Session Participants Research Articles

An Online Psychoeducational Pilot Program with Homecare Workers of Dependent Older Adults

Abstract: Homecare workers play an important role in caring for dependent older adults, but no resources are targeted specifically at this population. This study describes the implementation of an online psychoeducational pilot program among homecare workers of older adults receiving dependent care and presents the preliminary results in research settings. The research design was quasiexperimental and consisted of 20 homecare workers completing baseline and postintervention assessments. The intervention consisted of a 6-week online psychoeducational program conducted by a psychologist via videoconferencing. Attendance and dropout rates were recorded, along with the completion of homework assignments, participation in intervention sessions, and the collection of qualitative information about the intervention’s acceptability indexes. We discuss the lessons learned from the implementation of the pilot study, followed by the preliminary results regarding its effects on the well-being of care workers (trend toward improvements in burnout, anxiety, and depression). Finally, we propose clinical implications and future directions for online program development.

Assessment of impulsivity using an automated, self-adjusting delay discounting procedure.

Modelling delay discounting behavior in rodents is important for understanding the neurobiological mechanisms underlying cognitive control and associated impulsivity disorders. Conventional rodent delay discounting procedures require extensive training and frequent experimenter interaction, as rodents are tested in separate operant chambers away from their home cage. To address these limitations, we adapted and characterize here a self-adjusting delay discounting procedure to an automated CombiCage setup.Rodents were trained during the most active phase of the light-dark cycle, completing 120 trials daily. During each session, we measured large reward preference, mean adjusted delay, and trial participation across multiple delays. Results showed that rodents exhibited discounting behavior after two weeks, with performance stability increasing at 7 weeks training with delay. We also evaluated the influence of altering the consecutive choice criteria (ccc), number of trial choices for a delay step to adjust up or down. Lower ccc (3 vs 8) increased both the number of delay steps encountered per session and task participation. Additionally, we examined the effects of pharmacological interventions, including the psychostimulant amphetamine and the dopamine D1 receptor antagonist, SCH23390. A high dose amphetamine reduced preference for large immediate and short delayed rewards and decreased the mean adjusted delay in a non-dose dependent manner, while SCH23390 did not affect task performance.Together, this novel automated self-adjusting procedure enables high-throughput collection of delay discounting data, with potential applications for investigating impulsivity across the lifespan. However, the current extended session design may limit its suitability for pharmacological evaluations.

Snowball Group Usability Testing for Rapid and Iterative Multisite Tool Development: Method Development Study.

Usability testing is valuable for assessing a new tool or system's usefulness and ease-of-use. Several established methods of usability testing exist, including think-aloud testing. Although usability testing has been shown to be crucial for successful clinical decision support (CDS) tool development, it is often difficult to conduct across multisite development projects due to its time- and labor-intensiveness, cost, and the skills required to conduct the testing. Our objective was to develop a new method of usability testing that would enable efficient acquisition and dissemination of results among multiple sites. We sought to address the existing barriers to successfully completing usability testing during CDS tool development. We combined individual think-aloud testing and focus groups into one session and performed sessions serially across 4 sites (snowball group usability testing) to assess the usability of two CDS tools designed for use by nurses in primary and urgent care settings. We recorded each session and took notes in a standardized format. Each site shared feedback from their individual sessions with the other sites in the study so that they could incorporate that feedback into their tools prior to their own testing sessions. The group testing and snowballing components of our new usability testing method proved to be highly beneficial. We identified 3 main benefits of snowball group usability testing. First, by interviewing several participants in a single session rather than individuals over the course of weeks, each site was able to quickly obtain their usability feedback. Second, combining the individualized think-aloud component with a focus group component in the same session helped study teams to more easily notice similarities in feedback among participants and to discuss and act upon suggestions efficiently. Third, conducting usability testing in series across sites allowed study teams to incorporate feedback based on previous sites' sessions prior to conducting their own testing. Snowball group usability testing provides an efficient method of obtaining multisite feedback on newly developed tools and systems, while addressing barriers typically associated with traditional usability testing methods. This method can be applied to test a wide variety of tools, including CDS tools, prior to launch so that they can be efficiently optimized.

Challenges for activating undergraduate research: a summary from the 2021 American Society for Microbiology Conference for Undergraduate Educators.

