Personalized Health Intervention Research Articles

Zinc finger 259 gene polymorphisms in Egyptian patients with metabolic syndrome and its association with dyslipidemia.

Zinc finger protein 1 (ZPR1), encoded by the ZNF259 gene, plays crucial roles in transcriptional regulation and cell cycle progression. Despite its known functions, its specific involvement in Metabolic Syndrome (MetS) remains debated. Genome-wide association studies have identified several genes, including ZNF259, implicated in lipid metabolism and associated with MetS. Single nucleotide polymorphisms (SNPs) in ZNF259 have been linked to altered lipid metabolism during the development of MetS. This study aims to investigate the association between MetS in Egyptian patients and three specific ZNF259 SNPs: rs964184, rs2075294, and rs2075290. The objective is to explore how these SNPs correlate with MetS development, other health outcomes, and their interaction with dyslipidemia biomarkers. 200 Egyptian participants were enrolled, and divided into two groups: 100 patients diagnosed with dyslipidemia and 100 healthy controls. The study involved comprehensive assessments, including lipid profile analysis, anthropometric measurements, and genotyping of rs964184, rs2075290, and rs2075294 in the ZNF259 gene using Real-Time Polymerase Chain Reaction (PCR). The findings indicate that rs964184 SNP correlates significantly with elevated plasma triacylglycerol (TG) levels, while rs2075290 and rs2075294 are associated with higher total serum cholesterol (TC) and TG levels. Among these SNPs, rs2075294 showed the highest predictive value (area under the curve of 0.748), followed by rs2075290 (0.738), and rs964184 (0.583), suggesting rs2075294 as the most influential SNP in MetS prediction. This study underscores the predictive role of ZNF259 SNPs in MetS risk among Egyptians. Future research should further explore the implications of ZNF259 in MetS pathogenesis and its potential as a biomarker for personalized health interventions.

Zinc finger 259 gene polymorphisms in Egyptian patients with metabolic syndrome and its association with dyslipidemia.

Zinc finger protein 1 (ZPR1), encoded by the ZNF259 gene, plays crucial roles in transcriptional regulation and cell cycle progression. Despite its known functions, its specific involvement in Metabolic Syndrome (MetS) remains debated. Genome-wide association studies have identified several genes, including ZNF259, implicated in lipid metabolism and associated with MetS. Single nucleotide polymorphisms (SNPs) in ZNF259 have been linked to altered lipid metabolism during the development of MetS. This study aims to investigate the association between MetS in Egyptian patients and three specific ZNF259 SNPs: rs964184, rs2075294, and rs2075290. The objective is to explore how these SNPs correlate with MetS development, other health outcomes, and their interaction with dyslipidemia biomarkers. 200 Egyptian participants were enrolled, and divided into two groups: 100 patients diagnosed with dyslipidemia and 100 healthy controls. The study involved comprehensive assessments, including lipid profile analysis, anthropometric measurements, and genotyping of rs964184, rs2075290, and rs2075294 in the ZNF259 gene using Real-Time Polymerase Chain Reaction (PCR). The findings indicate that rs964184 SNP correlates significantly with elevated plasma triacylglycerol (TG) levels, while rs2075290 and rs2075294 are associated with higher total serum cholesterol (TC) and TG levels. Among these SNPs, rs2075294 showed the highest predictive value (area under the curve of 0.748), followed by rs2075290 (0.738), and rs964184 (0.583), suggesting rs2075294 as the most influential SNP in MetS prediction. This study underscores the predictive role of ZNF259 SNPs in MetS risk among Egyptians. Future research should further explore the implications of ZNF259 in MetS pathogenesis and its potential as a biomarker for personalized health interventions.

