Therapy Sessions Research Articles

Tumor Lysis Syndrome Following PSMA Radioligand Therapy.

Tumor lysis syndrome (TLS) is a rare complication following treatment in prostate cancer patients. We present a 65-year-old man with history of castration-resistant prostate cancer who developed TLS following 2 sessions of 177Lu-PSMA therapy. The patient presented with bulky axillary and mediastinal lymphadenopathies, an unusual site for prostate cancer metastasis. Although his PSA levels declined following treatment, he reported excessive weakness leading to immobility. Laboratory correlation showed markedly increased lactate dehydrogenase, from 413 to 543,000 U/L, suggesting the occurrence of TLS. Although being considered a relatively safe treatment, 177Lu-PSMA can sometime lead to life-threatening events, which is reviewed here.

Effect of visual biofeedback on fine motor function and activity daily of life in stroke patients: A pilot study

IntroductionMany stroke patients suffer from dysfunction in their upper limbs, which can lead to difficulties in performing activities of daily living (ADL) as well as social and work interactions. This is particularly true for patients whose dominant side has been affected. The aim of the current study was to explore how effective visual biofeedback could improve fine motor function in the hand and ADL for people suffering from a stroke. MethodsTen individuals who had experienced a stroke with aged from 60 to 74 years old (mean: 64.3 years) were randomly divided into two groups. Patients in study group (n: 5) received 15 sessions of visual biofeedback therapy along with routine occupational therapy. Control group (n: 5) received only routine occupational therapy. Fine motor function was measured by Fugl Meyer Scale (FMS), box and block test (BBT), and Purdue pegboard test (PPBT). Also, ADL was measured by functional independence measure (FIM). These clinical outcomes were evaluated before, after, and 1.5 months following the interventions. ResultsThe results showed that the study group experienced a significant increase in fine motor function after receiving visual biofeedback, compared to the control group. The ADL also improved in both the study and control groups after the intervention, but there was no significant difference between the two groups during the intervention and follow-up stages for ADL. ConclusionIt seems that combining biofeedback with routine occupational therapy could be a promising method to enhance fine motor function in individuals with stroke.

Sudden gains in internet cognitive therapy for social anxiety disorder in routine clinical practice

BackgroundSudden gains are large symptom improvements between consecutive therapy sessions. They have been shown to occur in randomised controlled trials of internet-delivered psychological interventions, but little is known about their occurrence when such treatments are delivered in routine clinical practice. ObjectiveThis study examined the occurrence of sudden gains in a therapist-guided internet-delivered Cognitive Therapy intervention for social anxiety disorder (iCT-SAD) delivered in the UK NHS talking therapies for anxiety and depression (formerly known as IAPT services). It aimed to assess whether sudden gains were associated with better therapy outcomes, and examine changes in process variables around the period of sudden gains. MethodsThe study examined sudden gains based on the Liebowitz Social Anxiety Scale. Of 193 treated patients, 146 provided sufficient data to permit analysis. Linear mixed effects models were used to examine the impact of sudden gains on clinical outcomes, and examine changes in negative social cognitions, self-focused attention, and depressed mood. ResultsSeventy sudden gains were found among 57 participants. The occurrence rate of sudden gains was 39 %. Individuals who experienced sudden gains had a larger reduction in social anxiety symptoms at end of intervention and at three-month follow-up. There was evidence of a reduction in the frequency of negative social cognitions prior to the gain, whereas changes in self-focused attention occurred simultaneously with the gain. Depressed mood did not show significant changes over these timepoints. ConclusionsApproximately 2 in 5 patients experienced a sudden gain whilst accessing the iCT-SAD intervention in routine practice. They were associated with better clinical outcomes following treatment compared to those who did not experience a sudden gain.

Interventions to Improve the Occupational Performance of Youth With Persistent Postconcussion Symptoms: A Systematic Review.

