Pre-post Improvements Research Articles

Improving Balance in Adults With Intellectual Developmental Disorder via Virtual Environments

Balance problems have been found among 57% of adults with Intellectual Developmental Disorder (IDD). Moreover, these adults have only partially participated in conventional activity programs. There is a clear need for new interventions that will enhance these individuals' interest and motivation toward improving their balance skills. Virtual gaming training experiences are a promising prospect in that regard. The purpose of this study was to examine the effect of virtual reality games on improving balance for adults with IDD. We recruited 31 individuals with mild-moderate IDD who had fallen at least twice in the year prior to initiating this intervention, and we evaluated these participants using the Timed Up and Go (TUG) test. The participants were randomly assigned to control and experimental groups, and only the latter group took part in a series of twelve 30-minute bi-weekly virtual game sessions, designed to improve balance using the SeeMe virtual game system. We found significant (p < .001) pre-post improvements in balance abilities in the experimental group and no significant pre-post change in the control group (p < .77). These data suggest that virtual game technology is a viable tool for improving balance among adults with IDD.

Cognitive Stimulation Therapy for People with Parkinson's Disease Dementia

<h3>Research Objectives</h3> To investigate the effect of Cognitive Stimulation Therapy (CST) for people with Parkinson's disease dementia (PDD) and their caregivers. <h3>Design</h3> Within-subjects pre-test post-test design. <h3>Setting</h3> Community-based, in partnership with the local American Parkinson Disease Association chapter. <h3>Participants</h3> Eighteen participants: 9 people with possible PDD (MoCA score < 21), and 9 caregivers. <h3>Interventions</h3> A 7-week program of bi-weekly 45-minute long CST group classes for people with PDD. CST is an intervention for people with dementia involving group activities and conversations that stimulate cognitive and social skills. <h3>Main Outcome Measures</h3> PDD participants completed the Montreal Cognitive Assessment (MoCA), Neuro Quality of Life Cognition Short Form (NeuroQOL Cog SF), Geriatric Depression Scale (GDS), Parkinson's Disease Questionnaire-39 (PDQ-39) and Relationship Assessment Scale (RAS). Caregivers completed the Caregiver Burden Scale (CBS) and RAS. After the course, both groups completed the Client Satisfaction Questionnaire (CSQ-8). <h3>Results</h3> The PDD group's MoCA scores improved from pre to post intervention (pre: M = 19.11, SD = 2.57; post: M = 21.22, SD = 2.95; p = 0.01). All other measures, except the PDD RAS and CBS, showed pre-post improvement, although these were not significant. The PDD participants and their caregivers reported high satisfaction with the program, as indicated by the CSQ-8 (M = 3.5 [out of 4 possible], SD = 0.16), with 72% of participants rating all items positively. <h3>Conclusions</h3> Participation in a group CST course resulted in improved cognition in this small sample of people with PDD. In addition, individuals with PDD and their caregivers were highly satisfied with the program. Although larger studies are needed, these findings suggest that CST may benefit cognition among people with PDD and is an acceptable program for people with PDD and their caregivers. <h3>Author(s) Disclosures</h3> The authors have no disclosures to report.

The impact of implementing a psychiatric emergency hotline on the reduction of acute hospitalizations in a Swiss tertiary hospital

