Within-subject Effects Research Articles

Family Care Intervention Effect on the Family Support Needs of Residents in Nursing Homes: A Cluster Randomized Trial

Purpose To assess the impact of a home care intervention on the family support needs of nursing home residents through a group clinical trial and blinded outcome assessment. Method A cluster randomized trial was conducted at two nursing homes in Zhengzhou. Each nursing home was randomized to either the intervention or control group. Eighty-two residents were enrolled in the study. Intervention group participants ( n = 41) received a family support intervention, and those in the control group ( n = 41) received the institution's standard daily care routine. The Questionnaire of Family Support Needs; Perceived Social Support Scale; and Family Adaptation, Partnership, Growth, Affection, Resolve Index were used to assess post-intervention outcomes. Results There were no significant differences between groups regarding baseline data. There were statistically significant ( p < 0.05) within-subject, between-subject, and interaction effects for both groups regarding family support needs, perceived social support, and family functioning. Conclusion Findings contribute to strengthening the care of residents in nursing homes, indicating the importance of family support, which can positively influence perceived social support and family function. The long-term efficacy of the intervention should be further verified. [ Journal of Gerontological Nursing, xx (xx), xx–xx.]

Study design features increase replicability in brain-wide association studies.

Brain-wide association studies (BWAS) are a fundamental tool in discovering brain-behaviour associations1,2. Several recent studies have shown that thousands of study participants are required for good replicability of BWAS1-3. Here we performed analyses and meta-analyses of a robust effect size index using 63 longitudinal and cross-sectional MRI studies from the Lifespan Brain Chart Consortium4 (77,695 total scans) to demonstrate that optimizing study design is critical for increasing standardized effect sizes and replicability in BWAS. A meta-analysis of brain volume associations with age indicates that BWAS with larger variability of the covariate and longitudinal studies have larger reported standardized effect size. Analysing age effects on global and regional brain measures from the UK Biobank and the Alzheimer's Disease Neuroimaging Initiative, we showed that modifying study design through sampling schemes improves standardized effect sizes and replicability. To ensure that our results are generalizable, we further evaluated the longitudinal sampling schemes on cognitive, psychopathology and demographic associations with structural and functional brain outcome measures in the Adolescent Brain and Cognitive Development dataset. We demonstrated that commonly used longitudinal models, which assume equal between-subject and within-subject changes can, counterintuitively, reduce standardized effect sizes and replicability. Explicitly modelling the between-subject and within-subject effects avoids conflating them and enables optimizing the standardized effect sizes for each separately. Together, these results provide guidance for study designs that improve the replicability of BWAS.

Affective Aspects of Religiousness and 6-Year Course of Depressive Symptoms in Aged Dutch Citizens.

In prospective studies on religiousness and depressive symptoms, it remains unclear whether religiousness is a predictor or parallels the fluctuating course of depressive symptoms. The current study focuses on several affective aspects of religiousness in their associations over time with late life depressive symptoms. As part of the population-based Longitudinal Aging Study Amsterdam, a subsample of 222 respondents (mean age 76.3 years) completed up to three postal questionnaires with 3-year intervals. The questionnaires included the Center for Epidemiologic Studies Depression scale and subscales of the Questionnaire God Representations and the Brief Religious Coping scale. Analyses were performed using mixed model analysis and logistic regression. Positive feelings toward God were associated with fewer depressive symptoms over time. Anxiety toward God, discontent about God, and negative religious coping predicted more depressive symptoms over time (between-subject effects) but also tended to run parallel to the course of depressive symptoms (within-subject effects).

Examining Between- and Within-subjects Effects of Posting and Exposure to Alcohol-Related Social Media Content on Drinking Over Time.