Persistent postconcussion symptoms (PPCS) may negatively affect youth's occupational performance in activities of daily living, education, play and leisure, social participation, and rest and sleep. This review provides occupational therapists with evidence related to interventions for youth with PPCS. Searches were performed in Embase, PubMed, SportDiscus, CINAHL, and Web of Science. Inclusion criteria were as follows: studies published in English from January 1, 2013, to February 7, 2023; youth ages 3 to 18 yr old; PPCS for at least 2 wk after injury; interventions within the scope of occupational therapy; and outcomes related to areas of occupation. All levels of evidence (1-5) were included and graded for quality using the Oxford Centre for Evidence-Based Medicine (2009) levels of evidence. This review followed Preferred Reporting Items for Systematic reviews and Meta-Analyses guidelines. Twenty articles met inclusion criteria (7 randomized controlled trials, 1 nonrandomized controlled group design, 3 single-group designs, 5 case series, and 4 single-subject designs). Interventions reviewed were active rehabilitation, vision-related interventions, psychoeducation, cognitive-behavioral therapy (CBT) techniques, the Cognitive Orientation to daily Occupational Performance (CO-OP), and music therapy. Strong evidence supports CBT, with significant clinical outcomes in sleep and education. Moderate strength of evidence supports psychoeducation and active rehabilitation for improving functional outcomes. More evidence is needed to make clinical recommendations regarding vision-related interventions, the CO-OP, and music therapy. Occupational therapists should consider CBT, psychoeducation, and active rehabilitation to improve occupational performance among youth with PPCS. Plain-Language Summary: Some youth will have persistent symptoms that do not resolve within 2 weeks after a concussion. Because of these persistent symptoms, they may have difficulty completing everyday activities. This review evaluated evidence addressing the ability of youth with persistent postconcussion symptoms (PPCS) to complete everyday activities. The authors found that cognitive-behavioral therapy, psychoeducation (aimed at helping youth understand and cope with their concussion symptoms), and active rehabilitation (aerobic and coordination exercises, such as jumping jacks and ball skills) should be considered when working with youth (ages 3-18 years) with PPCS. Using these interventions in occupational therapy sessions may improve the ability of youth to complete their everyday activities after a concussion.

Virtual connection and real community: the qualitative experience of participating in a videoconferencing-based psychotherapy group for postpartum depression and anxiety

BackgroundGroup psychotherapy, an effective treatment for common postpartum mental disorders (e.g. depression, anxiety), has increasingly been delivered virtually since the pandemic. This study aims to understand experiential aspects of participating in videoconferencing-based group psychotherapy in the postpartum period.MethodsOur urban academic ambulatory hospital has delivered group psychotherapy for women (cis and trans) and non-binary individuals of female sex with postpartum depressive and anxiety symptomatology via videoconferencing since 2020. One therapist-facilitator conducts weekly 60-min group therapy sessions with 5-6 participants for eight weeks. Group participants were invited to complete a semi-structured qualitative interview on their experience. Using an interpretive description approach, we conducted reflexive thematic analysis to code anonymized transcripts and construct themes. Facilitator interviews were used for triangulation and additional context.ResultsOf 134 patients in video psychotherapy groups over 11 months, 14 completed an interview, as did all group facilitators (n = 3). Overall, participants felt the experience with videoconferencing group therapy was beneficial for their mental health. Three themes were constructed: (1) “Moving Towards a New Normal”: The group helped participants normalize feelings and experiences around transition to parenthood, and accessing health care virtually was now considered to be normal practice, although some wanted an element of choice. (2) “Virtual Connection, Real Community”: Connections were made virtually, yet participants felt a real sense of community. Facilitators played an important role fostering an environment in which participants could create lasting bonds. Participants noted challenges with feeling comfortable virtually and provided pragmatic and structural suggestions for enhancing the creation of community. (3) “Trade-offs to Virtual Engagement”: Participants made positive and negative trade-offs (e.g. no informal interactions, travel, isolation at home, childcare challenges) to maximize their experience and were able to be more authentic in their self-presentation to the group.ConclusionsPeople with postpartum depression and anxiety who participated in videoconferencing-based group psychotherapy appreciated the sense of community within their groups to normalize their experience transitioning to parenthood. Participants had to make trade-offs to access virtual groups, but felt the experience was worthwhile and helped improve their mental health. Findings will help inform continued delivery of virtual group mental health services.