BackgroundInpatient treatment is not the most beneficial treatment setting for many patients with psychiatric disorders and overcrowding is a recurrent problem for psychiatric hospitals. Therefore, it is important to develop strategies to limit avoidable inpatient treatment. This study sought to evaluate the impact of an emergency hotline that was developed to better manage psychiatric patients, particularly for identifying those requiring a hospital admission.MethodsThis pre-post intervention quality improvement study compared changes in the management of psychiatric patients’ admission before and after the introduction of an emergency hotline where a specialist in psychiatry examines all inpatient referral from private practitioners.Main outcomes were the change in proportion of hospital admissions after referral from a private practitioner before and within 3 months after the intervention. Secondary outcomes were the average length of hospital stay, proportion of non-voluntary admission, the time required for triage and the impact of the intervention on treatments’ costs. Fisher’s Exact test was used to test the primary hypothesis of difference in the proportion of hospitalized patients before and after introduction of the emergency hotline. Secondary outcomes were tested with Student’s t-test for continuous variables and Fishers’s Exact test for proportions.ResultsAmong 45 admission requests from private practitioners during the 3 months after introduction of the new emergency hotline, 25 (55.6%) were accepted as inpatient treatment, while 20 (44%) were redirected to more appropriate outpatient treatments. There was a highly significant difference from the baseline period during which all 34 requests were accepted (44% vs 100%, p < 0.001). In addition, for the patients hospitalized after the introduction of the emergency hotline there was a trend-level reduction of the average length of stay (9.32 days vs 17.35 days).ConclusionImplementation of an emergency hotline manage by a specialist in psychiatry for admissions to acute psychiatric wards is feasible and simple to use. Importantly, it allows to significantly decrease the proportion of hospitalizations. Additional studies are needed to assess the generalizability of these exploratory results to other health care settings.

The influence of preoperative knee flexion contracture severity on short-term outcome of orthopedic surgery in ambulatory children with bilateral cerebral palsy

BackgroundIndications and cutoff value of deformities to determine surgical procedures for flexed knee gait are not clear. The aim was to determine the influence of none or mild, and moderate preoperative knee flexion contracture on the improvement of gait after orthopedic surgery in children with bilateral cerebral palsy (CP).MethodsInclusion criteria; bilateral CP, Gross Motor Function Classification System level I-III, and pre- and post operative-gait analysis. The 132 individuals identified were categorized into 2 groups based on the severity of knee flexion contracture (group 1: none or less than 11°; group 2: greater than or equal to 11°), and then matched according to the exact same soft tissue and/or bony orthopedic surgical procedures performed. The indication for surgery was to prevent progressive development of knee flexion contracture and stance phase flexed knee gait. Pre- and postoperative physical examination and gait analysis data were analyzed retrospectively.ResultsSixty (30 + 30) children, with mean age 10.6 years in each group, were included. The average follow-up time was 17 months.Gait Deviation Index (GDI) improved in group 1 from mean 66 (SD 19) to 74 (15), p = 0.004, and in group 2 from 60 (13) to 69 (15), p = 0.001. Knee flexion in stance improved in group 1 from 21.4 (16.1) to 12.1 (16.0) degrees, p = 0.002, and in group 2 from 32.2 (14.2) to 17.0 (15.9), p = 0.001. Step length improved in both groups, p = 0.017 and p = 0.008, respectively.Only in group 2 significant improvement was noted in walking speed, p = 0.018 and standing function, Gross Motor Function Measure (GMFM-D), p = 0.001. Knee flexion contracture decreased in group 1 from mean 4.6 (5.3) to 2.1 (8.3) degrees, p = 0.071 and in group 2 from 17.2 (4.9) to 9.6 (9.3), p = 0.001.There was no statistical difference between groups in pre-post improvement of GDI or other variables, except GMFM-D.ConclusionsRelative mild to moderate preoperative knee flexion contracture does not influence the short-term improvement of gait after orthopedic surgery in children with bilateral CP.

Intergenerational Montessori Program for Adults With Memory Concerns.

Purpose This study evaluated the effects of an intergenerational Montessori after-school program on the engagement, affect, and quality of life of older adults with memory concerns and on the attitudes of children toward older adults. Method Eleven older adults were paired with 11 children to participate in a 45-min after-school activity program. Observations of engagement and affect during the interactions were collected 3 times a week for 4 weeks. The older adults' engagement and affect also were observed during 45-min planning/discussion sessions without the children present before their arrival to the program. Results Results revealed significant differences in older adults' engagement and positive affect when the children were present. Significant pre-post improvements in reported quality of life and maintenance of cognitive status were associated with program participation. Children demonstrated more active than passive engagement and more happy than neutral affect during activity sessions. Four of the seven children improved their positive ratings of older adults. Conclusions This program documented success in improving engagement and affect in older adults with mild memory concerns while engaging with children. Future studies with a larger sample of participants with varying degrees of memory impairment are needed to investigate the potential of this promising program.