Addressing health disparities through IT: A review of initiatives and outcomes

This paper provides a comprehensive review of information technology (IT) initiatives to address health disparities and evaluate their outcomes. Health disparities, defined as unequal health outcomes and access to healthcare across different population groups, are a persistent challenge globally. IT, including telehealth, electronic health records (EHRs), mobile health (mHealth) applications, and data analytics, presents innovative opportunities to mitigate these disparities. The review discusses the successes and challenges of these IT initiatives, highlighting their potential to enhance healthcare access, improve the quality of care, and promote health equity. Telehealth has been instrumental in bridging the gap for remote and underserved populations, while EHRs have improved care coordination. mHealth applications offer personalized health interventions, and data analytics is crucial in identifying and addressing health disparities. However, the effectiveness of these IT solutions is hindered by barriers such as the digital divide, lack of digital literacy, and privacy concerns. The paper calls for continued investment in accessible and equitable IT initiatives. It emphasizes the need for a multidisciplinary approach involving policymakers, healthcare providers, and IT professionals to implement effective solutions. Through this review, the paper aims to contribute to understanding how IT can be leveraged to combat health disparities, offering insights for future research and policy development.

Programmatic implementation of depression screening and remote mental health support sessions for persons recently diagnosed with TB in Lima, Peru during the COVID-19 pandemic.

Few studies have explored a stepped care model for delivering mental health care to persons with tuberculosis (TB). Here, we evaluated depression screening and remote low-intensity mental health interventions for persons initiating TB treatment in Lima, Peru during the COVID-19 pandemic. We used the Patient Health Questionnaire 9 (PHQ-9) to screen participants for depressive symptoms (PHQ-9≥5). Participants with PHQ-9, 5-14 received remote Psychological First Aid (PFA) or Problem Management Plus (PM+). Participants were reevaluated 6months after intervention completion. We then compared the change in median PHQ-9 scores before and after intervention completion. Those with PHQ-9≥15 were referred to higher-level care. We found that 62 (45.9%) of the 135 participants had PHQ-9≥5 at baseline. Then, 54 individuals with PHQ-9, 5-9 received PFA, of which 44 (81.5%) were reevaluated. We observed significant reductions in median PHQ-9 scores from 6 to 2 (r=0.98; p<0.001). Four participants with PHQ-9, 10-14 received PM+ but were unable to be reevaluated. Four participants with PHQ-9≥15 were referred to higher-level care. Depressive symptoms were common among persons recently diagnosed with TB. We observed improvements in depressive symptoms 6months later for most participants who received remote sessions of PFA.

DIFFERENCES IN COGNITIVE DECLINE DUE TO ALZHEIMER’S DISEASE, NEURODEGENERATIVE DISORDERS, AND TRAUMA

Abstract Alzheimer’s disease (AD) is a form of progressive dementia associated with significant personal, social, and economic burdens, making targeted interventions aimed at mitigating the effects of this condition on cognitive decline highly desirable. However, AD is but one of a range Neurodegenerative Disorders (ND) classified as dementias of aging. Furthermore, neither AD/ ND nor cognitive decline itself are monolithic: each individual disorder degrades specific aspects of cognition at differing rates. Isolating the most vulnerable facet of good cognitive health associated with each condition can lead the way to more personalized health interventions and an overall reduction of the burdens posed by AD /ND. In this paper we assess how the presence of AD and/or other ND degrade immediate (IR) and delayed (DR) recall over an extended period of time vs. the effect of non-degenerative brain trauma and AD/ND-free aging. Using Medicare-linked data from the Health and Retirement Study we found that, when compared to AD/ND-free aging, the onset of AD accelerates the decrease of IR by an overage of 0.30-0.37 points bi-annually, with similar effects on DR. Vascular dementia was associated with a 0.24-point loss of IR, but only for individuals with initially low recall capacity (≤5); those with high initial recall capacity (6+) did not experience loss of IR but lost 1.01 points of DR bi-annually. For comparison, traumatic brain injury was associated with 0.12-0.23 points decline in IR and 0.15 in DR bi-annually.

Association between Body Image Flexibility and Intermittent Fasting in Chinese Medical Students: A Cross-Sectional Study.