Social media content featuring alcoholic beverages is posted and viewed by college students. Limited longitudinal research suggests that increased alcohol-related content (ARC) posting and exposure is associated with increased alcohol consumption among college students over time. Emerging evidence suggests this association may be bidirectional, with drinking predicting later ARC posting. The current study examined longitudinal bidirectional associations between alcohol consumption and: posting ARC (aim 1) and friend ARC exposure (aim 2). College students engaging in heavy or problematic drinking (N = 384; Mage = 20.04; 74.2% female; 79.6% White) completed four surveys (baseline, 1-month, 3-month, 6-month). Each survey assessed social media use (including ARC posting) and alcohol use, along with ARC posting behaviors of their social network (i.e., important friends). Random-intercept cross-lagged panel models revealed significant large associations only at the within-subjects level for posting ARC, but significant medium-large between- and within-subjects associations for ARC exposure. Within-subjects, greater alcohol consumption predicted posting 1 month later, and posting at the 3-month follow-up predicted increased drinking at 6-months (aim 1). Between-subjects, individuals who reported greater social network ARC exposure were more likely to report greater alcohol consumption. Within-subjects, greater-than-average ARC exposure at 1-month predicted decreased alcohol consumption at 3-months (aim 2). Results suggest the relationship between alcohol consumption and alcohol posting (self and ARC exposure) is complex and not necessarily bidirectional, with associations between posting and drinking fluctuating within subjects, while between- and within-subjects associations were observed for exposure and drinking. Associations between posting and drinking vary within individuals over time, while associations between exposure and drinking exist for groups, indicating the more people are exposed, the more alcohol they consume.

Breast Cancer Survivors' Perceptions of Mastectomy Reconstruction: A Comparative Analysis of Medical Tattooing Impact on Aesthetics.

Studies indicate that physical appearance changes affect a significant proportion of breast cancer survivors, often leading to post-surgical distress. Both reconstructive surgery and medical tattoos are associated with patient-reported satisfaction, yet further research is necessary to understand their combined impact on aesthetic outcomes from the patient perspective. This study examined how breast cancer survivors evaluated the cosmetic and decision satisfaction of other patients who made various cosmetic intervention choices post-mastectomy. Breast cancer survivor support networks (n = 180) across 20 states agreed to share information about the online survey to their members. Participants (n = 251) rated the cosmetic outcome and decision satisfaction of images depicting other patients who had received mastectomy with three types of intervention: reconstruction alone, medical tattooing alone (flat closure), and reconstruction and medical tattooing combined. A factorial MANOVA produced significant within-subjects effects indicating participants consistently rated images of patients with a combination of reconstruction and medical tattooing highest in cosmetic quality, lowest in scar visibility, and highest in treatment decision satisfaction. The findings suggest that medical tattooing serves as a valuable complementary cosmetic intervention, with many survivors expressing interest and recognizing potential benefits once informed about the option. However, the study's limitations, such as the need for a more diverse range of patient images for evaluation, should be acknowledged. Future research should address these gaps by incorporating photographs of patients across varying demographics, including age, body weight, disease severity, and surgical procedures, to minimize bias. Despite these limitations, this study highlights the significant role that medical tattooing can play in enhancing aesthetic outcomes after surgery, particularly from a patient-centered perspective. This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors https://link.springer.com/journal/00266 .

Impact of Neuropsychological Assessment on Subjective Memory Complaints in Patients With Mild Cognitive Impairment.

Patients with Alzheimer's disease (AD), namely at an initial stage like amnestic cognitive impairment (aMCI), typically present with memory complaints. They also have difficulties regarding self-knowledge about their cognitive deficits. In clinical practice, a formal neuropsychological assessment is often done. The present study aimed to understand whether patients with aMCI retain the ability to monitor the success or failure in their performance during the neuropsychological assessment and adjust the report of memory complaints accordingly, as compared to healthy controls. Participants were patients with aMCI and healthy controls who were questioned about their own memory abilities using the Subjective Memory Complaints (SMC) scale, applied before and after the neuropsychological assessment protocol. A repeated measures General Linear Model was performed to analyze changes in SMC (within-subjects effects) after the neuropsychological assessment, in patients with aMCI and healthy controls (between-subjects effects). Eighty volunteers, 40 patients with aMCI and 40 healthy controls, participated in the study. Patients with aMCI showed lower MMSE scores, more depressive symptoms, and deficits in memory and learning, language and executive domains. Patients with aMCI had higher SMC scores [9.4(3.6)] than healthy controls [4.4(2.3)] before the neuropsychological assessment. A statistically significant interaction was found between the SMC and the diagnostic group, meaning that healthy controls decreased SMC [3.4(1.9)] after the neuropsychological assessment, whereas patients with aMCI kept high levels of SMC [9.6(3.9)]. In patients with aMCI, an inverse correlation between logical memory and the change in SMC was found, so that patients with lower scores in the logical memory test tended to increase their memory complaints after the assessment. Both patients with aMCI and healthy controls can monitor and update the impression about their memory abilities following a formal neuropsychological assessment. Patients with aMCI maintain a high SMC level, which is inversely associated with their memory performance. In practical terms, SMC should be measured consistently at a particular moment in time, preferably preceding the objective neuropsychological assessment.

