Post-intervention Changes Research Articles

Reducing Barriers to Evidence-Based Services: A High School-University Partnership to Adapt the Unified Protocol for Urban, Underserved Youth with Elevated Internalizing Symptoms

ABSTRACT Background Rates of depression and anxiety in adolescents are rising and access to effective treatment remains limited. Public schools are instrumental in reducing barriers to treatment. Objective The present study describes a community-engaged approach to the adaptation and open trial of The Unified Protocol for Transdiagnostic Treatment of Emotional Disorders in Adolescents (UP-A; Ehrenreich-May et al. 2018) delivered as a group-based intervention in a Chicago Public High School among predominantly low-income Black and Latine adolescents experiencing elevated depression symptoms (i.e. “Healthy Minds, Happy Lives program;” HMHL). Methods This study utilized qualitative and quantitative analyses to evaluate: (1) the systematic adaptation process that aimed to balance fidelity (to the original UP-A intervention) and flexibility (e.g. the school-based group delivery, and community partner input), (2) the initial feasibility and acceptability of the HMHL intervention by analyzing salient themes from focus groups, and (3) pre- to post-intervention changes in symptoms, in order to inform intervention refinement and methodological considerations for a pilot clinical trial. Our adaptation process utilized the Framework for Reporting Adaptations and Modifications to Evidence-based Interventions and relied on the engagement of key school-staff partners (N = 8) and student-trial participants with elevated depression symptoms (N = 16). Focus group content was coded and thematically analyzed. Outcome trends were evaluated using reliable change indices. Results Preliminary feasibility was promising, with participants attending an average of 7 out of 8 hMHL sessions and retention was excellent with 100% of participants completing the program. Additionally, most trial participants demonstrated a clinically meaningful reduction in depression symptoms and increased emotional state awareness following the intervention. Conclusions HMHL may be a feasible and acceptable intervention for increasing access to care for youth who may otherwise not have access to evidence-based services. Recommendations are provided for enhancing both the content and delivery of the intervention.

Information provision and financial incentives in Catalonia's public primary care (2010–2019): an interrupted time series analysis

The relative efficacy of information provision versus financial incentives in improving primary care quality remains a critical, unresolved question. We investigated these two strategies in Catalonia's public primary care system from 2010 to 2019: an innovative online platform providing real-time quality indicator information and targeted economic incentives for achieving indicator goals. We conducted a comprehensive interrupted time series regression analysis on data from 272 primary care practices (5,628,080 patients). This analysis used linear regression models with Newey-West standard errors, and a sensitivity analysis including logit transformations to address ceiling effects. We evaluated 1) immediate post-intervention changes (step changes) in indicator results and inter-practice variability (coefficient of variation, CV), and 2) shifts in pre-intervention trends (slopes). We scrutinized 39 indicators after rigorous quality control: 23 novel (12 informed, 11 incentivized) and 16 derived from existing incentivized indicators. Robustness checks included 14 consistently incentivized and 10 non-intervened indicators. Overall, we assessed 63 indicators: 18 control, 13 follow-up, 9 quaternary prevention, 7 treatment, 7 diagnosis, 6 screening and 3 vaccination indicators. Informed indicators showed positive impacts in 75% (9/12) of cases, and incentivized indicators in 64% (7/11) of cases. Incentivized indicators displayed improvements in annual trends ranging from 6.66 to 1.25 percentage points, with step changes up to 8.87 percentage points. Information led to step changes ranging from 19.67 to 1.07 percentage points, along with trend improvements between 1.09 and 0.34 percentage points annually. Both interventions were associated with step reductions in variability (up to-0.18 CV reduction) and significant trend improvements. Derived indicators showed limited improvements in results or variability (31%, 5/16), with minor step increases up to 2.22 percentage points. Our findings reveal that information provision alone can match or even surpass the impact of financial incentives in improving care quality and reducing practice variability. This challenges conventional wisdom and offers a cost-effective, scalable approach to primary care quality enhancement, with far-reaching implications for global health policy. European Union, Horizon Europe.

Feasibility and preliminary efficacy of a systematic transaction model-guided dyadic coping nursing intervention for patients with breast cancer and their spousal caregivers: A pilot study

ObjectiveThis study aimed to assess the feasibility, acceptability, and preliminary efficacy of a Systematic Transaction Model (STM)-guided dyadic coping nursing intervention for patients with breast cancer and their spouses. MethodsA single-arm, pre-test/post-test pilot study was conducted at a tertiary hospital in Wuxi, China, recruiting 28 breast cancer patient–caregiver pairs. Each dyad participated in six hybrid intervention sessions. Paired t-tests were used to evaluate pre- and post-intervention changes, and effect sizes were calculated. Feasibility was assessed by recruitment and retention rates, acceptability via the Client Satisfaction Questionnaire-8 (CSQ-8), and preliminary efficacy through measures of body image, dyadic coping, post-traumatic growth, and marital satisfaction. ResultsAll 28 dyads completed the intervention. Patients showed small-to-moderate improvements in body image, post-traumatic growth, dyadic coping, and marital satisfaction (d ​= ​0.4–0.5, P ​≤ ​0.022), with clinically meaningful changes observed in 39%–68% of patients. Spousal caregivers also demonstrated improvements in post-traumatic growth, dyadic coping, and marital satisfaction (d ​= ​0.3–0.6, P ​≤ ​0.033), with 36%–46% showing clinically important differences. ConclusionsThis pilot study supports the feasibility and initial efficacy of an STM-guided dyadic coping intervention, which may benefit breast cancer patients and their spouses as a unit. Further large-scale trials are recommended to validate these findings. Trial registrationChina Clinical Trial Registry (ChiCTR2400083416).