Unhealthy dietary behaviors and body dissatisfaction are becoming increasingly common among college students. Understanding the association between body image flexibility and intermittent fasting is particularly meaningful, especially for medical college students. This study aimed to investigate the association between body image flexibility and intermittent fasting among medical students. We conducted a cross-sectional study with 5138 medical college students at Jitang College of North China University of Science and Technology. Univariate and multivariate logistic regression were used to evaluate the association between body image flexibility and intermittent fasting. Subgroup analysis and interaction tests were further used to examine the possible interaction between body image flexibility and intermittent fasting. In this study, 1329 (25.87%) students had intermittent fasting behavior. After adjustment for confounding factors, there was a negative association between body image flexibility and intermittent fasting (OR = 0.94, 95%CI = 0.93 to 0.95, p < 0.001). A significant interaction between body image flexibility and intermittent fasting was found in gender, academic year, major, and monthly living expenses (p for interaction < 0.05). E-value analysis suggested there was unlikely to be an unmeasured confounding. This association could contribute to the establishment of personalized health intervention strategies and provide recommendations for promoting the physical and mental health of medical students.

Use of Biological Feedback as a Health Behavior Change Technique in Adults: Scoping Review.

Recent advancements in personal biosensing technology support the shift from standardized to personalized health interventions, whereby biological data are used to motivate health behavior change. However, the implementation of interventions using biological feedback as a behavior change technique has not been comprehensively explored. The purpose of this review was to (1) map the domains of research where biological feedback has been used as a behavior change technique and (2) describe how it is implemented in behavior change interventions for adults. A comprehensive systematic search strategy was used to query 5 electronic databases (Ovid MEDLINE, Elsevier Embase, Cochrane Central Register of Controlled Trials, EBSCOhost PsycINFO, and ProQuest Dissertations & Theses Global) in June 2021. Eligible studies were primary analyses of randomized controlled trials (RCTs) in adults that incorporated biological feedback as a behavior change technique. DistillerSR was used to manage the literature search and review. After removing 49,500 duplicates, 50,287 articles were screened and 767 articles were included. The earliest RCT was published in 1972 with a notable increase in publications after 2000. Biological feedback was most used in RCTs aimed at preventing or managing diabetes (n=233, 30.4%), cardiovascular disease (n=175, 22.8%), and obesity (n=115, 15%). Feedback was often given on multiple biomarkers and targeted multiple health behaviors. The most common biomarkers used were anthropometric measures (n=297, 38.7%), blood pressure (n=238, 31%), and glucose (n=227, 29.6%). The most targeted behaviors were diet (n=472, 61.5%), physical activity (n=417, 54.4%), and smoking reduction (n=154, 20.1%). The frequency and type of communication by which biological feedback was provided varied by the method of biomarker measurement. Of the 493 (64.3%) studies where participants self-measured their biomarker, 476 (96.6%) received feedback multiple times over the intervention and 468 (94.9%) received feedback through a biosensing device. Biological feedback is increasingly being used to motivate behavior change, particularly where relevant biomarkers can be readily assessed. Yet, the methods by which biological feedback is operationalized in intervention research varied, and its effectiveness remains unclear. This scoping review serves as the foundation for developing a guiding framework for effectively implementing biological feedback as a behavior change technique. Open Science Framework Registries; https://doi.org/10.17605/OSF.IO/YP5WAd. RR2-10.2196/32579.

