Session Attendance Research Articles

0447 Racial disparities in patient outcomes and treatment engagement in cognitive behavioral therapy for insomnia among pregnant women

Abstract Introduction Insomnia affects over half of pregnant women, and epidemiological data suggest that insomnia rates are twice as high among black women relative to white women in pregnancy. Recently, cognitive behavioral therapy for insomnia (CBTI) has been supported as an efficacious intervention for prenatal insomnia. However, it remains unclear whether CBTI is equally efficacious across racial groups, which is necessary to help reduce race-related disparities in prenatal insomnia. Methods This study is a secondary analysis of a single-site trial. Thirty-nine women who self-identified as white (n=24) and black (n=15) completed CBTI during pregnancy. Insomnia was measured using the Insomnia Severity Index (ISI). Before CBTI, patients reported sociodemographics. Treatment outcomes were collected a week after completing treatment during pregnancy. Results Although racial groups did not differ in ISI before treatment, white patients reported significantly larger decreases in ISI relative to black patients after CBTI (-5.75 vs -2.13, p=.046). Notably, black women were less engaged in treatment than white women based on mean number of sessions attended (4.20 vs 5.54 sessions, p=.013). Even so, multivariate linear regression showed that posttreatment ISI was 4 points higher for black women than white women (b=4.10, p=.049) when controlling for baseline ISI (p=.001), obesity (p=.072), poverty (p=.091), sessions attended (p=.155), and short sleep (p=.406). Notably, 41.7% of white CBTI patients remitted relative to 26.7% of black CBTI patients, suggesting that white women are 56% more likely to remit from CBTI than black women. Conclusion Our data suggest that black pregnant women exhibit poorer response to digital CBTI than white pregnant women. Moreover, racial disparities in CBTI response during pregnancy were not attributable to differences in session attendance. We must identify barriers to treatment response in black women, thereby guiding refinement to CBTI to provide better care for black women during pregnancy. Support (If Any) Ameriican Academy of Sleep Medicine

The Effect of Creative Arts Therapy on Psychological Distress in Health Care Professionals

BackgroundWork-related psychological distress is common among health care professionals. We determined whether 4 creative arts therapy (CAT) programs were acceptable, feasible, and improved psychological distress and job turnover intention in health care professionals with burnout symptoms. MethodsHealth care professionals were enrolled during the coronavirus disease (COVID-19) pandemic from September 2020 until July 2021. Participants attended in-person weekly 90-minute group session for 12 consecutive weeks. Intervention and control subjects completed surveys before the beginning and after the end of their cohort. The study outcomes were session attendance (feasibility), program satisfaction (acceptability), and change in symptoms of anxiety, depression, burnout, posttraumatic stress disorder (PTSD), and job turnover intention. ResultsWe randomized 165 participants into 4 CAT interventions and 1 common control group across 3 sequential cohorts. Thirty-five randomized participants dropped out before the start of the cohort, and 16 were replaced from a waiting list. Therefore, the cohort consisted of 146 participants. On average, participants were 35 years old, white (85%), and female (92%). Overall, 52% were nurses, 10% were doctors, and 16% were behavioral health specialists. Participants attended a median of 9.5 [8-11] sessions. Program satisfaction was high with a median Client Satisfaction Questionnaire (CSQ-8) score of 31 [17-32] out of a possible score of 32. Participants randomized to the intervention had improvements in anxiety (P < .0001) and depression scores (P = .0007), total posttraumatic stress disorder score (P =.0002), burnout scores (P = .001, .003, .008), and turnover intention (P = .001). ConclusionsA CAT program is feasible, acceptable, and may reduce psychological distress and turnover intention for health care professionals.