The effect of a neuromuscular-cognitive training program on postural stability, hop performance, and agility in Division-I Women's Tennis athletes: A pilot study

BackgroundSituational awareness and cognitive function are often discounted in sports training programs, potentially limiting their effectiveness. ObjectiveThis research aimed to examine the effect of a six-week neuromuscular-cognitive training program on postural stability, hop performance, and agility with and without perceptual-cognitive challenge in a tennis team. DesignDouble baseline, quasi-experimental pretest-posttest. MethodsTen collegiate female tennis athletes volunteered to participate in this study. Participants completed two baseline testing sessions, a six-week training program, and a post-test session one week after the training program. Participants completed the neuromuscular-cognitive training twice a week for six weeks. The training integrated cognitive load (e.g., working memory and inhibitory control) during exercise (e.g., balance and shuffling). At each data collection session, subjects completed a single-limb stance on a force plate with and without an upper extremity reaction test, single-leg hop, single-leg memory hop, reactive agility, and a lower extremity reaction task. Pre-to post-intervention changes were analyzed using t-tests with corresponding Hedge's g effect sizes. Results were considered significant when p ≤ 0.05 and Hedge's g effect sizes were moderate to strong. ResultsStatistically significant improvements were identified for single and dual-task anteroposterior mean center of pressure velocity (g = −0.684–0.803), single-task time-to-boundary mediolateral mean minima (g = 0.921), and single and dual-task time-to-boundary anteroposterior mean minima (0.708–0.830). Additionally, significant improvements were identified in the upper extremity reaction task during the dual-task static balance (g = −0.795). ConclusionNeuromuscular-cognitive training may be beneficial in improving postural stability outcomes; however, more research is needed to develop this type of training further.

Web-Based Intervention (SunnysideFlex) to Promote Resilience to Posttraumatic Stress Disorder Symptoms During Pregnancy: Development and Pilot Study.

Approximately 4% to 8% of pregnant individuals meet the criteria for current posttraumatic stress disorder (PTSD), a known risk factor for a multitude of adverse maternal and child health outcomes. However, PTSD is rarely detected or treated in obstetric settings. Moreover, available prenatal PTSD treatments require in-person services that are often inaccessible due to barriers to care. Thus, web-based interventions offer great potential in extending PTSD treatment to high-risk pregnant individuals by providing affordable, accessible care. However, there are currently no web-based interventions designed specifically for the treatment of PTSD symptoms during pregnancy. This study aims to develop and pilot a 6-week, web-based, cognitive behavioral therapy intervention for PTSD, SunnysideFlex, in a sample of 10 pregnant women with current probable PTSD. Consistent with established guidelines for developing and testing novel interventions, the focus of this pilot study was to evaluate the initial feasibility and acceptability of the SunnysideFlex intervention and preintervention to postintervention changes in PTSD and depression symptoms. This approach will allow for early refinement and optimization of the SunnysideFlex intervention to increase the odds of success in a larger-scale clinical trial. The SunnysideFlex intervention adapted an existing web-based platform for postpartum depression, Sunnyside for Moms, to include revised, trauma-focused content. A total of 10 pregnant women in weeks 16 to 28 of their pregnancy who reported lifetime interpersonal trauma exposure (ie, sexual or physical assault) and with current probable PTSD (scores ≥33 per the PTSD checklist for DSM-5) were enrolled in the SunnysideFlex intervention. Assessments took place at baseline and 6 weeks (postintervention). All participants were retained through the postintervention assessment period. Engagement was high; participants on average accessed 90% of their lessons, logged on to the platform at least weekly, and reported a generally positive user experience. Moreover, 80% (8/10) of participants demonstrated clinically meaningful reductions in PTSD symptoms from baseline to postintervention, and 50% (5/10) of participants no longer screened positive for probable PTSD at postintervention. Most (6/10, 60%) of the participants maintained subclinical depression symptoms from baseline to postintervention. Findings from this small pilot study indicate that SunnysideFlex may be a feasible and acceptable mechanism for delivering PTSD intervention to high-risk, trauma-exposed pregnant women who might otherwise not have opportunities for services. Larger-scale trials of the intervention are necessary to better understand the impact of SunnysideFlex on PTSD symptoms during pregnancy and the postpartum period.

Assessment of Acceptability, Usage, and Impact on Caregivers of Children With Autism's Stress and Mindfulness: Multiple-Method Feasibility Study of the 5Minutes4Myself App's Mindfulness Module.

