Two-month Follow-up Research Articles

Cementless unicompartmental knee arthroplasty results in higher pain levels compared to the cemented technique: a prospective register study

PurposeIn recent years, the preferred fixation method for unicompartmental knee arthroplasty (UKA) has changed from cemented to cementless. The aim of this study was to compare patient-reported outcome measures (PROMs) from the cemented versus cementless techniques two- and twelve-months post-operation.MethodsFrom 2015 to 2019, 187 cemented and 261 cementless UKAs were included based on an institutional registry. The Oxford Unicompartmental Knee System™ (Zimmer Biomet, Bridgend, United Kingdom) was used for all patients. Three experienced surgeons performed all procedures. Data were collected pre- and peroperatively, and at two- and twelve-months postoperatively. PROMs included pain (evaluated on a numeric rating scale [NRS] during activity and at rest), and knee function (evaluated with the disease-specific short form of the Knee injury and Osteoarthritis Outcome Score [KOOS-PS]). Patients also rated postoperative joint function (better, unchanged, uncertain or worse) and were asked, “based on your experience to date, would you go through the surgery again?”. Duration of surgery was noted and revisions during the first post-operative year were evaluated.ResultsThe cemented group reported significantly lower activity-related pain at both two- and twelve-month follow-up. This was also the case for pain at rest at twelve-month follow-up, and KOOS-PS at two-month follow-up. Duration of surgery (adjusted for surgeon differences) was eight minutes less on average with the cementless technique. Eleven prosthetic joint infections (PJIs) were found following the cementless fixation technique compared to three using the cemented implant.ConclusionUKA cases with cemented implants had lower pain scores during activity two and twelve months after surgery compared with those who had cementless implants. Differences in favor of the cemented group were also found for pain at rest one year after surgery and for KOOS-PS two months after. Surgery was significantly shorter in duration in the cementless group, but a relatively high number of PJIs were found in that same group.Level of evidenceLevel II.

Effectiveness of Spiritual Counseling on the Enhancement of Hope in Iranian Muslim Patients with Myocardial Infarction: A Two-Month Follow-Up.

Hope is the most important source of coping in patients who have experienced acute cardiac events, and despair is considered an important cause of discontinued treatment and a threat to patients' mental health. This study aimed to determine the effectiveness of spiritual counseling on hope in patients with myocardial infarction over a two-month period. Fifty-six Iranian Muslim patients with myocardial infarction participated; participants were randomly allocated to either the intervention group (n = 28) or the control group (n = 28). The experiment group received three sessions of group spiritual counseling. The patients' hope was measured before intervention and immediately, one month, and two months after the intervention. The results indicated that no significant difference in hope was present between the intervention and control groups at baseline (Z = - 2.56, effect size = 0.75, P = 0.1). Significance between-group differences favoring the intervention group, however, were noted immediately post-intervention (Z = - 2.72, effect size = 0.91, P = 0.007), one month afterward (Z = - 6.22, effect size = 3.14, P < 0.001), and two months afterward (Z = - 6.10, effect size = 2.65, P < 0.001). Hope significantly improved in the intervention group during the study. Utilizing spiritual counseling as an effective non-aggressive form of treatment can improve hope among patients with myocardial infarction.

The effectiveness of self-differentiation training on improving family process and content in demanding couples of contested divorce