Based on a growing understanding of the many benefits of undergraduate research, advocacy for undergraduate research experiences has increased, with an emphasis on implementing course-based undergraduate research experiences (CUREs). To understand existing efforts to promote undergraduate research as well as challenges to implementation on higher education campuses, we hosted a session about undergraduate research at the 2021 American Society for Microbiology Conference for Undergraduate Educators. Session participants were surveyed about their experiences with undergraduate research on their home campuses, and we then conducted additional research on the undergraduate research offerings at the participants' home institutions. Survey responses and the discussion group identified many challenges to impactful undergraduate research facilitation. Several overarching themes emerged across survey responses and breakout room discourse, including funding, mentor recruitment, early skill development, diversity, equity, and inclusion (DEI) and identifying and connecting with students. In this perspective, we elaborate on this discourse to inspire and assist those seeking to foster undergraduate research in the field of microbiology and beyond.

Community-Based Tobacco Smoking Cessation Programmes Among Adolescents in Sarawak: Lesson Learned from Process Evaluation

Introduction: This study evaluated the effectiveness of community-based quit-smoking interventions using the 5A’s and 3A’s modules. Methods: The study was conducted between 2020 and 2021 in Samarahan and Asajaya District, Sarawak, Malaysia. The study included 519 participants out of 600 individuals, and both facilitators and observers evaluated the process. The process evaluation assessed various components: fidelity, dose delivered, dose received, reach, satisfaction, context, justification for intervention withdrawal, facilitator influence on sessions, and intervention feedback. Results: The study found that most facilitators executed more than 85% of both session modules, achieving at least 75% of the objectives. Most participants of both sessions were positively and actively engaged and would recommend intervention to others. The participants reported positive feedback. However, 26.3% of participants withdrew from the second session due to inconvenient timing. The observer’s fidelity evaluations of both intervention sessions were fully implemented according to plans, achieving over 75% of their objectives. Observers acknowledged active and engaged participants during both intervention sessions and regarded all facilitators as appropriate and positive toward participants. The process evaluation showed that the interventions were administered well, and smoking adolescents demonstrated a willingness to quit smoking due to the outcomes of this intervention. Conclusion: The findings of this study provide valuable insights into the effectiveness of community-based interventions for quitting smoking and highlight the importance of evaluating the process of interventions to understand their relationship with outcomes. The study’s results can inform the development and implementation of future interventions to reduce smoking incidence among adolescents.

Sosialiasi Pencegahan Hipertensi Pada Remaja di Sekolah Melalui Gerakan Jaga Jantung Dengan Gerak Aktif Senam Jantung Sehat

Abstract Hypertension is a chronic condition with a high prevalence, increasing the risk of cardiovascular diseases such as stroke, heart attack, and kidney failure. Recent data suggest that hypertension affects not only adults but also adolescents, with a rising prevalence. Major risk factors include an unhealthy lifestyle, obesity, genetic predisposition, and lack of physical activity. Preventive efforts are essential to increase awareness among adolescents about maintaining heart health through physical activity. This community service program aimed to enhance adolescents' understanding of hypertension risks and prevention through the "Heart Care Movement" with Healthy Heart Exercise. Conducted at SMAN 7 Tasikmalaya, the program involved 86 grade XII students. Methods included interactive education using leaflets and the implementation of Healthy Heart Exercise led by instructors from the Bachelor of Nursing program at Universitas Bakti Tunas Husada. Evaluations involved pre-test and post-test knowledge assessments and monitoring participants' heart rates. Results indicated a significant improvement in students' knowledge about hypertension and the benefits of physical activity. The average knowledge score increased from 59.77 in the pre-test to 83.02 in the post-test. Active participation in education and exercise sessions demonstrated strong enthusiasm for the program. Supported by the Community-Based Participatory Research (CBPR) model, which actively engaged the school, this initiative proved effective in raising awareness. Integrating such programs into routine school activities could foster a culture of healthy living from an early age and reduce future hypertension risks. Keywords: hypertension, adolescents, prevention, healthy heart exercise, community service.

Nucleus reuniens: Modulating emotional overgeneralization in peri-adolescents with anxiety.