Current practice in the measurement and interpretation of intervention adherence in randomised controlled trials: A systematic review

BackgroundIdeally all participants in a randomised controlled trial (RCT) should fully receive their allocated intervention; however, this rarely occurs in practice. Intervention adherence affects Type II error so influences the interpretation of trial results and subsequent implementation. We aimed to describe current practice in the definition, measurement, and reporting of intervention adherence in non-pharmacological RCTs, and how this data is incorporated into a trial's interpretation and conclusions. MethodsWe conducted a systematic review of phase III RCTs published between January 2018 and June 2020 in the National Institute for Health Research Journals Library for the Health Technology Assessment, Programme Grants for Applied Research, and Public Health Research funding streams. ResultsOf 237 reports published, 76 met the eligibility criteria and were included. Most RCTs (n = 68, 89.5%) reported adherence, though use of terminology varied widely; nearly three quarters of these (n = 49, 72.1%) conducted a sensitivity analysis. Adherence measures varied between intervention types: behavioural change (n = 10, 43.5%), psychological therapy (n = 5, 83.3%) and physiotherapy/rehabilitation (n = 8, 66.7%) interventions predominately measured adherence based on session attendance. Whereas medical device and surgical interventions (n = 17, 73.9%) primarily record the number of participants receiving the allocated intervention, a third (n = 33, 67.3%) of studies reported a difference in findings between primary and sensitivity analyses. ConclusionsAlthough most trials report elements of adherence, terminology was inconsistent, and there was no systematic approach to its measurement, analyses, interpretation, or reporting. Given the importance of adherence within clinical trials, there is a pressing need for a standardised approach or framework.

A Physical Activity Intervention in Older African Americans: The PAACE Pilot Randomized Controlled Trial.

Older African Americans have low levels of physical activity, which increases the risk of aging-related health conditions. This study aimed to determine the effectiveness of, and satisfaction with, a community-engaged physical activity intervention targeting older African Americans. Fifty-six older African Americans were randomized to a successful aging group (SAG) or a physical activity group (PAG) for 12 wk. The PAG consisted of two weekly group exercise sessions and two to three home-based exercise sessions per week. The SAG consisted of weekly group educational sessions related to various aspects of healthy aging. Physical activity was measured by ActiGraph accelerometers and the Community Healthy Activities Model Program for Seniors Activities Questionnaire in both groups, and a Fitbit was continuously worn by PAG participants. Group session attendance was 93% and 86% in the PAG and SAG, respectively. The increase in ActiGraph-derived steps per day (1085.3 ± 265.6 vs 34.7 ± 274.3; P = 0.008) and daily minutes of moderate-to-vigorous physical activity (MVPA; 6.2 ± 1.6 vs 0.3 ± 1.7; d = 0.68; P = 0.01), and self-reported Community Healthy Activities Model Program for Seniors Activities Questionnaire MVPA bouts (3.5 ± 0.77 vs 0.33 ± 0.79; P < 0.001) were significantly greater within the PAG than the SAG. ActiGraph-derived minutes of daily MVPA and steps as well as Fitbit-derived steps per day were significantly greater on days when PAG participants engaged in group sessions compared with days when they self-reported home-based exercise or no exercise ( P < 0.016). Participants in both study arms reported high levels of satisfaction (>4- on 5-point Likert scale). The intervention increased physical activity, was well attended, and resulted in high satisfaction. Future studies should assess long-term sustainability in this population.

Developing a novel treatment for patients with chronic pain and Opioid User Disorder