Yoga Intervention and Inflammatory Homoeostasis in Breast Cancer Patients

Objectives: Yoga, renowned for its ability to maintain physical, mental and spiritual well-being, has recently gained prominence as a supportive therapy during conventional breast cancer (BC) treatment. This paradigm shift reflects a growing trend of people embracing yoga to enhance their overall health and aid in managing BC. The objective of this study was to determine the yoga intervention and inflammatory homoeostasis in newly diagnosed BC patients. Materials and Method: This study recruited 44 newly diagnosed BC patients at stages II, III and IV (without distant metastasis or other inflammatory diseases), all admitted for neoadjuvant chemotherapy followed by surgery. A prospective non-randomised control design was employed. Baseline assessments were conducted before the first chemotherapy cycle, with follow-ups before the 2nd and 3rd chemotherapy cycles, before surgery, and 2 months post-surgery. The outcome was compared with the control group. Results: The study showed significant within-subject effects in the yoga intervention group on serum tumour necrosis factor-alpha, interleukin (IL)-1-beta and IL-6 levels, while no significant changes were observed in the control group. Although between groups did not show statistically significant, the mean values indicated a consistent downregulation of proinflammatory markers over time in the yoga group. Conclusion: Incorporating yoga as a complementary therapy alongside conventional BC treatment significantly improved the health outcomes of BC patients by modulating proinflammatory markers.

Sensorimotor brain–computer interface performance depends on signal-to-noise ratio but not connectivity of the mu rhythm in a multiverse analysis of longitudinal data

Objective.Serving as a channel for communication with locked-in patients or control of prostheses, sensorimotor brain-computer interfaces (BCIs) decode imaginary movements from the recorded activity of the user's brain. However, many individuals remain unable to control the BCI, and the underlying mechanisms are unclear. The user's BCI performance was previously shown to correlate with the resting-state signal-to-noise ratio (SNR) of the mu rhythm and the phase synchronization (PS) of the mu rhythm between sensorimotor areas. Yet, these predictors of performance were primarily evaluated in a single BCI session, while the longitudinal aspect remains rather uninvestigated. In addition, different analysis pipelines were used to estimate PS in source space, potentially hindering the reproducibility of the results.Approach.To systematically address these issues, we performed an extensive validation of the relationship between pre-stimulus SNR, PS, and session-wise BCI performance using a publicly available dataset of 62 human participants performing up to 11 sessions of BCI training. We performed the analysis in sensor space using the surface Laplacian and in source space by combining 24 processing pipelines in a multiverse analysis. This way, we could investigate how robust the observed effects were to the selection of the pipeline.Main results.Our results show that SNR had both between- and within-subject effects on BCI performance for the majority of the pipelines. In contrast, the effect of PS on BCI performance was less robust to the selection of the pipeline and became non-significant after controlling for SNR.Significance.Taken together, our results demonstrate that changes in neuronal connectivity within the sensorimotor system are not critical for learning to control a BCI, and interventions that increase the SNR of the mu rhythm might lead to improvements in the user's BCI performance.