Anxiety affects 4.4-million children in the USA with an onset between childhood and adolescence, a period marked by neural changes that impact emotions and memory. Negative overgeneralization - or responding similarly to innocuous events that share features with past aversive experiences - is common in anxiety but remains mechanistically underspecified. The nucleus reuniens (RE) has been considered a crucial candidate in the modulation of memory specificity. Our study investigated its activation and functional connectivity with the medial prefrontal cortex (mPFC) and hippocampus (HPC) as neurobiological mechanisms of negative overgeneralization in anxious youth. As part of a secondary data analysis, we examined data from 34 participants between 9 and 14years of age (mean age ± SD, 11.4 ± 2.0years; 16 females) with varying degrees of anxiety severity. During the Study session participants rated images as negative, neutral, and positive. After 12h, participants returned for a Test session, where they performed a memory recognition test with repeated (targets) and similar (lures) images. Labeling negative relative to neutral lures as "old" (false alarms) was our operational definition of negative overgeneralization. Negative relative to neutral false alarmed stimuli displayed elevated RE activation (at Study and Test) and increased functional connectivity with the Cornu Ammonis (CA) 1 (at Test). Elevated anxiety severity was associated with reductions in the RE-mPFC functional coupling for neutral relative to negative stimuli. Exploratory analyses revealed similar patterns in activation and functional connectivity with positive stimuli. Our findings demonstrate the importance of the RE in negative overgeneralization and anxiety.

Intra- and inter-rater reliability of the ActivForce Digital Dynamometer for cervical range of motion in patients with chronic neck pain

Background Chronic neck pain associated with reduced cervical range of motion, necessitating accurate and reliable assessment for effective rehabilitation. The ActivForce 2 electronic goniometer is a user-friendly tool with potential applicability in both clinical and research settings. Objective This study evaluated the intra- and inter-rater reliability of the ActivForce 2 electronic goniometer in measuring cervical range of motion in patients with chronic neck pain. Methods Thirty-one patients (21 women, 10 men; mean age ± standard deviation: 38.74 ± 11.08 years) were assessed over two sessions, one week apart. Two data collectors measured cervical movements, with three repetitions per movement. Intra-rater reliability was evaluated by having each collector assess participants in both sessions, while inter-rater reliability was tested by comparing measurements between collectors. Reliability was evaluated using the Intraclass Correlation Coefficient, Standard Error of Measurement, Minimum Detectable Change, Bland-Altman plots and linear regression. Results The electronic goniometer demonstrated excellent reliability, with ICC values ranging from 0.980-0.999 (intra-rater) and 0.954-1.00 (inter-rater). Low SEM and narrow Bland-Altman limits supported the precision of measurements. Conclusion The ActivForce 2 electronic goniometer is a reliable tool for assessing cervical spine movements in chronic neck pain patients.

Evaluation of the BIOSECURE Questionnaire in Patients Followed for Inflammatory Rheumatological and Gastrointestinal Diseases Through the Analysis of This Questionnaire.

Therapeutic education (TE) plays a central role in the management of chronic inflammatory rheumatic diseases and inflammatory bowel disease. The BIOSECURE questionnaire was developed and validated in 2012 to assess self-management and patient safety, initially in rheumatology. Objectives: The aim of our study was to assess the knowledge of patients followed in both rheumatology and gastroenterology regarding their treatment through the BIOSECURE questionnaire. The secondary objective was to identify factors associated with a low level of knowledge according to the BIOSECURE questionnaire. Methods: This was a descriptive observational study, conducted in a single center at the Reims University Hospital between January 2023 and April 2024. The population was divided into quartiles. Participation in therapeutic education (TE) included receiving brochures about their disease or treatment and/or participation in group or individual TE sessions. We compared the patients with the lowest scores to those with the highest scores. Results: The study population consisted of 312 patients, including 32.05% with rheumatoid arthritis (RA) and 29.81% with Crohn's disease. In our population, 82.03% had participated in therapeutic education, which included a TE session and/or the distribution of brochures about their disease and/or treatment. The median [IQR] BIOSECURE score was 71.04/100 [IQR 61.77-81.9]. When comparing patients with a low BIOSECURE score (<61.77) to those with a high score (>81.9), univariate factors associated with a low score were older age (p = 0.02), less participation in therapeutic education (p = 0.01), shorter duration of targeted therapy (p = 0.01), and lower level of education (p < 0.05). Conversely, patients who had received therapeutic education had a higher BIOSECURE score (p = 0.01). There was no difference in BIOSECURE scores based on place of residence, location of patient follow-up, route of administration, or type of inflammatory disease. In a multivariate analysis with a model including age, TE participation, and duration of targeted therapy, the results remained significant (p < 0.05). Discussion: We were able to compare the results of our study with two other French studies previously conducted on the same population of 677 patients undergoing biotherapy for chronic inflammatory rheumatism. The median BIOSECURE score in those studies was 73/100. In the study by Rat AC, published in 2017, the population was divided based on their BIOSECURE questionnaire results into three groups; they compared high and low response levels. Similarly to our study, a lower educational level and unemployment were associated with a lower rate of correct responses. The same was true for the absence of therapeutic education (TE) or distribution of brochures. Conclusions: The analysis of the BIOSECURE questionnaire in our population provides a practical message: factors associated with a low BIOSECURE score include older age, lower educational level, recent initiation of targeted therapy, and lack of participation in therapeutic education. This population could be a priority target for TE in order to ensure treatment safety for these patients.

