Significant Effect Size Research Articles

Change in Insomnia and Depressive Symptoms During COVID-19: A Prospective Longitudinal Study of Iranian Women with Multiple Sclerosis

ABSTRACT Background There is some evidence that sleep patterns and psychological health have worsened in the general population as a result of the COVID-19-pandemic. Persons with multiple sclerosis (MS) represent a particularly vulnerable population for COVID-19 infections and effects of restrictions. The present study investigated whether insomnia and depressive symptoms, as well as other MS-related symptoms (i.e. fatigue and paresthesia), changed from before to during the COVID-19-pandemic among persons with diagnosed MS. Method A sample of 90 Iranian females with MS (mean age; 37.62 years; median EDSS score: 2.5) completed a series of self-rating scales at two time points: Nine months before the COVID-19 outbreak in May 2019 (baseline) and then again during the COVID-19 pandemic in May 2020 (study end). Self-rating questionnaires covered sociodemographic and disease-related information, insomnia, depressive symptoms, fatigue, and paresthesia. Results Depressive symptoms increased over time with a significant p-value and medium effect size. Symptoms of insomnia increased over time (significant p-value, but small effect size), while no significant changes were observed in fatigue and paresthesia (very small effect sizes). The only predictor for insomnia during the COVID-19 pandemic was insomnia before the COVID-19 pandemic; the only predictor for depressive symptoms during the COVID-19 pandemic was insomnia before the COVID-19 pandemic. Conclusions Overall, the COVID-19 pandemic and its related social restrictions had significant effects on symptoms of depression and insomnia in this sample of Iranian women with MS, but had no effect on fatigue and paresthesia.

Clinical Research Updates.

Clinical Research Updates.

Effect of breathwork on stress and mental health: A meta-analysis of randomised-controlled trials

Deliberate control of the breath (breathwork) has recently received an unprecedented surge in public interest and breathing techniques have therapeutic potential to improve mental health. Our meta-analysis primarily aimed to evaluate the efficacy of breathwork through examining whether, and to what extent, breathwork interventions were associated with lower levels of self-reported/subjective stress compared to non-breathwork controls. We searched PsycInfo, PubMed, ProQuest, Scopus, Web of Science, ClinicalTrials.gov and ISRCTN up to February 2022, initially identifying 1325 results. The primary outcome self-reported/subjective stress included 12 randomised-controlled trials (k = 12) with a total of 785 adult participants. Most studies were deemed as being at moderate risk of bias. The random-effects analysis yielded a significant small-to-medium mean effect size, g = − 0.35 [95% CI − 0.55, − 0.14], z = 3.32, p = 0.0009, showing breathwork was associated with lower levels of stress than control conditions. Heterogeneity was intermediate and approaching significance, χ211 = 19, p = 0.06, I2 = 42%. Meta-analyses for secondary outcomes of self-reported/subjective anxiety (k = 20) and depressive symptoms (k = 18) showed similar significant effect sizes: g = − 0.32, p < 0.0001, and g = − 0.40, p < 0.0001, respectively. Heterogeneity was moderate and significant for both. Overall, results showed that breathwork may be effective for improving stress and mental health. However, we urge caution and advocate for nuanced research approaches with low risk-of-bias study designs to avoid a miscalibration between hype and evidence.

Can a shoe-mounted IMU identify the effects of orthotics in ways comparable to gait laboratory measurements?