Effectiveness of personalized treatment stage-adjusted digital therapeutics in colorectal cancer: a randomized controlled trial

BackgroundColorectal cancer survivors often experience decline in physical performance and poor quality of life after surgery and during adjuvant therapies. In these patients, preserving skeletal muscle mass and high-quality nourishment are essential to reduce postoperative complications and improve quality of life and cancer-specific survival. Digital therapeutics have emerged as an encouraging tool for cancer survivors. However, to the best of our knowledge, randomized clinical trials applying personalized mobile application and smart bands as a supportive tool to several colorectal patients remain to be conducted, intervening immediately after the surgical treatment.MethodsThis study is a prospective, multi-center, single-blinded, two-armed, randomized controlled trial. The study aims to recruit 324 patients from three hospitals. Patients will be randomly allocated to two groups for one year of rehabilitation, starting immediately after the operation: a digital healthcare system rehabilitation (intervention) group and a conventional education-based rehabilitation (control) group. The primary objective of this protocol is to clarify the effect of digital healthcare system rehabilitation on skeletal muscle mass increment in patients with colorectal cancer. The secondary outcomes would be the improvement in quality of life measured by EORTC QLQ C30 and CR29, enhanced physical fitness level measured by grip strength test, 30-sec chair stand test and 2-min walk test, increased physical activity measured by IPAQ-SF, alleviated pain intensity, decreased severity of the LARS, weight, and fat mass. These measurements will be held on enrollment and at 1, 3, 6 and 12 months thereafter.DiscussionThis study will compare the effect of personalized treatment stage-adjusted digital health interventions on immediate postoperative rehabilitation with that of conventional education-based rehabilitation in patients with colorectal cancer. This will be the first randomized clinical trial performing immediate postoperative rehabilitation in a large number of patients with colorectal cancer with a tailored digital health intervention, modified according to the treatment phase and patient condition. The study will add foundations for the application of comprehensive digital healthcare programs focusing on individuality in postoperative rehabilitation of patients with cancer.Trial registrationNCT05046756. Registered on 11 May 2021.

A Systematic Review of Personalized Health Applications through Human-Computer Interactions (HCI) on Cardiovascular Health Optimization.

Introduction: Currently, the deployment of human–computer interactive technologies to provide personalized care has grown and immensely taken shape in most healthcare settings. With the increasing growth of the internet and technology, personalized health interventions including smartphones, associated apps, and other interventions demonstrate prowess in various health fields, including cardiovascular management. This systematic review thus examines the effectiveness of various human–computer interactions technologies through telehealth (mainly eHealth) towards optimizing the outcomes in cardiovascular treatment. Methods: A comprehensive search of MEDLINE, EMBASE, and CINAHL databases using key terms was conducted from 2000 to November 2021 to identify suitable studies that explored the use of human–computer interaction technologies to provide a personalized care approach to facilitate bolstered outcomes for cardiovascular patients, including the elderly. The included studies were assessed for quality and risk of bias, and the authors undertook a data extraction task. Results: Ten studies describing the use of a mix of personalized health app (mHealth) interventions were identified and included in the study. Among the included studies, nine of them were randomized trials. All of the studies demonstrated the effectiveness of various personalized health interventions in maximizing the benefits of cardiovascular disease treatment. Conclusions: Personalized health application interventions through precision medicine has great potential to boost cardiovascular disease management outcomes, including rehabilitation. Fundamentally, since each intervention’s focus might differ based on the disease and outcome preference, it is recommended that more research be done to tailor the interventions to specific disease and patient outcome expectations.

Explainable Fall Risk Prediction in Older Adults Using Gait and Geriatric Assessments.

Older adults aged 65 and above are at higher risk of falls. Predicting fall risk early can provide caregivers time to provide interventions, which could reduce the risk, potentially avoiding a possible fall. In this paper, we present an analysis of 6-month fall risk prediction in older adults using geriatric assessments, GAITRite measurements, and fall history. The geriatric assessments included were Activities of Daily Living (ADL), Instrumental Activities of Daily Living (IADL), Mini-Mental State Examination (MMSE), Geriatric Depression Scale (GDS), and Short Form 12 (SF12). These geriatric assessments are collected by staff nurses regularly in senior care facilities. From the GAITRite assessments on the residents, we included the Functional Ambulatory Profile (FAP) scores and gait speed to predict fall risk. We used the SHAP (SHapley Additive exPlanations) approach to explain our model predictions to understand which predictor variables contributed to increase or decrease the fall risk for an individual prediction. In case of a high fall risk prediction, predictor variables that contributed the most to elevate the risk could be further examined by the health providers for more personalized health interventions. We used the geriatric assessments, GAITRite measurements, and fall history data collected from 92 older adult residents (age = 86.2 ± 6.4, female = 57) to train machine learning models to predict 6-month fall risk. Our models predicted a 6-month fall with an AUC of 0.80 (95% CI of 0.76–0.85), sensitivity of 0.82 (95% CI of 0.74–0.89), specificity of 0.72 (95% CI of 0.67–0.76), F1 score of 0.76 (95% CI of 0.72–0.79), and accuracy of 0.75 (95% CI of 0.72–0.79). These results show that our early fall risk prediction method performs well in identifying residents who are at higher fall risk, which offers care providers and family members valuable time to perform preventive actions.

