Step Approach Research Articles

The Sinclair method: The need for integrated and holistic approaches in alcohol treatment and recovery

The world’s consumption of alcohol per capita in 2016 among male and female drinkers worldwide was on average 19.4 litres of pure alcohol for males and 7.0 litres for females, and three million deaths worldwide are attributable to alcohol each year. The pathology of alcoholism and addiction has been a source of medical and psychological interest for nearly two centuries. This article provides a summary of genetic and neurobiological research, along with a comparison of a variety of treatment methods employed including the 12-step abstinence program, holistic approaches, and modern advances of pharmacotherapy interventions, such as the Sinclair Method.

Outcomes of intravitreal dexamethasone implant (Ozurdex®) in patients with post-surgical macular edema – a real-world scenario

BackgroundClinically significant macular edema (CME) is the leading cause of visual loss after ophthalmologic surgery due to the release of inflammatory mediators promoted by the procedures. We aimed to evaluate the outcomes of intravitreal Ozurdex® (700 µg dexamethasone) implants as a primary therapeutical option for post-surgical macular edema cases.MethodsPatients with post-surgical macular edema diagnosed by optical coherence tomography (Cirrus SD-OCT) and treated with Ozudex were selected for the current study. Data was retrospectively collected from medical records from January 2020 to December 2022 and included sex, age, laterality, and timeline of treatment (i.e. implant alone or at the time of silicon oil removal in cases requiring vitreorretinal surgery). Complications associated with treatment were also noted as well as the need of further treatments. The structural analysis focused on measuring central macular thickness (CMT—average thickness within the 1 mm circle of the ETDRS) from the internal limiting membrane to the Bruch’s membrane complex, as well as the average total macular thickness including parafoveal and perifoveal regions determined by the device (CAT). The functional evaluation was based on the best-corrected visual acuity (VA) measured in logMAR.ResultsA total of 46 participants were included (56.2% males, mean age: 60.9 ± 11.2 years old). A statistically significant change was observed in the postoperative versus the preoperative period for all parameters (p < 0.05). The mean VA difference was − 0.17 ± 0.24; CMT was − 109.22 ± 124.85 and CAT was − 14.76 ± 58.95. We observed a significant effect of the moment of Ozurdex implantation on VA improvement, so that cases with implantation at the time of oil removal showed lower improvement than cases with implantation at a distinct timing (Coef. 0.19, 95%CI: 0.02 to 0.36, p = 0.027). Eleven cases (23.9%) required further treatment such as new Ozurdex implantation (8 cases) or surgery (3 cases). Only one case (2.17%) showed increased intraocular pressure and underwent glaucoma surgery.ConclusionsIntravitreal Ozurdex implants significantly improved functional and structural aspects in post-surgical macular edema. The timing of implantation influenced VA improvement, with a distinct step approach showing better outcomes than at the time of oil removal.

The group as higher power: Analyzing the spiritual model of the 12-Step program

ABSTRACT The 12-Step program remains the most prolific avenue for addiction recovery. The program is resourced by a model of spirituality that centers the personal experience and belief of the individual within a larger context of mutual support, thus locating a personalistic spiritual quest within a framework for social cohesion. Despite the program’s prolific reach and apparent effectiveness, however, critical attention has not been given to how the 12-Step model of spirituality relates to, and illuminates, broader trends in spirituality-religion in late modernity. The program’s model arose in response to the pressures of secularization, drawing mutually on Jamesian analyses of spirituality-religion and the revivalist subculture of American evangelicalism. The enduring problems related to holding these influences in tension offer insight into the kinds of ‘spiritual but not religious’ models that were, in part, vitalized by the 12-Steps. Examining the program’s model of spirituality, both historical and contemporary, demonstrates that its success lies in its capacity to nurture community and shared purpose while promoting a relativistic approach to belief, thereby underscoring how belief in a ‘Higher Power’ can be de-centered, while not wholly discarded, in meaningful models of spiritual community.