BackgroundIt is critical to develop empirically based, community-treatment friendly, psychotherapy interventions to improve treatment for patients with comorbid chronic pain and Opioid Use Disorder. Understanding factors that increase patient adherence and attendance is important, along with strategies targeted to address those issues.MethodsBased on initial psychophysiology research on adults with OUD and chronic pain, we created an integrated cognitive-behavioral, 12-week outpatient group therapy called STOP (Self-regulation Therapy for Opioid addiction and Pain). In this study, we pilot tested STOP in a Stage 1a feasibility and acceptability study to identify unique treatment needs and factors that increased session attendance, adherence to treatment, and improved outcomes. Fourteen individuals on medication for OUD with co-occurring chronic pain participated.ResultsSTOP had high attendance rates (80%; and active patient engagement). Urine toxicology showed no illicit drug use after week 8. Data analysis from pre-intervention to a 3-month follow-up showed significant functional improvement (F(1,12) = 45.82;p < 0.001) and decreased pain severity levels (F(1,12) = 37.62;p < 0.01). Participants reported appreciation of the unique tools to counteract physiological activation during a pain flare or craving. Participants also reported benefit from in-session visual aids, applicable pain psychology information, take-home worksheets, tools for relaxation practice, learning to apply the therapy tools.DiscussionSTOP is a 90-min 12-week rolling-entry group therapy based on previous research identifying psychophysiological needs of pain and OUD patients that can be seamlessly incorporated into community addiction treatment clinics.ConclusionPreliminary results of STOP are promising with high patient engagement and adherence and significant reductions in drug use and pain.Trial registrationClinicalTrials.Gov NCT03363243, Registered Dec 6, 2017.

Habit Formation Intervention to Reduce Frailty Risk Factors: A Feasibility Study.

Frailty is common, detrimental, and costly in later life. Interventions can reduce the risk for frailty. To assess the feasibility of a frailty prevention intervention. A two-arm, prospective randomized controlled trial with blinded participant allocation and data collection at baseline and 1 wk postintervention by data collectors blinded to participant assignment. Community. Thirty community-dwelling, English-speaking, older African-Americans who were classified as prefrail were randomly recruited from a university research subject registry. The habit formation treatment was delivered face to face during 12 weekly home-based sessions approximately 45 min in length. We assessed feasibility as reflected in participant recruitment, retention, session attendance, and program satisfaction. Clinical outcomes included sedentary time and dietary quality (primary) as well as frailty status, physical activity, physical function, depression, quality of life, and anthropometry (secondary). Habit formation (mechanism of change) was assessed in the treatment group only. Twenty women (M age = 73.5 yr) completed the study. The recruitment rate was 69.8%, and we retained 95.2% of participants through the end of the study, with session attendance rates of 98.1% and 88.6% for the treatment and control groups, respectively, and mean acceptability scores of 30.3 and 28.0 for the treatment and control groups, respectively. Changes in primary and secondary clinical outcomes were largely in the expected direction. The intervention was feasible to deliver. Although future efficacy studies are needed, our preliminary data suggest the potential of an occupational therapy intervention to reduce frailty risk. What This Article Adds: Although it may be possible to slow or prevent the progression to frailty by modifying existing habits and occupations, few occupational therapy interventions address frailty. Our data provide new and much-needed insights about the potential feasibility of an occupational therapy intervention to reduce frailty risk.

Peer-led family-centred problem management plus for immigrants (PMP-I) for mental health promotion among immigrants in USA: protocol for a pilot, randomised controlled feasibility trial

IntroductionResearch is needed to investigate preventive strategies to reduce mental health burden and assess effective implementation among immigrants. Problem management plus (PMP) is a low-intensity multicomponent psychological intervention developed by...

Coming to Class Will Improve Your Grade: An Examination of Lecture Attendance and Lecture Exam Scores in an Undergraduate Human Anatomy Class