Effects of Combined Interventions with Aerobic Physical Exercise and Cognitive Training on Cognitive Function in Stroke Patients: A Systematic Review.

(1) Background: Stroke is a major cause of permanent disability in multiple functions, including the cognitive domain. Since both cognitive training and aerobic physical exercise may exert positive effects on cognition after stroke, one may expect synergistic benefits when combining both interventions. (2) Methods: We carried out a systematic search of studies testing, in adult stroke patients, whether structured aerobic exercise combined with cognitive training led to higher cognitive benefits than either of these interventions when applied singly, or than interventions not including aerobic exercise or cognitive training. (3) Results: Five fair-quality randomized controlled trials fulfilled the search criteria. Exercise intensity was moderate-vigorous and cognitive training was mainly computer-based. The studies were heterogeneous regarding the cognitive tests used, and for this reason, a meta-analysis was not performed. Only three studies included follow-up assessment. The combined intervention was associated with pre-post improvement in at least one cognitive test in all the studies, and with higher positive effects compared to other conditions (although statistical significance was not always reached) in four studies. (4) Conclusions: Further trials including a long-term follow-up and comprehensive neuropsychological testing should be undertaken to determine whether combined aerobic exercise and cognitive training leads to additive cognitive benefits after stroke.

Feasibility of a cognitive behavioral online intervention for women with Sexual Interest/Arousal Disorder

Difficulties with sexual desire and arousal are common in women, but most lack access to effective treatment such as cognitive-behavioral therapy (CBT). eSense is a recently created online CBT intervention for sexual difficulties with promising evidence of usability. The current study assessed the feasibility of women completing the full eSense CBT program without guidance. Eleven women with Sexual Interest/Arousal Disorder completed eSense and provided feedback via semi-structured interviews. Participants reported high satisfaction with eSense's functionality, improved knowledge about sexuality, greater awareness of their thought patterns, and better perspective around their sexual difficulties. Despite some difficulty completing homework, participants exhibited statistically significant pre-post improvements in sexual desire (d = 1.04), sexual arousal (d = 1.83), sexual satisfaction (d = 1.35), and sexual distress (d = 1.79). The findings add to the growing evidence that self-guided online interventions are feasible and potentially efficacious in treating female sexual dysfunction.

Feasibility and Preliminary Effectiveness of a Peer-Developed and Virtually Delivered Community Mental Health Training Program (Emotional CPR): Pre-Post Study

BackgroundThe COVID-19 pandemic has led to a global mental health crisis, highlighting the need for a focus on community-wide mental health. Emotional CPR (eCPR) is a program and practice developed by persons with a lived experience of recovery from trauma or mental health challenges to train community members from diverse backgrounds to support others through mental health crises. eCPR trainers have found that eCPR may promote feelings of belonging by increasing supportive behaviors toward individuals with mental health problems. Thus, clinical outcomes related to positive and negative affect would improve along with feelings of loneliness.ObjectiveThis study examined the feasibility and preliminary effectiveness of eCPR.MethodsWe employed a pre-post design with 151 individuals, including peer support specialists, service users, clinicians, family members, and nonprofit leaders, who participated in virtual eCPR trainings between April 20, 2020, and July 31, 2020. Instruments were administered before and after training and included the Herth Hope Scale; Empowerment Scale; Flourishing Scale (perceived capacity to support individuals); Mindful Attention Awareness Scale; Active-Empathic Listening Scale (supportive behaviors toward individuals with mental health challenges); Social Connectedness Scale (feelings of belonging and connection with others); Positive and Negative Affect Schedule; and University of California, Los Angeles 3-item Loneliness Scale (symptoms and emotions). The eCPR fidelity scale was used to determine the feasibility of delivering eCPR with fidelity. We conducted 2-tailed paired t tests to examine posttraining improvements related to each scale. Additionally, data were stratified to identify pre-post differences by role.ResultsFindings indicate that it is feasible for people with a lived experience of a mental health condition to develop a program and train people to deliver eCPR with fidelity. Statistically significant pre-post changes were found related to one’s ability to identify emotions, support others in distress, communicate nonverbally, share emotions, and take care of oneself, as well as to one’s feelings of social connectedness, self-perceived flourishing, and positive affect (P≤.05). Findings indicated promising evidence of pre-post improvements (not statistically significant) related to loneliness, empowerment, active-empathetic listening, mindfulness awareness, and hope. Nonprofit leaders and workers demonstrated the greatest improvements related to loneliness, social connectedness, empathic listening, and flourishing. Peer support specialists demonstrated the greatest improvements related to positive affect, and clinicians demonstrated the greatest improvements related to mindfulness awareness.ConclusionsPromising evidence indicates that eCPR, a peer-developed and peer-delivered program, may increase feelings of belonging while increasing supportive behaviors toward individuals with mental health problems and improving clinical outcomes related to positive and negative affect and feelings of loneliness.

