The Impact of Mental Imagery Instructions on Patients' and Therapists' Positive Affect and Strength-Based Behaviours Within Psychotherapy Sessions: A Randomized Controlled Process Study.

OBJECTIVE: Increased attention has recently been paid to the well-being and flourishing of patients in psychotherapy. This study investigated the occurrence of positive affect (PA) and strength-based behaviours within psychotherapy sessions contrasting positive versus neutral imagery instructions. METHODS: This is a secondary analysis of a randomized controlled trial. Seventy-eight sessions of cognitive behavioural therapy involving 26 patients (69.23% female; Mage = 40.31) treated by 13 therapists were selected. PA and strength-based behaviours of patients and therapists were coded on a minute-by-minute basis with the Resource-Oriented Microprocess Analysis. Each session started with a brief mental imagery instruction. Data were analysed using multilevel modelling. RESULTS: Mild levels of PA were very common, whereas stronger expressions were occasional, especially at the beginning and end of sessions. Strength-based behaviours were employed in one-fifth of the videos analysed. Therapists in the positive imagery instruction showed more strength-based behaviours in the beginning phase of sessions, p < 0.05. The two imagery instructions significantly differed in the session trajectories of PA, p < 0.05. A quadratic trend with higher initial values and a sharper decline in PA were found in the positive instruction, whereas the neutral instruction showed a flatter trend. CONCLUSION: Patients and therapists experience PA and discuss strengths in psychotherapy sessions despite patients' distress. The positive imagery instructions potentially induced a positive focus at baseline for therapists but had a negligible effect on the subsequent session progression. TRIAL REGISTRATION: ClinicalTrials.gov identifier: NCT03767101 (registered December 6, 2018).

Examining the mediating and moderating roles of social marketing behavioural enhancers regarding consistent condom use.

Since their importance was highlighted by Ayikwa and De Jager, social marketing behavioural enhancers (SMBEs) have been investigated in terms of their causal and correlational relationships with the intention to use condoms (IUC) and consistent condom use (CCU), as people often fail to act on their intentions. However, scrutiny of their mediating and moderating roles could provide insights pertinent to the design of effective HIV and AIDS preventative programmes. This study examined whether perceived behavioural control (PBC) and IUC interact with exposure to HIV and AIDS information (EI), ease of access to condoms (EAC) and level of related knowledge (KN) in determining CCU. It also investigated whether PBC and IUC predict CCU through increasing EI, EAC, and KN. A quantitative approach was adopted and data were collected from 607 participants, aged at least 18, living in Gauteng Province, South Africa. The questionnaire administered included pre-existing items, validated through exploratory and confirmatory factor analysis procedures. Regression analyses of the data for mediation and moderation testing were performed using PROCESS macro software for SPSS. The results indicated that none of the SMBEs mediated the non-significant PBC-CCU relationship: B = -0.0258, SE = 0.0199, p = 0.195. Nor did they mediate the significant IUC-CCU relationship: B = 0.0395, SE = 0.0195, p = 0.043. Similarly, none of the SMBEs were found to moderate the PBC-CCU relationship (EI*PBC: B = 0.0034, SE = 0.0056, p = 0.540; KN*PBC: B = -0.0006, SE = 0.0064, p = 0.931; EAC*PBC: B = 0.0011, SE = 0.0059, p = 0.854) as IUC-CCU relationship (EI*IUC: B = 0.0036, SE = 0.0054, p = 0.513; KN*IUC: B = -0.0096, SE = 0.0060, p = 0.111; EAC*IUC: B = 0.0044, SE = 0.0061, p = 0.469). A recommendation is made to scrutinise the mediating and moderating roles of SMBEs in the context of health behavioural models other than the theory of planned behaviour, which was considered in this study.

Revisiting the effectiveness of cognitive-behavioural therapy for reducing reoffending in the criminal justice system: A systematic review.