Quality management system in the Microbiology Laboratory…Step by Step approach

Quality management system in the Microbiology Laboratory…Step by Step approach

The moral voice in addiction and the self.

The robust literature on moral psychology research has often overlooked people struggling with addiction, partly due to social, theoretical, and methodological biases. This has created a gap in understanding the role of moral thinking and its influence on addiction and recovery. To address this, our hermeneutic phenomenological study, the first in a series, explores the moral voice of individuals contending with addiction. The study interviewed 34 male participants from various ethnical backgrounds and ages with substance and behavioral addictions using semi-structured methods, focusing on factors shaping their moral thinking and behavior. The findings highlight that moral thinking is central to individuals with addiction, yet it fails to regulate behavior due to conflicting addictive drives, and its presence during active addiction can hinder recovery efforts. This misalignment often leads to tormenting internal conflict and a detrimental effect on both self and others. Participants attempted to establish a modus vivendi (a manner of living) but often failed, resulting in covert moral schemas that complicate their psychological states. This phenomenon, described as a moral spin, illustrates the complex interplay between addiction and morality. To address rebuilding moral identity and recovery, we may support framing egocentrism positively through a self-compassionate moral inventory.

Menggali Makna Keadilan Gender Berbasis Kearifan Lokal Lio-Sikka; Upaya Mengurangi Kekerasan Terhadap Perempuan Di Sikka

Universally, cultural strength can be a locus in building the character of the Indonesian nation as a global society. Cultural diversity can be a primary source of strength in developing the implicit meanings within that culture, especially regarding gender justice, which has recently been experiencing degradation. Through this cultural potential, it is hoped to address the polemic of violence against women and be used as a subsystem in handling gender justice issues for the Women's Empowerment and Child Protection Office. Culture, as a system of values born from the womb of local culture, should be used as a reference for stakeholders in resolving the complex issues of gender justice. This research aims to delve deeper into gender issues from the perspective of local wisdom of the Lio-Sikka ethnic group. Additionally, it seeks to explore and interpret the meaning of gender justice perceived by Lio-Sikka customs. The research method used is descriptive qualitative with an ethnographic approach developed by Spradley. The data collection techniques include observation, interviews, and documentation. The main data sources were taken from traditional elders, community leaders, and the head of the Women's Empowerment Office in Sikka Regency. The data analysis technique used the 12-step method developed by Spradley. The research results show: that first, the reconstruction of gender justice from the perspective of the local wisdom of the Lio-Sikka ethnic group reveals several points, namely in the context of patriarchal ideology, social construction, women and marriage rituals, women and legendary stories. Second, the Meaning of Gender Justice in Relation to Lio-Sikka Customs includes, Ine Weta, Ama Laki (Mother as Protector, Father as Leader), Lelu wolo, ina tana (Father as Mountain, Mother as Earth), Embo wawa wolo, nggika wawa tana (Women Climb Mountains, Men Descend Valleys), Lela laku, ine eme (Father as Leader, Mother as Housekeeper), Nggaa nggipa, naja nggipa.

Bio-synthesis of TiO2 photocatalyst: a reduced step approach using leaf extract

ABSTRACT This study demonstrated the effectiveness of a green synthesis approach for TiO2, utilizing basil (Ocimum basilicum) leaf extract as a reducing agent. This method eliminated the need for additional precipitating agents and calcination in the preparation process. TiO2 was synthesized through traditional precipitation (TiO2–P) and biosynthesis with Holy Basil extract (TiO2–B), both resulting in anatase-phase TiO2 as the primary phase. FESEM images revealed that TiO2–P particles (200–250 nm) showed significant agglomeration, while TiO2–B particles were smaller. BET analysis indicated a higher specific surface area for TiO2–B (245.51 m2/g) compared to TiO2–P (19.55 m2/g), enhancing its suitability for photocatalytic applications. The band gap energies were determined to be 3.28 eV for TiO2–B and 3.35 eV for TiO2–P, with both exhibiting similar UV light responses. Photocatalytic testing revealed that TiO2–B achieved 90.4% degradation of tetracycline (TC) within 120 min, outperforming TiO2–P, which achieved 73.0% under the same conditions. Kinetic analysis indicated that the reaction rate constant for TiO2–B (0.015 min−1) was twice that of TiO2–P (0.0075 min−1). Hydroxyl radical generation was also confirmed, and TiO2–B showed reusability over three cycles, highlighting its sustainability and effectiveness for environmental use.