BackgroundFootwear and orthotic research has traditionally been conducted within laboratories. With increasing prevalence of wearable sensors for foot and ankle biomechanics measurement, transitioning experiments into the real-world is realistic. However wearable systems must effectively detect the direction and magnitude of response to interventions to be considered for future usage.MethodsRunScribe IMU was used simultaneously with motion capture, accelerometers, and force plates during straight-line walking. Three orthotics (A, B, C) were used to change lower limb biomechanics from a control (SHOE) including: Ground reaction force (GRF) loading rate (A), pronation excursion (A and B), maximum pronation velocity (A and B), and impact shock (C) to test whether RunScribe detected effects consistent with laboratory measurements. Sensitivity was evaluated by assessing: 1. Significant differences (t-test) and effect sizes (Cohen’s d) between measurement systems for the same orthotic, 2. Statistical significance (t-test and ANOVA) and effect size (Cohen’s d & f) for orthotic effect across measurement systems 3. Direction of orthotic effect across measurement systems.ResultsGRF loading rate (SHOE: p = 0.138 d = 0.403, A: p = 0.541 d = 0.165), impact shock (SHOE: p = 0.177 d = 0.405, C: p = 0.668 d = 0.132), pronation excursion (A: p = 0.623 d = 0.10, B: p = 0.986 d = 0.00) did not significantly differ between measurement systems with low effect size. Significant differences and high effect sizes existed between systems in the control condition for pronation excursion (p = 0.005 d = 0.68), and all conditions for pronation velocity (SHOE: p < 0.001 d = 1.24, A: p = 0.001 p = 1.21, B: p = 0.050 d = 0.64).RunScribe (RS) and Laboratory (LM) recorded the same significant effect of orthotic but inconsistent effect sizes for GRF loading rate (LM: p = 0.020 d = 0.54, RS: p = 0.042 d = 0.27), pronation excursion (LM: p < 0.001 f = 0.31, RS: p = 0.042 f = 0.15), and non-significant effect of orthotic for impact shock (LM: p = 0.182 d = 0.08, RS: p = 0.457 d = 0.24). Statistical significance was different between systems for effect of orthotic on pronation velocity (LM: p = 0.010 f = 0.18, RS: p = 0.093 f = 0.25).RunScribe and Laboratory agreed on the direction of change of the biomechanics variables for 69% (GRF loading rate), 40%—70% (pronation excursion), 47%—65% (pronation velocity), and 58% (impact shock) of participants.ConclusionThe RunScribe shows sensitivity to orthotic effect consistent with the laboratory at the group level for GRF loading rate, pronation excursion, and impact shock during walking. There were however large discrepancies between measurements in individuals. Application of the RunScribe for group analysis may be appropriate, however implementation of RunScribe for individual assessment and those including pronation may lead to erroneous interpretation.

The impact of metabolic control on cognition, neurophysiology, and well-being in PKU: A systematic review and meta-analysis of the within-participant literature.

Phenylketonuria (PKU) is a metabolic disease where Phenylalanine (Phe) rises much above normal levels. Cross-sectional and correlational studies provide valuable information on the importance of maintaining low blood-Phe to achieve good outcomes, but they may be confounded, at least partially, by differences in participant demographics. Moreover, the effect of Phe at older ages is difficult to ascertain because of strong associations between Phe levels across ages. Within-participant studies avoid confounding issues. We have reviewed these studies. We followed PRISMA guidelines to search the literature for studies reporting the impact of Phe changes within participants. Phe was either increased or decreased through diet relaxation/resumption or through pharmacological interventions. Forty-six separate articles reported, singly or in combination, results on cognition (N = 37), well-being (N = 22) and neurophysiological health (N = 14). For all studies, we established, in a binary way, whether a benefit of lower Phe was or was not demonstrated and compared numbers showing benefit versus a null or negative outcome. We then analyzed whether critical parameters (e.g., length of the study/condition for the change, size of Phe change achieved) influenced presence or absence of benefit. For a subset of studies that reported quantitative cognitive outcomes, we carried out a meta-analysis to estimate the size of change in cognitive performance associated with a change in Phe and its significance. There were significantly more studies with benefits than no benefits, both for cognitive and well-being outcomes, and a trend in this direction for neurophysiological outcomes. The meta-analysis showed a highly significant effect size both overall (0.55) and when studies with adults/adolescents were considered separately (0.57). There was some indication that benefits were easier to demonstrate when differences in Phe were larger and achieved across a longer period, but these effects were not always consistent. These results reinforce results from the literature by demonstrating the importance of lower Phe in children as well as in adolescents and adults, even when confounding factors in group composition are eliminated. The field would benefit from further studies where Phe levels are contrasted within-participants to ascertain how much Phe needs to be changed and for how long to see a difference and which measures demonstrate a difference (e.g., which cognitive tasks).

