Baseline Differences in Long-term Survivors and Nonsurvivors of the Colorado/Columbia Fetal Implant Trial.

OBJECTIVE: This study is based on long-term follow-up of participants in a randomized double-blind sham surgery-controlled trial (1995-1999) designed to determine the effectiveness of implantation of human embryonic mesencephalic tissue containing dopamine neuron precursors into the brains of patients with advanced Parkinson's disease (PD). We investigated differences between long-term survivors and nonsurvivors at baseline in order to contribute to information regarding optimal patient selection for upcoming stem cell trials. METHOD: Forty participants were randomly assigned to receive either neural implantation or sham surgery. Thirty-four patients who ultimately received the implant were followed periodically with the most recent assessment occurring in 2015-2016. Demographic information, neurological measures, positron emission tomography (PET) imaging, neuropsychological assessments, and a personality assessment were included in the current analyses. T-tests were used to compare survivors and nonsurvivors. Logistic regression analyses examined predictors of survivorship. RESULTS: Five of six survivors were female. They were younger than nonsurvivors (p = .03) and more neuropsychologically "intact" across a broad range of cognitive areas (significance levels ranged from <.001 to .045). There were no differences between survivors and nonsurvivors off medications at baseline on neurological or PET assessments. Survivors reported more "Openness to Experience" (p = .004) than nonsurvivors. Using empirically derived predictor variables, results of logistic regression analyses indicated that Animal Naming (cognitive task) and Openness to Experience (personality variable) were the strongest predictors of survivorship. CONCLUSIONS: Variables to consider when selecting participants for future cell-based therapies include being "intact" neuropsychologically, level of Openness to Experience, younger age, and inclusion of women.

Online acceptance and commitment therapy as treatment for loneliness among older adults: Report of a pilot study.

BACKGROUND: Loneliness has been linked to cognitive decline, cardiovascular risk, and risk of mortality among older adults. Creative approaches are needed to increase access for older adults to evidence-based intervention programs. One possible approach is acceptance and commitment therapy (ACT). The aim of this study was to pilot test a novel ACT-based online intervention to decrease loneliness in older adults living in the community. METHODS: A self-paced online ACT program consisting of eight interactive modules designed to teach participants skills to address common contributors to loneliness was evaluated. It was delivered to a sample of 529 men and women, aged 65 or over, who were assessed pre-intervention, postintervention, and at a one-month follow-up, with a short 10-item version of the UCLA Loneliness Scale. RESULTS: For participants who completed all eight modules of the intervention, average levels of loneliness significantly decreased from pre- to posttreatment, b = -0.013, t (385) = -4.69, p < 0.001 (Cohen's d = 0.30). The improvement in loneliness was maintained at the one-month follow-up assessment. These improvements were particularly robust for individuals who were lonely at outset (Cohen's d = 0.73). The change in loneliness among these individuals was significantly greater than that observed in members of a "hold-out" group of lonely individuals that did not participate in the intervention (Cohen's d = 0.24). CONCLUSIONS: This pilot investigation suggests the feasibility of this program for decreasing loneliness in older adults. Future controlled investigations with long-term follow-up assessments are needed to confirm the effectiveness and sustained benefits of the program.

A randomized clinical trial of acceptance and commitment therapy and the Duluth Model classes for men court-mandated to a domestic violence program.

OBJECTIVE: This is the first randomized controlled trial to compare Acceptance and Commitment Therapy (ACT) with the Duluth Model curriculum, which took place in community-based corrections for the treatment of men convicted of domestic violence. ACT is a third-wave cognitive-behavioral approach that utilizes experiential methods to foster psychological flexibility. The Duluth Model curriculum is an educational approach grounded in feminist theory that focuses on changing attitudes toward women and unlearning power and control motivations. This trial was preregistered at ClinicalTrials.gov (registration number: NCT03609801). METHOD: This study included 338 men who were court-mandated to complete a domestic violence program after being convicted of assault against a female partner. Participants were randomized to complete the 24 sessions of the ACT program or the Duluth Model Men's Nonviolence Classes. Outcomes included criminal justice data (domestic violence charges, other violent charges, and nonviolent charges) incurred during the 1 year following program dropout or completion, and victim reports of intimate partner violence (IPV; aggression, controlling behaviors, and stalking/harassment). RESULTS: In intent-to-treat comparisons to Duluth, ACT participants did not show a difference in domestic assault charges at 1 year posttreatment (p = .44). ACT participants acquired significantly fewer violent charges (p = .04) and nonviolent charges (p = .02) compared to Duluth participants. Data from victims indicated that victims of ACT participants reported significantly fewer IPV behaviors than victims of Duluth participants on the Conflict Tactics Scale (d = .78), the Controlling Behaviors Scale (d = .66) and the Stalking Behavior Checklist (d = .71) at 1 year posttreatment. CONCLUSIONS: An ACT-based group intervention delivered in community corrections reduced violent and nonviolent criminal charges compared to the Duluth classes. Domestic violence charges did not differ between groups but victim reports indicated that ACT participants engaged in fewer IPV behaviors. (PsycInfo Database Record (c) 2022 APA, all rights reserved).