Aim: The purpose of the present study was to determine the effectiveness of self-differentiation training on improving family process and content in demanding couples with contested divorce. Methods: A quasi-experimental design with pre-test, post-test and two-months follow-up with control group was used. The statistical population included couples who mutually consented for divorce, and had referred to the counselling clinic of Behravan in Qazvin in 2018. Ten couples (20 participants) were selected through purposeful sampling and assigned in experimental and control groups. Research tools included Samani’s (2008) family process and content questionnaire. Self-differentiation was administered for the experimental group in 10 weekly 90-minute sessions. The changes of family process and content was measured in posttest and follow-up and data were analyzed by repeated measurement. Results: Results indicated that self-differentiation significantly have promoted family process (P&lt;0.01, F=21.14) and family content (P&lt;0.01, F= 23.32). This effect was observed in follow-up, and four couples gave up the divorce requests (P&gt;0.01, t= 0.01). Conclusion: self-differentiation training, thorough empowering couples, helps in moderating between reason and emotions; while differentiaton of self from original family, affects the functions of family process and content. Therefore, it can be used as an efficient psycho-educational package for improving the functions of family process and content in divorce demanding couples, and may helpprevent divorce.

Investigating the Effectiveness of Couple Therapy based on Reality Therapy and Emotionally Focused Therapy (EFT) on Couples’ Happiness and Resilience

Aim: The purpose of this study is to investigate the effectiveness of reality-based and emotionally focused couple therapy (EFCT) interventions on the happiness and resilience of couples. Methods: The method of the present study was a single case experimental design of multiple simultaneous baselines. The statistical population of the study were maladapted couples referred to Talieh Mehr Couple Therapy Center in Tehran (149 couples), in which 6 couples were selected as a sample by purposive and voluntary sampling method. Then, the approaches were performed in pairs for reality therapy and EFT for each couple with a two-month follow-up. The standard Oxford happiness (Argyle, Martin, Crossland, 1989) and Conor-Davidson resilience (Conor-Davidson, 2003) questionnaires were completed as data collection tools. Data were analyzed by visual mapping, stable change index, and recovery percentage formula. Results: The results showed that reality therapy-based couple therapy increased the happiness and resilience of couples (61.06% and 49.31% recovery, respectively) and its effect was maintained until the end of the two-month follow-up period (60.05% and 51.88% recovery). Also, EFCT increased the happiness and resilience of couples, respectively (28.06% and 28.87% recovery) and its effect was maintained until the end of the two-month follow-up period (26.81% and 29.73%, recovery). The index of their change in reliability also indicated that these changes were significant (p &lt;0.05). Conclusion: The results showed the effectiveness of couple therapy interventions based on reality therapy and EFT on increasing the happiness and resilience of incompatible couples and the mentioned approaches can explain the desirable degree of variability of happiness and resilience of incompatible couples.

Utilization of a Reduced Graft from a Severely Traumatized Liver: A Case Report and Strategy to Increase Availability of Livers for Transplant

Background: Trauma victims with liver lacerations in the hilum are typically excluded from liver donation. We report a case of a successful liver transplant from a deceased donor with a grade 4 hilar liver laceration. Case Presentation: We used a liver with a high-grade laceration from a 28-year-old brain-dead traffic accident victim. The liver had grade IV lacerations in the right and caudate lobes. In situ split liver technique was applied to control the lacerations after an intraoperative cholangiogram revealed favourable anatomy. The left hemi-liver graft was procured, retaining the entire vena cava and the full length of the main hepatic vasculature. The recipient was a 62-year-old female patient with end-stage liver disease, with a Model for End-Stage Liver Disease-Sodium score of 19. The left lobe graft was transplanted using the standard piggy-back technique. The patient was discharged on postoperative day 7 after an uneventful recovery. At two-month follow-up, she continues to do well, with normal hepatic function and unremarkable imaging studies. Conclusion: This is the first reported case of a successful liver transplant of a severely lacerated liver made possible by the application of split liver techniques. In situ splitting of a severely traumatized liver could permit the utilization of a reduced graft for small recipients.

