BRIDGE to liver health: implementation of a group telehealth psychoeducational program through shared medical appointments for MASLD management.

BACKGROUND: Metabolic dysfunction-associated steatotic liver disease (MASLD) represents a significantly costly and increasingly prevalent disease, with treatment focused on lifestyle intervention. Integrating education and behavioral health into clinical care offers opportunities to engage and empower patients to prevent progression of liver disease. We describe the design and implementation of Behavioral Resources and Intervention through Digital Group Education (BRIDGE), a 6-session group telehealth program led by advanced practice providers (APPs) in 90-min shared medical appointments (SMAs) with small groups of MASLD patients in an academic outpatient hepatology clinic. The program contains multi-component group interventions, with didactic education and behavioral coaching, while leveraging peer-based learning and support. METHODS: A mixed-methods exploratory pilot study was conducted. Feasibility and acceptability of the clinical intervention were assessed by tracking recruitment, attendance, and retention of BRIDGE participants, patient interviews, and debriefing of clinician and staff views of the clinical program. Implementation metrics included program development time, workflow and scheduling logistics, and billing compliance for sustainability. Finally, patient parameters including changes in liver enzymes, FIB-4, weight, and BMI from pre- to post-BRIDGE were retrospectively analyzed. RESULTS: We included 57 participants (median age 57, interquartile range (IQR) 50 - 65 years), 38 (67%) female, 38 (67%) white, and 40% had public insurance. Thirty-three (58%) participants completed all six sessions, while 43 (75%) attended at least five sessions. Patients who completed all sessions were older (median age 61 vs 53.5; p = 0.01). Gender, race/ethnicity, and insurance type were not significantly associated with missed sessions, and patients had similar rates of completion regardless of weight, BMI, or stage of liver disease. Barriers to completion included personal illness, family reasons, work commitments, or insurance issues. Prior to BRIDGE, median BMI was 31.9 (SD 29 - 36), with a median weight loss of 2 pounds (IQR -2 - 6) after BRIDGE. CONCLUSION: The BRIDGE telehealth SMA program was feasible, well-attended, and positively reviewed. This pilot study informs future iterations of program development and evaluation of outcome measures.

Arriba por la Vida Estudio: a randomized controlled trial promoting standing behavior to reduce sitting time among postmenopausal Latinas.

Postmenopausal Hispanic/Latina (N = 254) women with a body mass index (BMI) ≥ 25 kg/m2 were randomized to an intervention to reduce sitting time or a comparison condition for 12 weeks. The standing intervention group received three in-person health-counseling sessions, one home visit, and up to eight motivational interviewing calls. The heart healthy lifestyle comparison group (C) received an equal number of contact hours to discuss healthy aging. The primary outcome was 12-week change in sitting time measured via thigh-worn activPAL. Group differences in outcomes were analyzed using linear mixed-effects models. Participants had a mean age of 65 (6.5) years, preferred Spanish language (89%), BMI of 32.4 (4.8) kg/m2, and sat for an average of 540 (86) minutes/day. Significant between-group differences were observed in reductions of sitting time across the 12-week period [Mdifference (SE): C - 7.5 (9.1), SI - 71.0 (9.8), p < 0.01]. Results demonstrate that coaching models to reduce sitting are feasible and effective.

Imaginal retraining reduces craving for high-calorie food.

Imaginal retraining (IR) is a treatment derived from approach bias modification to reduce strong craving for high-calorie food. The push component (IRpush) seems to be the most effective element according to a recent dismantling trial. Conclusions derived from prior studies are limited, however, by small sample sizes and restriction of participants to women. The present study aimed to overcome these limitations and also tested a new variant of IR (3P; decoupling with the elements pull, pause, push), which has previously been found to be more effective than the standard protocol in individuals with problematic alcohol use. The study was conducted online. A total of 1,106 participants with strong craving for high-calorie food were randomized to different brief interventions of IR or a passive control group. Before and after the interventions, participants indicated their craving for high-calorie food and appraised food pictures. The main conditions of interest were IRpush and 3P. The other two experimental conditions did not contain a motor element and served as active control conditions. IRpush proved the most effective intervention and reduced craving by approximately 18%, which was significantly larger than in the passive control group. IRpush worked especially well for those with higher initial weight, higher cravings, and more dysfunctional eating behavior. The novel 3P technique significantly reduced craving across time and was especially effective for those with high BMI and craving. The study suggests that a simple self-help component of imaginal retraining, IRpush, can decrease craving for high-calorie food to a relevant extent. Future trials should elucidate whether different forms of substance-related and behavioral addictions require adapted IR or 3P protocols to increase effectiveness.