Exploring Brain Activity in Different Mental Cognitive Workloads

Objective: Understanding neural mechanisms underlying cognitive workload is crucial for advancing our knowledge of human cognition and mental processes. In this study, we utilized electroencephalography (EEG) analysis to investigate brain activity associated with varying mental cognitive workloads from a psychological perspective. Method: We employed a publicly accessible EEG dataset consisting of a cohort of 36 healthy volunteers (75% female), aged 18 to 26 years, while the participants were at rest or engaged in an arithmetic task to explore mental cognitive workload. After preprocessing to reduce noise and various artifacts and to obtain a clean signal for every subject, functional connectivity and complexity features were calculated from EEGs through the coherence and permutation entropy algorithms, respectively. Then, repeated measures analysis of variance (ANOVA) was conducted to assess the differences in complexity and connectivity measures across various brain regions between the rest and task states. Results: Brain sites showed significant within-subject effects, and the interaction between states and channels was significant for connectivity values (F = 3.68, P = 0.034). Post hoc comparisons indicated that FP1-F7, FP1-F8 and FP1-Fz connectivity were significantly lower during the task state compared to the rest state (P < 0.05). Moreover, F4-P3, F4-P4, FP1-O1, FP2-O2, F3-O1, F4-O1, F8-O1, C4-O1, F3-O2, F4-O2, F7-O2, F8-O2, Fz-O1, Fz-O2, Cz-O1 and Fz-P4 connectivity were significantly higher during the arithmetic task state (P < 0.05). Furthermore, brain sites showed significant within-subject effects and the interaction between states and channels was significant for entropy values (F = 3.50, P = 0.041). Post hoc comparisons indicated that the permutation entropy was significantly higher in the FP1, T3, T4, P4 and Pz channels during the arithmetic task compared to the rest state (P < 0.05). Conclusion: During arithmetic tasks, the increased connectivity in the frontoparietal and frontooccipital networks and heightened complexity in the prefrontal, temporal and parietal lobes reflect the collaborative engagement of brain areas specialized in numerical processing, attention, working memory, cognitive control, and visual-spatial cognition. These changes in connectivity and complexity facilitate the integration of multiple cognitive processes essential for effective arithmetic problem-solving.

Postural and spinal stability analysis for different floor sitting styles

In contrast to Western countries, traditional floor-seating cultures are prevalent in Korea, Japan, the Middle East, and Africa, where sitting on the floor in static positions such as squatting, kneeling, or sitting cross-legged is common. Most studies on sitting posture have predominantly focused on chair sitting in Western cultures, resulting in a cultural bias. This study aimed to investigate the effects of different cushion types (floor and traditional cushions of 3-cm, 5-cm, and 8-cm thickness) and seating postures (cross-legged, mother's leg, and kneeling) on measures of postural stability, trunk muscle activity, rotational spinal stability, and subjective postural stability in an Asian population. Forty right-hand and right-foot-dominant volunteers who did not experience activity-limiting back pain in the past 12 months were recruited. Multivariate analyses of variance (MANOVA) and ANOVA with a repeated-measures design were employed to assess the within-subject effects of the cushion type and seating posture. An alpha value of 0.05 was set for statistical significance. The results of this study suggest that preventing lordosis posture, seating on the floor, and maintaining a kneeling posture may reduce the loss of balance and trunk muscle fatigue. These results emphasize the need for additional ergonomic studies that focus on the seating traditions of Asian cultures.

Psychological responses to the COVID-19 pandemic and situational impact: A network analysis in Hong Kong residents

BackgroundThe COVID-19 pandemic has had situational impacts and induced various psychological responses among residents. The present study aims to analyze the network structure of psychological responses to the pandemic and their relationships with situational impact, resilience, and well-being through a network approach. MethodsAn online survey recruited 1122 residents (mean age = 32.5 years, 65.4 % female) in Hong Kong from October 2020 to October 2021. The participants completed the Mental Impact and Distress Scale: Psychological Response (MIDc-PR) and other validated measures. Gaussian graphical modeling was conducted in R to identify the central MIDc-PR symptoms and their bridge linkages with situational impact, resilience, and well-being. ResultsIn the MIDc-PR network, the central symptoms were ‘Routine’ and ‘Images’ for Anticipation and ‘Tense’ and ‘Lonely’ for Modulation, with 12 bridge edges between the two clusters. In the combined network, the MIDc-PR nodes showed 12 bridge edges with situational impact, particularly in the health domain. ‘Concerned’, ‘Sleep’, and ‘Lonely’ showed negative linkages with resilience; ‘Unmotivated’ and ‘Trapped’ showed negative linkages with well-being. The network models showed good levels of stability and did not differ significantly in network structure and global strength across gender and age groups. LimitationsThe cross-sectional study design only allowed undirected associations in the network and could not model the within-subject effects. ConclusionsThe study findings contributed to the literature by elucidating the network structure of psychological responses to the pandemic. The central and bridge symptoms have clinical implications as potential targets for future interventions.