This is the protocol for a Campbell systematic review. The objectives are as follows. The proposed systematic review is an update to, and extension of, Lipsey et al. (2007). As such we build on their previous aims to: (i) Assess and synthesise the overall impact of cognitive behavioural therapy (CBT) on offender recidivism; (ii) Examine possible sources of variability in the effectiveness of CBT. Data permitting, we will examine if the effectiveness of CBT varies by: (a) Characteristics of the CBT intervention (e.g., cognitive restructuring vs. cognitive skills training, group v. individual implementation; and/or custodial v. community setting, and/or), (b) Characteristics of the population (e.g., juveniles vs. adult offenders), (c) Implementation factors (e.g., implementing practitioner, use of structured/manualised approaches, delivery mode, and/or programme duration or intensity), (d) Evaluation methods (e.g., randomised vs. non-randomised research designs); (iv) Determine whether there is a decline in the effect of CBT on recidivism over time; and (v) Investigate whether there is an interaction between implementation factors and time in terms of the effect on recidivism.

Enhancing making every contact count (MECC) training and delivery for the third and social economy (TSE) sector: a strategic behavioural analysis.

OBJECTIVE: To enhance Making Every Contact Count (MECC, an opportunistic approach to health promotion), training in the Third and Social Economy (TSE, all groups and organisations primarily working towards social justice, outside of the government or household) by examining the degree to which the behavioural content of MECC training tackled significant factors influencing MECC delivery. METHODS AND MEASURES: A strategic behavioural analysis design. Semi-structured interviews with service providers (n = 15) and users (n = 5) were coded for barriers and facilitators of MECC delivery using the Theoretical Domains Framework (TDF). Existing MECC training was coded for behaviour change techniques (BCTs) and intervention functions (IFs). The degree to which BCTs and IFs addressed the key TDF domains of influences on MECC delivery in the TSE were examined using prespecified tools. RESULTS: Seven key TDF domains of influences in MECC delivery were identified. Overall, only 9/31 linked BCTs were utilised within MECC training, with percentage utilisation of relevant BCTs for each domain ranging from 0% to 66.7%. Training adequately addressed 2/7 key domains. CONCLUSION: The TSE and healthcare share many common key TDF domains, although there are differences in how each are relevant. Limitations and recommendations for MECC training are discussed.

Within-population variation in an invasive fish' sociability when associating with conspecifics or heterospecifics.

Behavioural traits are key to promote invasion success because they are easier to adjust to changing environmental conditions than morphological or life history traits. Often, research has overlooked variance in behavioural traits within populations or has assumed it to be mere noise. However, a recent focus towards individual variation of behaviour of successful invaders has revealed new and more profound insights into the invasion process. Behavioural variation within a population could lead to more successful invasions, as they include individuals with diverse behaviours, which ensures at least some individuals could be able to cope with changing conditions. The aim of this research was to examine if invasive guppies (Poecilia reticulata) present within-population differences in their sociability (time spent associating with a shoal) when interacting with conspecifics or heterospecifics. Guppies presented significant differences in their individual tendencies to associate with conspecific or heterospecific shoals. There were among-individual differences in the time spent shoaling with conspecifics versus heterospecifics, where most individuals did not differ in their sociability with conspecifics or heterospecifics, and only 22% of individuals presented a higher tendency to associate with conspecifics. Our results are the first to show individual differences in fish' tendencies to associate with heterospecifics among individuals of the same population and rearing conditions. Given that associations with heterospecific natives have been found to be as beneficial as associations with conspecifics for invaders, our results contribute to the understanding of mechanisms behind heterospecific sociability between natives and invaders.

Rethinking fish-friendliness of pumps by shifting focus to both safe and timely fish passage for effective conservation.