Case study: Modifying repetitive behavior in a polar bear (Ursus maritimus).

Stereotypic pacing in zoo-housed carnivores has been intensively researched for decades, revealing that it is a subtly complex behavior with a highly variable etiology. While pacing can be an indicator of poor welfare, it can also be anticipatory in nature, or even have a completely different motivating operation. In this case study, the pacing of a zoo-housed polar bear, "Tundra," was maintained through inadvertent reinforcement. Baseline data revealed that in 86% of afternoon observations, Tundra paced when the door to shift him off-exhibit was opened. Upon changing the contingencies of reinforcement, there was a change in his behavior; initially with a shift in time, and then a shift in duration. Using a strategy of Differential Reinforcement of an Incompatible behavior, the pacing bout duration significantly decreased from a median of 4 min 13 s to 2 min 26 s. Due to the potential for repetitive walking to negatively influence captive carnivore welfare and the high individual variability of this behavior, investigation into the ontogeny and motivation for these behaviors should continue.

Paying attention to each other. An essay on the transnational intersections of industrial economy, subjectivity, and governance in East Germany's social-psychological training.

This article examines a little-known chapter both in the history of socialist labor relations and the history of psychology: Social Psychological Training (SPT) for industrial leaders in the German Democratic Republic (GDR). Based on previously untapped archival sources, it uncovers the transnational genesis of SPT and its intricate relationships with Western "therapeutic culture" of the 1970s. Governmental perspectives are addressed, as well as the level of individual appropriation of SPT and possible unintended side effects of techniques that were drawn from the social psychological and therapeutical fields. This case study helps to explore the functions of psychological expertise in authoritarian political contexts, as well as the polyvalence of group methods of change, the effects of which could turn out repressive as well as liberating on both sides of the Iron Curtain. The history of SPT solicits a polycentric view on therapeutic culture, capturing its diverse manifestations and interconnections between different societies and political economies.

Daily self-monitoring of blood pressure decreases systolic and diastolic blood pressure in hypertensive participants.

Hypertension is a major risk factor for cardiovascular diseases, and behavior modification has been shown to improve blood pressure (BP). We investigated whether daily self-monitoring of systemic BP and other factors related to cardiovascular events decreased BP in hypertensive participants. In this prospective, randomized, open, blinded-endpoint trial, we assigned 161 participants with hypertension to monitor their BP daily (BP-measurement group) or, in addition to BP, monitor their body fat, sleeping time, and daily step count (multiple-measurement group) or no self-monitoring (control group) for 2 months. The primary endpoint was the absolute change in systolic BP from baseline to 2 months after assignment. There were no differences in the baseline age and gender ratios among the three groups. After 2 months, systolic BP in the morning was unchanged in the control group, at a median of 149 mmHg [interquartile range (IQR) 136-164] from 150 mmHg (IQR 138-164), and was significantly decreased to 139 mmHg (IQR 125-148) from 142 mmHg (IQR 131-157) in the BP-measurement group. BP did not further decrease in the multiple-measurement group, 134 mmHg (IQR 121-146) from 141 mmHg (IQR 131-157). Daily self-monitoring of BP decreased the BP of participants with hypertension, but additional daily self-monitoring of body fat, sleeping time, and daily step count did not further decrease BP. This behavior modification merits use as a nonpharmacological hypertension treatment.

Educating behavior clinicians in a community behavior care center for children with autism spectrum disorder: Medication administration a pilot study in the United States.