Caregiver wellness programs need to be easily accessible to address caregivers' constraints to participation. We aimed to assess the feasibility of 5Minutes4Myself app's mindfulness module (usability, usage, and impact on caregivers' levels of mindfulness and perceived stress). Before and after participation in the 5Minutes4Myself program, 15 participants were asked to complete the Perceived Stress Scale (PSS) and Five Facet Mindfulness Questionnaire (FFMQ). Data on the usage of app-delivered meditations were collected electronically via the app, and app usability was rated on the Modified System Usability Scale. Analyses assessed participants' frequency of use of app-delivered meditations, app usability, and changes in participants' stress and mindfulness post intervention. Overall, participants completed 10.9 minutes of mindfulness meditations per week and rated the app 76.7, indicating above-average usability. Related samples t tests (2-tailed) found that group PSS (t10=1.20, P=.26) and FFMQ (t10=-1.57, P=.15) pre- or postintervention mean scores were not significantly different. However, a visualization of pre- and post-PSS and mindfulness scores suggested there was a group of responders who had decreased stress with increased mindfulness. This was confirmed via an individual change analysis. The effect size of the FFMQ scores (d=0.47) suggests there may be treatment effects with a larger sample. A hierarchical multiple regression analysis examined the degree mindfulness impacted perceived stress; 20% of the variance in participants' perceived stress could be attributed to increases in self-rated mindfulness (P=.04) when controlling for preintervention stress levels. Caregivers found the app highly usable and on average used low-dose levels of mindfulness meditations (10 min/wk). For responders, increased mindfulness was related to stress reduction to population-based levels.

An Intervention to Support Newly Admitted Students’ Transition to Pharmacy School

ObjectiveThis study aimed to provide prematriculation intervention addressing basic needs for newly admitted Doctor of Pharmacy students, and to assess postintervention changes made by students in the transition areas. MethodsSix transition areas were identified as basic needs that should be addressed by students before matriculation to enhance their potential for academic success. These areas included housing, commute, nonschool responsibilities and commitments (eg, childcare, excessive extracurricular activities), work, finances, and study approach. A prematriculation survey was administered to 24 students enrolling in January 2024. On the basis of the survey responses, members of the college’s transition team contacted students to intervene in 1 or more of the 6 transition areas when plans had not been made or were deemed as a potential barrier to academic success. A postmatriculation survey was administered during new student orientation to assess the changes that students made following the interventions. ResultsA total of 24 students (100%) completed the presurveys and postsurveys. On the basis of presurvey data, 14 students were contacted (7 video conferences, 7 email exchanges). The interventions addressed work (36.8%), study approach (31.6%), finances (15.8%), non–school-related responsibilities (10.5%), and housing (5.3%). Students made a total of 54 changes in the transition areas. Thirty-three (61.1%) of the changes were made by students who received intervention, and 21 (38.9%) were made by students who had not been contacted for intervention. ConclusionPrematriculation intervention addressing basic needs assists students in the transition to pharmacy school and proactively supports academic success.

Healthy Change Intervention: A Cluster RCT in Preschooler Mothers in Mexico and the United States.

To assess effects of Healthy Change intervention on maternal perception of her child's body weight (MPCW), maternal feeding style, and obesogenic home environment. A randomized control trial was conducted, consisting of two arms: the intervention group received the Healthy Change program, and the control group received the Hygiene and Accident Prevention program. A total of 356 mother-preschool child dyads participated, 182 in the intervention group and 174 in the control group, residing in Mexico and the United States. Data were collected at baseline and after the program through self-administered questionnaires completed by mothers and child anthropometric measurements. Although no significant between-group difference in pre- and post-intervention change of MPCW was found, sub-analyses revealed that a higher proportion of mothers in the intervention group accurately perceived their child's body weight at the study endpoint using categorical (67% vs. 57.1%, p < 0.005) and visual scales (48.9% vs. 41.8%, p < 0.015). Additionally, more mothers of overweight children in the intervention group accurately perceived their children's overweight and obese status compared to those in the control group (29.8% vs. 10.3%, X2 = 4.26, df = 1, p < 0.039). The intervention group also displayed a higher proportion of mothers with authoritative feeding style (26.4% vs. 16.5%, p < 0.036) and significantly higher family nutrition and physical activity scores (29.1 vs. 28.0, p < 0.000) at the study endpoint. Healthy Change Intervention led to improved accuracy of MPCW, a shift toward maternal authoritative feeding styles, and positive changes in obesogenic home environments.