Effects of perceived treatment on quality of life and medical outcomes in a double-blind placebo surgery trial.

CONTEXT: This study was part of a large double-blind sham surgery-controlled trial designed to determine the effectiveness of transplantation of human embryonic dopamine neurons into the brains of persons with advanced Parkinson's disease. This portion of the study investigated the quality of life (QOL) of participants during the 1 year of double-blind follow-up. OBJECTIVES: To determine whether QOL improved more in the transplant group than in the sham surgery group and to investigate outcomes at 1 year based on perceived treatment (the type of surgery patients thought they received). DESIGN: Participants were randomly assigned to receive either the transplant or sham surgery. Reported results are from the 1-year double-blind period. SETTING: Participants were recruited from across the United States and Canada. Assessment and surgery were conducted at 2 separate university medical centers. PARTICIPANTS: A volunteer sample of 40 persons with idiopathic Parkinson's disease participated in the transplant ("parent") study, and 30 agreed to participate in the related QOL study: 12 received the transplant and 18 received sham surgery. INTERVENTIONS: Interventions in the parent study were transplantation and sham brain surgery. Assessments of QOL were made at baseline and 4, 8, and 12 months after surgery. MAIN OUTCOME MEASURES: Comparison of the actual transplant and sham surgery groups and the perceived treatment groups on QOL and medical outcomes. We also investigated change over time. RESULTS: There were 2 differences or changes over time in the transplant and sham surgery groups. Based on perceived treatment, or treatment patients thought they received, there were numerous differences and changes over time. In all cases, those who thought they received the transplant reported better scores. Blind ratings by medical staff showed similar results. CONCLUSIONS: The placebo effect was very strong in this study, demonstrating the value of placebo-controlled surgical trials.

Exercise and psychosocial factors modulate immunity to influenza vaccine in elderly individuals.

BACKGROUND: Decreases in immune responsiveness with age contribute to the increased incidence and severity of infectious disease among elderly adults. The immune response to immunization also decreases with advancing age. Lifestyle factors (exercise, diet) have been established to play an important role in immunosenescence, and the practice of "healthy" behavior may minimize the age-associated decline of immune function. The objective of this study was to determine whether exercise, diet, and psychosocial factors were associated with altered immune response to influenza vaccine. METHODS: Adults aged 62 years and older were categorized into one of three groups: active (> or =20 min vigorous exercise three or more times per week), moderately active (regular exercise but with less intensity, frequency, and/or duration), or sedentary (no exercise). Two weeks postimmunization, serum was frozen for antibody analysis, and peripheral blood mononuclear cells (PBMC) were cultured in vitro with influenza vaccine to elicit antigen-specific responses (proliferation and cytokine [IL-2, IFN-gamma, IL-10] production). Cytokines and antibody were measured by enzyme-linked immunosorbent assay. RESULTS: The results demonstrated that anti-influenza IgG and IgM were greater in active as compared with moderately active or sedentary participants. PBMC proliferation was lowest in sedentary subjects. Perceived stress was a significant predictor of IL-2. Greater optimism and social activity were associated with greater IL-10. Daily multivitamin intake was significantly correlated with IL-2. CONCLUSIONS: These results suggest that lifestyle factors including exercise may influence immune response to influenza immunization. The practice of regular, vigorous exercise was associated with enhanced immune response following influenza vaccination in older adults.