Autism Spectrum Disorder (ASD) is a multifaceted developmental disability requiring specialized supports. Due to the growing diagnoses of ASD, the demand for behavior treatment centers has also grown. These centers offer a wide range of beneficial services to children with ASD, including medication administration and management. While centers may employ highly educated and certified employees, there may be a gap in education related to medication administration and medication management knowledge. Using an evidence based education tool, this study sought to explore if clinicians in a behavior care center could gain knowledge in their ability to accurately administer and manage medications for children with ASD, and postulate if existing post-secondary curricula for behavior clinicians should be enriched to include medication administration and management training. This comprised two separate day long sessions of an implementation pilot study of best practice education in medication administration and medication management for behavior clinicians employed at a community behavior care center for children with ASD in the United States. Using the Statistical Package for the Social Sciences, 25 (SPSS), the paired samples t-test was applied for analysis. The quantitative results demonstrated the skill level treatment effect was statistically significant (p < .001). On the basis of the results the author makes recommendations regarding how to include medication administration and medication management education into existing behavior clinician curricula in the United States.

Related factors associated with exercise behavior in patients with peripheral arterial disease.

[Purpose] This study aimed to identify the factors associated with exercise behavior in patients with peripheral arterial disease. [Participants and Methods] The study included 43 patients with peripheral arterial disease (mean age, 75.2 ± 5.6 years) who were admitted for endovascular treatment from January 2020 to June 2021. Participants were surveyed through questionnaires to assess their physical function for determining their exercise behavior and the presence of physical, personal, and environmental factors that might have affected their stage of change regarding exercise behavior. [Results] A comparison of physical, personal, and environmental factors between the two groups classified by the presence or absence of exercise behavior showed that subjective health and exercise self-efficacy were significantly lower in the group without exercise. Furthermore, a difference was noted in the presence or absence of work. The adjusted binomial logistic regression analysis results using each of the factors differing between the groups, plus the walking impairment questionnaire total score as explanatory variables, showed a significant relationship with exercise self-efficacy only. [Conclusion] The results of this study showed that exercise self-efficacy presented a useful predictive relationship with the presence of exercise behavior in patients with peripheral arterial disease.

Influence of active versus passive parental presence on the behavior of preschoolers with different intelligence levels in the dental operatory: a randomized controlled clinical trial.

BACKGROUND: Dental fear and anxiety still pose the most common factors proposed for the child's negative behavior in the dental operatory. Intelligence has an impact on the children's communication, feelings, and responsiveness to dental situations. The benefits of parental presence on reinforcing the child's behavior during dental treatment are still debatable. This study aimed to assess the effect of parental active versus parental passive presence techniques on the overall behavior of preschool children with different intelligence levels. METHODS: This randomized controlled trial was conducted from December 2017 to August 2019. It recruited 150 healthy children, 3-6-year-old, with no history of previous dental pain/treatment, and intelligence quotient level of 70- ≤ 110 stratified into 3 equal groups (high, average, low). In the first visit, each IQ group was randomly divided into test (PAP) and control (PPP) groups. In the second visit, dental fear was assessed before preventive intervention, the test groups were then managed using parental active presence technique, while the control groups were managed using parental passive presence technique. The overall behavior was assessed at the end of the visit. Data was analyzed using Chi-square test and logistic regression analysis. RESULTS: The parental active presence technique had significant effect on children with high and low intelligence quotients. There were significantly higher odds of positive behavior in high than low intelligence quotient children, (OR 4.08, 95% CI 1.43, 11.67, P = 0.01). The parental active presence technique had significantly higher odds of positive behavior than the parental passive presence technique, (OR 4.08, 95% CI 1.71, 9.76, P = 0.002). CONCLUSIONS: The parental active presence technique had positively influenced the children's overall behavior irrespective of their intelligence levels. This trial was retrospectively registered, trial identifier number: NCT04580316, 8/11/2020.

Frequently overlooked realistic moral bioenhancement interventions.