Effectiveness of a Delirium Prevention Initiative on an Inpatient Neuroscience Unit.

BACKGROUND: Delirium frequently develops in hospitalized patients and results in increased mortality, longer length of stay, and need for transitional care. Neurological patients are at an increased risk for developing delirium. There is a paucity of research on effective prevention strategies for this population. PURPOSE: The objectives of this project were to improve nurses' knowledge and confidence in delirium prevention, design a delirium volunteer program, and establish ongoing monitoring for continued improvement. METHODS: This study is a quality improvement project using a pretest-posttest design to examine the benefits of refocusing care from delirium management to delirium prevention. The sample included 304 patients pre and 332 post intervention. The interventions included delirium education for nurses and the recruitment of trained volunteers to implement nonpharmacological, multicomponent delirium prevention interventions. RESULTS: Forty-eight nurses completed delirium education, and 11 volunteers were recruited and trained. There was a significant increase in nursing knowledge (z = 3.967, P < .0005) and confidence (z = 3.989, P < .0005). Volunteers visited 54 patients and implemented 99 interventions post implementation. CONCLUSION: This pre-post improvement project provides beginning evidence that nursing education increased nurses' knowledge and confidence in preventing and treating delirium. Trained volunteers supported using nonpharmacological delirium prevention interventions, but ongoing evaluation is needed to determine the impact of volunteers on delirium rates.

Use of EMDR-Derived Self-Help Intervention in Children in the Period of COVID-19: A Randomized-Controlled Study

Self-help treatments are an important intervention tool, with high accessibility and ease of application. To our knowledge, no research has previously been conducted on any self-help intervention derived from eye movement desensitization and reprocessing (EMDR) therapy. In this study, we evaluated the mental health status of children not directly affected by the pandemic and investigated the effects of using an EMDR-derived self-help intervention in children as a low-intensity treatment. The mental health status of 178 children was evaluated online via the State-Trait Anxiety Inventory for Children (STAIC) and Childhood Posttraumatic Stress Reaction Index (CPTS-RI). Then, children were randomly assigned to intervention and waitlist. A booklet containing EMDR-derived techniques was sent via the school online portal and the intervention was conducted. Posttests were administered 4 weeks later. The attrition rate was 45.5%, with 97 children completing the trial (intervention: 52; waitlist: 45). At baseline, 76.4% of children showed posttraumatic stress symptoms (PTSS) above threshold. Results showed a statistically significant decrease in the posttest PTSS scores for the intervention group compared to waitlist. The intervention group had significant pre–post improvement on all but one subscale, while the waitlist group showed a significant increase in state anxiety on the STAIC. In conclusion, posttraumatic stress was found to be high in children during the COVID-19 outbreak period, and EMDR-derived self-help intervention appeared to be an effective psychosocial intervention tool.