Effectiveness of Acceptance and Commitment Therapy on Treatment Adherence in People with Non-Alcoholic Fatty Liver Disease

Introduction: The present study was conducted with the aim of acceptance and commitment therapy (ACT) on treatment adherence in people with non-alcoholic fatty liver disease (NAFLD). Methods: This study was a quasi-experimental design with an experimental group and a control group with pre-test, post-test and two-month follow-up. This study was conducted in 2019 in Tehran in the statistical population of people with NAFLD diagnosis. In this study, 30 individuals with NAFLD were purposefully selected and they were randomly assigned to two groups and received a pre-test. Then, the experimental group underwent group intervention of acceptance and commitment therapy during two months of ten sessions while the control group had received the typical routine interventions from medical centers. The Morisky Medication Adherence Scale (Moriski et al., 2008) was conducted in the all of three stages of measurement. In order to analyze the data, repeated measures analysis of variance test with SPSS-16 software was used. Results: The trend of changes in the intervention group compared to the control group in the measurement stages in the treatment adherence to the treatment (F= 4.243, P=0.03) was significantly different (P &lt;0.05) and about 15% of the differences observed in this variable is due to group membership (intervention). To compare these changes over time, Benfron's subtest was used. The difference between pre-test with post-test and follow-up were only significant in the intervention group (P &lt;0.05). Conclusion: Acceptance and commitment-based therapy increases treatment adherence. Therefore, it is suggested that this method be used to increase treatment adherence in people with non-alcoholic fatty liver.

Comparing the Effectiveness of Behavioral Activation and Acceptance and Commitment Therapy in Cognitive-Attentional Syndrome in Patients with Depression

Background: Cognitive-attentional syndrome (CAS) is one of the primary constructs of depression, the treatment of which is highly challenging because of its high prevalence and the emergence of symptoms such as feelings of sadness, emptiness, and hopelessness. Objectives: The present study aimed to investigate the effectiveness of behavioral activation (BA) and acceptance and commitment therapy (ACT) in CAS in patients with depression. Methods: This quasi-experimental research utilized a pretest, posttest, and two-month follow-up design with a control group. The study population comprised 260 patients with a diagnosis of depression who referred to the psychological centers of Ahvaz in 2019. The sample consisted of 45 patients with depression selected by convenience sampling. We randomly divided the participants into two experimental groups (BA and ACT) and a control group (n = 15 per group). The research instrument included the cognitive-attentional syndrome (CAS-1) questionnaire. Data were analyzed using SPSS version 24.0 with descriptive and inferential statistics, such as mean, standard deviation, and multivariate analysis of covariance (MANCOVA). Results: In terms of CAS and its components, there was a significant difference between the experimental and control groups in the posttest and follow-up phases (P = 0.0001). Besides, ACT and BA significantly reduced CAS and its components in the posttest phase (P = 0.0001). However, the effectiveness of BA in decreasing CAS and its components remained during the follow-up phase. Furthermore, the results showed that ACT was more effective in reducing attention to threat and metacognitive beliefs during the posttest phase. Conclusions: According to research findings, both BA and ACT are efficient therapies in reducing CAS in patients with depression. Thus, both approaches can be used to strengthen treatment interventions to reduce CAS in patients with depression.

The Efficiency of Spa Rehabilitation in Chronic Ischemic Stroke Patients-Preliminary Reports.

Background: Rehabilitation-oriented therapy after a stroke must continue in various forms as a life-long effort. Aim: The study investigated the impact of spa rehabilitation on the quality of life and functional efficiency in patients after an ischemic stroke at a chronic stage of recovery. Methods: The assessment was carried out in a spa resort in southeastern Poland. It involved 32 patients with strokes who participated in a three-week rehabilitation program. Three examinations were performed: upon admission, on the day of discharge and at a two-month follow-up. The quality of life and functional efficiency were assessed with the WHOQOL-BREF and Barthel Index. Results: The quality of life was significantly higher in Exam II compared with Exam I (p < 0.001), and improvement was retained at the follow-up. The Barthel scores were higher in Exam II compared with Exam I (79.84 vs. 68.59), while the differences between the scores in Exams II and III were small (p = 0.039). Conclusions: Three-week spa rehabilitation seems to favorably affect the functional efficiency and quality of life after a stroke. The effects appear to be long-term. The gender, age and time from stroke onset do not seem to impact short-term effects. However, long-term effects are related to the time from stroke onset.