Globally, catadromous freshwater eels of the genus Anguilla are of conservation concern, including critically endangered European eel (Anguilla anguilla). Pumping stations that move river water to a higher elevation severely impact eels during their seaward spawning migration. Fish-friendly pumps can mitigate fish injury and mortality but here we uniquely rethink a fish-friendly pump as a fish passage solution. In this pluriannual study, the seasonal timing of pump operation was misaligned with the typical silver eel migration period. Eels were almost exclusively nocturnal but night-time pumping represented as little as 5.6% a year. Night-time eel approaches were primarily influenced by pump duration and temperature, but did not align with lunar phase, unlike in unregulated rivers. After reaching the pumping station, eel passage was influenced by weedscreen aperture and increased when the aperture was increased. Passive sensor collision suggested non-pump infrastructure could cause injury and mortality to eels. It is therefore recommended pump operation should align with the timing of silver eel migration, weedscreen and pump entrance efficiencies should be maximised, and non-pump infrastructure must have low fish injury risk. Ultimately, considering the entire structure a fish passage solution will help ensure fish-friendly pumps have high conservation value for anguillid eels globally.

Impact of an intervention for perinatal anxiety on breastfeeding: findings from the Happy Mother-Healthy Baby randomized controlled trial in Pakistan.

BACKGROUND: The study examined the effects of Happy Mother-Healthy Baby (HMHB), a cognitive-behavioural therapy (CBT) intervention on breastfeeding outcomes for Pakistani women with prenatal anxiety. METHODS: Breastfeeding practices were evaluated in a randomized controlled trial between 2019 and 2022 in a public hospital in Pakistan. The intervention group was randomized to receive six HMHB sessions targeted towards prenatal anxiety (with breastfeeding discussed in the final session), while both groups also received enhanced usual care. Breastfeeding was defined in four categories: early breastfeeding, exclusive early breastfeeding, recent breastfeeding, and exclusive recent breastfeeding. Early breastfeeding referred to the first 24 h after birth and recent breastfeeding referred to the last 24 h before an assessment at six-weeks postpartum. Potential confounders included were mother's age, baseline depression and anxiety levels, stress, social support, if the first pregnancy (or not) and history of stillbirth or miscarriage as well as child's gestational age, gender. Both intent-to-treat and per-protocol analyses were examined. Stratified analyses were also used to compare intervention efficacy for those with mild vs severe anxiety. RESULTS: Out of the 1307 eligible women invited to participate, 107 declined to participate and 480 were lost to follow-up, resulting in 720 women who completed the postpartum assessment. Both intervention and control arms were similar on demographic characteristics (e.g. sex, age, income, family structure). In the primary intent-to-treat analysis, there was a marginal impact of the intervention on early breastfeeding (OR 1.38, 95% CI: 0.99-1.92; 75.4% (N = 273) vs. 69.0% (N = 247)) and a non-significant association with other breastfeeding outcomes (OR1.42, 95% CI: 0.89-2.27; (47) 12.9% vs. (34) 9.5%, exclusive early breastfeeding; OR 1.48, 95% CI: 0.94-2.35; 90% (N = 327) vs. 86% (N = 309), recent breastfeeding; OR1.01, 95% CI: 0.76-1.35; 49% (N = 178) vs 49% (N = 175) exclusive recent breastfeeding). Among those who completed the intervention's six core sessions, the intervention increased the odds of early breastfeeding (OR1.69, 95% CI:1.12-2.54; 79% (N = 154) vs. 69% (N = 247)) and recent breastfeeding (OR 2.05, 95% CI:1.10-3.81; 93% (N = 181) vs. 86% (N = 309)). For women with mild anxiety at enrolment, the intervention increased the odds of recent breastfeeding (OR 2.41, 95% CI:1.17-5.00; 92% (N = 137) vs. 83% (N = 123). CONCLUSIONS: The study highlights the potential of CBT-based interventions like HMHB to enhance breastfeeding among women with mild perinatal anxiety, contingent upon full participation in the intervention. TRIAL REGISTRATION: ClinicalTrials.gov NCT03880032.

Effects of a prenatal anxiety randomized controlled trial intervention on infant development in Pakistan.