Does personality change as a result of fetal tissue transplantation in the brain?

This study examined the effects on personality of transplantation of fetal tissue into the brains of participants in a double-blind placebo control trial for the treatment of Parkinson's disease (PD). Thirty persons with PD (equal numbers of males and females) participated in a larger study investigating the efficacy of transplantation of fetal neural tissue versus placebo surgery. Participants were randomly assigned to receive either the fetal transplant or placebo surgery. The blind was lifted for all patients approximately 13 months after surgery, at which time individuals who had received the placebo surgery could choose to receive the transplant surgery. In this study 12 persons originally received the transplant and 18 received placebo surgery. The NEO Five-Factor Inventory (NEO-FFI), a commonly used measure of personality characteristics, was administered to participants at baseline, 12, and 24 months after surgery. Scores at baseline for the Openness and Agreeableness scales were significantly higher for this sample of PD patients than scores for the normative group. There were no changes on any of the five scales from baseline to 12 months for the total group. The only significant change in the original transplant group was a decrease in Conscientiousness from baseline to 24 months. There were no changes over time among the group who had placebo surgery first and then the transplant. Results indicate that personality, as measured by the NEO-FFI, basically remained stable during the two-year follow-up period of this study. In this case, no change is regarded as a positive outcome.

Predictors of loneliness in caregivers of persons with Parkinson's disease.

This study examined loneliness among caregivers of individuals with Parkinson's disease (PD). The sample included 70 caregivers (74% female; 96% spouses) who were currently living with the patient. A postal survey was sent to caregivers of persons with PD on the mailing list of a regional Parkinson association; response rate was 39%. Assessment instruments included the UCLA Loneliness Scale, Social Provisions Scale, Hoehn and Yahr (caregiver version), a perceived Self-Efficacy Scale developed previously for use with PD caregivers, and questions related to both patient and caregiver characteristics. Caregivers reported more loneliness than all similar normative groups except Alzheimer caregivers (P<0.001 to P=0.011). Hierarchical regression analyses were used to determine whether patient or caregiver characteristics were more predictive of loneliness. Results indicated that patient variables accounted for only 12% of the variance in loneliness, whereas caregiver variables accounted for an additional 46% of the variance (P<0.01). Among the significant individual caregiver predictors of greater loneliness were less education, lower perceived self-efficacy (both P<0.05) and poorer physical health (P<0.01). It was also found that persons attending caregiver support groups reported less loneliness (P<0.05) and more perceived support (P<0.05) than those not attending support groups. Because loneliness was significantly predicted by caregiver rather than patient variables, it is possible that strategic interventions for caregivers could ameliorate loneliness.

Computerised screening for hazardous drinking in primary care.

INTRODUCTION: Brief interventions undertaken in primary care settings have been shown consistently to reduce hazardous drinking, but they are not commonly offered in practice. The aims were to determine the uptake by young people of an offer of screening in a primary care setting; to identify patients' drinking risk levels; and to estimate the proportion who would consent to computerised brief intervention and follow-up. METHODS: Participants were 1120 patients attending a university student health service that were invited for screening while in the waiting room. Participants were also asked for their consent to be contacted for follow-up assessment 1, 6, and 12 months later. RESULTS: 1,010 patients (90%) accepted the invitation for screening. Of these, 35 (4%) failed to complete screening, thus leaving 975 with complete Alcohol Use Disorders Identification Test (AUDIT) data. Sixty percent of women and 73% of men screened positive. Twenty-three patients (4%) eligible for intervention declined follow-up assessments. DISCUSSION: The study demonstrates that the primary care setting can be used to facilitate access via computer to a large number of individuals whose drinking is hazardous. Limitations of the study include the use of an educated segment of the population who may be more receptive to computerised screening than other groups. Strengths of the study include the high rate of participation and the naturalistic setting in which the data were collected.

The Effect of Prior Information on Attitude Change.

An 18 month longitudinal study tested the assumption that the amount of prior political information influences the degree of ideological attitude change under conditions of exposure to counterattitudinal presentations. Male and female college students (n = 97) served as Ss, and the study was conceived as a natural experiment in which the attitudes of beginning freshmen were exposed to the questioning and challenge of college coursework. Results indicated that well and moderately informed students changed their political orientation less than poorly informed students.