Patient Perception of Mental Effort in Voice Therapy

ObjectiveOne challenge in voice therapy is that mastering new vocal techniques is inherently cognitively effortful. While effort is critical for learning, it can also lead to frustration and reduced patient engagement. The purpose of this study was to investigate the relationship between patient-perception of voice handicap and mental effort in voice therapy, and to determine if different therapy approaches and stimuli elicit different perceptions of mental effort. MethodsA non-experimental, prospective investigation was conducted with adult patients receiving voice therapy. Prior to therapy initiation, patients completed the Voice Handicap Index-10 (VHI-10) to quantify perceived severity of their voice disorders. To assess mental effort, a Borg mental effort scale and the NASA Task Load Index (NASA-TLX) were administered following each therapy session. Therapy type and treatment stimulus/level of treatment hierarchy was documented for each session. Kruskal-Wallis H-test was used to compare differences in baseline VHI-10 and mental effort among voice disorder diagnoses. Pairwise comparisons, linear random-intercept mixed-effects model, and generalized estimating equation method were used to determine correlation between VHI-10 and mental effort, and therapy type, stimulus, and effort. ResultsTwenty-seven participants (89% female, 60% white) completed the study. There was no significant difference in VHI-10 or baseline perceptions of mental effort between races or among voice disorder diagnoses. There was a significant positive correlation between VHI-10 scores and session 1 mental effort. There was no significant difference in effort ratings among therapy types, but effort was rated as significantly greater for therapy stimuli that involved connected speech practice than other stimuli. Perceived mental effort significantly decreased over time. DiscussionVoice therapy imposes a cognitive load on the patient, and is particularly challenging for individuals with more severely perceived voice disorders. Further, patients think voice treatment approaches that utilize connected speech stimuli are more effortful than those that use simple stimuli, regardless of treatment target (e.g. resonance, flow).

Effects of robot-assisted hand function therapy on brain functional mechanisms: a synchronized study using fNIRS and sEMG.

Robot-assisted hand function therapy is pivotal in the rehabilitation of patients with stroke; however, its therapeutic mechanism remains elusive. Currently, research examining the impact of robot-assisted hand function therapy on brain function in patients with stroke is scarce, and there is a lack of studies investigating the correlation between muscle activity and alterations in brain function. This study aimed to investigate the correlation between forearm muscle movement and brain functional activation by employing the synchronized use of functional near-infrared spectroscopy and surface electromyography methods. Moreover, it sought to compare neural activity patterns during different rehabilitation tasks and refine the mechanism of robot-assisted hand function therapy for post-stroke hand function impairments. Stroke patients with hand dysfunction underwent three sessions of robot-assisted hand function therapy within 2 weeks to 3 months of onset. The fNIRS-sEMG synchronous technique was used to observe brain function and forearm muscle activation. Ten participants were randomly assigned to receive mirror, resistance, or passive rehabilitation training. During the intervention, cortical and muscle activation information was obtained using fNIRS and electromyographic signals. The primary outcomes included changes in oxyhemoglobin concentration and root mean square of surface electromyography. Compared to the resting state, the Oxy-Hb concentration in the brain regions involved in three rehabilitation tasks with robot-assisted hand function therapy significantly increased (p < 0.05). Mirror therapy significantly enhanced the prefrontal cortex and the superior frontal cortex activation levels. In contrast, resistance therapy significantly promoted the activation of the supplementary motor area and the premotor cortex. Passive rehabilitation tasks showed some activation in the target brain area premotor cortex region. Robot-assisted hand function therapy has shown that forearm muscle movement is closely related to oxygenated hemoglobin concentration activity in specific brain regions during different rehabilitation tasks. The simultaneous sEMG-fNIRS study found a significant correlation between muscle movement and brain activity after stroke, which provides an important basis for understanding the treatment mechanism of hand function impairment.

Evaluation of the impact of shockwave therapy on the functioning of a patient with a lower calcaneal spur

Introduction. A common cause of heel pain is the presence of a calcaneal spur. This condition may disrupt the posterior superficial fascia chain and can also lead to problems in distant areas of the body. Among the physical methods used, shockwave therapy is often applied. The aim of the study was to assess the effectiveness of shockwave therapy and its effect on the tension of the gastrocnemius muscle, which is part of the posterior fascia chain. Materials and Methods. A 52-year-old female patient diagnosed with a left lower calcaneal spur underwent a series of six radial shockwave therapy sessions, performed twice a week. The method for assessing the therapy’s effectiveness involved measuring pain on the Visual Analogue Scale (VAS) and changes in tissue temperature before, immediately after, and five minutes post-therapy. Electromyographic (EMG) examination was used to assess the tension of the gastrocnemius muscle. Results. An average decrease in temperature was observed immediately after the treatment (from 25.3°C to 24.45°C). After five minutes, the temperature increased to 27.05°C compared to the initial measurement. The resting tension of the gastrocnemius muscle, as measured by EMG, decreased as follows: channel 1: from 0.6 µV to 0.4 µV, channel 2: from 4.3 µV to 3.2 µV. Pain decreased from a level of 7 to 2 on the VAS scale. Conclusions. Shockwave therapy is an effective solution for alleviating pain in the case of a calcaneal spur. The reduction of resting tension in the gastrocnemius muscle leads to a decrease in elevated tension within the posterior myofascial chain, which may help reduce the risk of secondary pathologies in distant areas along the chain.