At the onset of the COVID‐19 pandemic, many traditional in‐person courses were converted to synchronous, asynchronous, or hybrid online formats. Instructors of a large undergraduate Basic Human Anatomy course at Indiana University ‐ Bloomington leveraged these changes to convert the lecture portion of the course to a flipped‐classroom model with two components: asynchronous online course content delivery, and live in‐person interactive learning sessions. The in‐person interactive learning sessions introduced students to active learning strategies and techniques (drawing, memory matrices, flow charts, diagrams, etc.), and the students actively participated in these sessions through the use of an online interactive learning platform ‐ TopHat. Here we sought to assess the efficacy and outcomes of the active learning sessions on student performance in the course.Basic Human Anatomy (ANAT‐A215) is a 5 credit hour undergraduate (baccalaureate) course that has an enrollment of 480 students with 1 large lecture section and 12 smaller lab sections. In Fall 2021, the instructors modified the lecture component of the course into a flipped classroom format. Lecture content was delivered via asynchronous online lectures, and the F2F class time was listed as optional (but strongly encouraged) for attendance. To facilitate greater student‐instructor interaction, one half of the class attended on Mondays and the other half attended on Fridays, and participated in similar interactive sessions. Wednesday F2F interactive lecture sessions were open to the entire class. To encourage attendance and participation in the optional F2F interactive lecture sessions, extra credit points could be earned through participation in TopHat anatomy questions. Points were earned for participation only (.5 points per question). TopHat questions were created by the instructors and consisted of both lower order and higher order questions that tested lecture and lab anatomical content. At the end of each lecture exam block of material, the instructors selected multiple TopHat questions at random for extra credit, with a range of 2‐4 extra credit points that could be earned per exam block.We found a statistically significant positive correlation between the number of points accumulated for participating in the F2F active learning lecture session questions and lecture exam scores. Using the number of points accumulated via the TopHat questions as a proxy for lecture attendance, we found that more TopHat points accumulated by students resulted in higher mean lecture exam scores – the greatest benefits occurring if students participated in multiple (&gt;3) F2F lecture sessions per block. Students who regularly attended F2F interactive sessions saw the greatest gains in their lecture exam scores. These findings indicate that active learning strategies could be efficacious in supplementing an asynchronous lecture content delivery format. We shared our findings with the class to encourage them to attend the active learning sessions, but encouraging some student populations to attend these sessions remains a challenge. Future research should be conducted on methods to encourage student involvement and participation in the course.

Interpersonal Psychotherapy for Depression in Parkinson's Disease: A Feasibility Study.

Individuals living with Parkinson's disease (PD) experience interpersonal stressors that contribute to depressive risk. Interpersonal psychotherapy (IPT) emphasizes the bidirectional relationship between interpersonal stressors and mood may therefore be a suitable treatment for PD-depression. The primary aim of this study was to evaluate the feasibility of delivering 12 sessions of IPT to depressed PD patients and explore the need for modifications. A secondary aim was to obtain descriptive information about efficacy outcomes. The study used a pre-post design without a comparison group. Participants were 12 PD patients with a major depressive disorder. IPT was well accepted and tolerated by patients and required minimal modifications. Compliance with session attendance and completion of study questionnaires were excellent and treatment satisfaction was high. Depression scores declined from baseline to endpoint, with 7 patients meeting criteria for remission at endpoint. Findings are encouraging and a larger randomized controlled trial is currently underway to ascertain if IPT is an efficacious treatment for PD-depression.

Rapid Marking Attendance with Face Recognition

Marking attendance (MA) of students in the classroom and exam halls is not only a burdensome task for the instructors, but it is also time consuming. There is a growing need for efficient and autonomous techniques in AM. This article introduces an attendance system based on face recognition. The developed method detects the students exploiting their faces present in live camera images or in a given image through the Eigen Face Recognizer algorithm. After then, students are recognized and their attendance information recorded in an offline database. HAAR algorithm is used as a classifier in recognition process. In the experimental studies, it has been observed that the face recognition system works with an average accuracy of 79.31% in the real classroom environment. The obtained results showed that the designed system is promising for automatic authentication and marking attendance in classroom and exam sessions. It has been also shown that with the proposed system, marking, authentication and recording works can be completed in a much shorter time and with higher accuracy.