OBJECTIVES: Given that infant development is influenced by caregiver mental health, we tested whether an intervention to reduce antenatal anxiety could affect infant development. A secondary aim was to test depressive symptoms, maternal responsiveness, and maternal infant bonding as mediators of this relationship. METHODS: Between 2020 and 2022, pregnant women participated in a randomized controlled trial of the Happy Mother-Healthy Baby (HMHB) program based on cognitive behavioral therapy. We collected data on child development from 202 intervention and 198 control participants in a public hospital in Pakistan. Child development was measured using the Ages and Stages Questionnaires-Version 3 at six weeks postpartum. Using intent-to-treat analyses, we examined whether the intervention was associated with performance on the five ASQ-3 domains. Causal mediation analysis was used to assess depressive symptoms, bonding, and maternal-infant responsiveness as mediators. RESULTS: Socio-demographic characteristics were evenly distributed between study arms. Intervention arm infants showed a 2.1-point increase (95% CI: 0.12, 4.17) in communication scores compared to controls. Though not achieving statistical significance, intervention infants also showed a 2.0-point increase (95% CI:-0.06, 4.09) in gross motor development performance. Bonding, depression, and responsiveness were mediators between the intervention and infant communication (Bindirect=1.94 (95%CI: 0.86, 3.25) depression; Bindirect=0.57 (95% CI: 0.09, 1.16) bonding; Bindirect=0.53 (95% CI: 0.01, 1.21) responsiveness; and Bindirect=1.94 (95%CI: 0.86, 3.25). Bonding, responsiveness, and depression mediated 25%, 23%, and 87% of the total association, respectively. CONCLUSIONS: HMHB positively affected infant communication at six-week follow-up. Larger studies with longer follow-up are needed to confirm and extend these findings. TRIAL REGISTRATION: ClinicalTrials.gov NCT03880032; https://clinicaltrials.gov/ct2/show/NCT03880032.

BEAMER: A Data Informed Model to Improve Adherence Behaviour.

OBJECTIVE: In this poster, we will present the BEAMER model, an emerging disease-agnostic model to improve adherence behaviour based on actionable factors and promote optimal health outcomes for all. METHODS: Data on behavioural and structural factors affecting adherence to treatment have been collected from several sources and are being used to build the BEAMER model, where we aim to apply Machine Learning Modelling to forecast and diversify support towards more adherent behaviour. RESULTS: The BEAMER model can assist healthcare providers in eliciting patient needs to adopt targeted actions to support patients in improving their adherence. The collected data indicate that BEAMER must conform to standardised approaches to patient adherence to treatment. CONCLUSION: We anticipate that the BEAMER model will contribute to provide personalised patient support to drive adherence behaviour.

Nexus among indigenous languages, agricultural radio programmes and behavioural change towards agricultural practices in Nigeria.

This study investigated the interrelationship between indigenous languages, agricultural radio programmes and behavioural change towards agricultural practices in Nigeria, focusing on three states (Benue, Nasarawa and Plateau). The following research objectives guided the study: to ascertain farmers' awareness of radio programmes in indigenous languages, identify farmers' sources of information, ascertain farmers' access to agricultural extension workers and the language of engagement, and examine the influence of radio programmes in indigenous languages on farmers' behaviour towards agricultural practices. The study adopted a survey research design with a questionnaire administered to 663 randomly selected farmers in Plateau, Nasarawa, and Benue states using a multistage sampling technique. Findings showed that indigenous languages play an integral role in bringing about behavioural change towards agriculture in Nigeria, with a mean Score of 3.4706 and a Standard Deviation of 1.5668. Further findings also indicate that agricultural extension workers are ready sources of information, with the language of communication being that of the local community. The study concluded that behavioural changes are evident in agricultural practices because these programmes have exposed farmers to innovations that have positively affected their agricultural practices. Thus, it is recommended that agricultural radio programmes aired in local languages should continue to be encouraged and sustained. This will help keep farmers abreast of trends in the farming sector, improving their agricultural practices.