Ambulatory and longitudinal relationships between mindfulness and eating problems: The mediating role of self-objectification

Previous research has shown a negative association between mindfulness and its facets and eating problems. Few studies have examined the mechanism involved between them. As an important cognitive factor of eating problems, self-objectification may be a mediating variable in the prediction of eating problems as they relate to mindfulness. We examined the relation between mindfulness and its facets and eating problems using an ambulatory assessment and follow-up test as well as the mediating effect of self-objectification. A total of 106 college students were recruited to complete the full study. State mindfulness, state self-objectification, and eating problems in daily life were measured by an ambulatory assessment. Trait self-objectification and overall eating problems were measured at a two-month follow-up. For the ambulatory assessment, state mindfulness and five facets of mindfulness could not predict eating problems at the next moment in daily life, and there was no mediating effect of state self-objectification. For the longitudinal survey, acting with awareness, as a facet of mindfulness, can predict eating problems. Trait self-objectification mediated the relationship between acting with awareness and overall eating problems. The findings indicate that the association between mindfulness and eating problems mainly occurs at the trait level.

Acceptability and preliminary efficacy of a school-based body image intervention in urban India: A pilot randomised controlled trial

This pilot study evaluated the acceptability and preliminary efficacy of a culturally adapted school-based body image intervention, Dove Confident Me, for use in urban India. Two private schools in New Delhi were randomly assigned at the school level to receive either the five-session intervention facilitated by trained psychologists or lessons-as-usual (control). Participants were Year 7 students (N = 166; Mage = 11.9 years). Students, facilitators, and observing teachers, provided acceptability feedback. Fidelity was assessed. Body image and related measures were completed by students in a classroom setting at pre-intervention, post-intervention, and two-month follow-up. Most students enjoyed (73.7 %) and understood (84.2 %) the intervention. Facilitators (90 %) and observing teachers (70 %) reported that the learning objectives were achieved. Adherence and facilitator competence were rated as very good. Body esteem improved significantly among intervention students at post-intervention and follow-up (Cohen’s ds = .45–.46), relative to control students. Positive affect also improved at post-intervention (d = .58). No significant effects on internalisation, life engagement, eating pathology, self-esteem, or negative affect emerged. This study provides evidence for the acceptability and preliminary efficacy of Dove Confident Me in urban India. Intervention refinements to increase acceptability and efficacy are recommended.

Palliating Symptoms in Patients With Hepatocellular Carcinoma Involving the Inferior Vena Cava With External Beam Radiation Therapy.

IntroductionPatients with hepatocellular carcinoma (HCC) involving the inferior vena cava (IVC) and/or right atrium (RA) often experience debilitating symptoms, including lower extremity edema, dyspnea on exertion, shortness of breath at rest, chest pain, and ascites, that impact quality of life. The efficacy of external beam radiation therapy (EBRT) in palliating these symptoms is unclear. Thus, we sought to assess the effectiveness of EBRT in the palliation of symptoms and treatment outcomes in this patient population.Materials and methodsAll patients with HCC that compressed or invaded the IVC, received EBRT, and had a two-month follow-up visit to assess clinical response at our institution between 2010 and 2018 were analyzed. Patient demographics and clinical features were retrieved from the electronic medical record. Local control, local progression-free survival, and overall survival (OS) were measured from the last day of EBRT and calculated using the Kaplan-Meier method.ResultsTwenty-six patients with invasion or compression of the IVC were identified, 11 of whom (42%) had involvement of the RA. The median follow-up was 3.6 months. Five patients (19%) were treated with stereotactic body radiation therapy (SBRT) (all with five fractions) and 21 patients (81%) were treated with fractionated radiation therapy (range 10-16 fractions), both to a median dose of 3,000 cGy (range 2500-4000 cGy for SBRT, 2500-3750 cGy for fractionated radiation therapy). Significant proportions of patients experienced symptomatic relief from peripheral edema (54%), dyspnea on exertion (57%), shortness of breath (83%), chest pain (67%), and ascites (25%) after receiving EBRT. Additionally, they experienced few toxicities, with zero experiencing grade three or higher toxicities. One-year and two-year local control rates were 11.5% and 7.7%, respectively, and the median local progression-free survival was 4.8 months. One-year and two-year OS rates were 38.4% and 38.4%, respectively.ConclusionsOur results suggest that EBRT should be considered as a potential treatment option for patients with HCC invading or compressing the IVC with or without involvement of the RA. EBRT was very well-tolerated and effectively palliated a variety of symptoms in patients with advanced disease.