Periodized versus classic exercise therapy in Multiple Sclerosis: a randomized controlled trial

BackgroundPeriodizing exercise interventions in Multiple Sclerosis (MS) shows good high intensity exercise training adherence. Whether this approach induces comparable training adaptations with respect to exercise capacity, body composition and muscle strength compared to conventional, linear progressive training programs however is not known. MethodsThirty-one persons with MS (all phenotypes, mean EDSS 2.3±1.3) were randomized into a twelve-week periodized (MSPER, n=17) or a classic endurance (MSCLA, n=14) training program. At baseline (PRE), exercise capacity (maximal exercise test, VO2max), body composition (DEXA) and muscle strength (Biodex®) were assessed. Classic, moderate intensity endurance training (60-80% HRmax, 5 training sessions/2w, 60min/session) was performed on a stationary bicycle. Periodized exercise included 4 recurrent 3-week cycles of alternated endurance training (week 1: endurance training as described above), high intense exercise (week 2: 3 sessions/w, 3 × 20s all-out sprints, 10min/session) and recovery weeks (week 3: one sprint session as described above). POST measurements were performed similar to baseline. Total exercise volume of both programs was expressed as total peak-effort training minutes. ResultsFor MSCLA, total exercise volume included 1728 total peak-effort training minutes, whereas MSPER included only 736. Despite this substantially reduced training volume, twelve weeks of periodized training significantly (p<0.05) improved VO2max (+14%, p=0.001), workload (+20%) and time until exhaustion (+25%). Classic training significantly (p<0.05) improved workload (+10%) and time until exhaustion (+17%), but not VO2max (+5%, p=0.131). Pre-post improvements for VO2max were significantly higher in MSPER compared to MSCLA (p=0.046). ConclusionThese data show that despite substantially lower training time (57% less peak-effort training minutes), 12 weeks of periodized exercise training in persons with MS seems to induce larger improvements in parameters of exercise capacity compared to classic endurance training. We therefore recommend to further investigate the effect of training periodization on various functional rehabilitation measures in MS.

The comparison between CBT focused on perfectionism and CBT focused on emotion regulation for individuals with depression and anxiety disorders and dysfunctional perfectionism: a randomized controlled trial.

There is considerable evidence indicating that similar aetiological and maintenance processes underlie depressive and anxious psychopathology. According to the literature, perfectionism and emotion regulation are two transdiagnostic constructs associated with symptoms of emotional disorders. This study is the first randomized controlled trial comparing the efficacy of cognitive behavioural therapy for perfectionism (CBT-P) and the unified protocol for the transdiagnostic treatment of emotional disorders (UP). Seventy-five participants with a range of depressive and anxiety disorders and elevated perfectionism were randomized to three conditions: CBT-P, UP or a waitlist control (WL). Repeated measures ANOVA indicated that the treatment groups reported a significantly greater pre-post reduction in the severity of symptoms of disorders, as well as a significantly greater pre-post increase in quality of life, all with moderate to large effect sizes compared with the WL group. Treatment gains were maintained at 6-month follow-up. The CBT-P group reported a significantly greater pre-post reduction in perfectionism compared with UP, and the UP group reported a significantly greater pre-post improvement in emotion regulation compared with CBT-P. Findings support CBT for perfectionism and regard UP as efficacious treatments for individuals with depression and anxiety disorders who also have dysfunctional perfectionism. It appears that perfectionism cannot be a serious obstacle to UP. As this is a preliminary study and has some limitations, it is recommended that further research be conducted.

Mechanisms of improvements and maintenance in online relationship programs for distressed low-income couples.

Web-based relationship interventions have been shown to improve relationship functioning for low-income couples, with gains maintained up through 12 months (Doss et al., 2020; Roddy et al., 2020). However, little is known about mechanisms of improvements and maintenance for these programs. A sample of 742 low-income couples (Mage = 33; 55% non-Hispanic White; 52% married; Mdn annual household income = $27,000) were randomly assigned to the OurRelationship (OR) program, the ePREP program, or a waitlist control group. Couples were repeatedly assessed over 6 months on two relationship outcomes (satisfaction and breakup potential) and five relationship mechanisms (positive and negative communication, relationship problem intensity and confidence, and emotional support) with self-report measures. Intervention couples, compared with the control couples, experienced significantly greater improvements in all mechanisms by the end of the program (Mean |d| = 0.58). Those with greater improvements in mechanisms also reported greater improvements in both relationship outcomes. From post- to 4-months follow-up, only prepost improvements in negative communication significantly predicted maintenance of gains in satisfaction. In contrast, prepost improvements in all mechanisms significantly predicted maintenance of reductions in breakup potential, with the largest effect via improvements in emotional support. These results indicate that both programs improve targeted mechanisms during the intervention period and support the role of these constructs as mechanisms of improvements in broader relationship functioning. Moreover, findings on mechanisms of maintenance highlighted the importance of including an emphasis on communication and emotional support to better maintain program gains. (PsycInfo Database Record (c) 2020 APA, all rights reserved).