Optic neuropathy from hypovitaminosis A in a series of children with severe dietary restrictions.

AIM: Hypovitaminosis A is a leading cause of preventable childhood blindness, especially in developing nations. Vitamin A is a fat-soluble essential micronutrient that serves vital functions in the visual system and in regulating bone resorption. We report on a series of four children with mixed nutritional and compressive optic neuropathy and provide a review of the literature. METHODS: A retrospective observational study of four males (ages 9-12), three with autism spectrum disorder who presented with loss of vision and multiple vitamin deficiencies including hypovitaminosis A. RESULTS: Patients presented with unexplained visual loss or a change in visual behaviour. All patients had severely restricted diet comprising of predominantly carbohydrates. Two of the four cases demonstrated optic nerve pallor at initial presentation with marked optic atrophy developing in all patients over time. Electrophysiology available in two patients demonstrated optic nerve dysfunction with preserved retinal function. Extensive investigations revealed profound deficiency in multiple vitamins including vitamin A (<0.1-0.2 µmol/L, normal = 0.9-1.7 µmol/L). Three patients also had low vitamin B12 (90-111 pmol/L, normal = 170-800 pmol/L) with normal folate. All four cases had radiological evidence of skull base thickening indicative of low vitamin A. Genetic testing did not find any relevant pathogenic variants. CONCLUSIONS: Hypovitaminosis A is a crucial form of nutritional deprivation that results in significant visual loss with potential hyperostosis and optic nerve compression exacerbating nutritional optic neuropathy. Additional micronutrient deficiencies usually co-exist and may contribute. Extra vigilance in vitamin replacement is required of clinicians with patients with autism who have restricted diets.

Business case for psychosocial interventions in clinics: potential for decrease in treatment discontinuation and costs.

RESEARCH QUESTION: From a value-based healthcare (VBHC) perspective, does an assessment of clinical outcomes and intervention costs indicate that providing cognitive behavioural therapy (CBT) or mindfulness to women seeking fertility treatment add value compared with no such intervention? DESIGN: Proof-of-concept business case based on a VBHC perspective that considers clinical outcomes and costs. Potential effects on psychological and fertility outcomes were based on existing research. Cost outcomes were estimated with a costing model for the Dutch fertility treatment setting. RESULTS: Thirty-two studies were identified; 13 were included. Women who received CBT had 12% lower anxiety, 40% lower depression and 6% higher fertility quality of life; difference in clinical pregnancy rates was six percentage points (CBT [30.2%]; control [24.2%]); difference in fertility discontinuation rates was 10 percentage points (CBT [5.5%]; control [15.2%]). Women who received training in mindfulness had 8% lower anxiety, 45% lower depression and 21% higher fertility quality of life; difference in mean clinical pregnancy rate was 19 percentage points (mindfulness [44.8%]; control [26.0%]). Potential total cost savings was about €1.2 million per year if CBT was provided and €11 million if mindfulness was provided. Corresponding return on investment for CBT was 30.7%, and for mindfulness 288%. Potential cost benefits are influenced by the assumed clinical pregnancy rates; such data related to mindfulness were limited to one study. CONCLUSIONS: The provision of CBT or mindfulness to women seeking fertility treatment could add value. Higher quality primary studies are needed on the effect of mindfulness on clinical pregnancy rates.

Hyperbolic discounting underpins response curves of mammalian avoidance behaviour.