Father Participation in Parent-Child Interaction Therapy: Predictors and Therapist Perspectives

ABSTRACT Although engaging fathers effectively can bolster and sustain treatment outcomes, fathers participate in their children’s treatment at lower rates than mothers and have been left out of the literature on caregiver engagement. Because provider attitudes and behaviors shape the course of treatment, therapist perspectives on father attendance and engagement should be investigated. A mixed-method study design examined rates and predictors of father attendance in treatment and therapist perspectives on father engagement in Parent-Child Interaction Therapy (PCIT). Quantitative data were gathered through a survey distributed to PCIT therapists (n = 267) to identify the effects of: 1) therapist and caseload characteristics, 2) therapist confidence working with fathers, 3) therapist use of father engagement strategies, and 4) organizational practices for engaging fathers, on father attendance rates. Qualitative interviews with 23 therapists were thematically analyzed to expand upon therapist experiences engaging fathers. Therapists reported that on average, 60.97% of cases with a father available had regular session attendance by the father. Only frequency of therapist use of father engagement strategies predicted father attendance rate. Qualitative interviews expanded on the many barriers therapists face to engaging fathers and the variety of strategies they employ to engage fathers. Rates of father attendance in PCIT are higher than what has been previously reported in the literature but still show room for improvement. Despite barriers, therapists remain dedicated to developing solutions to elicit father engagement. Future research should evaluate whether therapist-reported engagement strategies effectively increase father participation and can be more widely disseminated.

Compassion Focused Group Therapy for Adult Female Survivors of Childhood Sexual Abuse: a Preliminary Investigation

ObjectivesThe adverse effects of childhood sexual abuse (CSA) are often significant and enduring. It is therefore important to identify therapeutic interventions that can effectively minimize these effects. Compassion focused therapy (CFT) was originally developed for people with high levels of self-criticism and shame. It holds significant promise as an intervention for survivors of CSA, but has not yet been empirically tested. This study explored both the acceptability and preliminary efficacy of a CFT group intervention (CFT-SA) for adult female survivors of CSA.MethodsCFT-SA was developed and tested with adult female survivors of CSA, to determine if there was any change in outcome measure scores after participating in the 12-week intervention (n = 30) and at 3-month post-intervention follow-up (n = 25).ResultsLow attrition and high session attendance, in addition to positive participant feedback, suggested the program had high acceptability. Significant improvement was observed across all outcome variables from pre- to post-intervention (n = 30), which were maintained at follow-up (n = 25). Participants demonstrated increased self-compassion and self-reassurance, and reduced symptoms of post-traumatic stress, shame, and self-criticism, as well as fears of compassion, depression, anxiety, and stress, with medium to large effect sizes (d = .55 to 1.36). Across all measures, between 20 and 57% of participants demonstrated reliable change pre- to post-intervention, and 22 to 57% from pre-intervention to follow-up.ConclusionsThis study provides preliminary support for the acceptability and potential benefits of utilizing CFT-SA as an intervention for adult female survivors of CSA and offers recommendations for future research.Trial Registration.Australian New Zealand Clinical Trials Registry, ACTRN12616001041448.

The Multi-Caregiver Role and Its Relationship to Behavioral Adherence and Weight Among Treatment Engaged Black Women.

To examine the relationship between the multiple caregiver role and its perceived barriers to self-care on behavioral adherence in a weight loss intervention. A secondary analysis of data from a behavioral weight loss intervention. The study was conducted in two cohorts from March 2016 to February 2017 at the University of North Carolina at Chapel Hill. Eighty-one Black women with overweight/obesity (age = 48.4 ± 10.9 years [M ± SD], BMI = 36.4 ± 4.5kg/m2 [M ± SD]). Identification with the multiple caregiver role and barriers was assessed with the Multiple Caregiving Measurement Instrument. Weight was measured with a digital scale and height with a stadiometer. The Block food frequency questionnaire evaluated dietary intake. Moderate-to-vigorous physical activity (MVPA) was measured objectively with an accelerometer. Study adherence was measured by session attendance, self-weighing, and self-monitoring (diet and physical activity) frequency. Generalized linear models were used to examine the relationship between the multiple caregiver scales and the outcomes of interest, controlling for study arm, cohort, and income. Chi-square tests tested correlations. Greater identification with the multiple caregiver role was associated with decreased session attendance (β = -.56 [SE = .27], P < .05) and a trend towards weight gain (β = .36, [SE = .19], P = .07). Greater multiple caregiver barriers score predicted a decrease in fruit/vegetable intake (β = -.17 [SE = .07], P < .05). All regression results are unstandardized. Negative correlations between multiple caregiver barriers and MVPA (r = -.24, P = .06) and daily self-weighing (r = -.19, P = .10) approached significance. Participants' identification with multiple caregiving role and barriers can reduce adherence, behavior and weight change. Interventions to address Black women's multiple roles and barriers during weight loss are needed to maximize outcomes.