Student interest and perception of ethical reasoning learning: Insights from medical education.

Medical ethics teaching is one of the pillars of medical education. Ethical reasoning learning (ERL) is one of the means of teaching medical ethics. The aim of our study was to evaluate the pedagogical interest and the students' perceptions of ERL in directed teaching in internal medicine among fifth-year students. This was a cross-sectional study conducted in the Internal Medicine Department of Habib Thameur Hospital during one academic year. The pedagogical interest and the student's perception were evaluated by comparing a pre-test and a post-test filled in by the students, respectively, before and after an ERL session. Our study included 44 students. Before the ERL session, almost two-thirds of the students (63.6%) found the ERL to be "extremely interesting" in medical training and practice. This extremely high level of educational interest in the ERL was statistically associated with previous participation in ERL sessions among our students. Prior to the ERL session, just over four-fifths of the students (84.1%) had a "favourable" perception of the ERL. After the ERL session, our study noted an improvement in students' pedagogical interest in ERL. Our study also showed an improvement in students' perceptions of the ERL. The improvement in students' pedagogical interest and perception of ERL exceeded 80% after the session. Our study concluded that there was a significant pedagogical interest and a favourable perception of the students' point of view regarding the ERL in internal medicine- directed teaching among fifth-year medical students.

Teaching Internal Medicine Residents to Critically Appraise the Role of Race in Pulmonary Function Testing.

Race-specific equations for spirometry reference values are one example of race-specific algorithms traditionally used in medicine. The American Thoracic Society now recommends use of race-neutral reference equations instead of race-specific equations. However, no published curricula on interpretation of spirometry using race-based compared to race-neutral reference equations exist. We developed a curriculum for internal medicine residents to address this gap and equip providers to interpret spirometry in a race-conscious fashion. An internal medicine resident and an attending in pulmonary medicine developed the curriculum and invited other experts to review and edit the material. The internal medicine resident delivered an hour-long, interactive, slide-based, didactic presentation during a weekly, residency-wide videoconference to 45 participants. The presentation included the following components: (1) history of spirometry and race, (2) race-specific equations, (3) race-neutral equations, and (4) clinical implications. The presentation opened with a clinical case and small-group discussions. We conducted pre- and posttest surveys; the posttest survey was designed using the Kirkpatrick model to assess reaction, learning, and anticipated behavioral change. Mean score differences were evaluated for level 2 questions using Cohen's d effect size. Thirty-eight respondents completed the pretest survey, and 24 completed the posttest survey. Test scores significantly improved after session participation, with Cohen's d ranging from 0.27 to 1.17. This curriculum was successful in engaging participants in critically appraising race-based interpretations of pulmonary function testing. The structure of the curriculum could be repurposed to create didactic content on other examples of race-based clinical algorithms.