Supporting Children's Mental Health Needs in Disasters.

Public health emergencies, including climate-related and manmade disasters such as active shooter incidents, occur regularly in the United States. A comprehensive approach is needed to ensure that children's mental health needs are adequately addressed following disasters. This article summarizes the latest evidence on how health systems can effectively address children's unique developmental, social, emotional, and behavioral needs in the context of disasters. To do so requires the integration of mental health considerations throughout all disaster phases, including preparedness, response, and recovery. We discuss the role of traditional emergency response systems and emerging models for responding to mental health crises. These include the national children's disaster mental health concept of operations and specific resources such as crisis lines, mobile crisis units, and telemental health. To achieve a broader reach in addressing children's mental health needs during disasters, health systems can foster a "pediatric disaster system of care" by partnering with community touch points such as schools, faith-based organizations, public health, and law enforcement. Unique considerations during disasters are required to maintain access to care for children with preexisting behavioral health conditions. During disasters, attention is needed to promote equitable identification of mental health needs and linkage to services, particularly for minoritized groups and children living in rural, frontier, and high-poverty areas. Strategies to address children's mental health needs during disasters include the provision of psychological first aid, screening for and triaging mental health needs, and stepped care approaches that progressively allocate higher-intensity evidence-based treatments to children with greater and enduring needs.

Cardiometabolic risk factors among thyroid cancer survivors

IntroductionThyroid cancer incidence has tripled in the last decades, resulting in a growing population of survivors. In addition to the risks associated with the cancer itself, cardiovascular disease represents a major cause of morbidity and mortality in thyroid cancer survivors. Our study aims to assess the frequency of cardiovascular and metabolic risk factors in thyroid cancer survivors (TCS).MethodsA cross-sectional analysis of thyroid cancer patients at Constantine’s University Hospital, Algeria (January 2021 to July 2022), used the WHO STEPS approach to assess risk factors. Cancer data were extracted from medical records.ResultsA total of 342 patients were included, of whom 88.9% were women. The mean age was 48 years (range 21–85), papillary thyroid cancer accounted for 82% of cases. The mean survival duration was 4 years (6 months to 32 years), and 74.5% of patients responded well to initial treatment. The current smoking rate was 2.6%, 7.5% of patients engaged in vigorous physical activity, and only 7.8% consumed more than 5 fruits or vegetables daily. At the study time, over 80.7% were overweight or obese, and 86% exhibited android obesity. Hypertension (48.8%), diabetes (27.5%), prediabetes (32.5%), dyslipidemia (77.5%), and metabolic syndrome (61.1%) were common. Factors associated with metabolic syndrome included a family history of obesity (OR) of 1.80 (1.08–3.02), age over 40 OR of 2.71 (1.63–4.51), overweight/obesity OR of 5.134 (2.68–9.84), and levothyroxine doses ≥ 125 µg/day OR of 2.480 (1.45–4.23).ConclusionCardiovascular and metabolic risk factors are prevalent in our population of thyroid cancer survivors.

Peyton’s Four- steps Approach Influence on Critical Nursing Students' Performance, Self-efficacy and Satisfaction Regarding Endotracheal Tube Suctioning.

Peyton’s Four- steps Approach Influence on Critical Nursing Students' Performance, Self-efficacy and Satisfaction Regarding Endotracheal Tube Suctioning.