Exercise Intensity May Not Moderate the Acute Effects of Functional Circuit Training on Cognitive Function: A Randomized Crossover Trial.

Functional circuit training (FCT) has been demonstrated to acutely enhance cognitive performance (CP). However, the moderators of this observation are unknown. This study aimed to elucidate the role of exercise intensity. According to an a priori sample size calculation, n = 24 healthy participants (26 ± 3 years, 13 females), in randomized order, performed a single 15-min bout of FCT with low (20–39% of the heart rate reserve/HRR), moderate (40–59% HRR) or high intensity (maximal effort). Immediately pre- and post-workout, CP was measured by use of the Digit Span test, Stroop test and Trail Making test. Non-parametric data analyses did not reveal significant differences between conditions (p > 0.05) although parameter-free 95% confidence intervals showed pre-post improvements in some outcomes at moderate and high intensity only. The effort level does not seem to be a major effect modifier regarding short-term increases in CP following HCT in young active adults.

Family Functioning and Mental Health Changes Following a Family Therapy Intervention in Kenya: a Pilot Trial.

Family-based interventions offer a promising avenue for addressing chronic negative family interactions that contribute to lasting consequences, including family violence and the onset and maintenance of mental health disorders. The purpose of this study was to conduct a mixed-methods, single group pre-post pilot trial of a family therapy intervention (N = 10) delivered by lay counselors in Kenya. Results show that both caregivers and children reported reductions in family dysfunction and improved mental health after the intervention. Point estimates represent change of more than two standard deviations from baseline for the majority of primary outcomes. Treated families also reported a decrease in harsh discipline, intimate partner violence, and alcohol-related problems. These results were corroborated by findings from an observational measure of family functioning and in-depth qualitative interviews. This study presents preliminary evidence of pre-post improvements following a family therapy intervention consisting of streamlined, evidence-informed family therapy strategies to target family dysfunction and mental health.

Feasibility of a Brief Online Psychoeducational Intervention for Women With Sexual Interest/Arousal Disorder

BackgroundLow sexual desire and arousal are the most common sexual concerns in women, but most women lack access to effective treatment such as cognitive behavioral therapy. Web-based psychological interventions, which are economical, private, easily accessible, and potentially effective, may increase the reach of evidence-based treatment. AimTo determine the feasibility of translating cognitive behavioral therapy for the most common female sexual dysfunction, Female Sexual Interest/Arousal Disorder, into an online format. The present study examined the feasibility of an introductory psychoeducational module of eSense, an online program currently being developed that is based on existing empirically supported in-person treatments, which delivers content to the user in a visually appealing and interactive manner. MethodsSixteen cisgender women (M age = 31.9) with female sexual arousal/interest disorder worked through a pilot module of eSense inperson at a sexual health laboratory. OutcomesQualitative semistructured interviews and online questionnaires were used to assess participants’ experiences of usability of the platform, clarity/relevance of the content, satisfaction with the experience, and any changes in clinical outcomes of sexual function and distress. ResultsParticipants reported a high level of satisfaction with the website’s functionality and presentation. They reported greater knowledge, felt validated and more hopeful, and were eager to continue the remaining modules. Participants also reported notable prepost improvements in sexual desire, arousal, and satisfaction. Clinical ImplicationsInitial user-experience assessment may represent a method of simultaneously improving online interventions and providing therapeutic education to participants. Strengths & LimitationsThis is one of the first studies, to our knowledge, to test a graphics-rich, interactive online intervention for sexual difficulties that does not require direct contact with expert providers or support groups. Limitations include the high level of education, motivation, and technical fluency of the sample and the potentially confounding effect of the researcher’s presence during interviews. Because this was a feasibility study, the sample size was small, and no control group was included, limiting conclusions about efficacy and generalizability. ConclusionThe format of eSense appears to be feasible and usable, lending support to the growing evidence that it is possible to take in-person therapeutic interventions online.Zippan N, Stephenson KR, Brotto LA, Feasibility of a Brief Online Psychoeducational Intervention for Women With Sexual Interest/Arousal Disorder. J Sex Med 2020;17:2208–2219.