Many supporters of 'moral bioenhancement' (MBE), the use of biomedical interventions for moral improvement, have been criticised for having unrealistic proposals. The interventions they suggest have often been called infeasible and their implementation plans vague or unethical. I dispute these criticisms by showing that various interventions to implement MBE are practically and ethically feasible enough to warrant serious consideration. Such interventions include transcranial direct current stimulation over the medial and dorsolateral prefrontal cortex, as well as supplementation with lithium and omega-3. Considering their efficacy and feasibility, it is strange that these interventions have rarely been proposed or discussed as MBE. I review evidence that each of those interventions can reduce antisocial behaviour, reduce racial bias, increase executive function or increase prosocial traits like fairness and altruism. I then specify and defend realistic, ethically permissible ways to implement these interventions, especially for violent offenders and public servants-the former as rehabilitation and the latter to meet the high standards of their occupations. These interventions could be given to violent offenders in exchange for a reduced sentence or compulsorily in some cases. Potential intervention methods for non-prisoners include increasing the USDA-recommended dose of omega-3, encouraging food companies to supplement their products with omega-3 or trace lithium, requiring MBE for employment as a police officer or political leader, and insurance companies providing discounts for undergoing MBE. In some reasonably limited form, using these interventions may be a good first step to implement the project of MBE.

"Well, good luck with that": reactions to learning of increased genetic risk for Alzheimer disease.

PURPOSE: Apolipoprotein-E (APOE) genetic testing to estimate risk for developing late-onset Alzheimer disease is increasingly being offered without prior genetic counseling or preparation. Consumer interest continues to grow, raising the question of how best to conduct such testing. METHODS: Twenty-six semistructured interviews were carried out to study the reactions of individuals who had already learned of their higher risk after APOE testing had been done because of a family history of Alzheimer disease, or from genetic tests done for other health-related or general-interest reasons. RESULTS: Adverse psychological reactions were reported by a substantial fraction of the participants, including those who had specifically sought testing, those for whom the information came as a surprise, those with a family history, and those with no known history. Still, nearly all of those interviewed said that they had benefited in the long term from lifestyle changes, often learned from online sources, that they subsequently made. CONCLUSION: The results show that people should be prepared prior to any genetic testing and allowed to opt out of particular tests. If testing is carried out and a higher risk is revealed, they should be actively assisted in deciding how to proceed.

Assessing air quality index awareness and use in Mexico City.

BACKGROUND: The Mexico City Metropolitan Area has an expansive urban population and a long history of air quality management challenges. Poor air quality has been associated with adverse pulmonary and cardiac health effects, particularly among susceptible populations with underlying disease. In addition to reducing pollution concentrations, risk communication efforts that inform behavior modification have the potential to reduce public health burdens associated with air pollution. METHODS: This study investigates the utilization of Mexico's IMECA risk communication index to inform air pollution avoidance behavior among the general population living in the Mexico City Metropolitan Area. Individuals were selected via probability sampling and surveyed by phone about their air quality index knowledge, pollution concerns, and individual behaviors. RESULTS: The results indicated reasonably high awareness of the air quality index (53% of respondents), with greater awareness in urban areas, among older and more educated individuals, and for those who received air quality information from a healthcare provider. Additionally, behavior modification was less influenced by index reports as it was by personal perceptions of air quality, and there was no difference in behavior modification among susceptible and non-susceptible groups. CONCLUSIONS: Taken together, these results suggest there are opportunities to improve the public health impact of risk communication through an increased focus on susceptible populations and greater encouragement of public action in response to local air quality indices.

Lifestyle intervention using Internet of Things (IoT) for the elderly: A study protocol for a randomized control trial (the BEST-LIFE study).