Empirical Study: Brand Performance and Consumer Satisfaction as Determinants of Brand Switching

In the current era of globalization, where changes in technology and the flow of information are increasingly advanced and rapidly encouraging the emergence of competition in the business world, consumer needs are not limited to the main function that can be provided for a product (primary demand), but develop into secondary needs (secondary primary), namely the desire for a brand. The purpose of this research is to determine the influence of brand performance on brand switching on Gudang Garam (GG) cigarettes, to determine the influence of brand performance on the level of brand satisfaction on GG cigarettes and to determine the influence of the level of brand satisfaction on brand switching on GG cigarettes. The research variables are brand performance, brand satisfaction and brand switching and the variable measurement scale used in this research is an interval scale, while the variable measurement technique uses the semantic differential technique. The sample for this research was people who bought and consumed GG brand cigarettes in East Jakarta, totaling 110 respondents. Analysis technique using One Step Approach to SEM (Structural Equation Modeling). Based on the test results, the hypothesis which states that brand performance and the level of brand satisfaction has a negative influence on brand switching is proven to be significant, while the hypothesis which states that brand performance has a positive influence on brand switching is also proven to be significant.

From Batch to Continuous Flow Synthesis in Enzymatic Process Towards Molnupiravir.

Molnupiravir (1) is one among the limited therapeutic options for treating COVID-19 infection and exhibits pan-antiviral potency. Because of urgent demands during the COVID-19 pandemic, a number of methods were developed to offer more efficient routes. In this report, we present a facile 2-step and scalable synthesis of molnupiravir for batch processing and show the implementation of continuous flow biocatalysis to improve the efficiency in synthesis. Our key step entails immobilized lipase and isobutyric anhydride to facilitate regioselective esterification. In batch process, transamination of cytidine (2) provides N4-hydroxycytidine (NHC, 3) with 75 % yield followed by esterification of NHC to give molnupiravir with 64 % yield, providing 48 % overall yield and 99.98 % purity (HPLC). Compared to batch approach in the esterification step, the continuous flow process provides similar product yield and purity and highlights the advantages including 2.42-fold better productivity (mol/day), 2.47-fold improved reaction time, and 30-fold higher space-time-yield. The optimized batch and continuous flow biocatalysis enhance synthesis efficiency and reduce environmental impact, offering a sustainable approach for industrial molnupiravir production.

When math legitimizes knowledge: a step by step approach to Bayes’ rule in diagnostic reasoning

INTRODUCTION: Many mistakes in clinical practice arise from confusing the probability of a positive test in those with the disease and the probability of having the disease in those who test positive. This misunderstanding leads to overestimating disease probability, diagnosing diseases in healthy individuals, ordering invasive diagnostic tests, and prescribing unnecessary treatments, resulting in unjustified adverse effect, psychological stress, and increased cost. Probabilistic reasoning is an essential skill to mitigate this confusion, and Bayes theorem is an important tool to accomplish this goal. OBJECTIVE: To present a step-by-step demonstration of Bayes' formula for positive and negative predictive values, fostering understanding and enabling its adoption in evidence-based medicine education and clinical practice as a supporting tool in the decision-making process. METHODS: In this article, we explain the difference between deductive and inductive thinking and how diagnostic reasoning is predominantly inductive, where evidence (the test result) is used to predict the cause (the presence of disease), a path that involves reverse probability, for which our reasoning is hazier. Through a clinical example involving the diagnosis of systemic lupus erythematosus, we use the Bayesian framework as a tool to help understand the difference between sensitivity/specificity (forward probability; deductive) and positive/negative predictive values (reverse probability: inductive). CONCLUSIONS: Excellent doctors are masters at applying Bayesian reasoning without using any formulas: they understand that the most important component of the diagnostic process is the reasoning that originates it and the resulting clinical decision depends on interpreting results considering their interaction with the context, not in isolation. Bad clinical reasoning results in bad clinical decisions, despite how accurate the diagnostic test: garbage in, garbage out. We hope our step-by-step approach to Bayes' rule can help demystify this powerful statistical tool and strengthen the idea that the value of a diagnostic test is directly proportional to the quality of clinical reasoning that led to its request.