Exercise-based telerehabilitation for the management of chronic pain in people with severe haemophilia: a mixed-methods feasibility study

BackgroundChronic pain is reported by between 30 and 71% of people with haemophilia (PWH). Exercise is shown to be effective for pain management in other arthritides, but it remains unclear if such an approach is effective or acceptable to PWH. The aim of this study was to evaluate the feasibility and acceptability of a telerehabilitation exercise intervention for PWH living with chronic pain.MethodsThis was a multisite, non-randomised, pre-post feasibility design, with a nested qualitative study. People with severe haemophilia > 18 years, living with chronic pain, were recruited. The intervention comprised 12 low-impact/moderate intensity, individualised exercise sessions and 3 knowledge-sharing and discussion sessions. Primary objectives assessed according to predefined progression criteria were as follows: (a) recruitment rate (5 participants enrolled per site over 8 weeks), (b) adherence (≥ 75% participants would adhere to ≥ 75% of sessions), (c) follow-up rate (≥ 75% completion of self-reported measures), (d) fidelity (intervention delivered as described in protocol) and (e) safety (≤ 30% participants would report adverse events). Acceptability was evaluated from thematic analysis of post-intervention participant interviews. Preliminary evaluation of self-reported pain, function and quality of life (QoL) was a secondary objective. Results were reported using descriptive statistics integrated with qualitative findings.ResultsTen PWH were recruited and completed the intervention. Nine agreed to be interviewed post intervention. Attendance at individual sessions was 84.5% compared to 52.1% for the group sessions. Outcome measures were successfully completed for 100% at baseline, 70% at intervention end and 60% at 3-month follow-up. No serious adverse events were recorded. Group median values in outcome measures (pain, function, QoL) showed minimal change post intervention. Participant interviews highlighted high levels of enjoyment, confidence in continuing exercises independently and positive views of virtual delivery and condition-specific exercise.ConclusionsRecruitment rate and safety met the predefined progression criteria. Fidelity partially met the progression criteria, but the follow-up rate for self-reported measures did not. The study was acceptable to both participants and physiotherapists. Further intervention development is needed to review approaches to outcome measure collection and refine the usefulness of the knowledge-sharing sessions.Trial registrationThe study was prospectively registered on 9 July 2021: International Standard Randomised Controlled Trial Number ISRCTN 17454597.

A Dual-Modality Home-Based Cardiac Rehabilitation Program for Adults With Cardiovascular Disease: Single-Arm Remote Clinical Trial.

Cardiac rehabilitation (CR) is a safe, effective intervention for individuals with cardiovascular disease (CVD). However, a majority of eligible patients do not complete CR. Growing evidence suggests that home-based cardiac rehabilitation (HBCR) programs are comparable in effectiveness and safety with traditional center-based programs. More research is needed to explore different ways to deliver HBCR programs to patients with CVD. We aimed to assess the feasibility and impact of a digital HBCR program (RecoveryPlus.Health) that integrates both telehealth and mHealth modalities on functional exercise capacity, resting heart rate, and quality of life among adults with CVD. This 12-week prospective, single-arm remote clinical trial used a within-subject design. We recruited adults with CVD (aged ≥40 years) from the community with a CR-eligible diagnosis (stable angina pectoris, myocardial infarction, and heart failure) between May and August 2023. All enrolled patients referred to the RPH clinic in Roanoke, Texas, were included. The care team provided guideline-concordant CR services to study participants via two modalities: (1) a synchronous telehealth exercise training through videoconferencing; and (2) an asynchronous mobile health (mHealth) coaching app (RPH app). Baseline intake survey, electronic health record, and app log data were used to extract individual characteristics, care processes, and platform engagement data. Feasibility was measured by program completion rate and CR service use. Efficacy was measured by changes in the 6-minute walk test, resting heart rate, and quality of life (12-Item Short-Form Health Survey) before and after the 12-week program. Paired t tests were used to examine pre- and postintervention changes in the outcome variables. In total, 162 met the inclusion criteria and 75 (46.3%) consented and were enrolled (mean age 64, SD 10.30 years; male: n=37, 49%; White: n=46, 61%). Heart failure was the most common diagnosis (37/75, 49%). In total, 62/75 (83%) participants completed the 12-week study and used the telehealth modality with 9.63 (SD 3.33) sessions completed, and 59/75 (79%) used the mHealth modality with 10.97 (SD 11.70) sessions completed. Post intervention, 50/62 (81%) participants' performance in the 6-minute walk test had improved, with an average improvement of 40 (SD 63.39) m (95% CI 25.6-57.1). The average 12-Item Short-Form Health Survey's physical and mental summary scores improved by 2.7 (SD 6.47) points (95% CI 1.1-4.3) and 2.2 (SD 9.09) points (95% CI 0.1-4.5), respectively. There were no changes in resting heart rate and no exercise-related adverse events were reported. The RecoveryPlus.Health digital HBCR program showed feasibility and efficacy in a group of nationally recruited patients with CVD. The findings add to the evidence that a telehealth and mHealth dual-modality HBCR program may be a promising approach to overcome some of the main barriers to improving CR access in the United States. ClinicalTrials.gov NCT05804500; https://clinicaltrials.gov/search?cond=NCT05804500.

Mindfulness-based therapy for insomnia in Black women: a pilot randomized controlled trial.