Case Report of Faded Bedtime Intervention on Delayed Sleep-Onset and Sleep Duration in an Adolescent with Autism Spectrum Disorder

Delayed sleep-onset is a common problem among children and youth with intellectual and developmental disabilities. This case report describes the effects of a faded bedtime intervention on delayed sleep-onset and sleep duration in an adolescent student with autism spectrum disorder (ASD) at a residential-care setting. Faded bedtime consisted of putting him to bed later in the evening following an extended pre-bedtime routine that was based on his average time to sleep-onset recorded during a pre-intervention phase. Faded bedtime was associated with the student falling asleep more rapidly and sleeping longer each night. These outcomes improved further at a two-month follow-up assessment. Compared to previous research, the results suggest that faded bedtime can be effective beyond hospital and family-home settings, when implemented with a fixed (non-adjusting) daily schedule, and without additional intervention procedures.

Effects of Problem-solving Skills Training on the Anxiety and Sleep Quality of Patients After Coronary Artery Bypass Graft Surgery

Background: Cardiovascular diseases are the leading cause of mortality worldwide, and sleep disturbance and anxiety play a key role in the prognosis of these patients. Objectives: The present study aimed to evaluate the effects of problem-solving skills training (PSST) on the anxiety and sleep disturbance of cardiac patients. Methods: This quasi-experimental study was carried out in three stages before, after, and during a two-month follow-up after eight PSST sessions (one hour each). Sample population included 20 male patients with heart failure who had undergone coronary artery bypass graft (CABG) surgery at Imam Ali Hospital of Kermanshah, Iran. The patients were randomly divided into the experimental (n = 10) and control groups (n = 10). Data were collected using Spielberger’s state-trait anxiety inventory (STAI) and Pittsburgh sleep quality index (PSQI). Data analysis was performed in SPSS using the analysis of covariance to compare the groups. Results: MANCOVA and Tukey’s post-hoc test indicated a significant difference in the sleep quality score of the patients at the posttest (P = 0.001) and follow-up (P = 0.017), as well as in the score of anxiety at the posttest (P = 0.01) and after the PSST intervention. However, no significant differences were observed in the scores of the control group at different stages of the study (P &gt; 0.05). Conclusions: According to the results, PSST could improve anxiety and sleep quality in patients with heart failure. Therefore, it is recommended that such training be provided to cardiac patients.

Development and evaluation of an online continuing education course to increase healthcare provider self-efficacy to make strong HPV vaccine recommendations to East African immigrant families