Study design features increase replicability in cross-sectional and longitudinal brain-wide association studies.

Brain-wide association studies (BWAS) are a fundamental tool in discovering brain-behavior associations. Several recent studies showed that thousands of study participants are required for good replicability of BWAS because the standardized effect sizes (ESs) are much smaller than the reported standardized ESs in smaller studies. Here, we perform analyses and meta-analyses of a robust effect size index using 63 longitudinal and cross-sectional magnetic resonance imaging studies from the Lifespan Brain Chart Consortium (77,695 total scans) to demonstrate that optimizing study design is critical for increasing standardized ESs and replicability in BWAS. A meta-analysis of brain volume associations with age indicates that BWAS with larger variability in covariate have larger reported standardized ES. In addition, the longitudinal studies we examined reported systematically larger standardized ES than cross-sectional studies. Analyzing age effects on global and regional brain measures from the United Kingdom Biobank and the Alzheimer's Disease Neuroimaging Initiative, we show that modifying longitudinal study design through sampling schemes improves the standardized ESs and replicability. Sampling schemes that improve standardized ESs and replicability include increasing between-subject age variability in the sample and adding a single additional longitudinal measurement per subject. To ensure that our results are generalizable, we further evaluate these longitudinal sampling schemes on cognitive, psychopathology, and demographic associations with structural and functional brain outcome measures in the Adolescent Brain and Cognitive Development dataset. We demonstrate that commonly used longitudinal models can, counterintuitively, reduce standardized ESs and replicability. The benefit of conducting longitudinal studies depends on the strengths of the between- versus within-subject associations of the brain and non-brain measures. Explicitly modeling between- versus within-subject effects avoids averaging the effects and allows optimizing the standardized ESs for each separately. Together, these results provide guidance for study designs that improve the replicability of BWAS.

Testing the potential therapeutic effects of an online creative arts-based intervention for people with anxiety

ABSTRACT Background Creative arts-based interventions are a relatively new addition to the toolkit of psychological treatments for mental afflictions. As such, the therapeutic efficacy of these therapies when conducted remotely via digital media has been under-researched. To address this gap, this study tested the effects of an online creative arts-based intervention to alleviate anxiety. Method A repeated measures quasi-experimental design was employed on a sample of British adults (N = 41). Data were collected using pre- and post-intervention scores on the General Anxiety Disorder (GAD-7) and Warwick-Edinburgh Mental Wellbeing (WEMWBS) scales. Results Inferential analysis procedures consisting of multiple tests for within-subjects effects all showed significantly lower levels of anxiety and higher levels of mental wellbeing post-intervention. Conclusion Whilst additional confirmatory and longitudinal research is needed, the results of this exploratory study tentatively indicate that creative arts-based “interventions” delivered through digital media may be effective in substantively reducing common symptoms of anxiety.

Course of growth and nutritional status in Swiss children with food allergies

Summary Purpose Studies suggest that children with immunoglobulin E (IgE)-mediated food allergies (FA) are at risk of impaired growth, especially those with cow’s milk or multiple FA. However, there is limited long-term data available on this topic. This analysis presents the growth of Swiss children for the first year after FA diagnosis. Methods This is a secondary analysis of data from a multicentered study following food allergic children (0–10 years) over 1 year post diagnosis, comparing those who received dietary counselling with those who did not. Growth z‑scores were calculated based on World Health Organization (WHO) standards, using data reported by caregivers. To analyze data, linear mixed models with between-subject factors related to dietary counselling, number of FA, and cow’s milk allergy were fitted to the data. Results In the 48 children (median age 16 months) studied, we observed an increasing prevalence of wasting (weight-for-length/height z‑score < 2; 2–10%) and a lower prevalence of stunting (length/height-for-age < 2; 0–2%) over the 1‑year period. Twelve months after diagnosis, all median z‑scores showed an increase. Linear mixed model analysis did not find any significant within-subject and between-subject effects on growth. Conclusion Children with IgE-mediated FA can have normal growth if children with cow’s milk allergy or multiple food allergies receive dietary counselling. Routine length/height and weight measurements should be taken to identify individual malnutrition and to initiate tailored nutritional interventions. Larger studies with longer duration are needed to assess further growth development in children with IgE-mediated food allergies.