Effectiveness of Autogenic Relaxation Training as an Adjunct to Usual Physiotherapy in Enhancing Emotional Well-Being and Functional Independence in Stroke Survivors: A Randomized Controlled Study

Background Regular participation in stroke rehabilitation sessions and adherence to prescribed physical activities are crucial, however, emotional imbalances often act as barriers, resulting in low adherence among stroke survivors. The autogenic relaxation technique (ART) has shown positive effects in various conditions but remains underexplored in the stroke population. Objective This experimental study evaluated the outcomes of ART in addition to usual physiotherapy for stroke survivors in improving emotional wellbeing and enhancing patients’ commitment to physical activity and functional independence. Methodology Sixty-six participants were randomly assigned to either an experimental group or a control group using stratified block randomization. Experimental group participants received 20 minutes of ART followed by 40 minutes of usual physiotherapy, and the control group received 60 minutes of usual physiotherapy. The 12-week program involved three 1-hour sessions per week (one supervised and two non-supervised). Intervention outcomes were assessed using the Hospital Anxiety and Depression Scale for Anxiety (HADS), the Recovery Locus of Control (RLOC) Scale for perceived control and beliefs about health, and Modified Barthel Index (MBI) for functional independence. Intervention effects were analyzed using mixed-model analysis of variance. Changes in the outcome measures were analyzed using paired and independent t-tests, with p < 0.05 considered statistically significant. Results After the 12-week intervention, there were significant time and group effects for all outcomes (p < 0.01), with significant reductions in participants’ HADS – Anxiety (p = 0.001) and HADS-Depression (p = 0.001) scores, and improvement in RLOC (p = 0.016) and MBI (p = 0.007) scores. Conclusion These findings highlight the effectiveness of ART as a non-intimidating and readily accessible strategy with wide-ranging benefits for stroke survivors.

The Effects of a Carbohydrate Mouth Rinse on Soccer-Specific Skills Following a Morning High-Intensity Practice.

Carbohydrate mouth rinse (CMR) is suggested to improve aerobic, anaerobic, and skill-related performance. The current study examined the influence of CMR on soccer-specific skills in 13 faster collegiate female soccer players. Athletes completed a control (CON) and two counterbalanced, double-blind experimental sessions. Sessions consisted of a warm-up, high-intensity soccer practice, followed by four soccer-specific skill tests. During the experimental sessions participants rinsed with a color-and-taste-matched CMR or placebo (PLA) solution before the skill tests. Thirst sensation (TS), rating of perceived exertion (RPE) and heart rate (HR) were assessed throughout sessions. Performance scores and HR values between sessions were compared with a one-way repeated measurements ANOVA. A Friedman test was used to compare RPE and TS. Post-hoc analyses were implemented when necessary. Agility times were significantly faster (p = .01) during CON session (10.9 ± 0.4 s) compared to PLA session (11.2 ± 0.4 s). There was no significant difference in scores for the other tests (p > .05). Post-practice RPE was lower (p = .01) for CMR session than CON session. TS was lower during PLA and CMR sessions compared to CON session following the warm-up (PLA p = .004; CMR p = .003) and practice (PLA p = .002; CMR p = .001). Average (p = .094) and maximal HR (p = .334) were similar across sessions. While CMR did not hinder soccer skill-related performance, the current study determined the use of CMR may not enhance soccer skill-related performance in fasted collegiate female soccer players.

ACCEPTABILITY AND SATISFACTION WITH VIVO: PARTICIPANT FOCUS GROUPS AND SURVEY

Abstract As part of the Vivo feasibility study, each participant (n= 22) completed a program satisfaction survey and participated in a focus group (four groups of 5-8 participants each). The satisfaction survey showed 1) 95% were satisfied with the program; 2) 86% indicated they would continue to do strength training exercises after the study; and 3) 77% indicated participation in Vivo made them more aware of the importance of strength training. To further examine acceptability and satisfaction with Vivo, our team conducted four focus groups focused on identifying key barriers and facilitators to participation in the virtual exercise sessions. Two coders, through individual coding and iterative team meetings with the larger team, used descriptive content analysis to code and identify common themes. Our team identified four themes: 1) self-reported positive outcomes (i.e., regained function after injury, variety of exercise kept interest); 2) positive exercise experience (i.e., manageable exercise with little equipment, felt inclusive, focus on safe exercise); 3) social connection with others (i.e., developed peer group, facilitate group discussion that helped bond group); and 4) importance of an individualized exercise program (i.e., modifiable depending on ability that day, individual feedback from trainers). Areas for improvement included: making rescheduling easier, optimizing trainer communication, and clarifying needed hardware. These findings support the acceptability and high satisfaction with virtual exercise programs for older adults with pre-diabetes.