ObjectiveTo develop and evaluate an online continuing education (CE) course designed to improve healthcare provider self-efficacy to make strong adolescent HPV vaccine recommendations to East African immigrant families. MethodsFocus groups with providers and East African immigrant mothers informed course development. Providers serving East African immigrant families were recruited to view the course and complete pre-/post-test and two-month follow-up surveys. Pre-/post differences were compared with paired t-tests. Results202 providers completed the course and pre-/post-test; 158 (78%) completed two-month follow-up. Confidence to make strong HPV vaccine recommendations to East African families increased from 68% pre-test to 98% post-test. Confidence to address common parental concerns also increased: safety, 54% pre-test, 92% post-test; fertility, 55% pre-test, 90% post-test; child too young, 68% pre-test, 92% post-test; and pork gelatin in vaccine manufacturing, 38% pre-test, 90% post-test. Two-month follow-up scores remained high (97% for overall confidence, 94%–97% for addressing parental concerns). All pre-/post-test and pre-test/two-month follow-up comparisons were statistically significant (p < 0.05). ConclusionsThe online CE course focused on culturally appropriate strategies for making strong recommendations and addressing specific parental concerns was effective for increasing provider self-efficacy to recommend HPV vaccination to East African families. Similar courses could be tailored to other priority populations.

اثربخشی طرحواره درمانی گروهی بر دشواری تنظیم هیجان و پرخاشگری در دختران نوجوان

هدف از پژوهش حاضر بررسی اثربخشی و تداوم اثر طرح‌واره درمانی بر دشواری تنظیم هیجان و پرخاشگری در دانش‌آموزان دختر نوجوان بود. روش پژوهش از نوع شبه آزمایشی با طرح پیش‌آزمون، پس‌آزمون و پیگیری دوماهه با گروه کنترل بود. جامعۀ آماری پژوهش را کلیۀ دانش‌آموزان دختر متوسطه دوم شهر تهران در سال تحصیلی 98-97 تشکیل دادند که با استفاده از روش نمونه‌گیری هدفمند تعداد 40 نفر از آن‌ها انتخاب و در گروه‌های آزمایشی و کنترل (هر گروه 20 نفر) گمارده شدند. به‌منظور گردآوری اطلاعات از پرسشنامه‌های دشواری تنظیم هیجان و پرخاشگری، در سه مرحله استفاده شد. گروه‌ آزمایشی تحت طرح‌واره‌درمانی (8 جلسۀ 90 دقیقه‌ای) قرار گرفتند؛ اما گروه کنترل هیچ‌گونه مداخله‌ای دریافت نکردند. داده‌ها با استفاده از آزمون آماری تحلیل واریانس با اندازه‌های مکرر تجزیه و تحلیل شد. نتایج پژوهش نشان داد طرح‌واره درمانی بر کاهش تمام مؤلفه‌های دشواری تنظیم هیجان و پرخاشگری دانش‌آموزان دختر نوجوان اثربخش بود. اما گذشت زمان باعث شد به صورت معناداری این تأثیر در مرحلۀ پیگیری کاهش داشته‌باشد. درواقع طرح‌واره‌درمانی با کار بر روی ابعاد چندوجهی فرد زمینۀ تغییر را فراهم کرده و اثر‌بخش است. از آن‌جایی که دوران نوجوانی فی‌نفسه با دشواری در تنظیم هیجان و ناهنجاری‌های رفتاری از جمله پرخاشگری همراه است، می‌توان طرح‌واره‌درمانی را به‌منظور کاهش دشواری تنظیم هیجان و پرخاشگری نوجوانان به‌کار برد.

Effectiveness of the Treatment Through Self-Differentiation on the Couples’ Marital Intimacy and Adjustment