Adherence to hemodialysis and medical regimens among patients with end-stage renal disease during COVID-19 pandemic: a cross-sectional study

BackgroundAdherence of patients with End-Stage Renal Disease (ESRD) to Hemodialysis (HD), prescribed medications, diet and fluid restrictions is essential to get the desirable outcome and prevent complications. During COVID-19 pandemic, ESRD patients became more concerned with attending the HD sessions and following the protective measures because of the potential for increased susceptibility to COVID-19. The aim of this study was to evaluate the impact of the pandemic on patients' adherence to HD and medical regimens.MethodsTwo hundred five ESRD patients on HD were interviewed with the ESRD Adherence Questionnaire (ESRD-AQ) and the Fear-of-COVID-19 Scale (FCV-19S). Clinical and laboratory correlates of adherence were retrieved from patients' records.ResultsSelf-reported adherence to HD showed that 19.5% were not adherent to HD during the pandemic compared to 11.7% before the pandemic (p < 0.001), with a significant agreement with the actual attendance of HD sessions (Kappa = 0.733, p < 0.001). Twenty-five patients (12.2%) had a history of COVID-19. The FCV-19S had a mean score of 18.8 and showed significant positive correlations with the pre-dialysis phosphorus and potassium. Multivariate analysis showed that the main predictors of non-adherence were the history of COVID-19, understanding and perception scores, and the Fear-of-COVID score.ConclusionsThe COVID-19 pandemic adversely affected the adherence of ESRD patients to HD and medical regimen. Strategies to mitigate patients' fears of COVID-19 and improve their understanding and perceptions of adherence to HD and medical regimen should be adopted in HD centers during the pandemic.

Parents of minor children lose less weight during a behavioral weight loss intervention: Findings from the Rural LEAP trial.

The transition to parenthood is associated with worsening health behaviors, yet the impact of parental status on successful weight loss has rarely been examined. The purpose of this study was to examine the effect of parental status of minor children on weight loss and behavioral adherence in a rural community-based weight loss intervention. Five hundred and twenty-eight adults (age 21-75years, body mass index [BMI] 30-45kg/m2) were enrolled in a group-based weight loss intervention consisting of 16 weekly sessions delivered in face-to-face group sessions at Cooperative Extension Service (CES) offices. Participants who were parents with at least one minor child (≤18 years old) in the home were compared to participants with no minor children in the home. Measures included percent weight loss, session attendance, adherence to self-monitoring, and achieving calorie and physical activity goals. Compared to participants without minor children, parents with minor children lost significantly less weight (7.5% vs. 6.2%, respectively; p=0.01), and were less likely to lose ≥5% of baseline weight (59.2% vs. 70.2%, respectively; p=0.02). In addition, parents with minor children attended significantly fewer sessions, had lower adherence to self-monitoring, and met calorie and step goals less often (all ps<0.001). The association between parental status and percent weight loss was not significantly moderated by gender of the parent. Parents of minor children had greater difficulty adhering to intervention goals and lost less weight than participants without minor children. Future research should investigate whether tailoring intervention to meet the unique needs of parents can enhance outcomes, especially given the large segment of the population represented by this group.