Encouraging Behavior Changes and Preventing Cardiovascular Diseases Using the Prevent Connect Mobile Health App: Conception and Evaluation of App Quality.

BackgroundCardiovascular diseases are a major cause of death worldwide. Mobile health apps could help in preventing cardiovascular diseases by improving modifiable risk factors such as eating habits, physical activity levels, and alcohol or tobacco consumption.ObjectiveThe aim of this study was to design a mobile health app, Prevent Connect, and to assess its quality for (1) assessing patient behavior for 4 cardiovascular risk factors (unhealthy eating, sedentary lifestyle, alcohol, and tobacco consumption) and (2) suggesting personalized recommendations and mobile health interventions for risky behaviors.MethodsThe knowledge base of the app is based on French national recommendations for healthy eating, physical activity, and limiting alcohol and tobacco consumption. It contains a list of patient behaviors and related personalized recommendations and digital health interventions. The interface was designed according to usability principles. Its quality was assessed by a panel of 52 users in a 5-step process: completion of the demographic form, visualization of a short presentation of the app, testing of the app, completion of the user version of the Mobile App Rating Scale (uMARS), and an open group discussion.ResultsThis app assesses patient behaviors through specific questionnaires about 4 risk factors (unhealthy eating, sedentary lifestyle, alcohol, and tobacco consumption) and suggests personalized recommendations and digital health interventions for improving behavior. The app was deemed to be of good quality, with a mean uMARS quality score of 4 on a 5-point Likert scale. The functionality and information content of the app were particularly appreciated, with a mean uMARS score above 4. Almost all the study participants appreciated the navigation system and found the app easy to use. More than three-quarters of the study participants found the app content relevant, concise, and comprehensive. The aesthetics and the engagement of the app were also appreciated (uMARS score, 3.7). Overall, 80% (42/52) of the study participants declared that the app helped them to become aware of the importance of addressing health behavior, and 65% (34/52) said that the app helped motivate them to change lifestyle habits.ConclusionsThe app assessed the risky behaviors of the patients and delivered personalized recommendations and digital health interventions for multiple risk factors. The quality of the app was considered to be good, but the impact of the app on behavior changes is yet to be demonstrated and will be assessed in further studies.

Experimental Phenomenology as an Approach to the Study of Contemplative Practices.