Abstract Introduction and purpose: the presence of intimacy and adjustment between the couples causes the family stability and the couples’ and children’s health. Therefore, the present study was conducted with the aim of investigating the effectiveness of the treatment through self-differentiation on the couples’ marital intimacy and adjustment. Material and methods: it was an applied study in case of purpose and quasi-experimental in case of data collection method with pretest, posttest, control group and two-month follow-up design. The statistical population of the study included all the couples who referred to Healthy Family Consultation Center in the city of Qom in 2017. 16 couples (8 women and 8 men) who were willing to participate in the study were selected through convenient method and accommodated into experimental and control groups (each group of 8). The experimental group underwent 10 sessions of self-differentiation treatment during two-and-a-half months, while the control group didn’t receive the aforementioned interventions. The applied questionnaires included marital conflict questionnaire (Barati and Sanaei, 1998), marital intimacy questionnaire (Bagarouzi, 2001) and marital adaptation questionnaire (Spinner, 1976). The data from the study were analyzed through repeated measurement ANOVA method. Findings: the results showed that the treatment through self-differentiation method has significant effect on the couples’ marital intimacy and adaptation (p<0.001) such that it succeeded in the improvement of the couples’ marital intimacy (effect size 66%) and adaptation (effect size 66%). Conclusion: the findings of the present study indicated that the treatment through self-differentiation can be applied as an efficient method to improve the couples’ marital intimacy and adaptation through utilizing techniques such as fusion, making the couples aware of triangulation, explaining familial projection and the concept of affective cut.

Effects of Basketball and Baduanjin Exercise Interventions on Problematic Smartphone Use and Mental Health among College Students: A Randomized Controlled Trial.

Problematic smartphone use (PSU) has become a prevalent issue worldwide. Previous studies suggest that physical exercising may effectively reduce smartphone users' addiction levels. Comparisons and further evaluations on the long-term effects of different types of exercise-based interventions on treating PSU remain to be investigated. Objective. We investigated if group-based basketball and Baduanjin exercise (a type of Qigong) would reduce PSU and improve the mental health of college students and whether such effects would be sustained. A twelve-week experiment was conducted, where 96 eligible Chinese college students with PSU were randomly assigned to two intervention arms (i.e., basketball and Baduanjin exercises) and a control arm. Outcome measures, including PSU (measured by the Mobile Phone Addiction Index in Chinese (MPAI)) and mental health indices for anxiety (measured by Self-Rating Anxiety Scale (SRAS)), loneliness (measured by the short-form of the UCLA Loneliness Scale (UCLA-LS)), inadequacy (measured by the revised Janis and Field's Feelings of Inadequacy Scale (FIS)), and stress (measured by the Chinese version of Perceived Stress Scale (CPSS)) were collected at the baseline, the end of week 12, and the two-month follow-up. A Generalized Estimating Equations (GEE) model for longitudinal data was utilized in analyses. Results. Both exercise interventions demonstrated significant effects on decreasing PSU (basketball: p < 0.01; Baduanjin: p < 0.01), feelings of anxiety (basketball: p < 0.01; Baduanjin: p=0.04), loneliness (basketball: p < 0.01; Baduanjin: p < 0.01), inadequacy (basketball: p < 0.01; Baduanjin: p < 0.01), and perceived stress (basketball: p < 0.01; Baduanjin: p=0.04), at the end of interventions. At two months after interventions, both exercise interventions demonstrated significant effects on decreasing PSU (basketball: p < 0.05; Baduanjin: p < 0.05), feelings of anxiety (basketball: p < 0.01; Baduanjin: p=0.03), loneliness (basketball: p < 0.01; Baduanjin: p < 0.01), and inadequacy (basketball: p < 0.01; Baduanjin: p=0.01), but not for feeling of stress. Furthermore, group-based basketball demonstrated larger improvements for all these significant results on reducing PSU and meanwhile improving their related mental health parameters among college students.

"I am Learning to Protect Myself with Mika:" A Teacher-based Child Sexual Abuse Prevention Program in Turkey.