Preparing Families for Evidence-Based Treatment of ADHD: Development of Bootcamp for ADHD

Objective: Many families of children with attention-deficit/hyperactive disorder (ADHD) do not initiate evidence-based treatments (EBTs), placing these children at risk for poor outcomes. Bootcamp for ADHD (BC-ADHD) is a novel, four-session, group intervention designed to prepare parents as informed consumers to engage in multimodal EBTs for ADHD. This paper describes the theory of change and the development of BC-ADHD, outlines its components, and provides an initial proof of concept of the program. Method: Participants were 11 families of children with ADHD (ages 5–11; 55% male; 91% non-Hispanic; 55% White, 27% Black, 18% more than one race) who were the initial participants receiving BC-ADHD during a small-scale, randomized controlled trial. Parent-report outcome measures assessed parental empowerment, treatment preferences, affiliate stigma, intention to pursue treatment, and treatment initiation at baseline, posttreatment, and 6-week follow-up. Results: Parent engagement was high, as indicated by an 86% session attendance rate and high ratings of program satisfaction. Parents reported an increase in empowerment to access systems of care. Ratings of acceptability for behavior therapy increased at posttreatment and follow-up with minimal or no concerns about feasibility. The acceptability of medication was high at each assessment, although parents expressed increased concerns about stigma and adverse effects of medication at posttreatment and follow-up. Nonetheless, there was a marked increase in parental intention to use medication at posttreatment and follow-up. Accounting for ceiling effects, parents reported substantial increases in intention to use medication, behavioral parent training (BPT), and school services. Changes in treatment initiation were in the expected direction. Conclusions: BC-ADHD has the potential to promote family empowerment in seeking services and increase their intent to initiate EBTs, as well as actual initiation of these treatments.

Use of Learning Management System Data to Predict Student Success in a Pharmacy Capstone Course

Objective. Learning management system (LMS) data from online classes may provide opportunities to identify students at risk of failure. Previous LMS studies have not addressed the possibility of change in student engagement over time. The purpose of this study was to apply a novel statistical technique, group-based trajectory modeling (GBTM) to LMS data in an online course to identify predictors of successful course completion.Methods. Exploratory GBTM was used to assess the association of LMS activity (total activity time, dates of activity, and pages viewed) and attendance at virtual synchronous learning sessions with examination performance in a capstone disease-management course delivered in the final didactic quarter of a three-year Doctor of Pharmacy program. Groups were assigned based on trajectories of weekly page view counts using structural-equation modeling.Results. Group-based trajectory modeling identified three page view engagement groups (median total page views, n): group 1, high (1,818, n=24): group 2, moderate (1,029, n=74), and group 3, low (441 views, n=35). Group assignment alone was somewhat associated with final grade. Stratification based on consistent virtual synchronous learning session attendance improved predictive accuracy; for example, a top (A or A-) grade was earned by 49.0% and 24.0%, respectively, of group 2 students with and without consistent synchronous engagement.Conclusion. Application of GBTM to LMS data, including information about synchronous engagement, could provide data that allow educators to identify early warning signs that a student may fail a course and target interventions to those at-risk students. The technique should be further tested with alternative LMS data and obtained early in the didactic curriculum, before patterns of engagement are established.

Effectiveness of a self-management education program on hypertension control and contributing factors in older adults: an interventional trial

Background: One of the common disorders that may negatively affect the health status in elderly is hypertension. Self-management education offers an effective method to control various disorders. This study was designed to assess the effectiveness of self-management educational program on blood pressure, and other cardiometabolic risk factors control among elderly patients from Tabriz, Iran. Material and methods: 227 eligible hypertensive elderly patients from three primary health care centers of Tabriz participated in 12 sessions of self-management education intervention conducted in 6 months from April to October 2019. Systolic (SBP) and diastolic blood pressure (DBP), serum levels of fasting blood sugar (FBS), total cholesterol (TC), and triglyceride, as well as anthropometric indices were assessed both before and at the end of the intervention. Results: The participants were 64.5 ± 5.8 years of age (mean ± SD). After 6-month attendance in educational sessions, the SBP (p = 0.04), body weight (p = 0.01), body mass index (BMI) (p = 0.02), FBS (p = 0.01), and TC (p &lt; 0.0001) were lower as referred to baseline. Conclusion: Study suggests self-management education programs in elderly may be beneficial for cardiovascular risk factors control.