As humans clear natural habitat, they are brought into increased conflict with wild animals. Some conflict is direct (e.g. elevated exposure of people to predators), some indirect (e.g. abandoning suitable habitat because of human activity). The magnitude of avoidance is expected to track frequency of human activity, but the type of response is an open question. We postulated that animals do not respond passively to increased disturbance nor does response follow a power law; instead, their ability to estimate magnitude leads to 'discounting' behaviour, as in classic time-to-reward economic models in which individuals discount larger value (or risk) in more distant time. We used a 10-year camera dataset from southern California to characterize response curves of seven mammal species. Bayesian regressions of two non-discounting models (exponential and inverse polynomial) and two discounting models (hyperbolic and harmonic) revealed that the latter better fit response curves. The Arps equation, from petroleum extraction modelling, was used to estimate a discount exponent, a taxon-specific 'sensitivity' to humans, yielding a general model across species. Although discounting can mean mammal activity recovers rapidly after disturbance, increased recreational pressure on reserves limits recovery potential, highlighting a need to strike a balance between animal conservation and human use.

Host behaviour driven by awareness of infection risk amplifies the chance of superspreading events.

We demonstrate that heterogeneity in the perceived risks associated with infection within host populations amplifies chances of superspreading during the crucial early stages of epidemics. Under this behavioural model, individuals less concerned about dangers from infection are more likely to be infected and attend larger sized (riskier) events, where we assume event sizes remain unchanged. For directly transmitted diseases such as COVID-19, this leads to infections being introduced at rates above the population prevalence to those events most conducive to superspreading. We develop an interpretable, computational framework for evaluating within-event risks and derive a small-scale reproduction number measuring how the infections generated at an event depend on transmission heterogeneities and numbers of introductions. This generalizes previous frameworks and quantifies how event-scale patterns and population-level characteristics relate. As event duration and size grow, our reproduction number converges to the basic reproduction number. We illustrate that even moderate levels of heterogeneity in the perceived risks of infection substantially increase the likelihood of disproportionately large clusters of infections occurring at larger events, despite fixed overall disease prevalence. We show why collecting data linking host behaviour and event attendance is essential for accurately assessing the risks posed by invading pathogens in emerging stages of outbreaks.

"How difficult it is to change dietary behaviour" experience of older people with sarcopenic obesity: a qualitative study.

BACKGROUND: Dietary intervention is an important method to manage sarcopenic obesity, but the implementation in real world is difficult to achieve an ideal condition. This study aimed to the experiences of older people with sarcopenic obesity during the implementation of dietary behavioural change (DBC) intervention. METHODS: This study is a semi-structured individual interview embedded within a pilot randomized controlled trial on community-dwelling older people with sarcopenic obesity. Purposive sampling was applied to invite 21 participants who had received a 15-week DBC intervention. The interviews were audio-recorded and transcribed verbatim. Content analysis was performed to analyze the data. RESULTS: The themes for facilitators included: (a) Attach importance to self's health; (b) Family's support; (c) Concern self's body shape; (d) Instructor's support; (e) Regular food diary taken. The themes for barriers included: (a) Difficulties of taking food diary; (b) Difficulties of calculating the food amount; (c) Yield to offspring's appetite; (d) Misjudging self's or family's appetite. CONCLUSION: Support from family members and instructor, caring about self's health and body image facilitated the intervention implementation. The complication of food amount estimation and diary record, personal sacrifice for next generations, and previous living experience were barriers for implementing the intervention. Overall, the older people with sarcopenic obesity can accept the design of DBC intervention program and have great willing to join.

A behavioural exploration of language aptitude and experience, cognition and more using Graph Analysis.

Language aptitude has recently regained interest in cognitive neuroscience. Traditional language aptitude testing included phonemic coding ability, associative memory, grammatical sensitivity and inductive language learning. Moreover, domain-general cognitive abilities are associated with individual differences in language aptitude, together with factors that have yet to be elucidated. Beyond domain-general cognition, it is also likely that aptitude and experience in domain-specific but non-linguistic fields (e.g. music or numerical processing) influence and are influenced by language aptitude. We investigated some of these relationships in a sample of 152 participants, using exploratory graph analysis, across different levels of regularisation, i.e. sensitivity. We carried out a meta cluster analysis in a second step to identify variables that are robustly grouped together. We discuss the data, as well as their meta-network groupings, at a baseline network sensitivity level, and in two analyses, one including and the other excluding dyslexic readers. Our results show a stable association between language and cognition, and the isolation of multilingual language experience, musicality and literacy. We highlight the necessity of a more comprehensive view of language and of cognition as multivariate systems.