During history humans have developed a large variety of contemplative practices, in many different areas of life, and as part of many different traditions and contexts. Although some contemplative practices are very old, the research field of Contemplation Studies is young, and there are no agreed-upon definitions of central concepts such as contemplative practices and contemplative experiences. The present paper focuses on contemplative practices, defined as practices that are engaged in for the sake of the contemplative experiences they afford (e.g., the contemplation of nature, or the contemplation of various aspects of being-in-the world). The purpose of the present paper is to discuss the potential of experimental phenomenology to contribute to the development of the research field of Contemplation Studies. Experimental phenomenology is defined as the investigation of phenomenological practices and their effects on experience. Phenomenological practices involve intentional variations of experiencing by means of changes in the direction of attention and the choice of attitude, typically as guided by verbal instructions or self-instructions. It is suggested that contemplative practices represent a subcategory of phenomenological practices. Two different varieties of experimental phenomenology are described and illustrated in the present paper: (1) an informal variety which involves the development of new phenomenological practices by creative variation of procedures and observation of effects; and (2) a more rigorously scientific variety, which involves the systematic variation of phenomenological practices in accordance with experimental designs to study their experiential effects. It is suggested that the development of contemplative practices during the ages is the result of an informal experimenting of the first kind; this variety of experimental phenomenology can also be used to develop personalized health interventions in a clinical setting. As to the more rigorously scientific experimental phenomenology, it is possible that it may lead not only to an improved understanding of general principles underlying contemplative practices, but also to a more systematic development of new contemplative practices. The experimental-phenomenological approach to contemplative practices is illustrated by various examples involving mindfulness, gratitude, receiving and giving.

Experimental Phenomenology as Personalized Health Intervention: A Case Illustration

Experimental phenomenology is the investigation of phenomenological practices and their effects. To engage in a phenomenological practice means to focus attention on aspects of one’s experiences (e.g., sense impressions or body sensations) while adopting a specific kind of attitude (e.g., an explorative attitude) according to some set of instructions. The basic assumption is that the regulation of attention and attitudes involved in such practices may have effects on people’s health and quality of life. The present paper describes the basic principles of experimental phenomenology as an approach to personalized health interventions and illustrates these principles with a case, where a mindful embodiment practice was constructed for an individual suffering from insomnia due to early morning awakenings. The results are discussed in terms of the importance of personalization, the ambition to formulate general conclusions about the effects of phenomenological practices, and the need for measurements not only before and after treatment but also during the treatment process.

Mental health interventions for persons living with HIV in low- and middle-income countries: a systematic review.

IntroductionAddressing the intersection between mental health and HIV is critical for the wellbeing of persons living with HIV (PLWH). This systematic review synthesized the literature on mental health interventions for PLWH in low‐ and middle‐income countries (LMICs) to determine intervention components and explore their relationship with intervention effectiveness.MethodsWe included only controlled clinical trials of interventions aiming to improve the mental health of PLWH. We conducted a search in the following databases: PubMed, CINAHL, PsycINFO and EMBASE for eligible studies describing the evaluation of interventions for mental health problems among PLWH in LMICs published through August 2020. Two reviewers independently screened references in two successive stages of title/abstract screening and then full‐text screening for references meeting title/abstract criteria.ResultsWe identified a total of 30 eligible articles representing 6477 PLWH who were assigned to either the intervention arm (n = 3182) or control arm (n = 3346). The mental health interventions evaluated were psychological (n = 17, 56.67%), pharmacological (n = 6, 20.00%), combined psychological and pharmacological (n = 1, 3.33%) and complementary/alternative treatments (n = 6, 20.00%). The mental health problems targeted were depression (n = 22, 73.33 %), multiple psychological symptoms (n = 1, 3.33%), alcohol and substance use problems (n = 4, 13.33%), post‐traumatic stress disorder (n = 1, 3.33%) and HIV‐related neuro‐cognitive impairment (n = 2, 6.67%). Studies of interventions with significant effects had significantly a higher number of active ingredients than those without significant effects [3.41 (2.24) vs. 1.84 (1.46) Mean (SD)] [Mean difference = −1.56, 95% CI = −3.03 to −0.09, p = 0.037].ConclusionsThere continue to be advances in mental health interventions for PLWH with mental illness in LMICs. However, more research is needed to elucidate how intervention components lead to intervention effectiveness. We recommend scale up of culturally appropriate interventions that have been successfully evaluated in low‐ and middle‐income countries.

Process and Outcome Evaluation of a Mindfulness-Based Cognitive Therapy Intervention for Cisgender and Transgender African American Women Living with HIV/AIDS.