EFFECTIVENESS OF RADIAL EXTRACORPOREAL SHOCKWAVE THERAPY IN THE LOCAL MANAGEMENT OF HYPERTONIA (SPASTICITY AND DYSTONIA) IN PATIENTS WITH CEREBRAL PALSY.

To assess the effect of radial extracorporeal shockwave therapy on the reduction of local hypertonia in patients with cerebral palsy. Explorative pre-post intervention study. Forty-five patients with cerebral palsy. All patients received 3 sessions of radial extracorporeal shockwave therapy with a time interval of 1 week for each session. The outcomes were V1 and V3 of the Tardieu scale, the Timed Up and Go test, and the 10-metre walk test. The measurements were collected at baseline, immediately after the last session of shockwaves, at 12 and 24 weeks after baseline. The statistical analysis used was a mixed linear model of repeated measures. The degrees on the Tardieu scale increased significantly in all the treated muscles. The results of the Timed Up and Go test and the 10 m walk test confirmed a significant functional effect after the shockwave therapy (p < 0.001). Functional improvement in patients treated with extracorporeal shockwave therapy has been observed to last up to 24 weeks.

Massed treatment of posttraumatic stress disorder, traumatic brain injury, and co-occurring conditions: the Home Base intensive outpatient program for military veterans and service members.

The two-week Home Base Intensive Clinical Program (ICP) provides treatment to veterans and active duty service members suffering from primary diagnoses of posttraumatic stress disorder (PTSD), traumatic brain injury (TBI), anxiety, or depression. First launched in 2015, this paper provides a programmatic update, including new treatment components implemented since inception, and examines outcomes for all participants who entered the program from September 2015 to July 2024 (n = 2561). The Home Base ICP provides a massed care approach through daily individual Prolonged Exposure, Cognitive Processing Therapy, Unified Protocol, or cognitive rehabilitation, along with groups targeting coping skills. Participants entering the program are provided with core group programming, as well as individualized therapy sessions tailored to their unique needs and symptom presentation. Supplemental dual recovery support is also available for all participants with co-occurring substance use or behavioral addiction concerns. Participants' support people receive education, support, and case management services. Participants have a multidisciplinary team comprising therapists, psychopharmacology providers, case managers, nurses, and wellness providers. Results demonstrate that program participants exhibited statistically significant reductions in PTSD symptoms (Cohen's d = 0.80), depression (d = 0.68), post-concussion symptoms (d = 0.71), and increased satisfaction in social roles (d = -0.65). Completion rate was 94.60% (n = 2422), suggesting that the Home Base ICP is a well-received and effective model of care for veterans and service members.

Detecting climate anxiety in therapy through natural language processing

A well-documented consequence of global warming is increased psychological distress and climate anxiety, but data gaps limit action. While climate anxiety garners attention, its expression in therapy remains unexplored. Natural language processing (NLP) models can identify climate discussions in therapy, aiding therapists and informing training. This study analyzed 32,542 therapy sessions provided by 849 therapists to 7,916 clients in U.S. behavioral health programs between July 2020 and December 2022, yielding 1,722,273 labeled therapist-client micro-dialogues. Climate- and weather-related topics constituted a mere 0.3% of the sessions. Clients exhibiting higher levels of depressive or anxiety symptoms were less likely to discuss weather and climate compared to those with mild or no symptoms. Findings suggest that although global warming is known to impact mental health, these issues are not yet adequately addressed in psychotherapy. This study suggests a potential gap between the documented mental health concerns associated with climate change and their representation in psychotherapy. NLP models can provide valuable feedback to therapists and assist in identifying key moments and conversational topics to inform training and improve the effectiveness of therapy sessions.

The role of early orthotic intervention in the management of post-traumatic elbow contractures: Study protocol for phase II double-blinded randomised controlled trial.