This study aimed to explore the effectiveness of a teacher-based child sexual abuse prevention program entitled "I am learning to protect myself with Mika." The sample consisted of 290 children, their parents, and their classroom teachers. The participants were randomly assigned to intervention (n = 137) or wait-list comparison groups (n = 153) by classroom. The age of the children ranged from 46 to 71 months (M = 58.99, SD = 6.64). The prevention program was a 5-week program that consisted of five modules, including emotional awareness, good touch-bad touch, and body safety rules. To investigate the effectiveness of the prevention program, a latent Markov analysis was conducted. A three-class solution was identified as the best model: Status-1 (self-protecting group), Status-2 (risky secret keepers), and Status-3 (risk group). Following the intervention, members of the two at-risk groups (Statuses 2 and 3) were more likely to move into the Status-1 group than were those participants who had not received the intervention (wait-list comparison). Self-protection skills were analyzed using a 2 × 2 ANOVA with repeated measures. The increase in self-protection skills was greater for participants in the intervention group than for those in the wait-list comparison group from pre-test to post-test. Two-month follow-up analysis showed that gain in knowledge and skills was maintained. This program should be considered as a potential approach to meeting the need for child sexual abuse preventive efforts in Turkish preschool curriculum.

Effectiveness of group psychodrama on aggression and social anxiety of children with attention-deficit/hyperactivity disorder: A randomized clinical trial

This study aimed to determine the effects of psychodrama-based group therapy on reducing aggression, social anxiety, and attention-deficit/hyperactivity disorder (ADHD) symptoms in children. This clinical trial, with a pretest-posttest design and a two-month follow-up, involved 48 children (aged 8–12) at two hospitals in Iran. The participants were selected by available sampling and randomly divided into experimental and control groups (each 24 participants). Group psychodrama in sessions of 2 h a week for 10 weeks was applied as an intervention for the experimental group, while the control group was assigned to a waiting list. The Child Behavior Checklist and Spence Children's Anxiety Scale were used for collecting the data. The mean and standard deviation were measured, and repeated measures ANOVA and Bonferroni correction tests were performed. We found that social anxiety, aggression, and ADHD symptoms significantly decreased in posttest in the psychodrama group, while there were no changes in these variables in the control group. Also, these results were persistent at the two-month follow-up. The present findings revealed that group psychodrama is effective in reducing aggression, social anxiety, and ADHD symptoms in children.

اثربخشی درمان مبتنی بر پذیرش و تعهد بر اضطراب، افسردگی و نشانه های جسمانی افراد مبتلا به درد مزمن

Background and Objective: Chronic pain is among the most common causes of referring to primary medical care centers. The aim of this study was to determine the effectiveness of acceptance and commitment therapy on anxiety, depression, and physical symptoms in patients with chronic pain. Materials and Methods: This study was a quasi-experimental study with pre-test, post-test, follow-up, and a control group. Participants included 60 patients with chronic pain who were referred to medical centers in Tehran in 2019, who were selected in a two steps sampling method. First, a questionnaire was circulated among patients with chronic pain at medical centers who were selected via convenience sampling method. Then, 60 participants were randomly selected from patients who received the highest scores, then randomly assigned to intervention (30 patients) and control (30 patients) groups. Data were collected using the Beck Depression Inventory and Beck Anxiety Inventory. The experimental group received acceptance and commitment therapy in eight sessions of 90 minutes once a week for two months, but the control group did not receive any treatment. Both groups responded to the research questionnaires in three stages: pre-test, post-test, and two-month follow-up. Data analysis was performed using repeated measure ANOVA using SPSS software version 22. Results: The mean (SD) age of participants in the experimental group was 43.7 (8.9) and in the control group 45.2 (9.2). In the experimental group, the mean (SD) depression score decreased from 32.6 (4.4) in the pre-test to 23.2 (5.1) in the post-test, and 22.1 (5.2) follow-up (P<0.001) and the mean (SD) anxiety score decreased from 33.6 (4.9) in the pre-test to 22.6 (4.2) in the post-test and 22.6 (5.1) in follow-up (P<0.001) and the mean (SD) of physical symptoms decreased from 41.5 (3.2) in the pre-test to 33.7 (3.1) in the post-test and 31.8 (3.3) follow-up stages (P<0.001). In the control group, the scores in the three stages of pre-test, post-test and follow-up were not different. Conclusion: Acceptance and commitment therapy was effective in reducing anxiety, depression and physical symptoms in patients with chronic pain.