qualitative research methodologies, and cultivation of collaborative partnerships with disability advocacy organizations to develop more comprehensive intervention approaches. Noteworthy limitations of the current discourse include the potential for tokenistic representations and the imperative for genuine and substantive engagement with the voices and experiences of individuals with disabilities.

ADVANCEMENTS IN VESTIBULAR PHYSIOTHERAPY: A COMPREHENSIVE REVIEW

Purpose. Vestibular disorders pose significant challenges to individuals' daily functioning and quality of life, necessitating effective management strategies. This comprehensive review explores modern advancements in vestibular physiotherapy, encompassing assessment techniques, intervention modalities, technological innovations, and interdisciplinary collaboration. Material/Methods. Accurate assessment and diagnosis are essential for tailoring treatment plans to individual needs. Traditional clinical tests, such as the Dix-Hallpike maneuver and head impulse test (HIT), remain foundational while emerging technologies like video head impulse testing (vHIT) offer objective measures of vestibular function. Treatment of benign paroxysmal positional vertigo (BPPV) often involves canalith repositioning maneuvers (CRM), with recent modifications and augmented reality applications enhancing efficacy and patient comfort. Results. Vestibular rehabilitation therapy (VRT) plays a pivotal role in promoting central nervous system compensation for vestibular deficits. Incorporating exercises targeting balance, gaze stabilization, habituation, and sensory integration, VRT facilitates symptom reduction and functional improvement. Technological innovations, including virtual reality (VR) systems and smartphone applications, augment traditional VRT approaches, enhancing engagement and accessibility. Moreover, interdisciplinary collaboration among healthcare professionals ensures comprehensive management of vestibular disorders. Physiotherapists, otolaryngologists, neurologists, audiologists, and psychologists collaborate to deliver personalized care and empower patients through education and counseling. Conclusions. Modern vestibular physiotherapy offers a multifaceted approach to address the complex needs of individuals with vestibular disorders. By leveraging evidence-based practices, integrating technological solutions, and fostering interdisciplinary partnerships, healthcare providers can optimize treatment outcomes and enhance patients' overall well-being.