Restoration of full elbow extension following trauma is difficult and influenced by the injury profile, surgeon preference, patient and environmental factors. The literature suggests that orthotic interventions are effective in improving contractures when movement plateaus despite normal therapeutic interventions. It is not known if extension orthotic intervention is more superior to standard treatment regardless of when it is commenced. The literature lacks patient-reported considerations to contracture management using elbow orthoses. This protocol describes a Phase II double blinded randomised controlled feasibility trial (RCT) and mixed methods study, aimed to examine outcome with extension in an orthotic intervention group (OG) versus control (CG). All participants will undergo six weekly therapy sessions, which include a standardised therapeutic program. OG participants will be provided with an additional extension orthosis and the outcome is assessed according to the change in elbow extension motion after 6 weeks of intervention. Data will be collected via questionnaires, logbooks, feedback forms, and semi-structured interviews at baseline and final assessments for descriptive statistical analysis. Under the guidance of a statistician, all quantitative data will be evaluated using the appropriate parametric or non-parametric analyses to evaluate for systematic differences between groups. Preliminary extension gains are used to determine the final sample size required to achieve adequate power for a full-scaled RCT. Interview data on OG participants will be qualitatively analysed using the "five-factorial dimensions of adherence" framework to identify key differences in the influencers between adherent or non-adherent groups. ANZCTR ACTRN12619001402134p.

Patient Experiences With Group Teletherapy for the Treatment of Mental Illness: A Qualitative Study.

The authors sought to understand patient experiences with group teletherapy to inform improvements in service delivery. From December 2022 to October 2023, semistructured interviews were conducted with 20 adults with depression or bipolar disorder who had received outpatient group teletherapy in the past 2 years. A rapid thematic analysis was conducted by using a matrix to identify patterns and synthesize data. A logic model from the patients' perspective was developed by extracting common themes related to elements of effective group teletherapy. Telehealth allowed for more empowered engagement in group teletherapy and enabled better access and longitudinal attendance for many patients, compared with in-person group therapy. However, many patients reported a reduced sense of emotional intimacy and connectedness with telehealth, and some reported that technology challenges and distractions contributed to feelings of disconnection. Patients were divided in their modality preferences, but many expressed an interest in receiving at least some of their group therapy sessions by telehealth. Although group teletherapy has the potential to meet patients' needs and preferences, more work is needed to improve the quality of the experience for patients.

A Review of Chatbots Application on Supporting International Students’ Mental Health

International students face distinctive challenges, including acculturative stress, homesickness, language barriers, and heightened academic expectations. As a result, their mental health and overall well-being have become subjects of growing concern and significance in academic and support communities worldwide. The emergence of AI technologies, like ChatGPT, opens new avenues for international student mental health interventions. However, no specific Chatbot has been approved as effective for this population. This study aims to comprehensively summarize Chatbot applications in mental health counseling and analyze the challenges of applying them to international students. The study found that prominent Chatbots could demonstrate efficacy in reducing symptoms of depression and anxiety through techniques such as cognitive behavioral therapy (CBT). Chatbots are becoming integral to mental health care, providing accessible and evidence-based interventions and psychoeducation. Compared with traditional in-personal mental health counselling, a Chatbot is more functioning in providing personalized therapy sessions, essay accessibility, real-time responses, and suitable assistance, which could solve current challenges and unmet mental health counselling needs of international students. Despite their potential, ethical considerations and privacy challenges must be addressed to ensure reliable and secure use. Continued refinement is needed for international students’ application to enhance multicultural sensitivity, the accuracy of cross-language interpretation, and personalization. The evolution of Chatbots holds significant promise for enhancing mental health support, particularly for international students navigating and coping with their unique challenges.

Development and validation of a self-esteem improvement program for family caregivers with dementia ‐ Utilizing ICT

The sense of caregiving burden can be significant among family caring for people with dementia and can impact mental health. Research to find ways to alleviate this burden is extremely important. Dr Yoshihiro Saito, Faculty of Nursing, Reiwa Health Sciences University, Japan, is leading a team working to develop and validate a self-esteem improvement programme designed for family caregivers of those with dementia. The project was inspired by Saito experiencing firsthand the stresses placed on family carers of people with dementia. The goal of the programme is to reduce the self-blame of dementia family caregivers and is informed by Saito’s expertise in cognitive behavioural therapy. A key part of the programme is self-compassion in order to help caregivers realise their worth. Ultimately, the aim is that, through the programme, caregivers can be kinder to themselves and realise the value and significance of their efforts. Alongside heading up this project, Saito is a supervisor for the Cognitive Behavioural Therapy Training Programme of the Ministry of Health, Labour and Welfare in Japan, focusing on popularising cognitive behavioural therapy and training the next generation. In this role, he listens to and reviews recordings of cognitive behavioural therapy sessions, providing practical advice. In the context of Japan’s ageing population, there will be an increase in people with dementia and family caregivers. Therefore, Saitoâ–™s work will be hugely beneficial in assisting those with dementia, caregivers and society.