Identification and treatment of obstructive sleep apnea by a primary care team with a subset focus on chronic pain management.

BackgroundPatients diagnosed with obstructive sleep apnea (OSA), who also consume prescription opioids, have a greater likelihood of morbidity and mortality. This study evaluated whether a primary care team, focused on chronic pain care management, could use a validated questionnaire (STOP-Bang) and motivational follow-up, to increase identification and treatment of OSA.MethodsThis study was a retrospective, dual arm, pre/post controlled study. Participants of this study included the complete chronic pain management sub group treated by this primary care team. Participants were ≥ 18 years old and prescribed daily opioids for treatment of chronic pain. All participants had a multifaceted, individualized, educational meeting that included completing a STOP-Bang questionnaire. Participants who received a score ≥ three were advised to follow up with their primary care physician. Participants were seen quarterly throughout the study.ResultsThe primary outcome of this study was that 65% of participants with likely OSA were using CPAP for a minimum of 12 months (range of 12–25 months, 18-month average) post-intervention vs. 37% CPAP-use in the control group (12 months of observation), both groups were chronic opioid users with OSA. This was a 28% relative improvement (p = 0.0034). A secondary outcome was that 8.9% of non-prior CPAP users obtained CPAP post- intervention; a 56.7% pre-post improvement (p = 0.0064, x2 = 10.08 with 1 degree of freedom). Also, participants who were likely to have OSA (STOP-Bang score ≥ 3 or had a positive polysomnography (AHI >5 with comorbidities)) compared to those unlikely to have OSA (STOP-Bang score <3 or had a negative polysomnography (AHI <5)) in this study were more likely to be male, have a higher BMI, have hypertension, have cardiovascular disease and/or have diabetes (all types).ConclusionTeam based care management for participants taking prescription opioids, where STOP-Bang questionnaires were completed, were associated with an increase in the identification and treatment of OSA.

Behavioral and emotional quality of life of patients undergoing inpatient geriatric rehabilitation.

In the context of geriatric rehabilitation, 2 quality of life (QoL) facets are of particular importance: a behavioral, more objective facet, and an emotional, more subjective facet. This study looked at changes in these 2 QoL facets during rehabilitation, their relationship to each other and potential mediating processes. Ninety-two geriatric patients were assessed by the geriatric assessment and a structured face-to-face interview at admission to and discharge from an inpatient geriatric rehabilitation ward. Behavioral QoL was measured in terms of independence in the activities of daily living and mobile abilities, while positive and negative affect represented emotional QoL. As potential mediators, self-perceptions of health (self-rated health, subjective pain, temporal health comparison) were assessed. Statistical analysis comprised repeated-measures (multivariate) analyses of variance as well as regression and mediation analyses based upon a fixed effects-panel model. All behavioral and emotional QoL indicators showed significant prepost improvements. During rehabilitation, changes in behavioral QoL were significantly related to changes in emotional QoL. Multiple regression of changes in emotional QoL on changes in behavioral QoL and in self-perceptions of health revealed, however, that only health perceptions significantly predicted emotional QoL. Mediation analysis showed that self-perceptions of health fully mediated the relationship between behavioral and emotional QoL outcomes. During geriatric rehabilitation, significant progress can be made regarding QoL. The results indicate that the influence of physical progress on affective improvements is conveyed through self-perceptions of health, showing the importance of self-perceptions of health for emotional QoL in geriatric rehabilitation. (PsycInfo Database Record (c) 2020 APA, all rights reserved).

A multiple baseline study of a brief alcohol reduction and family engagement intervention for fathers in Kenya.