The purpose of the study was to evaluate the feasibility, acceptability, and preliminary efficacy of mindfulness-based therapy for insomnia (MBT-I) among Black women. The MBT-I group received weekly sessions that included mindfulness meditation and behavioral sleep strategies. The time and attention control group received lifestyle health education (HE) that included healthy eating, physical activity, and sleep hygiene. The primary outcome was post-intervention changes in insomnia severity score by the Insomnia Severity Index (ISI) at week 10. Other measures included: Pittsburgh Sleep Quality Index, Sleep Hygiene Practice, Spielberger State-Trait Anxiety Inventory (STAI), and Patient Health Questionnaire-9 (PHQ-9). Objective sleep was measured by Actiwatch™ at baseline and week 10. Thirty Black women completed the interventions with no attrition. About 97% of all participants attended 6-8 out of 8 sessions. The ISI scores were reduced at week 10 (MBT-I vs. HE: -7.67 vs. -7.22, p < .05). Anxiety and depression symptoms were significantly improved only in the MBT-I group. This is the first MBT-I for Black women with insomnia. Online MBT-I may be feasible and acceptable for Black women. The MBT-I and HE showed a clinically significant improvement in insomnia symptoms (ISI reduction > 7). MBT-I may be more effective in improving anxiety and depression symptoms than HE. Our findings encourage further study efforts with a longer follow-up and larger sample size to address sleep health disparities among Black women.

“I Felt More Mentally Present”: Examining Student Metacognitive Skills, Perceived Stress, and Academic Resilience Before and After a Classroom Mindfulness Intervention

Mindfulness interventions continue to be a recommendation for improving student well-being, particularly in the aftermath of the COVID-19 pandemic and the rise in student-reported mental health challenges. However, in the abundance of research supporting these recommendations, fewer studies have integrated mindfulness into college classrooms. This study reports on a 6-week classroom mindfulness intervention in an introductory psychology course. Students (N = 91) completed pre- and post-intervention measures of mindfulness, metacognitive ability, perceived stress, and academic resilience, as well as open-ended items about their perceptions of the intervention. Mindfulness and metacognitive ability were significantly higher post-intervention, but not perceived stress and academic resilience. More frequent in-class practice predicted greater post-intervention changes in mindfulness, metacognitive ability, and perceived stress. Perceptions of the intervention were mixed, consistent with prior research showing mindfulness interventions are not universally well-received. Implications and recommendations for classroom use are discussed.

The Effect of External Focus Versus Internal Focus Instruction on Jump-Landing Biomechanics in Healthy Females.

There are different ways to deliver external focus (EF) and internal focus (IF) instruction. Understanding each modality better will help to develop more effective interventions to reduce injury risk. To investigate the difference in landing biomechanics between participants who received EF and IF instruction and control participants. A secondary aim was to evaluate participant perceptions of focus of attention. Randomized controlled trial. Laboratory. Forty-one healthy women (EF: n = 14, 23.0 ± 2.9 years, 1.69 ± 0.07 m, 64.0 ± 6.8 kg; IF: n = 15, 22.9 ± 3.2 years, 1.66 ± 0.08 m, 66.2 ± 12.4 kg; control: n = 12, 21.1 ± 2.9 years, 1.67 ± 0.11 m, 74.3 ± 15.1 kg). Participants scoring greater than or equal to 5 on the Landing Error Scoring System were allocated into the EF, IF, or control group. Knee and hip flexion and abduction were collected pre- and postintervention during 5 drop vertical jumps. For the intervention, each group was provided separate instructions. In between the intervention jumps, participants answered, "What strategy were you focusing on when completing the previous jump-landing trials?" Postintervention minus preintervention change scores were calculated, and separate 1-way analysis of variance assessments were performed to determine differences in the dependent variables. Individuals in the EF group had a greater change in hip and knee flexion angles than individuals in the control group. There was no significant difference between the EF and IF groups for any variables. There were no significant differences in frontal plane variables. In the EF group, 71.4% aligned with the instructions given; in the IF group, 80% aligned; and in the control group, 50% aligned. External focus instruction may not produce immediate changes in movement compared with IF instruction. Hip and knee flexion were greater in the EF group than in the control group but was not better than that in the IF group. Clinicians should provide instructions to patients, but the mode of instruction may not be as critical to see positive biomechanical changes. Patients may not always focus on the instruction being given; therefore, the relationship between instruction and patient experience should be further explored.

Math Abilities Among Children with Neurodevelopmental Difficulties: Understanding Cognitive Factors and Evaluating a Pilot Intervention.