Empowering Women Entrepreneurs in Professional Education: Opportunities and Challenges

This study examines the factors influencing female entrepreneurship in the formation of educational enterprises, focusing on the impact of government policies and social and family support. The study uses correlational and retrospective analysis to examine the relationship between those factors. These are the women entrepreneurs most likely to start businesses in vocational education. The results reveal a significantly positive relationship between the implementation of government policies and the tendency of working women to start an educational career. Furthermore, the study highlights the critical role of social-family support and shows a statistically significant effect size on women entrepreneurs' development in this particular context. These data contribute valuable insights to policymakers and stakeholders that promote and support women's entrepreneurship in entrepreneurship education.

Really just a little prick? A meta-analysis on adverse events in placebo control groups of seasonal influenza vaccination RCTs.

The Corona pandemic and ongoing mass vaccinations raise the question of the nocebo mechanisms involved. Since immunization is usually administered to healthy people as a preventive health measure, adverse events (AE) following immunization are less accepted and could contribute to vaccine hesitancy. Assuming that vaccinees experience nocebo responses, the aim of this meta-analysis was to investigate the effect sizes of solicited adverse events (or assumed reactogenicity) reported in placebo groups in RCTs on seasonal influenza vaccination. Literature search via PubMed, Web of Science, and CENTRAL was conducted considering gray literature. Only RCTs with placebo groups using pharmacologically inert substances (like saline) were included. Quality was assessed using Cochrane Collaboration's Risk of Bias Tool. Effect sizes were estimated using a random mixed effects model based on k=31 studies covering 14,326 participants in placebo groups. Reported solicited AEs in placebo groups showed significant effect sizes of proportions (ESp). In k=13 analyzed placebo groups, 35% of the participants reported at least one solicited systemic AE (p=0.007). The most common particular solicited systemic AEs were headache (k=27; 17%; p=0.001), malaise (k=13; 12%; p=0.004), and hyperhidrosis (k=4; 12%; p<0.001) within one week after vaccination. The results show significant solicited AEs in placebo groups, indicating substantial nocebo responses after vaccination. Based on the fact that most vaccination programs include similar groups of healthy people, we expect that comparable nocebo effects occur during other campaigns. Health care professionals should be aware of the nocebo response and take action to prevent or decrease the burden of adverse events following immunization. Fear of side effects must be addressed early in order to diminish vaccine hesitancy. Prospero identifier: CRD42020156287, October 2019.

유아 양성평등교육 프로그램 메타분석

The purpose of this study was to provide basic data on the development of early childhood gender equality education programs. For this study, 15 individual studies related to the gender equality education program for young children in Korea were selected and 25 effect sizes were extracted. EXCEL and CMA programs were used for analysis, and the research results are as follows. It was confirmed that the overall effect size of the early childhood gender equality education program was a large effect size based on Cohen (1988). Looking at the effect size for each dependent variable, it was confirmed that all six dependent variables had a large effect size, and the difference according to the dependent variable was also significant. In addition, it was found that there was a significant effect size in four dependent variables: gender role stereotypes, gender role identification, gender equality consciousness, and gender role identity. Looking at the effect size according to the control variable, it was found that only the effect size according to the number of people in the experimental group had a significant difference. However, a significant large effect size was confirmed only when the number of people was 20 or less, 6 ~ 10 weeks in the period, 11 ~ 20 times in the number of times, and when the family connection included experience. Through this study, it was confirmed that the early childhood gender equality education program was very effective, suggesting that it is necessary to consider the difference between the dependent variable and the control variable in order to develop the program.