Can families help veterans get more from PTSD treatment? A randomized clinical trial examining Prolonged Exposure with and without family involvement

BackgroundPosttraumatic stress disorder occurs in as many as one in five combat veterans and is associated with a host of negative, long-term consequences to the individual, their families, and society at large. Trauma-focused treatments, such as Prolonged Exposure, result in clinically significant symptom relief for many. Adherence to these treatments (i.e., session attendance and homework compliance) is vital to ensuring recovery but can be challenging for patients. Engaging families in veterans’ treatment could prove to be an effective strategy for promoting treatment adherence while also addressing long-standing calls for better family inclusion in treatment for posttraumatic stress disorder. This paper describes the methods of a pragmatic randomized controlled trial designed to evaluate if family inclusion in Prolonged Exposure can improve treatment adherence.MethodsOne hundred fifty-six veterans, with clinically significant symptoms of posttraumatic stress disorder, will be randomized to receive either standard Prolonged Exposure or Prolonged Exposure enhanced through family inclusion (Family-Supported Prolonged Exposure) across three different VA facilities. Our primary outcomes are session attendance and homework compliance. Secondary outcomes include posttraumatic stress disorder symptom severity, depression, quality of life, and relationship functioning. The study includes a concurrent process evaluation to identify potential implementation facilitators and barriers to family involvement in Prolonged Exposure within VA.DiscussionWhile the importance of family involvement in posttraumatic stress disorder treatment is non-controversial, there is no evidence base supporting best practices on how to integrate families into PE or any other individually focused trauma-focused treatments for posttraumatic stress disorder. This study is an important step in addressing this gap, contributing to the literature for both retention and family involvement in trauma-focused treatments.Trial registrationClinicalTrials.govNCT03256227. Registered on August 21, 2017.

The relation of grit to weight loss maintenance outcomes

Biological, genetic, and environmental factors make weight loss very difficult. Acceptance-based behavioral treatment (ABT) supplements standard behavioral treatments (BT) for obesity by teaching skills to accept the discomfort inherent to weight control behaviors and prioritize long-term, values-based goals. Grit, the ability to persevere in goal pursuit, overlaps conceptually with ABT principles and may predict outcomes in ABT. During a randomized controlled trial comparing three weight loss interventions (BT, BT with an emphasis on physical activity [BT + PA], ABT with an emphasis on physical activity [ABT + PA]), this study examined if grit predicted weight loss, intervention engagement (session attendance and dietary self-monitoring), and perceived intervention effectiveness, and whether intervention condition moderated these relationships. Participants (N = 309) with overweight/obesity enrolled in an 18-month weight loss intervention completed the Short Grit Scale at baseline. Weight and PA were measured at baseline, during the intervention (12 and 18 months), and at follow-up (24 and 36 months). Session attendance and dietary self-monitoring were assessed throughout the intervention, and perceived intervention effectiveness at end-of-intervention. The relation of grit to several outcomes depended on condition. In ABT + PA, but not BT or BT + PA, lower grit related to higher weight loss at 12 and 24 months, session attendance, and perceived intervention effectiveness. Grit was not related to PA or dietary self-monitoring in any condition. ABT's focus on building skills to facilitate long-term goal pursuit may be unique and beneficial to those with lower grit. Those with higher grit may already possess ABT-consistent skills and benefit less from ABT. Research on trait-level characteristics like grit in relation to weight must be cautious not to reinforce weight bias; rather, this work suggests that an evidence-based intervention (ABT) may be well-suited to those with lower grit levels seeking weight loss.