The development of the psychoanalytic psychotherapy process with a depressed adolescent: an empirical case study

ABSTRACT This paper explores the psychotherapy process in a short-term psychoanalytic treatment (STPP) with a depressed adolescent. The empirical case study draws on both quantitative and qualitative data to examine the development of the psychotherapy process over time. 15 of the 29 audio recorded therapy sessions with a 16-year-old boy were sampled at intervals across the treatment. Session transcripts were coded using the Adolescent Psychotherapy Q-Set (APQ) and data analysed descriptively to compare characteristics of the process across the three treatment phases – beginning, middle, and ending. Descriptive statistics are supported with session extracts. Analysis of the APQ data suggests change in the patient’s presentation across the therapy. In the early stages, he appeared withdrawn and made minimal responses to the therapist’s attempts to work together; in the middle phase, he became more engaged, more able to talk about feelings, and more active in the sessions; and this was reflected in a less depressed presentation in the final phase. The therapist maintained a consistent therapeutic approach across all phases: supportive, non-judgemental, and working to make sense of the young person’s experiences, looking for patterns and inviting curiosity about how things might be understood differently. Despite increased engagement in the therapy, depressive symptoms remained in the clinical range.

Should face-to-face in-person therapy be preserved for some clients with anxiety? Evaluation of Anxiety UK's psychological therapy services before and during the COVID-19 pandemic.

The COVID-19 pandemic initiated a mass switch to psychological therapy being delivered remotely, including at Anxiety UK, a national mental health charity. Understanding the impact of this forced switch could raise implications for the provision of psychological therapies going forwards. To understand whether the forced switch to remote therapy had any impact on outcomes, and if certain groups should continue to be routinely offered certain delivery modalities in future. Data were available for 2323 individuals who accessed Anxiety UK services between January 2019 and October 2021. Demographic data, baseline and discharge anxiety and depression symptoms, and mode of therapy delivery were available.Regression models were built to model (a) the mode of therapy delivery received pre-pandemic using logistic regression, and (b) outcomes pre- and post-pandemic onset within demographic groups. No statistically significant changes in baseline anxiety symptoms, demographics or outcomes were observed before and after the onset of the COVID-19 pandemic.Pre-pandemic, males were more likely to receive online video therapy than telephone therapy (Relative Risk Ratio (RRR) 1.42, [1.01, 1.99]), while older clients were less likely to receive online video therapy (RRR 0.98, [0.97, 0.99]). However, no differences in outcomes were observed post-pandemic onset within these groups, with only the number of sessions of therapy being a significant predictor of outcomes. Anxiety UK services remained effective throughout the pandemic. We observed no evidence that any demographic group had worse outcomes following the forced switch to remote therapy.

Predictors of Outpatient and Inpatient Service Utilization Among Publicly-Insured Youth With Eating Disorders.

Although eating disorders (EDs) affect youth from all socioeconomic backgrounds, little is known about the treatment experiences of under-resourced youth with EDs. To address this gap, we examined patterns of outpatient and inpatient service utilization among publicly-insured youth with EDs in California and potential disparities for youth with additional marginalized identities. Participants were identified from the full sample of California Medicaid/Medi-Cal beneficiaries aged 7-18 with ≥ 1 service episode between January 1, 2014 and December 31, 2016. Claims data were extracted for youth with a full year of claims after the first known ED diagnosis (N = 3311) to analyze outpatient mental health, outpatient medical/physical, inpatient mental health, and inpatient medical/physical service use across ED diagnosis and demographic characteristics (sex, age, race/ethnicity, and preferred language). Outpatient individual and family therapy service utilization was low across ED diagnoses (4-7 individual therapy sessions and ≈5 family therapy sessions annually). Conversely, hospitalization rates were high, particularly among youth with anorexia nervosa (27.8%) and bulimia nervosa (30.0%). Youth with other specified feeding or ED had high medical service utilization, with more days of outpatient medical care and greater odds of medical hospitalization than youth with all other diagnoses. Latinx youth, Black youth, and boys tended to receive fewer services after accounting for diagnosis, with disparities particularly pronounced for Latinx youth. Publicly-insured youth with EDs in California experience high hospitalization rates but receive limited outpatient therapy. Additional research is needed to identify possible unmet needs and factors contributing to treatment disparities among these youth.