Sleep Problems, Social Anxiety and Stuttering Severity in Adults Who Do and Adults Who Do Not Stutter

Background: While there is sufficient evidence that children and adolescents who stutter reported more impaired sleep compared to children and adolescents who did not stutter, findings among adults who stutter (AWS) were scarce. Furthermore, stuttering is associated with issues related to verbal communication in a social context. As such, it was conceivable that AWS reported higher scores for social anxiety, compared to adults who do not stutter (AWNS). In the present study, we tested whether AWS reported higher sleep complaints compared to AWNS. We further tested whether scores for social anxiety and stuttering independently predicted sleep disturbances. Methods: A total of 110 AWS (mean age; 28.25 years, 27.30% females) and 162 AWNS (mean age; 29.40 years, 51.20% females) completed a series of self-rating questionnaires covering sociodemographic information, sleep disturbances and social anxiety. Adults with stuttering further completed a questionnaire on stuttering. Results: Compared to AWNS, AWS reported a shorter sleep duration, a lower sleep efficiency, higher scores for drug use in terms of sleep-promoting medications (significant p-values and medium effect sizes), and an overall higher PSQI score (significant p-values and large effect size), when controlling for age and social anxiety. Next, while p-values were always significant for subjective sleep quality, sleep disturbances, and daytime functioning, when controlling for age and social anxiety, their effect sizes were trivial or small. For sleep latency, the p-value was not significant and the effect size was trivial. Among AWS, higher scores for stuttering and older age, but not social anxiety, predicted higher sleep disturbances. The association between higher sleep disturbances and higher stuttering severity was greatest among those AWS with highest scores for social anxiety. Conclusions: When compared to AWNS, AWS self-reported higher sleep disturbances, which were associated with older age, and higher scores for stuttering severity, but not with social anxiety. Adults who stutter might be routinely asked for their sleep quality.

Systematic Review and Meta-Analysis of Damage Associated Molecular Patterns HMGB1 and S100B in Schizophrenia.

Immune system dysregulation is hypothesised to be central to the aetiopathogenesis of schizophrenia; however, the role of sterile inflammation remains unclear. Damage associated molecular patterns are key initiators of sterile inflammation and are detectable in peripheral blood. A defined systematic search of the Web of Science, PubMed, and Scopus was performed to identify adult case-control studies published between January 1990 and June 2022. Three studies consisting of 242 cases and 83 controls met inclusion for the systematic review and meta-analysis of HMGB1 while twenty-eight studies consisting of 1,544 cases and 1,248 healthy controls were included for S100B. A significant standardised mean difference in peripheral S100B and HMGB1 concentrations was detected between cases and controls. S100B subgroup analysis determined the largest significant effect size for unmedicated individuals diagnosed with schizophrenia. This study provides evidence that peripheral S100B and HMGB1 concentrations are elevated in individuals diagnosed with schizophrenia when compared with healthy controls. These results should be interpreted with caution as significant heterogeneity was present during meta-analysis of S100B in the entire sample and in sub-group analysis. The persistence of significant heterogeneity throughout subgroup analysis indicates that the current diagnostic groupings may be a barrier to understanding human behaviours and emotions.

Dysphagia treatments in Parkinson's disease: A systematic review and meta-analysis.

The majority of patients with Parkinson's disease (PD) develop oropharyngeal dysphagia during the course of their disease. However, the efficacy of dysphagia treatments for these patients remains controversial. Therefore, we conducted this systematic review and meta-analysis to evaluate treatment efficacy based on the evidence from randomized controlled trials (RCTs). Five electronic databases were systematically searched from inception date to April 2022. Two reviewers independently extracted and analyzed the data. The outcome measures were changes in swallowing-related characteristics based on instrumental swallowing assessments. An initial search identified 187 RCT studies of relevance. After screening, nine studies with a total sample size of 286 were included in the meta-analysis. The pooled effect size for all dysphagia treatments compared with control comparators was significant and medium (SMD [95% CI]=0.58 [0.22, 0.94], p=0.001; I2 = 50%). Subgroup analysis revealed a significant and medium pooled effect size for stimulation treatments (brain stimulation, peripheral neurostimulation and acupuncture) (SMD [95% CI]=0.54 [0.15, 0.92]; p=0.006; I2 = 22%). Specifically, the effect sizes for the single RCTs on neuromuscular stimulation (SMD [95% CI]=1.58 [0.49, 2.86]; p=0.005) and acupuncture (SMD [95% CI]=0.82 [0.27, 1.37]; p=0.003) were significant and large. Our results showed that overall, dysphagia treatments, particularly stimulation treatments, can potentially benefit PD patients. However, given the limited number of small RCTs for each type of treatment, the evidence remains weak and uncertain. Further large-scale, multicenter RCTs are warranted to fully explore their clinical efficacy in the PD population.