Math development in children relies on several underlying cognitive functions, including executive functions (EF), working memory (WM), and visual-motor abilities, such as visual-motor integration (VMI). Understanding how these cognitive factors contribute to children's math performance is critical to supporting math learning and long-term math success. The present quasi-experimental waitlist control study (N = 28) aimed to (a) examine the unique contributions of EF, WM, and VMI to math abilities among children ages 5-8 years old with neurodevelopmental difficulties; (b) determine whether a math intervention (the Mathematics Interactive Learning Experience; MILE) that supports these cognitive processes was effective when modified to be delivered to small groups in a school setting, and (c) examine whether any participant characteristics, such as age or IQ, were correlated with post-intervention math score changes. At baseline, participants' math scores were significantly below the normative mean in all math content areas (ps < .01). EF, WM, and VMI were highly correlated with math ability; however, verbal WM was the only unique predictor of math ability in regressions analysis. Compared to a waitlist control group, children in the immediate MILE intervention group achieved significantly greater math gains overall. When all children who ultimately completed the intervention were considered together, significant improvement was observed in more than half of math content areas. Furthermore, at the individual level, 85.7% of participants showed reliable change in at least one math content area. Implications for supporting math learning in children with neurodevelopmental difficulties are discussed.

Fostering Prosociality in Refugee Children: An Intervention With Rohingya Children.

Prosocial behavior is a distinguishing characteristic of human nature. Although prosocial behaviors emerge early in development, contextual factors play an important role in how these behaviors are manifested over development. A large body of research focuses on the trajectory of prosocial development across diverse cultures and investigating contexts that foster it. Against this backdrop of developmental research endeavoring to understand and enhance the cooperative side of humanity, is the catastrophic impact of profoundly negative forces on social-emotional development for children forced to flee from violent conflict. Close to half a million Rohingya children, whose families were forced to flee genocide in Myanmar, now live in the largest refugee camp in the world. To examine the resilience of human prosociality in the face of extreme adversity, we documented initial levels of prosociality in Rohingya refugee children living in a mega-camp (Cox's Bazar, Bangladesh) and the extent to which those levels were improved following a multifaceted intervention designed to foster prosociality. The research was a partnership between Rohingya community members with lived experience, humanitarian practitioners, and developmental researchers. A sample of 152 Rohingya children (5-12 years) participated in pre- and postintervention assessments of prosocial behaviors and related cognitive-affective processes. The 10-day collaboration-based intervention was implemented between November 2021 and January 2022 by Rohingya researchers. Birthplace was used as a proxy measure of trauma level. Children born in Myanmar (N = 88) directly experienced relatively higher levels of trauma (genocide, forced migration) than children who were born in the camp after their families fled from Myanmar (N = 64). Children were individually tested pre- and postintervention with a task battery, including a helping (Origami) and two sharing tasks (Dictator Game [DG], Forced Choice sharing) measuring prosocial behavior. Assessments of related cognitive-affective processes included measures of empathic responding and emotion perspective-taking in story tasks (Imagine, Judgment) and executive function (EF) skills (Younger: Hearts & Flowers; Older: Dimensional Change Card Sorting). Small group intervention sessions conducted over 10 days targeted these prosocial behaviors and cognitive-affective processes and were based on collaborative activities, emotion perspective taking and EF skills training with the same partner throughout the intervention phase. We used latent change modeling to examine initial levels (preintervention) and intervention-related changes in these measures from pre- to postintervention. Prosocial responding was found across all measures (preintervention) and improvements (pre- to postintervention change) were apparent across most measures. Age and birthplace variables were significant predictors of initial levels and intervention-related change. Initial levels: Regarding age, older children (9-12 years) showed higher levels than younger children (5-8 years) of sharing in the Forced Choice task but lower levels in the DG. Older children also showed higher levels of empathic responding when asked to report how they would feel and respond to another person's misfortune in the Imagine task. Regarding birthplace, prior to the intervention camp-born children showed higher levels than Myanmar-born children of helping in the Origami task and reported more behavioral responses indicating how they would respond to misfortune in the Imagine task. In contrast, Myanmar-born children had higher levels of sharing in the DG and consistently chose equality over inequality in the Forced Choice sharing task, even when their partner would receive more, indicating a pattern of generosity in these children. Myanmar-born children had lower levels than camp-born children on EF measures. Intervention-related change: Regarding age, older but not younger children were more likely to increase choices for equality over inequality on the Forced Choice sharing task following the intervention. Regarding birthplace and helping, camp-born children increased behaviors that helped their partner make origami shapes themselves ("how-to" helping), whereas Myanmar-born children increased behavior that took over folding for their partner ("do-for" helping). For sharing tasks, Myanmar-born but not camp-born children increased sharing in the DG and showed an increased pattern of generosity in Forced Choice sharing task. In the Imagine story task, children born in Myanmar were more likely than those born in camp to increase empathic responding (i.e., imagining how they would feel). Children born in Myanmar showed less improvement on EF measures than children born in the camp. Taken together, these findings provide evidence that in a context of extreme adversity, Rohingya children exhibited prosociality and benefitted from a multifaceted intervention. Our research adds credence to the view that human prosociality is a fundamental characteristic of humanity that not only survives but can be enhanced in even the most adverse of childhood environments. Our multifaceted intervention, which was implemented within a collaborative social context and targeted prosocial behaviors and related cognitive-affective processes, was designed to be easily implemented within existing psychosocial support programs in refugee contexts. As the numbers of children affected by violent conflict and forced migration rise alarmingly worldwide, there is a critical need to expand research partnerships that aim to improve developmental outcomes for these millions of children.