Effects of hyperbaric oxygen therapy on recovery after a football match in young players: a double-blind randomized controlled trial.

Football is a physically demanding sport that requires effective recovery strategies to maintain performance level and prevent injuries. This study investigated if a single 1-h hyperbaric oxygen therapy (HBOT) session affects recovery and performance after a football match in elite youth players. Twenty elite youth football players (age 17.3 ± 0.5 years) were randomly assigned to a HBOT group or a control group (CON). They played a 90-min football game and underwent either a 60-min HBOT or placebo intervention. Before (T1), at the end of the match (T2), 1 h after HBOT or CON session (T3), and 12 h after HBOT session (T4), subjects underwent biochemical (serum samples (myoglobin (MB), creatine kinase (CK), lactate dehydrogenase (LDH), alanine aminotransferase (ALT), and aspartate aminotransferase (AST)) and performance measurements (linear speed at 5 m, 10 m and 20 m, squat jump (SJ), countermovement jump (CMJ) and countermovement jump with arm swing (CMJa)). The Hooper Index (HI) was collected and heart rate was measured during the game. The football match induced significant increases in all biochemical markers, but no significant differences were found between the HBOT and control group in biochemical or performance parameters at any time point. However, there was a significant interaction effect between time and group for HI (p = 0.012, η2 = 0.124), with the HBOT group showing significantly lower HI values (8.6 ± 2.41) than the control group (11.0 ± 3.23) at 1 h post-HBOT. A single 1-h session of HBOT did not significantly affect recovery or performance parameters in elite youth football players, though it did show a moderate positive affect on the HI at 1 h post-HBOT. Further studies should explore the impact of either longer or sequential HBOT sessions on recovery.

Comparative Study of Two Semi-Occluded Vocal Tract Protocols: A Randomized Clinical Trial.

Semi-occluded vocal tract exercises (SOVTEs) are widely used as a therapeutic tool to create flow resistance in the upper airway. The current study was a randomized controlled clinical trial to establish the efficacy of two SOVTE protocols, flow-resistant tube (FRT) and Lessac-Madsen Resonant Voice Therapy (LMRVT). Exploratory investigations included a noninferiority analysis of FRT to the widely adopted therapy protocol (LMRVT), as well as examining the dosing required to improve acoustic measures and subjective ratings. Sixty-seven participants with voice disorder were randomized into one of five groups: 4-week FRT (n = 14), 8-week FRT (n = 19), 4-week LMRVT (n = 15), 8-week LMRVT (n = 5), and control (n = 14). Voice Handicap Index (VHI) and Vocal Fatigue Index scores were collected pre- and posttreatment. Acoustic analysis using the Acoustic Voice Quality Index was completed. We compared VHI between controls and 8-week FRT and LMRVT, adjusting for pre-VHI using linear regression. We examined the efficacy of 4-week protocols relative to controls and conducted a noninferiority comparison of FRT (4 and 8 weeks) to LMRVT (4 and 8 weeks) using 5- and 10-point margins. Finally, we compared the 4- versus 8-week sessions for both therapies. A statistically significant reduction of VHI in both 8-week FRT relative to controls (-10.60, 95% CI [-19.80, -1.40], p = .025) and 8-week LMRVT (-15.74, 95% CI [-29.40, -2.08], p = .025) was found. We also found an improvement in 4-week FRT relative to controls (-10.11, 95% CI [-20.03, -0.20], p = .046), but the 4-week LMRVT result was not statistically significant (p = .057). FRT was found to be noninferior to LMRVT in terms of VHI using a 10-point margin (FRT - LMRVT: 0.69, 95% CI [-5.76, 7.15], p = .01), but not using a 5-point margin (p = .054). There were no statistically significant differences in VHI scores between 4- and 8-week sessions for either therapy. Both FRT and LMRVT improved VHI scores relative to controls. FRT was noninferior to LMRVT in terms of VHI scores. There were no statistically significant differences in VHI scores between 4- and 8-week therapy sessions.