Effects of a community-based substance use prevention program in Iranian adolescents (SUPPIA)-using social cognitive theory

ABSTRACT Objective This study aimed to develop and assess a tailored community-based intervention protocol for preventing substance use based on social cognitive theory in adolescents. Methods A tailored community-based substance use prevention intervention was undertaken with 140 boys and girls (14-18- years old) participating in the study in Isfahan, Iran. The intervention group attended eight 45-minute theory-based sessions based on social cognitive theory from 2018 to 2020. Data were analyzed 6, 18, and 24 months later by the SPSS.23 software. Results Social cognitive theory indicators, including positive outcome expectancies (p < .001, F = 25, ES = 0.34), negative outcomes expectancies (p < .001, F = 31.2, ES = 0.38), and self-efficacy (p < .001, F = 12.3, ES = 0.45) showed significant improvements at three stages (6, 18, and 24 months after intervention). The program also demonstrated significant but low effect size reductions in the incidence of cigarette (ES = 0.15), alcohol (ES = 0.05), and other drug use (ES = 0.01) in the intervention group among three follow-ups. Conclusion The results support the effectiveness of the community-based intervention program based on social cognitive theory in reducing the incidence of substance use among Iranian adolescents.

Agresivitas Pajak Terhadap Agresivitas Pelaporan Keuangan Dimoderasi oleh Book-Tax Confirmatory

The purpose of this study is to determine the effect of tax aggressiveness on the financial reporting aggressiveness in Indonesia because both practices are closely related to the profits presented in the financial statements where these financial statements are the center of attention for investors and the general public. In addition, there is a Book-Tax Confirmatory variable as a moderator of the relationship between the two which is allegedly able to create a trade-off and there is also a variable operating cash flow and company size. This study uses a sample of companies on the IDX during 2017-2021 with a purposive sampling method, with the results of tax aggressiveness and book-tax confirmatory having no effect on the financial reporting aggressiveness. However, another result obtained is that operating cash flow has a significant positive effect and company size has a significant negative effect on financial reporting aggressiveness.

A photoplethysmography-based system for talking detection in bedridden patients

Background and objectivesVerbal interaction may help bedridden patients to manage or prevent frustration, anxiety, and depression caused by the restrictions they find when performing daily living activities. In this regard, automatic monitoring of how long and often bedridden patients talk could help to identify who is at risk. A considerable body of work has focused on using sensing devices to capture and quantify speech events. However, such approaches may raise privacy concerns and produce discomfort. This study introduces a non-invasive, easy-to-deploy, and privacy-protective system based on photoplethysmography (PPG) to detect talking in bedridden patients. MethodRaw finger PPG signals were acquired from 36 participants who were lying in a bed for six minutes within which they were allowed to talk. We averaged six features extracted from PPG records and investigated statistically significant differences and effect sizes between silence and talking periods. Features showing statistically significant differences and moderate-to-high effect sizes were normalized to train a single perceptron and a binomial logistic regression. ResultsThe absolute amplitude, the pulse amplitude, and the interpulse interval of PPG waveforms decreased significantly with talking and showed moderate-to-high effect sizes. Using the abovementioned features, the perceptron and the logistic regression achieved classification accuracies of 88.89% and 94.12%, respectively. ConclusionsResults showed that it is possible to detect speech events in individuals with restricted mobility by tracking changes in the PPG signal's contour. Future work should aim to discriminate talking-driven effects on PPG signals during physical activity and establish validation criteria for correctly identifying speech events.