Utilization of Learning Action Cell (LAC) Session Contents among Science Teachers in Vigan, Ilocos Sur

The professional development of teachers is essential for effectively implementing the K to 12 Basic Education Program in the Philippines. Learning Action Cells (LACs) provide a collaborative platform for teachers to enhance competencies in addressing diverse learners' needs, integrating 21st-century skills, and contextualizing the curriculum. This study examined the utilization of LAC session contents by 42 Junior High School Science teachers in Vigan City and its impact on teaching practices. Using a mixedmethod design, data were collected through surveys and interviews. Quantitative data were analyzed statistically, while qualitative data underwent thematic analysis. The study focused on Learners' Diversity and Student Inclusion, Content and Pedagogy, 21st-century Skills and ICT Integration, Assessment, and Curriculum Contextualization. Findings revealed high utilization of LAC content across all areas, with Learners' Diversity being the most utilized. Teachers’ educational attainment and position significantly influenced their LAC content utilization, with correlations noted between these factors and session attendance. Key outcomes included enhanced subject matter knowledge, improved pedagogy, and refined assessment strategies. A proposed action plan emphasized inclusive teaching methods, curriculum localization, digital literacy, and contextual integration. Recommendations include encouraging postgraduate studies, active participation in LAC sessions, and ICT-related training for teachers. Administrators are advised to monitor LAC utilization, provide comprehensive guides, and support professional growth. Broader studies are recommended to validate these findings and further explore LAC's impact on educational practices. This study underscores the pivotal role of LACs in fostering professional development and improving teaching efficacy.

Pengembangan Kualitas Vokal dan Harmoni melalui Latihan Koor di Gereja dalam Program MBKM Mandiri di SMPK St. Theresia Kupang

The MBKM (Merdeka Belajar Kampus Merdeka) program is mandatory for every student at the Faculty of Teacher Training and Education, Universitas Katolik Widya Mandira Kupang. The program aims to share new knowledge and provide direct experience through field activities that can enhance the competence of prospective teachers. One of the MBKM activities outside the classroom is choir training. The community service is conducted through assisting choir practice for students of SMPK St. Theresia Kupang at the Catholic Church of Santo Fransiskus Aisi BTN Kolhua, located at JL. Fetor Funay No. 8, Kolhua, Maulafa Subdistrict, Kupang City, East Nusa Tenggara. Choir training is a form of musical art that requires good teamwork and coordination among members to achieve perfect harmony. This article aims to explore effective methods in choir training, with the church as the venue for the students’ activities to fulfill the KKN or MBKM program based on extracurricular activities to enhance vocal quality and harmony. This research was conducted through observation, interviews with the choir trainer, and active participation in training sessions, focusing on Vocal techniques (Pitch, Phrasing, Harmonization, Articulation, and Intonation) and Expression (Tempo, Dynamics, Interpretation, Rhythm, and Resonance). The results of the study show that vocal warm-ups, clear voice division, and regular evaluations play a crucial role in the success of choir practice. By applying these methods, the choir group was able to achieve better musical quality. Additionally, this program successfully fostered social responsibility and teamwork. In conclusion, this extracurricular activity positively impacts the development of vocal skills and social awareness within the learning environment.

Empowerment of Eucalyptus Oil Farmer Groups Through Training in The Use of Social Media for Product Marketing

In Buru Regency, Waimiting Village is one of the eucalyptus oil processing centers. Processed eucalyptus oil products still have obstacles in marketing management in the community. The lack of optimization of farmers' marketing management institutions has had an economic impact on farmers' welfare. Therefore, training on the use of social media for marketing eucalyptus oil products is important to be carried out to increase the empowerment of farmers in fulfilling income which then leads to the welfare of farmers. The objective of this program is to support the growth of small businesses owned by a group of social entrepreneurship-based entrepreneurs and eucalyptus oil distillation centers. The research was conducted using participatory surveys, observations, lectures, discussions, and silent practice, involving about 12 people who are members of the "Kayu Putih Lestari" farmer group. The results of the program implementation showed the seriousness and enthusiasm of the participants in each training session. Program partners were able to understand a number of technical issues, such as social media-based marketing management, utilization of social media marketing, and brand creation agreements for eucalyptus oil distillation-based business ventures from farmer groups in Waimiting Village. They also showed an increase in understanding by 14 points (80%) during the training. Participants were also able to put the training into practice during the learning sessions.