Enhancing adherence to clinical practice guidelines for hypertension management: Evaluation of the effectiveness of a Hypertension Management Tool Kit (HMTK) among primary healthcare doctors. (ImprovBP-HMTK)

IntroductionAdherence to guidelines in managing hypertension among primary healthcare doctors remains suboptimal. ObjectiveWe assessed the effectiveness of a Hypertension Management Tool Kit (HMTK) in improving guideline adherence. MethodsMedical records of 392 patients attending 2 primary care clinics in the Klang district with 3 or more anti-hypertensive medications were audited. Paired T-test and repeated measure ANOVA were used to evaluate the effectiveness of the HMTK intervention with the evaluation of interaction within-subject effects, between subject effect and time. ResultsThe mean MOGC score of doctors with <5 years of service was 79.765 (95 % CL 78.351,81.178) and with >5 years of service; 81.238 (95 % CI 80.621,81.855). Statistically significant (p-value <0.001) results were shown based on the time effect and mean MOGC score with HMTK; pre-intervention 72.426 (95%CI 71.045, 73.808) and post-intervention 88.576 (95 % CI 87.922, 89.230). The mean MOGC score post-intervention based on the time effect and years of service for both groups were statistically significant (p-value <0.001) and increment was shown in <5 years of service; 69.252 (14.915) to 87.149 (6.484) while >5 years of service; 73.485 (14.281) to 89.613 (5.149). Statistically significant was shown by years of service in time-group interaction effect pre- and post-intervention (p-value <0.001); pre-intervention for <5 years of service; 71.892 (95%CI 69.339,74.446) and >5 of service; 72.960 (95 % CI 71.895,74.075). Post-intervention in <5 years of service; 87.692 (95%CI 86.427,88.846) while >5 years of service; 89.516 (95%CI 88.987,90.044). ConclusionThe HMTK is an effective tool to improve the management of hypertension among doctors.

Alternative Virtual Lab-Based Practical Learning Model to Improve Scientific Attitude and Science Process Skills

A virtual laboratory is computer software that has the ability to perform mathematical modeling of computer devices presented in the form of simulations. Virtual laboratories are not a substitute for real laboratories, but are used to complement and improve the weaknesses of real laboratories. This research aims to determine the effect of virtual labs on science education students' scientific attitude abilities and science process skills in science courses. The design of this research is a repeated pre-experiment without a control class, with a one-group and pretest-posttest design. The sample in this study was 60 students of the science education study program at Makassar State University, Indonesia, used as experiment 1 group A (n = 30), experiment 2 group B (n = 30). Two groups (experiment 1 and experiment 2) were tested with a pretest and posttest. Each group uses a virtual lab-based practical model (PbVLab). Scientific attitudes and scientific skills were measured using multiple choice tests before and after treatment. The mixed method ANOVA statistical test was used to determine how effective the use of PbVLab was in improving scientific attitudes and science process skills. The results of testing research based on Within-Subjects Effects showed that there was no difference between the pretest-posttest scores for scientific attitudes and scientific skills (F = 0.00; p &lt; 0.05) in each group. The results of the pairwise comparison showed a significance value of &lt;0.05, and there was a significant increase in the pretest-posttest scores for scientific attitudes and science process skills in each group. The effect size results (partial eta squared) show that experimental group 1 experienced an increase in scientific attitudes by 52%; science process skills 53%, experimental group 2 scientific attitudes 54% and science process skills 56%. So, it can be concluded that experimental group 1 and experimental group 2 (PbVab model) provide the most effective contribution to improving scientific attitudes and science process skills.