Quality of observational studies of clinical interventions: a meta-epidemiological review

BackgroundThis meta-epidemiological study aimed to assess methodological quality of a sample of contemporary non-randomised clinical studies of clinical interventions.MethodsThis was a cross-sectional study of observational studies published between January 1, 2012 and December 31, 2018. Studies were identified in PubMed using search terms ‘association’, ‘observational,’ ‘non-randomised’ ‘comparative effectiveness’ within titles or abstracts. Each study was appraised against 35 quality criteria by two authors independently, with each criterion rated fully, partially or not satisfied. These quality criteria were grouped into 6 categories: justification for observational design (n = 2); minimisation of bias in study design and data collection (n = 11); use of appropriate methods to create comparable groups (n = 6); appropriate adjustment of observed effects (n = 5); validation of observed effects (n = 9); and authors interpretations (n = 2).ResultsOf 50 unique studies, 49 (98%) were published in two US general medical journals. No study fully satisfied all applicable criteria; the mean (+/−SD) proportion of applicable criteria fully satisfied across all studies was 72% (+/− 10%). The categories of quality criteria demonstrating the lowest proportions of fully satisfied criteria were measures used to adjust observed effects (criteria 20, 23, 24) and validate observed effects (criteria 25, 27, 33). Criteria associated with ≤50% of full satisfaction across studies, where applicable, comprised: imputation methods to account for missing data (50%); justification for not performing an RCT (42%); interaction analyses in identifying independent prognostic factors potentially influencing intervention effects (42%); use of statistical correction to minimise type 1 error in multiple outcome analyses (33%); clinically significant effect sizes (30%); residual bias analyses for unmeasured or unknown confounders (14%); and falsification tests for residual confounding (8%). The proportions of fully satisfied criteria did not change over time.ConclusionsRecently published observational studies fail to fully satisfy more than one in four quality criteria. Criteria that were not or only partially satisfied were identified which serve as remediable targets for researchers and journal editors.

PP19 Reimbursable Health Apps (DiGA) In Germany: Which Factors Impact The BfArM’s Assessment And Directory Listing? – Updated Research

IntroductionSince May 2020, reimbursement can be requested for Digital healthcare applications (DIGAs) in Germany. The prerequisite for reimbursement is a listing in the Federal Institute for Drugs and Medical Devices (BfArM) DiGA-directory, granted after successful completion of an assessment process. In June 2021, IQVIA first evaluated the BfArM’s decision-making and identified criteria that may positively impact a directory listing. In November 2021, the research was updated to consider the latest developments.MethodsPublished information for each app in the DiGA-directory was qualitatively compared according to pre-specified criteria by two independent reviewers. With no data available for denied apps, only DiGAs with permanent or preliminary listings were compared.ResultsBy 26 November 2021, twenty-four apps had received a positive assessment. Permanently listed apps (n=6) focused on health status improvements and/or patients’ health competency. None claimed to improve patients’ quality of life. Results from at least one randomized controlled trial (RCT) showed efficacy with medium or strong significant effect sizes (Cohen’s d &gt; 0.4) versus standard of care (SOC). For preliminarily listed DiGAs (n=18), final results of positive care effects were not yet provided, but applications included study designs for RCTs including definitions of primary endpoints. The BfArM accepted the trial designs to be suitable to measure an app’s positive effects on health care within twelve months after listing. Since the last analysis, no preliminarily listed apps have been granted permanent DiGA-status. Evaluation periods were extended by up to five months for three apps. With none of the trials for preliminary apps being completed, possibilities for assessment remain limited. Claims for either medical benefit and/or patient-relevant structural/procedural improvements do not seem to impact the type of listing.ConclusionsUpdated research confirmed previous findings. For a DiGA-directory listing DiGA, the (planned) provision of RCT data seems to be gold standard. Medium to strong effects on the improvement of health status compared to SOC appear to be important for a permanent listing. Evaluation periods of five preliminarily listed apps are expected to be completed in December 2021, allowing for further analyses in the future.