The effect of Montreal's supervised consumption sites on injection-related infections among people who inject drugs: An interrupted time series.

Between June and November 2017, four supervised consumption sites (SCS) began operating in Montreal, Quebec. Earlier studies on SCS focused on examining their effects on blood-borne viral infections and overdose mortality. Our objective was to examine the effect of Montreal's SCS on the incidence, health service use and outcomes of injection-related infections (IRI) in people who inject drugs. We used Quebec's provincial administrative health data to identify people who inject drugs in Montreal and calculated the incidence of IRI in this population between December 2014 and December 2019. We conducted a retrospective, population-based interrupted time series to estimate the effect of Montreal's four SCS on the monthly incidence rates of IRI-related hospitalizations, emergency department (ED) visits, physician visits, and mortality. We also examined the effects of SCS on average length of IRI-related hospitalizations and incidence of hospitalizations involving surgery. The average age of Montreal's people who inject drugs was 41.84 years, and 66.41% were male. After the implementation of SCS, there was a positive level change in the incidence of hospitalizations (0.97; 95% confidence interval [CI]: 0.26, 1.68) for IRI. There was also a significant post-intervention decline in hospitalization trends (-0.05; 95% CI: -0.08, -0.02), with modest trend changes in ED visits (-0.02; 95% CI: -0.05, 0.02). However, post-intervention changes in level (0.72; 95% CI: -3.85, 5.29) and trend (0.06; 95% CI: -0.23, 0.34) for physician visits remained limited. SCS had no effect on the average length of hospitalizations, but there was a decreasing post-intervention trend in hospitalizations involving surgery (-0.03; 95% CI: -0.06, 0.00). Following the opening of the SCS, there was a moderate decline in the rate of hospitalizations to treat IRI, but the impact of the sites on the rate of physician visits remained limited. These findings suggest that SCS may mitigate the incidence of more serious and complicated IRI over time.

The effects of a 12-week combined motor control exercise and isolated lumbar extension intervention on lumbar multifidus muscle stiffness in individuals with chronic low back pain.

Exercise therapy is the primary endorsed form of conservative treatment for chronic low back pain (LBP). However, there is still conflicting evidence on which exercise intervention is best. While motor control exercise can lead to morphological and functional improvements of lumbar multifidus muscle in individuals with chronic LBP, the effects of exercise prescription on multifidus stiffness assessed via shear wave elastography are still unknown. The primary aim of this study is to determine the effects of a combined motor control and isolated lumbar extension (MC + ILEX) intervention on lumbar multifidus muscle stiffness. A total of 25 participants aged 18 to 65 were recruited from local orthopedic clinics and the university community with moderate to severe non-specific chronic LBP. Participants performed a 12-week MC + ILEX intervention program. Stiffness of the lumbar multifidus muscle (primary outcome) at L4 and L5 was obtained at baseline, 6-week, and 12-week using shear wave elastography. Changes in stiffness ratio (e.g., ratio of lumbar multifidus muscle stiffness from rest to contracted) were also assessed at both time points. Pre to post-intervention changes in lumbar multifidus muscle stiffness were assessed using a one-way repeated measure ANOVA. Following the 12-week intervention, there were no statistically significant changes in lumbar multifidus muscle stiffness at rest on the right side at L4 (p = 0.628) and the left side at L4 and L5 (p = 0.093, p = 0.203), but a statistically significant decrease was observed on the right side at L5 (p = 0.036). There was no change in lumbar multifidus muscle stiffness ratio. This study provides preliminary evidence to suggest that a 12-week MC + ILEX intervention had minimal effect on lumbar multifidus muscle stiffness in individuals with chronic LBP. Further investigations are needed to confirm our findings and clarify the relationship between muscle stiffness and functional outcomes.

Translation, cross-cultural adaptation and validation of the universal Welch Emotional Connection Screen using primary and bilingual Spanish-speaking coders of videotaped mother-child interactions

IntroductionUsing clear explicit translatable language, we translated the Welch Emotional Connection Screen into a new universal language instrument, the English uWECS. In this study, we had two aims: Aim 1 was to establish concurrent validity of the uWECS by comparing scores coded by primary Spanish-speaking coders using the Spanish translation of the uWECS to scores coded by bilingual, secondary Spanish-speaking coders using the oWECS. Aim 2 was to establish the criterion-related validity in terms of oWECS and uWECS performance in tracking change in autonomic emotional connection (AEC) during the course of an intervention among preschool aged children.MethodsWe created a library of 52 five-minute Spanish-speaking mother-child videos that were collected during a randomized controlled trial of Mother-Child Emotional Preparation intervention (MCEP). The videos were collected at two time points, at enrollment and at a 6-month follow-up. The subsample of Primary Spanish-Speaking dyads from the MCEP study were coded by two independent teams of coders. We trained primary English-speaking (bilingual Spanish) coders on the oWECS, using the original training program. A different team of primary Spanish-speaking coders coded the same cases using the novel uWECS guide and trained briefly for reliability with the Spanish uWECS translation materials.ResultsWe found that the Spanish oWECS and Spanish uWECS ratings from the baseline and 6-month follow-up observations were robustly correlated, with intraclass correlations ranging from .81 to .84 and all p-values&amp;lt;.001, thus demonstrating sound concurrent validity for the uWECS. The oWECS and uWECS scores also achieved parallel results when evaluating the efficacy of the MCEP for primary Spanish-speaking dyads. Both the AEC scores of the oWECS [F(1, 27) = 4.31, p &amp;lt; .05] and the scores of the uWECS [F(1,27) = 4.06, p &amp;lt; .05] similarly demonstrated significant change post intervention, thus demonstrating sound criterion-related validity of the uWECS.DiscussionThese findings demonstrate that the uWECS can be used to measure parent/child AEC in linguistically diverse populations and cultures.