Modification of lifestyle habits, including diet and physical activity, is essential for the prevention and control of type 2 diabetes mellitus (T2DM) in elderly patients. However, individualized treatment is more critical for the elderly than for general patients. This study aimed to determine lifestyle interventions that resulted in lowering hemoglobin A1c (HbA1c) in Japanese pre- and early diabetic elderly subjects. The BEST-LIFE trial is an ongoing, open-label, 6-month, randomized (1:1) parallel group trial. Subjects with HbA1c of ≥5.6%-randomly assigned to the intervention or control group -use wearable monitoring devices loaded with Internet of things (IoT) systems that aids them with self-management and obtaining monthly remote health guidance from a public health nurse. The primary outcome is changes in HbA1c after a 6-month intervention relative to the baseline values. The secondary outcome is the change of behavior modification stages. The background, rationale, and study design of this trial are also presented. One hundred forty-five subjects have already been enrolled in this lifestyle intervention program, which will end in 2019. The BEST-LIFE trial will provide new evidence regarding the effectiveness and safety of our program on lowering HbA1c in elderly subjects with T2DM. It will also investigate whether information communication technology tools and monitoring devices loaded with IoT can support health care in elderly subjects. The trial registration number is UMIN-CTR: UMIN 000023356.

Self-Regulatory Self-Efficacy, Action Control, and Planning: There's an App for That!

INTRODUCTION: Advances in technology have resulted in smartphone-based applications (apps) that could possibly serve to support physical activity (PA). This study compares health action process approach social cognitions between exercisers who do (n = 29) and do not (n = 76) use apps. MATERIALS AND METHODS: Exercisers completed an online questionnaire assessing usage of apps, the health action process approach (HAPA) social cognitions, and PA. RESULTS: A multivariate effect was found between app users and nonusers for HAPA social cognitions. Follow-up univariate analyses were calculated and determined that app users had significantly greater goal-setting efficacy, scheduling efficacy, recovery efficacy, action control, and planning compared with nonusers. CONCLUSIONS: App use may be related to greater self-regulatory cognitions and skills. Future research should further explore app use in relation to social cognitions and long-term PA.

Healthy lifestyle change and subclinical atherosclerosis in young adults: Coronary Artery Risk Development in Young Adults (CARDIA) study.

BACKGROUND: The benefits of healthy habits are well established, but it is unclear whether making health behavior changes as an adult can still alter coronary artery disease risk. METHODS AND RESULTS: The Coronary Artery Risk Development in Young Adults (CARDIA) prospective cohort study (n=3538) assessed 5 healthy lifestyle factors (HLFs) among young adults aged 18 to 30 years (year 0 baseline) and 20 years later (year 20): not overweight/obese, low alcohol intake, healthy diet, physically active, nonsmoker. We tested whether change from year 0 to 20 in a continuous composite HLF score (HLF change; range, -5 to +5) is associated with subclinical atherosclerosis (coronary artery calcification and carotid intima-media thickness) at year 20, after adjustment for demographics, medications, and baseline HLFs. By year 20, 25.3% of the sample improved (HLF change ≥+1); 40.4% deteriorated (had fewer HLFs); 34.4% stayed the same; and 19.2% had coronary artery calcification (>0). Each increase in HLFs was associated with reduced odds of detectable coronary artery calcification (odds ratio=0.85; 95% confidence interval, 0.74-0.98) and lower intima-media thickness (carotid bulb ß=-0.024, P=0.001), and each decrease in HLFs was predictive to a similar degree of greater odds of coronary artery calcification (odds ratio=1.17; 95% confidence interval, 1.02-1.33) and greater intima-media thickness (ß=+0.020, P<0.01). CONCLUSIONS: Healthy lifestyle changes during young adulthood are associated with decreased risk and unhealthy lifestyle changes are associated with increased risk for subclinical atherosclerosis in middle age.

Evaluation of a continuing education course for occupational therapy practitioners on the use of applied behavior analysis.

A three hour continuing education course combining occupational therapy practice and behavior analysis strategies related to children with autism spectrum disorders was developed and delivered to 24 occupational therapy practitioners. Participants completed evaluations pre-course, post-course, and one month follow up on their self-efficacy, knowledge, and skills in managing challenging behaviors of children with autism spectrum disorders. Overall, ratings scores showed an increase in participants' self-efficacy and knowledge and skill at post-course and one-month follow-up. Despite this increase, participants continued to implement sensory strategies to decrease challenging behaviors due to increased self-efficacy in using sensory strategies and the lack of support in implementing behavior techniques outside their session time.