Prefrontal cortex stimulation normalizes deficient adaptive learning from outcome contingencies in low mood

Depression and anxiety are associated with deficits in adjusting learning behaviour to changing outcome contingencies. This is likely to drive and maintain symptoms, for instance, by perpetuating negative biases or a sense of uncontrollability. Normalising such deficits in adaptive learning might therefore be a novel treatment target for affective disorders. The aim of this experimental medicine study was to test whether prefrontal cortex transcranial direct current stimulation (tDCS) could normalise these aberrant learning processes in depressed mood. To test proof-of-concept, we combined tDCS with a decision-making paradigm that manipulates the volatility of reward and punishment associations. 85 participants with low mood received tDCS during (or before) the task. In two sessions participants received real or sham tDCS in counter-balanced order. Compared to healthy controls (n = 40), individuals with low mood showed significantly impaired adjustment of learning rates to the volatility of loss outcomes. Prefrontal tDCS applied during task performance normalised this deficit, by increasing the adjustment of loss learning rates. As predicted, prefrontal tDCS before task performance (control) had no effect. Thus, the effect was cognitive-state dependent. Our study shows, for the first time, that a candidate depression treatment, prefrontal tDCS, when paired with a task, can reverse deficits in adaptive learning from outcome contingencies in low mood. Thus, combining neurostimulation with a concurrent cognitive manipulation is a potential novel strategy to enhance the effect of tDCS in depression treatment.

Implementing and Assessing Climate Change Education in a Pediatrics Residency Curriculum.

Background For physicians to effectively combat the growing health crisis that is climate change, they should begin learning during medical training about its health implications. However, there is little data on residents' knowledge of the climate crisis, and even less data regarding the effectiveness and acceptability of climate change education in graduate medical training programs. Objective To incorporate a new educational session on the health implications of climate change into a residency curriculum and evaluate the acceptability of the session and its effects on residents' knowledge, attitudes, and perceptions of the topic. Methods In July 2021, a 90-minute, interactive, small-group format educational session on the health implications of climate change was incorporated into the first-year curriculum of a pediatric residency program. From July 2021 through June 2023, resident participants completed pre- and post-session surveys that assessed their knowledge, attitudes, and perceptions regarding health implications of climate change. Likert scale data were analyzed using Wilcoxon signed-rank tests. Results Of the 109 residents scheduled to participate, 50 (46%) completed both the pre- and post-session surveys. Session participation increased residents' self-reported knowledge of how climate change impacts health and how physicians can act as climate advocates. Ninety-eight percent of all post-session respondents (58 of 59) agreed that they would recommend the session to other residents. With 3 facilitators, the monthly session required ≤4 hours of preparation and ≤12 hours of direct teaching time per facilitator each academic year. Conclusions A single educational session improved residents' self-reported knowledge of the health implications of climate change and was well-received by participants.

Penyuluhan Mengenai Pentingnya Posyandu untuk Bayi dan Balita di Posyandu Mawar Indah RW 07 KP. Cikatuncar Kelurahan Kotabaru Kota Tasikmalaya

Based on the record owned by the cadre, there are currently 97 babies and toddlers. However, the attendance rate of mothers and toddlers at the Mawar Indah Posyandu (integrated health service post) averages only 35% each month. This low attendance rate attracted researchers to initiate a community counseling program with goals to increase awareness and participation among mothers of infants and toddlers in the area. The approach to community empowerment adopted in this study is centered on a public health education campaign, highlighting the critical role of Posyandu in supporting the growth and development of infants and toddlers. The initiative included key steps starting with presenting the benefits of Posyandu for children's growth and developments, engaging participants in a discussion session, and providing door prizes as incentives. The result of the outreach program is attended by 28 mothers along with their children. However, at this level of attendance achieved an average at 28.8%, falling short of the defined success indicators and lower than the previous rate. This outcome was influenced by several factors as outlined in H.L. Bloom’s theory, including environmental factors, individual behavior, healthcare services, and genetic predispositions. The findings indicate that despite efforts to increase awareness and participation, the involvement of mothers with infants and toddlers in the area remains insufficient. Contributing factors include environmental, behavioral, and healthcare service factors. To achieve more optimal results, improvements in these aspects are essential to increase maternal participation in Posyandu programs.