Non-invasive pulse arrival time as a surrogate for oscillometric systolic blood pressure changes during non-pharmacological intervention

Background. Non-invasive continuous blood pressure (BP) monitoring is of longstanding interest in various cardiovascular scenarios. In this context, pulse arrival time (PAT), i.e., a surrogate parameter for systolic BP (change), became very popular recently, especially in the context of cuffless BP measurement and dedicated lifestyle interventions. Nevertheless, there is also understandable doubt on its reliability in uncontrolled and mobile settings. Objective. The aim of this work is therefore the investigation whether PAT follows oscillometric systolic BP readings during moderate interventions by physical or mental activity using a medical grade handheld device for non-invasive PAT assessment. Approach. A study was conducted featuring an experimental group performing a physical and a mental task, and a control group. Oscillometric BP and PAT were assessed at baseline and after each intervention. Interventions were selected randomly but then performed sequentially in a counterbalanced order. Multivariate analyses of variance were used to test within-subject and between-subject effects for the dependent variables, followed by univariate analyses for post-hoc testing. Furthermore, correlation analysis was performed to assess the association of intervention effects between BP and PAT. Main results. The study included 51 subjects (31 females). Multivariate analysis of variances showed that effects in BP, heart rate, PAT and pulse wave parameters were consistent and significantly different between experimental and control groups. After physical activity, heart rate and systolic BP increased significantly whereas PAT decreased significantly. Mental activity leads to a decrease in systolic BP at stable heart rate. Pulse wave parameters follow accordingly by an increase of PAT and mainly unchanged pulse wave analysis features due to constant heart rate. Finally, also the control group behaviour was accurately registered by the PAT method compared to oscillometric cuff. Correlation analyses revealed significant negative associations between changes of systolic BP and changes of PAT from baseline to the physical task (−0.33 [−0.63, 0.01], p < 0.048), and from physical to mental task (−0.51 [−0.77, −0.14], p = 0.001), but not for baseline to mental task (−0.12 [−0,43,0,20], p = 0.50) in the experimental group. Significance. PAT and the used digital, handheld device proved to register changes in BP and heart rate reliably compared to oscillometric measurements during intervention. Therefore, it might add benefit to future mobile health solutions to support BP management by tracking relative, not absolute, BP changes during non-pharmacological interventions.

Ultrasound and magnetic resonance imaging–based investigation of the role of perfusion and oxygen availability in menstrual pain

BackgroundThe mechanisms responsible for menstrual pain are poorly understood. However, dynamic noninvasive pelvic imaging of menstrual pain sufferers could aid in identifying therapeutic targets and in testing novel treatments. ObjectiveTo study the mechanisms responsible for menstrual pain, we analyzed ultrasonographic and complementary functional Magnetic Resonance Imaging (fMRI) parameters in dysmenorrhea sufferers and pain-free controls under multiple conditions. Study DesignWe performed fMRI on participants with and without dysmenorrhea during menses and non-menses. To clarify whether regional changes in oxygen availability and perfusion occur, fMRI R2* measurements were made of the endometrium and myometrium. R2* measurements are calculated nuclear magnetic resonance relaxation rates sensitive to the paramagnetic properties of oxygenated and deoxygenated hemoglobin. We also compared parameters before and after an analgesic dose of naproxen sodium. In addition, we performed similar measurements with Doppler ultrasonography to identify whether changes in uterine arterial velocity occurred during menstrual cramping in real time. Mixed model statistics were performed to account for within-subject effects across conditions. Corrections for multiple comparisons were made with a false discovery rate adjustment. ResultsDuring menstruation, a notable increase in R2* values, indicative of tissue ischemia, was observed in both the myometrium (beta ± standard error of the mean: 15.74 ± 2.29 s-1, p = 0.001, q = 0.002) and the endometrium (26.37 ± 9.33 s-1, p = 0.005, q = 0.008) among participants experiencing dysmenorrhea. A similar increase was noted in the myometrium (28.89 ± 2.85 s-1, p = 0.001, q = 0.002) and endometrium (75.50 ± 2.57 s-1, p = 0.001, q = 0.003) among pain-free controls. Post-hoc analyses revealed that R2* values during menstruation were significantly higher than those in participants with dysmenorrhea (Myometrium: p = 0.008, Endometrium: p = 0.043). Whereas naproxen sodium increased endometrial R2* in participants with dysmenorrhea (48.29 ± 15.78 s-1,p = 0.005, q = 0.008), it decreased myometrial R2*in pain-free controls. Doppler findings were consistent with fMRI (-8.62 ± 3.25 s-1, p = 0.008, q = 0.011). The pulsatility index (-0.42 ± 0.14, p = 0.004, q = 0.004) and resistance index (-0.042 ± 0.012, p = 0.001, q = 0.001) decreased during menses compared with non-menses, and effects were significantly reversed by naproxen sodium. Naproxen sodium had the opposite effect in pain-free controls. There were no significant real-time changes in the pulsatility index, resistance index, peak systolic velocity, or minimum diastolic velocity during episodes of symptomatic menstrual cramping. ConclusionsfMRI and Doppler metrics suggest participants with dysmenorrhea have better perfusion and oxygen availability than pain-free controls. Naproxen sodium's therapeutic mechanism is associated with relative reductions in uterine perfusion and oxygen availability. An opposite pharmacological effect was observed in pain-free controls. During menstrual cramping, there is insufficient evidence of episodic impaired uterine perfusion. Thus, prostaglandins may have protective vasoconstrictive effects in pain-free controls and opposite effects among participants with dysmenorrhea.