Pilates and improvement of balance and posture in older adults: A meta-analysis with focus on potential moderators

• Pilates training improves balance in older adults, but changes seem to be more consistent in dynamic than static balance. • Favorable adaptations in posture are less convincing due to the limited quantity of trials producing significant effect sizes. • Study quality moderated the effects on dynamic balance, with greater effect sizes reported by poorer quality trials. • Greater training volumes (duration x number of sessions) produced higher effect sizes for changes in dynamic balance and posture. The moderators of Pilates training on balance and posture in older individuals are unclear. We investigated through meta-analysis the effectiveness of Pilates to improve the balance and posture of older individuals and examine potential moderators of those effects. Electronic databases were searched by multiple reviewers until September 30th, 2021 to locate articles published in English, Spanish or Portuguese. Qualifying trials included adults aged ≥60 y and measured static/dynamic balance or posture pre-post intervention. Data on study design, sample characteristics, and features of Pilates interventions were tested as moderators of balance and posture outcomes. Twenty-seven trials included 1,017 individuals (69.2±4.7 y). Overall, sessions of 58.2±8.6 min were performed 2.1±0.5 d/wk for 12.3±9.7 wk. Information on loads was often imprecise. The effect sizes (ES) in controlled vs. uncontrolled trials were: static balance ( k =13, ES 0.270, 95% confidence interval [CI] 0.182-0.358 vs. k =4, ES 0.284, CI 0.155-0.413); dynamic balance ( k =14, ES 0.714, CI 0.428-1.000 vs. k =4, ES 0.648, CI (-0.008-1.303); posture ( k =2; ES 0.311, CI -0.106-0.729 vs. k =5, ES 0.349, CI 0.240-0.458). Trials with lower methodological quality as reflected by the median of TESTEX inventory produced greater ES for dynamic balance (ES 0.928 vs. 0.523; p<0.05). Greater training volumes (duration x number of sessions) increased ES of dynamic balance (ES 0.743 vs. 0.715) and posture (ES 0.422 vs. 0.176), the opposite occurring for static balance (ES 0.237 vs. 0.405) (p<0.05). Pilates seems to improve static and dynamic balance in older adults, while data on posture are less convincing. Poor study quality may overestimate the effects on dynamic balance. Greater training volumes appear to favor improvements in dynamic balance and posture.

Effect of attentional focus on squats on lactate production and rating of perceived exertion in trained men

The aim of this study was to investigate the effect of internal focus (IF) and external focus (EF) on lactate production and the perception of perceived exertion in the squat in strength trained-men. Methods: Thirteen men with experience in strength training (age =22.61 ± 1.19 years; height = 180 ± 6.55 cm; body mass = 79.38 ± 5.57 kg; BMI = 24.56 ± 2.11 kg·m-2; Squat = 129 ± 20 kg) performed two sessions, separated by one week, comprising 3 sets of 10 repetitions of the back squat with one minute of rest between sets. During the IF protocol participants were instructed to focus on tightening the quads during all repetitions, while participants in the EF were instructed to focus on lifting the barbell. Blood lactate samples were collected before and at immediately after each of the 3 sets, as well as 15 minutes after the last set. Additionally, the rating of perceived exertion (RPE) was evaluated using the OMNI-RES scale immediately after the completion of each session. Results: Significant increases were found in the IF protocol at the end of each of the 3 sets, with significant effect sizes (1ª set, P= .000, d= 2.66; 2ª set, P= .000; d= 3.14; 3ª set, P= .000, d= 3.50), as in the EF protocol (1ª set, P= .001, d= 2.24; 2ª set, P= .000, d= 3.35; 3ª set, P= .000; d= 3.67). However, there were no significant inter-group differences between pre and any set (1ª set, P=0.951, d=0.03; 2ª set, P=0.239, d=0.47; 3ª set, P=0.435, d=0.31, respectively). Additionally, the perceptions on the RPE scale were higher in the FI (P= 0.032; d = 0.47). Conclusions: Findings suggest that the application of IF may indirectly contribute to muscle hypertrophy in multi-joint lower limb exercises, due to the increase in RPE values and the existing correlation with lactate production. Keywords: Mind-muscle, muscle hypertrophy, internal focus, mind-muscle connection, resistance training