Adherence to the Mediterranean diet during pregnancy and behavioural problems at 4 years of age.

There is an increasing prevalence of psychological issues in childhood. Lifestyle factors during pregnancy, including maternal nutrition, have been linked to children's behavioural development. This study aims to assess the impact of adherence to the Mediterranean diet during pregnancy on the behavioural problems of children at the age of 4. A total of 231 mother-child pairs were assessed. Maternal adherence to the Mediterranean diet during pregnancy was estimated using a relative Mediterranean Diet Score (rMED). Behavioural outcomes were evaluated through the Child Behaviour Checklist 1½--5, Teacher's Report Form 1½-5, and Behaviour Rating Inventory of Executive Function-Preschool Version questionnaires. The results indicated that a higher rMED score during pregnancy was associated with a reduced probability of obtaining a clinical score for total problems (OR = 0.42; 95% IC from 0.21 to 0.85), including externalising (OR = 0.29; 95% IC from 0.14 to 0.62), attention problems (OR = 0.32; 95%IC from 0.15 to 0.70), attention-deficit/hyperactivity problems (OR = 0.36; 95% IC from 0.15 to 0.87), oppositional defiant problems (OR = 0.06; 95% IC from 0.06 to 0.75), and depressive problems (OR = 0.38; 95% IC from 0.15 to 0.96). This study highlights the importance of maternal diet, especially Mediterranean diet, during gestation for proper child development.

Assessing the Stability of Clusters of Neuropsychiatric Symptoms in Alzheimer's Disease and Mild Cognitive Impairment.

AIM: The aim of the study was to investigate the factors that underpin neuropsychiatric symptoms and how they might evolve over time in people with Mild Cognitive Impairment (MCI) and Alzheimer's disease (AD) dementia. BACKGROUND: Neuropsychiatric symptoms are psychiatric and behavioural manifestations that occur in people with AD. These are highly prevalent along the continuum of the disease, including at the stage of MCI, as well as before cognitive decline. Various small- and large-scale projects have investigated the underlying factors that underpin these symptoms; however, the identification of clear clusters is still a matter of debate; furthermore, no study has investigated how the clusters might change across the development of AD pathology by comparing different time points. OBJECTIVE: Our objective was to investigate the factors that underpin neuropsychiatric symptoms in Alzheimer's disease (AD) and Mild Cognitive Impairment (MCI) and to assess how the loadings might differ based on considerations such as the disease stage of the samples. METHODS: Data was obtained from the Alzheimer's Disease Neuroimaging Initiative database (adni. loni.usc.edu), using scores from the Neuropsychiatric Inventory, followed up yearly from baseline until month 72. Participant groups included those with MCI or AD dementia, or a mixture of both, with all participants presenting with at least one neuropsychiatric symptom. A series of exploratory Principal Component and Factor (Principal Axis) Analyses were performed using Direct Oblimin rotation. RESULTS: The best-fitting structure was interpreted for each time point. A consistent, unique structure could not be identified, as the factors were unstable over time, both within the MCI and AD groups. However, some symptoms showed a tendency to load on the same factors across most measurements (i.e., agitation with irritability, depression with anxiety, elation with disinhibition, delusions with hallucinations). CONCLUSION: Although the analyses revealed some degree of co-occurrence of neuropsychiatric symptoms across time points/samples, there was also considerable variation. In the AD group, more discrete syndromes were evident at the early time points, whereas a more complex picture of co-occurring symptoms, with differences likely reflecting disease staging, was seen at later time points. As a clear and distinctive factor structure was not consistently identified across time points/ samples, this highlights the potential importance of sample selection (e.g., disease stage and/or heterogeneity) when studying, for example, the neurobiological underpinnings of neuropsychiatric symptoms.