Acceptance and Commitment Therapy for Adults Living With Inflammatory Bowel Disease and Distress: A Randomized Controlled Trial.

The bidirectional relationship between disease activity and mental health in inflammatory bowel disease (IBD) has prompted investigations into the efficacy of psychotherapeutic interventions such as acceptance and commitment therapy (ACT) on biopsychosocial outcomes. We aimed to examine the efficacy of an ACT program (intervention) in comparison with a cognitive behavioral therapy-informed psychoeducation program (active control) for individuals with IBD and coexistent psychological distress. Both programs were delivered online through a hybrid format (i.e., therapist-led and participant-led sessions). A total of 120 adults with IBD were randomized to either the intervention (N = 61) or active control groups (N = 59). Efficacy was determined using linear mixed models for group differences, in rate of changes in study outcomes, between baseline, postintervention, and 3-month follow-up. The primary outcome health-related quality of life significantly improved in the intervention group when compared with the active control group, with a significantly different rate of change observed from baseline to postintervention ( t [190] = 2.15, P = 0.033) in favor of the intervention group with a medium effect size (β = 0.41, mean difference = 0.07, 95% confidence interval 0.01-0.12, P = 0.014). Similarly, the secondary outcome Crohn's disease activity significantly reduced in the intervention group when compared with the active control group, with a significantly different rate of change observed from baseline to 3-month follow-up ( t [90] = -2.40, P = 0.018) in favor of the intervention group with a large effect size (β = -0.77, mean difference = -9.43, 95% confidence interval -13.72 to -5.13, P < 0.001) ( P = 0.014). Furthermore, when observing the rate of change in outcomes over time for the groups separately, anxiety symptoms and pain significantly improved in the intervention group only, and conversely, ulcerative colitis activity and stress symptoms significantly improved in the active control group only. All other outcomes (N = 14) significantly improved over time in both groups including IBD activity, gastrointestinal unhelpful thinking patterns, visceral anxiety, fatigue interference, fatigue severity, fatigue frequency, psychological inflexibility, self-efficacy, resilience, current health status, depression symptoms, IBD control, and pain catastrophizing; however, these changes were not significantly different between the groups. Both programs were of benefit to people with IBD and distress. However, ACT offers a significant added benefit for health-related quality of life and self-reported Crohn's disease activity and may be a useful adjuvant therapy in integrated IBD care.

The Changes in Broad-spectrum Antimicrobial Consumption during the COVID-19 Pandemic in a Japanese Acute Tertiary-care Hospital: An Interrupted Time-series Analysis.

Objective The novel coronavirus disease 2019 (COVID-19) pandemic has spread worldwide, and hospitals in Japan have been forced to respond to the situation. This study evaluated the broad-spectrum antimicrobial use before and during the COVID-19 pandemic in an acute tertiary-care hospital. Methods This single-center, retrospective study was conducted between January 2019 and June 2021. Patients We reviewed patients treated with three broad-spectrum antipseudomonal agents: carbapenems, tazobactam/piperacillin, and cefepime. Monthly aggregated hospital antimicrobial consumption was measured as days of therapy (DOTs) per 1,000 patient-days, and the monthly incidences of Clostridioides difficile infection (CDI), multidrug-resistant Pseudomonas aeruginosa (MRPA), and carbapenemase-producing Enterobacteriaceae (CPE) were recorded. Results The median monthly carbapenem-DOTs during the pre-pandemic and pandemic era were 8.4 and 8.2 per 1,000 patient-days, respectively. A time-series analysis showed non-significant changes in the level between periods (coefficients: 2.08; 95% confidence interval [CI]: -2.9 to 7.0; p=0.44). No change in the trend of monthly carbapenem-DOTs was observed after intervention. No post-intervention changes in the incidence of MRPA or CPE were observed; however, the trend in the incidence of CDI per 1,000 patient-days significantly differed between the two periods (coefficient: -0.04; 95% CI: -0.07, 0.00; p=0.01), and a downward trend was observed in the monthly CDI incidence during the COVID-19 period. Conclusion The consumption of broad intravenous antimicrobial agents has not changed significantly during the pandemic. We need to maintain the quality of medical care, including antimicrobial stewardship, even in specialized resource-limited facilities during a pandemic.