There is a need for evidence-based contextualized mental health interventions for persons living with HIV/AIDS. In the current study, the primary researcher conducted open trials with African American women living with HIV/AIDS (AAWLWHA) to examine the acceptability and feasibility of Project UPLIFT, a mindfulness-based cognitive therapy intervention that has demonstrated effectiveness in persons living with epilepsy. Women were recruited for a tele-delivered phone intervention group separated by gender identity, as well as participated in pre- and post-test assessments. Additionally, data on acceptability was collected. Both cis- and transgender women were highly satisfied with the intervention and demonstrated improvement in depressive and stress symptoms. The intervention seemed to be particularly feasible for cisgender women, though more qualitative mental health research may be warranted with transgender women. The current research has implications for the utility of mindfulness-based interventions such as UPLIFT, with AAWLWHA.

Common trust and personal safety issues: A systematic review on the acceptability of health and social interventions for persons with lived experience of homelessness.

BackgroundPersons experiencing homelessness and vulnerable housing or those with lived experience of homelessness have worse health outcomes than individuals who are stably housed. Structural violence can dramatically affect their acceptance of interventions. We carried out a systematic review to understand the factors that influence the acceptability of social and health interventions among persons with lived experience of homelessness.MethodsWe searched through eight bibliographic databases and selected grey literature sources for articles that were published between 1994 and 2019. We selected primary studies that reported on the experiences of homeless populations interacting with practitioners and service providers working in permanent supportive housing, case management, interventions for substance use, income assistance, and women- and youth-specific interventions. Each study was independently assessed for its methodological quality. We used a framework analysis to identify key findings and used the GRADE-CERQual approach to assess confidence in the key findings.FindingsOur search identified 11,017 citations of which 35 primary studies met our inclusion criteria. Our synthesis highlighted that individuals were marginalized, dehumanized and excluded by their lived homelessness experience. As a result, trust and personal safety were highly valued within human interactions. Lived experience of homelessness influenced attitudes toward health and social service professionals and sometimes led to reluctance to accept interventions. Physical and structural violence intersected with low self-esteem, depression and homeless-related stigma. Positive self-identity facilitated links to long-term and integrated services, peer support, and patient-centred engagement.ConclusionsIndividuals with lived experience of homelessness face considerable marginalization, dehumanization and structural violence. Practitioners and social service providers should consider anti-oppressive approaches and provide, refer to, or advocate for health and structural interventions using the principles of trauma-informed care. Accepting and respecting others as they are, without judgment, may help practitioners navigate barriers to inclusiveness, equitability, and effectiveness for primary care that targets this marginalized population.

Population Health Impact and Cost-Effectiveness of Community-Supported Agriculture Among Low-Income US Adults: A Microsimulation Analysis.

Objectives. To estimate the population-level effectiveness and cost-effectiveness of a subsidized community-supported agriculture (CSA) intervention in the United States.Methods. In 2019, we developed a microsimulation model from nationally representative demographic, biomedical, and dietary data (National Health and Nutrition Examination Survey, 2013-2016) and a community-based randomized trial (conducted in Massachusetts from 2017 to 2018). We modeled 2 interventions: unconditional cash transfer ($300/year) and subsidized CSA ($300/year subsidy).Results. The total discounted disability-adjusted life years (DALYs) accumulated over the life course to cardiovascular disease and diabetes complications would be reduced from 24 797 per 10 000 people (95% confidence interval [CI] = 24 584, 25 001) at baseline to 23 463 per 10 000 (95% CI = 23 241, 23 666) under the cash intervention and 22 304 per 10 000 (95% CI = 22 084, 22 510) under the CSA intervention. From a societal perspective and over a life-course time horizon, the interventions had negative incremental cost-effectiveness ratios, implying cost savings to society of -$191 100 per DALY averted (95% CI = -$191 767, -$188 919) for the cash intervention and -$93 182 per DALY averted (95% CI = -$93 707, -$92 503) for the CSA intervention.Conclusions. Both the cash transfer and subsidized CSA may be important public health interventions for low-income persons in the United States.