Mediating Effects of Self-Efficacy and Illness Perceptions on Mental Health in Men with Localized Prostate Cancer: A Secondary Analysis of the Prostate Cancer Patient Empowerment Program (PC-PEP) Randomized Controlled Trial.

Understanding how interventions reduce psychological distress in patients with prostate cancer is crucial for improving patient care. This study examined the roles of self-efficacy, illness perceptions, and heart rhythm coherence in mediating the effects of the Prostate Cancer Patient Empowerment Program (PC-PEP) on psychological distress compared to standard care. In a randomized controlled trial, 128 patients were assigned to either the PC-PEP intervention or standard care. The PC-PEP, a six-month program emphasizing daily healthy living habits, included relaxation and stress management, diet, exercise, pelvic floor muscle exercises, and strategies to improve relationships and intimacy, with daily activities supported by online resources and live sessions. Participants in the intervention group showed significant improvements in self-efficacy and specific illness perceptions, such as personal control and emotional response, compared to the control group. These factors mediated the relationship between the intervention and its psychological benefits, with self-efficacy accounting for 52% of the reduction in psychological distress. No significant differences in heart rhythm coherence were observed. This study highlights the critical role of self-efficacy and illness perceptions in enhancing psychological health in prostate cancer patients through the PC-PEP. The results underscore this program's effectiveness and the key mechanisms through which it operates. Given the high rates of distress among men undergoing prostate cancer treatments, these findings emphasize the importance of integrating the PC-PEP into clinical practice. The implementation of the PC-PEP in clinical settings can provide a structured approach to reducing psychological distress and improving overall patient well-being.

Advancing Programme Science approaches to understand gaps in HIV prevention programme coverage for key populations in 12 Nigerian states: findings from the 2020 Integrated Biological and Behavioural Surveillance Survey.

INTRODUCTION: Effective HIV prevention programme coverage is necessary to achieve Nigeria's goal of ending the epidemic by 2030. Recent evidence highlights gaps in service coverage and utilization across the country. The Effective Programme Coverage framework is a Programme Science tool to optimize a programme's population-level impact by examining gaps in programme coverage using data generated through programme-embedded research and learning. We apply the framework using Integrated Biological and Behavioural Surveillance Survey (IBBSS) data from Nigeria to examine coverage of four prevention interventions-condoms, HIV testing, and needle and syringe programmes (NSP)-among four key population groups-female sex workers (FSW), men who have sex with men (MSM), people who inject drugs (PWID) and transgender people. METHODS: Data from Nigeria's 2020 IBBSS, implemented in 12 states, were analysed to examine HIV prevention programme coverage among key populations. For each key population group and prevention intervention of interest, weighted IBBSS data were used to retrospectively generate coverage cascades that identify and quantify coverage gaps. Required coverage targets were informed by targets articulated in Nigeria's National HIV/AIDS Strategic Framework or, in their absence, by guidelines from policy normative bodies. Availability-, outreach- and utilization coverage proxy indicators were defined using variables from IBBSS data collection tools. Sankey diagrams are presented to visualize pathways followed by participants between coverage cascade steps. RESULTS: Required coverage targets were missed for HIV testing and NSP among all key population groups. Condom availability coverage surpassed required coverage targets among FSW and MSM, while utilization coverage only among FSW exceeded the 90% required coverage target. Outreach coverage was low for all key population groups, falling below all required coverage targets. CONCLUSIONS: Our findings identify critical gaps in HIV prevention programme coverage for key populations in Nigeria and demonstrate non-linear movement across coverage cascades, signalling the need for innovative solutions to optimize coverage of prevention services. Programme-embedded research is required to better understand how key population groups in Nigeria access and use different HIV prevention services so that programmes, policies and resource allocation decisions can be optimized to achieve effective programme coverage and population-level impact.