To evaluate a lay provider-delivered, brief intervention to reduce problem drinking and related family consequences among men in Kenya. The 5-session intervention combines behavioral activation (BA) and motivational interviewing (MI). It integrates family-related material explicitly and addresses central cultural factors through gender transformative strategies. A nonconcurrent multiple-baseline design was used. We initiated treatment with 9 men ages 30 to 48 who were fathers and screened positive for problem drinking; the median Alcohol Use Identification Test score was 17 (harmful range). Participants were randomized to staggered start dates. We measured the primary outcome of weekly alcohol consumption 4 weeks before treatment, during treatment, and 4 weeks posttreatment using the Timeline Followback measure. Secondary outcomes were assessed using a pre-post assessment (1-month) of men's depression symptoms, drinking- and family-related problem behavior, involvement with child, time with family, family functioning, relationship quality (child and partner), and harsh treatment of child and partner. Men, partners, and children (ages 8-17) reported on family outcomes. Eight men completed treatment. Mixed-effects hurdle model analysis showed that alcohol use, both number of days drinking and amount consumed, significantly decreased during and after treatment. Odds of not drinking were 5.1 times higher posttreatment (95% CI [3.3, 7.9]). When men did drink posttreatment, they drank 50% less (95% CI [0.39, 0.65]). Wilcoxon signed-ranks test demonstrated pre-post improvements in depression symptoms and family related outcomes. Results provide preliminary evidence that a BA-MI intervention developed for lay providers may reduce alcohol use and improve family outcomes among men in Kenya. (PsycInfo Database Record (c) 2020 APA, all rights reserved).

Effects of Equal Volume Heavy-Resistance Strength Training Versus Strength Endurance Training on Physical Fitness and Sport-Specific Performance in Young Elite Female Rowers.

Strength training is an important means for performance development in young rowers. The purpose of this study was to examine the effects of a 9-week equal volume heavy-resistance strength training (HRST) versus strength endurance training (SET) in addition to regular rowing training on primary (e.g., maximal strength/power) and secondary outcomes (e.g., balance) in young rowers. Twenty-six female elite adolescent rowers were assigned to an HRST (n = 12; age: 13.2 ± 0.5 yrs; maturity-offset: +2.0 ± 0.5 yrs) or a SET group (n = 14; age: 13.1 ± 0.5 yrs; maturity-offset: +2.1 ± 0.5 yrs). HRST and SET comprised lower- (i.e., leg press/knee flexion/extension), upper-limbs (i.e., bench press/pull; lat-pull down), and complex exercises (i.e., rowing ergometer). HRST performed four sets with 12 repetitions per set at an intensity of 75–95% of the one-repetition maximum (1-RM). SET conducted four sets with 30 repetitions per set at 50–60% of the 1-RM. Training volume was matched for overall repetitions × intensity × training per week. Pre-post training, tests were performed for the assessment of primary [i.e., maximal strength (e.g., bench pull/knee flexion/extension 1-RM/isometric handgrip test), muscle power (e.g., medicine-ball push test, triple hop, drop jump, and countermovement jump), anaerobic endurance (400-m run), sport-specific performance (700-m rowing ergometer trial)] and secondary outcomes [dynamic balance (Y-balance test), change-of-direction (CoD) speed (multistage shuttle-run test)]. Adherence rate was >87% and one athlete of each group dropped out. Overall, 24 athletes completed the study and no test or training-related injuries occurred. Significant group × time interactions were observed for maximal strength, muscle power, anaerobic endurance, CoD speed, and sport-specific performance (p ≤ 0.05; 0.45 ≤ d ≤ 1.11). Post hoc analyses indicated larger gains in maximal strength and muscle power following HRST (p ≤ 0.05; 1.81 ≤ d ≤ 3.58) compared with SET (p ≤ 0.05; 1.04 ≤ d ≤ 2.30). Furthermore, SET (p ≤ 0.01; d = 2.08) resulted in larger gains in sport-specific performance compared with HRST (p < 0.05; d = 1.3). Only HRST produced significant pre-post improvements for anaerobic endurance and CoD speed (p ≤ 0.05; 1.84 ≤ d ≤ 4.76). In conclusion, HRST in addition to regular rowing training was more effective than SET to improve selected measures of physical fitness (i.e., maximal strength, muscle power, anaerobic endurance, and CoD speed) and SET was more effective than HRST to enhance sport-specific performance gains in female elite young rowers.