Building Resilience through Intervention, Direct Guidance, and Empowerment (BRIDGE): A demonstration project to assist youth aging out of foster care in Poland

Building Resilience through Intervention, Direct Guidance, and Empowerment (BRIDGE) is an innovative program designed to prevent homelessness and other negative outcomes among youth aging out of foster care. BRIDGE was pilot-tested on youth aging out of two orphanages in a city in southern Poland in 2009–2012. Youth were recruited at age 17, before aging out at age 18. Quasi-experimental methods were used to evaluate program outcomes among nine BRIDGE clients compared to two matched groups (n = 9 and n = 18) of youth who had recently aged out of orphanages in the same Polish region. Consistent with Hypothesis 1, results of chi-square tests showed that, over an 18-month follow-up period, BRIDGE clients experienced superior housing outcomes relative to both matched groups. Consistent with Hypothesis 2, the results of a between-subjects ANOVA showed that BRIDGE clients received significantly greater income relative to the matched groups. Within-subjects effects of BRIDGE from baseline across 6-, 12-, and 18-month follow-ups were examined with repeated-measures ANOVAs. Consistent with Hypotheses 3–5, results showed that across time BRIDGE clients experienced a general increase in income and decrease in psychological distress (i.e., total distress, obsessive-compulsiveness, interpersonal sensitivity, and paranoia). The study’s findings support the further development of BRIDGE and similar programs.

A reduction in cigarette smoking improves health-related quality of life and does not worsen psychiatric symptoms in individuals with serious mental illness

IntroductionIndividuals with serious mental illness (SMI) smoke cigarettes at a much higher rate than the general population, increasing their risk for medical illnesses and mortality. However, individuals with SMI do not get enough support to quit smoking, partially because of concerns from medical providers that reducing smoking may worsen their symptoms or quality of life. MethodsVeterans with SMI and nicotine dependence (n = 178) completed a 12-week smoking cessation trial (parent trial dates: 2010–2014) including assessments of smoking status, psychiatric symptoms (Brief Psychiatric Rating Scale), and quality of life (Lehman Quality of Life Interview–Short Version) at up to four time points: baseline, post-treatment, three-month follow-up, and 9-month follow-up. Bayesian multilevel modeling estimated the impact of changes in the self-reported number of cigarettes per day in the past seven days on psychiatric symptoms and quality of life. ResultsBetween subjects, each additional pack of cigarettes smoked per day was associated with a 0.83 point higher score (95%CI: 0.03 to 1.7) on a negative symptoms scale ranging from 0 to 35. Within subjects, each one-pack reduction in the number of cigarettes smoked per day was associated with an improvement of 0.32 (95%CI = 0.12 to 0.54) on the health-related quality of life scale, which ranges from 0 to 7 points. There were no other significant between- or within-subjects effects of smoking on psychiatric symptoms or quality of life. ConclusionsIndividuals with SMI and their providers should pursue smoking cessation without fear of worsening psychiatric symptoms or quality of life.