Reframing Powerlessness in the Addiction Recovery Process

Traditionally, addiction has been seen as a loss-of-control issue, marked by a subjective sense of powerlessness. However, a paradoxically positive perception of powerlessness exists, partly rooted in the 12-step program, though its scientific exploration and practical implications remain limited. This phenomenological study examined perceptions and experiences of powerlessness among individuals recovering from substance and behavioral addictions ( n = 31), family members ( n = 9), and therapists ( n = 9). The findings revealed a dialectical process leading to a reframing of powerlessness, with two main themes: (a) negative attributions of powerlessness and (b) the powerlessness reframing process. This study enriches the addiction recovery literature by emphasizing the importance of understanding and leveraging the positive aspects of powerlessness through a Positive Criminology lens. It addresses criticisms of narrow understandings and a lack of awareness of the foundational role of powerlessness in recovery and recommends tailored therapeutic interventions.

Protocol for a randomized controlled trial with a stepped care approach, utilizing PrEP navigation with and without contingency management, for transgender women and sexual minority men with a substance use disorder: Assistance Services Knowledge-PrEP (A.S.K.-PrEP)

BackgroundIn the United States, most (~ 70%) annual newly diagnosed HIV infections are among substance-using sexual minority men (SMM) and gender minority transgender women (trans women). Trans women and SMM are more likely to report or be diagnosed with a substance use disorder (SUD) than their cisgender or heterosexual counterparts and the presence of an SUD substantially increases the risk of HIV infection in both groups. Although Pre-Exposure Prophylaxis (PrEP) is highly effective, initiation, adherence, and persistence are exclusively behavioral outcomes; thus, the biomedical benefits of PrEP are abrogated by substance use. SUD is also associated with reduced quality-of-life, and increased overdose deaths, utilization of high-cost healthcare services, engagement in a street economy, and cycles of incarceration.ObjectiveTo determine the optimal (considering efficacy and cost-effectiveness) strategy for advancement along the PrEP Care Continuum among trans women and SMM with an SUD.MethodsThis study will implement a randomized controlled trial, evaluating two Stepped Care approaches involving A.S.K.-PrEP vs. standard of care (SOC) to determine optimal intervention strategies for trans women and SMM with an SUD (N = 250; n = 83 trans women; n = 167 SMM) for advancement along the PrEP Care Continuum. Participants will be randomized (3:1) to Stepped Care (n = 187) or SOC (n = 63). Participants in the Stepped Care arm will be assessed at 3-months for intervention response; responders will be maintained in A.S.K.-PrEP, while non-responders will receive added attention to their SUD via Contingency Management (CM). Non-responders will be re-randomized (1:1) to either (a) receive A.S.K.-PrEP + CM, or (b) shift the primary focus to their SUD (CM alone).ResultsRecruitment and enrollment began in May 2023. Recruitment will span approximately 36 months. Data collection, including all follow-up assessments, is expected to be completed in April 2027.DiscussionTrans women and SMM with an SUD have the two highest HIV prevalence rates in the United States, which underscores the urgent need for effective measures to develop scalable behavioral interventions that can encourage advancement along the PrEP Care Continuum. To improve public health, researchers must identify scalable and cost-effective behavioral interventions to promote PrEP initiation, adherence, and persistence among trans women and SMM who use substances.Trial registrationThis trial has been registered at ClinicalTrials.gov under the number NCT05934877.

Success rate and predictors of return to work after implementation of a formal return-to-work trajectory: A retrospective cohort study.