PHIT for Duty, a Mobile Application for Stress Reduction, Sleep Improvement, and Alcohol Moderation.

Post-traumatic stress and other problems often occur after combat, deployment, and other military operations. Because techniques such as mindfulness meditation show efficacy in improving mental health, our team developed a mobile application (app) for individuals in the armed forces with subclinical psychological problems as secondary prevention of more significant disease. Based on the Personal Health Intervention Toolkit (PHIT), a mobile app framework for personalized health intervention studies, PHIT for Duty integrates mindfulness-based relaxation, behavioral education in sleep quality and alcohol use, and psychometric and psychophysiological data capture. We evaluated PHIT for Duty in usability and health assessment studies to establish app quality for use in health research. Participants (N = 31) rated usability on a 1 (very hard) to 5 (very easy) scale and also completed the System Usability Scale (SUS) questionnaire (N = 9). Results were (mean ± SD) overall (4.5 ± 0.6), self-report instruments (4.5 ± 0.7), pulse sensor (3.7 ± 1.2), sleep monitor (4.4 ± 0.7), sleep monitor comfort (3.7 ± 1.1), and wrist actigraphy comfort (2.7 ± 0.9). The average SUS score was 85 ± 12, indicating a rank of 95%. A comparison of PHIT-based assessments to traditional paper forms demonstrated a high overall correlation (r = 0.87). These evaluations of usability, health assessment accuracy, physiological sensing, system acceptability, and overall functionality have shown positive results and affirmation for using the PHIT framework and PHIT for Duty application in mobile health research.

Personalized Mobile Health Intervention for Health and Weight Loss in Postpartum Women Receiving Women, Infants, and Children Benefit: A Randomized Controlled Pilot Study.

Prepregnancy maternal obesity and excessive weight gain during pregnancy lead to significant morbidities in mothers and their children. Mothers who never return to their prepregnancy weight begin subsequent pregnancies at a greater weight and have a larger propensity for excess gestational weight gain and postpartum weight retention. In this pilot study, 40 postpartum women credentialed to receive postpartum women, infants, and children (WIC) service were randomized to usual care ("WIC Moms") or a personalized health intervention delivered via a SmartPhone ("E-Moms"). Assessments, including body weight, vital signs, circumferences, and body composition, were completed at week 0 (6-8 weeks postpartum), week 8, and week 16. Results are presented as change from week 0 at 16. As per the completers analysis, body weight change was not different between the groups (WIC Moms vs. E-Moms; 1.8 ± 0.9 vs. -0.1 ± 0.9 kg; p = 0.10), neither was the change in percent body fat (1.7 ± 0.6 vs. 0.1% ± 0.6%; p = 0.90) or waist/hip ratio (-0.01 ± 0.01 vs. -0.02 ± 0.01 cm; p = 0.60). However, due to notable variability in intervention adherence as the study progressed, participants were classified post hoc as having low (<40% adherence), medium (40%-70% adherence), or high adherence (>70% adherence). Participants with high intervention adherence (n = 5) had a significant reduction in body weight (-3.6 ± 1.6 vs. 1.8 ± 0.9 kg; p = 0.005) and percent body fat (-2.5 ± 1.0 vs. 1.7% ± 0.6%; p = 0.001) when compared to WIC Moms. Overall, the E-Moms intervention was not able to decrease postpartum weight retention in women receiving WIC benefits compared to usual care received through the current WIC program. However, there is some evidence to suggest improved adherence to the intervention would improve weight management.

Envisioning the next generation of behavioral health and criminal justice interventions

The purpose of this paper is to cast a vision for the next generation of behavioral health and criminal justice interventions for persons with serious mental illnesses in the criminal justice system. The limitations of first generation interventions, including their primary focus on mental health treatment connection, are discussed. A person–place framework for understanding the complex factors that contribute to criminal justice involvement for this population is presented. We discuss practice and research recommendations for building more effective interventions to address both criminal justice and mental health outcomes.