Race, racial matching, and cultural understanding as predictors of treatment engagement in youth mental health services

Objective This study examined the role of youth race, youth-therapist racial matching, and youth-reported therapist cultural understanding on early treatment engagement in mental health services. Method The sample included 1158 youths and 126 therapists. Approximately four weeks after the first therapy session, youths responded to a survey assessing five engagement dimensions. Cultural understanding was assessed by asking youths to rate within that questionnaire the extent their therapist “understands their culture and values.” Three multivariate multiple regression models were conducted to assess the associations of race, racial matching, and cultural understanding with treatment engagement. Results Youth race and racial matching were not significant predictors of treatment engagement, whereas youth-reported therapist cultural understanding was a significant predictor of engagement. Cultural understanding had the highest average effect size across all treatment engagement dimensions (ηp 2 = .36) compared with youth race (ηp 2 = .00) and racial matching (ηp 2 = .00). Race was examined as a moderator of the effects of racial matching and cultural understanding on treatment engagement and did not yield significant effect sizes. Conclusions Findings suggest that increasing therapists’ cultural understanding of their youth clients may be a promising strategy for engaging youths early in mental health services.

Efficacy of computer- and/or internet-based cognitive-behavioral guided self-management for depression in adults: a systematic review and meta-analysis of randomized controlled trials

BackgroundDepression is a worldwide disease. CBT-based self-help treatment allows patients with mild to moderate depression symptoms to improve their depression or to bridge the waiting- or pandemic period until they receive further clinical treatment.ObjectiveThis systematic review and meta-analysis aims to explore the efficacy, acceptability and improvement in quality of life of computer-delivered and/or internet-based CBT self-help interventions with minimal guidance (up to 10 min) for depression. The second aim was to compare the effectiveness of reducing depression symptoms at post-treatment of treatment by the type of minimal guidance: (1) e-mail, (2) telephone calls, (3) e-mail and telephone together, or (4) face-to-face.MethodsThe Cochrane depression, anxiety, and neurosis review group’s specialized register electronic searches, grey literature, reference lists and correspondence were used to search for published and unpublished RCTs that reported efficacy of computer- and/or internet-based CBT self-help treatments for depression with minimal guidance up to 10 min per week. Methodological quality of included studies was evaluated with Cochrane Collaboration tools for assessing risk of bias. The meta-analysis was accomplished using the RevMen software.ResultsIn total, 2809 study abstracts were checked for eligibility. Out of these, 19 studies (21 samples) with a total of 3226 participants were included. The results showed that concerning efficacy, the treatment group is superior to the control group with a medium to large effect size of 0.65. Also, treatment groups with combined guidance by e-mail and telephone calls together had greater effects (SMD -0.76) than groups with other types of minimal guidance (guided by e-mail SMD -0.63; guided face to-face SMD – 0.66; guided by telephone calls SMD -0.49). Findings showed also, that iCBT with minimal guidance had small but statistically significant effect size of 0.28 in improving quality of life. Moreover, there were higher drop-out rates in the treatment condition (RR 1.36) than in the control groups.ConclusionsThe results of this meta-analysis support the efficacy of computer- and/or internet-based CBT self-help programs with minimal weekly guidance up to only 10 min for improving depression symptoms at post-treatment for adults.In addition, the results are pointing towards two practical implications. Firstly, depressed persons can use self-help treatment with minimal guidance at home to improve their symptoms or to bridge the waiting time – or pandemic period – before they receive professional face-to-face treatment. Secondly, it can help clinicians to make the decision about using CBT-based self-help treatments for patients that do not need urgent professional treatment, or to combine it with face-to-face therapy.