Long term sick leave (SL) is increasing in Europe, several countries have legislative initiatives to reduce long-term absenteeism. We evaluated the impact of a legally defined return-to-work (RTW) trajectory on the RTW of employees on sick leave in Belgium. This was a retrospective register-based cohort study of employees (n = 1416) who followed an RTW trajectory in 2017. We linked workers' data from a prevention service with social security data. By multinomial logistic regression, we analysed which characteristics predicted the RTW with the same or another employer. One year after their RTW trajectory, 69.2% of the 1416 employees did not RTW; 10.7% returned to work with the same employer and 20.1% with a new employer. Duration of SL was an important predictor for the RTW with both the same employer and another employer. The odds of RTW were lower when the SL duration was > 6 months compared to < 6 months. Marital status, organization-size, and the occupational physician decision had a significant impact on the RTW with the same employer. Age and who initiated the RTW-trajectory were important predictors on the RTW with another employer. Overall, 30.8% of employees returned to work after their RTW trajectory. A one-size-fits-all approach is not recommended. A stepped approach with an early, informal start of the RTW process is advised. When employees or employers fail to initiate the RTW on their own, a legally defined RTW trajectory could be useful. In particular, RTW with another employer seemed a positive effect of the RTW-trajectory.

Facets of mindfulness are associated with inflammation biomarkers in a sample of sexual minority men with HIV

ABSTRACT Sexual minority men (SMM) are disproportionately impacted by HIV and thus, HIV related-health complications. HIV has been linked to earlier onset of multi-morbid chronic diseases and declines in physical and cognitive functioning attributable to chronic HIV immune activation and resulting inflammation. Inflammation has been targeted with mindfulness-based interventions (MBIs); however, hypothesized negative associations between mindfulness and inflammation need to be confirmed in SMM with HIV. This is a secondary data analysis of baseline data from a randomized clinical trial (RCT) of SMM living with HIV with biologically confirmed recent methamphetamine use (ARTEMIS). Mindfulness was assessed with the Five Factor Mindfulness Questionnaire (FFMQ). Inflammation was assessed via cytokines interleukin-6 (IL-6) and tumor necrosis factor-alpha (TNF-α). Separate adjusted (for age, viral load, CD4 count, and methamphetamine use) regression models evaluated associations between four facets of mindfulness (description, awareness, non-judgement, and non-reactivity) with IL-6 and TNF-α. The average age of the participants was 43.86 (SD = 8.95). Both description (b = .54, se = .24) and awareness (b = .50, se=.23) were positively associated with IL-6. All other associations between mindfulness and inflammation were non-significant in adjusted models. There was also some evidence to suggest that engagement in care moderated associations between description and non-reactivity with IL-6 (ΔR 2 = .03, F = 3.64), such that description and non-reactivity were each positively associated with inflammation among those who attended <100% of primary care appointments (b = 1.04, se=.34 and b = 1.23, se=.39, respectively), but was not associated with inflammation among those who attended 100% of appointments (b =.16, se=.32 and b=-.17, se=.40, respectively). There was also a significant interaction between 12-step program attendance and awareness with IL-6 (ΔR2= .03, F = 4.26), such that awareness was positively associated with inflammation among those who attended 12-step programming (b = 1.25, se = .41), but not associated with inflammation among those who did not (b = .22, se = .28). Further research is needed to understand how and under what circumstances mindfulness is associated with pro- versus anti-inflammatory processes.Trial Registration: NCT01926184.

Application of Convolutional Neural Networks to time domain astrophysics. 2D image analysis of OGLE light curves

In recent years the amount of publicly available astronomical data has increased exponentially, with a remarkable example being large-scale multiepoch photometric surveys. This wealth of data poses challenges to the classical methodologies commonly employed in the study of variable objects. As a response, deep learning techniques are increasingly being explored to effectively classify, analyze, and interpret these large datasets. In this paper we use two-dimensional histograms to represent Optical Gravitational Lensing Experiment phasefolded light curves as images. We use a Convolutional Neural Network (CNN) to classify variable objects within eight different categories (from now on labels): Classical Cepheid, RR Lyrae, Long Period Variable, Miras, Ellipsoidal Binary, Delta Scuti, Eclipsing Binary, and spurious class with Incorrect Periods (Rndm). We set up different training sets to train the same CNN architecture in order to characterize the impact of the training. The training sets were built from the same source of labels but different filters and balancing techniques were applied. Namely: Undersampling, Data Augmentation, and Batch Balancing (BB). The best performance was achieved with the BB approach and a training sample size of ~370 000 stars. Regarding computational performance, the image representation production rate is of ~76 images per core per second, and the time to predict is ~60 μs per star. The accuracy of the classification improves from ~92%, when based only on the CNN, to ~98% when the results of the CNN are combined with the period and amplitude features in a two step approach. This methodology achieves comparable results with previous studies but with two main advantages: the identification of miscalculated periods and the improvement in computational time cost.

Towards a Non-pharmacological Intervention on Apathy in Korsakoff's Syndrome: A Systematic Narrative Review Across Different Clinical Conditions.

Apathy is a quantitative reduction of goal-directed activity, which can be observed in relation to behavior, cognition, emotions and social interaction. It is an invalidating behavioral symptom that is frequently present across different psychiatric conditions and neurocognitive disorders including Korsakoff's Syndrome (KS). In fact, apathy is one of the most severe behavioral symptoms of KS and has a major impact on the lives of patients and their relatives and other informal caregivers. However, guidelines for the treatment of apathy in KS are currently not available. This systematic narrative review provides a transdiagnostic overview of the effectiveness of different types of non-pharmacological interventions on apathy across different study populations that at symptom-level share characteristics with KS. This evidence may inform the development of an intervention targeting apathy in KS. The included study populations are dementia (due to Alzheimer's disease, or vascular dementia), Parkinson's disease, schizophrenia and traumatic brain injury. Through a stepped selection approach and with regard to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines, 22 systematic reviews and 32 empirical articles on the non-pharmacological treatment of apathy were identified. The results show a variety of effective non-pharmacological interventions on apathy. In conditions with severe cognitive impairments, successful interventions did not rely on intrinsic motivation, self-monitoring, or illness insight of the patients, but depend on external stimulation and behavioral activation. Since apathy is a multidimensional construct, identification of the extent and type of apathetic behavior before starting an intervention is highly recommended. Furthermore, it is important to adjust the treatment to the patients' personal interests and needs and embedded in daily care. CRD42022298464 (PROSPERO).

A personalised nutrition intervention for adolescent depression: a mixed-methods feasibility pilot study.

Randomised controlled trials have demonstrated the benefit of diet modification to improve diet quality in the treatment of adult major depressive disorder (MDD). However, research examining nutritional interventions for adolescents with MDD is sparse. This pilot study examined the feasibility of a personalised nutrition intervention for adolescents with MDD. Ten adolescents with MDD and their parents recruited from a tertiary care setting participated in an 8-week, single-arm mixed-methods study. Feasibility was assessed using five criteria (demand, acceptability, implementation, adaptation and limited efficacy testing) alongside qualitative interviews. The intervention involved four bi-weekly virtual nutrition counselling sessions with a stepped approach to dietary change, menu planning, grocery delivery and educational eHealth messages. Study participants sought positive changes in diet, health and lifestyle for adolescents and family-wide benefits. Recruitment challenges included concerns about managing mood fluctuations, anticipated dietary restrictions and the potential time and effort required for diet adherence. Feedback based on interviews emphasised moderate to high acceptability, satisfaction with menu planning and counselling and recognition of the benefits of trying new foods and sustaining positive dietary changes beyond the study. Improvements in depression symptoms (Cohen's d = 0·36, 95 % CI (-0·24, 3·36)), parent food modeling (Cohen's d = 0·24, 95 % CI (-0·43, 1·16) and the family food environment (Cohen's d = 0·61, 95 % CI (-0·04, 2·61)) were observed. This nutrition intervention was feasible for adolescents with MDD and was acceptable to both parents and depressed adolescents. These preliminary data suggest that further examination of the intervention and its potential benefits on depression symptoms and family food dynamics are warranted.