Evidence-based early rehabilitation for children with cerebral palsy: co-development of a multifaceted knowledge translation strategy for rehabilitation professionals.

Background: Cerebral palsy (CP) is the most common childhood physical disability. Early and evidence-based rehabilitation is essential for improving functional outcomes in children with CP. However, rehabilitation professionals face barriers to adopting evidence-based practices (EBP)s. The objective of this project is to develop a knowledge translation (KT) strategy to support CP-EBP among pediatric rehabilitation professionals. Methods: We follow an integrated KT approach by collaborating with clinician- and patient-partners. Partners engaged in co-design through team meetings and content review via email. The KT strategy comprises two components: (1) An electronic (e)-KT toolkit was created from summarized evidence extracted from randomized clinical trials on early rehabilitation for children with CP, and (2) a multifaceted online KT training program developed with guidance from a scoping review exploring effective KT strategies. Results: The e-KT toolkit summarizes twenty-two early interventions for children with or at risk for CP aged 0-5 years. Each module features an introduction, resources, parent/family section, and clinician information, including outcomes, intervention effectiveness, and evidence level. The KT training program includes three 10-15 min video-based training modules, text summaries, quizzes, and case studies. Site champions, identified as qualified rehabilitation professionals, were onboarded to support the site implementation of the training program. A champion-training booklet and 1-hour session were designed to equip them with the necessary knowledge/resources. Conclusion: The tailored, multifaceted, and co-designed KT strategy aims to be implemented in pediatric rehabilitation sites to support professional's uptake of CP-EBPs. Lessons learned from its development, including the co-development process and multifaceted nature, hold potential for broader applications in rehabilitation.

Knowledge, Attitude, and Perception towards Autism Spectrum Disorders among Parents in Sakaka, Al-Jouf Region, Saudi Arabia: A Cross-Sectional Study.

Parents are an essential element of family intervention for all children, including those with autism spectrum disorders (ASDs). We can better understand and address parents' knowledge gaps about ASD through in-depth research and inquiry into parents' current level of understanding, attitude, and perception. We aimed to assess the knowledge, attitude, and perception of ASD and influencing factors towards ASD among a group of parents with and without a child diagnosed with ASD in Sakaka, Al-Jouf Region, Saudi Arabia. Using the cross-sectional study design, information from the parents was gathered using a pretested questionnaire that included validated scales for measuring knowledge, attitudes, and perceptions related to ASD. The required number of participants was selected using the convenience sampling method. We used Spearman's correlation test to determine the strength and direction of correlation between each domain. As a last step, we analyzed the influencing factors using binomial logistic regression. Among the 400 participants, 41.2% had high knowledge, 69.1% had a positive attitude, and 60.3% had a high perception of ASD. We found that knowledge was significantly higher among the parents with autistic individuals in the family (p = 038). The high and positive attitude was significantly greater among females (p = 0.010) and parents with high income (p = 0.007), and the perception was significantly associated with females (p = 0.037) and highly educated participants (p = 0.046). Furthermore, we found a positive correlation between knowledge, attitude, and perception. Overall, only less than half of the participants had a high knowledge of ASD. Hence, we recommend awareness-raising programs for the parents in this region. Furthermore, a prospective study involving parents from all provinces of Saudi Arabia is recommended.

'We are all children of war': a qualitative inquiry into parenting following adolescents' recent traumatic exposure in a multiple crisis setting in Beirut, Lebanon.

Background: Strong familial bonds are crucial to building resilience among youth exposed to traumatic events in socially adverse environments. Exploring parental experiences in the aftermath of adolescents' traumatic exposure in these settings would help tailor early interventions.Objective: We qualitatively explored experiences and perceived needs among parents of teenagers aged 11-16 years who were exposed in the last three months to a potentially traumatic event in Beirut, Lebanon.Method: We purposively sampled 28 parents of 24 adolescents meeting the inclusion criteria. Semi-structured interviews were conducted, and thematic analysis was applied combined with a grounded theory approach.Results: The most frequent traumatic event was direct exposure to the violent clashes that happened in Beirut on 14 October 2021. Parents identified that the recent event exacerbated pre-existing mental health difficulties caused by cumulative stress. They were reminded of their own war experiences and tended to reject the 'sick role' associated with trauma. A majority of participants viewed resilience as a fixed trait characteristic of the Lebanese and avoided communication with their children about traumatic memories, while a significant minority criticised resilience as a myth that added pressure on them and had more open communication about trauma. Parenting styles oscillated between controlling behaviours, warmth, and avoidance, which impacted the family dynamic. Despite adversity, most parents tried to cope through social connectedness, humour, and living day by day.Conclusions: Our findings hold implications for contextual adaptations of early posttraumatic interventions aimed at strengthening family support, such as addressing parental mental health; increasing awareness among first-line responders on parents' potential representations of trauma and resilience; addressing the issue of controlling parenting; and including a component in psychoeducation on traumatic stress that validates the impact of daily stressors on mental health while avoiding direct labelling. Further research is needed to validate the impact of these domains.

Parents of adolescents recently exposed to trauma in Beirut endure cumulative stress and recall war memories.Some parents see resilience as innate, and others criticise it as a myth.Early interventions should target parental mental health and conceptions on trauma and resilience.

The effectiveness of early interventions for post-stroke spasticity: a systematic review.

PURPOSE: To synthesize evidence on the effect of early post-stroke spasticity interventions. METHODS: Systematic literature search (PubMed, Embase, and Web of Science) encompassing studies on spasticity reducing interventions within 3 months post stroke on outcome defined within the International Classification of Functioning (ICF). RESULTS: In total, 27 studies were identified with n = 1.658 cases. Botulinum toxin (2-12 weeks; 10 studies, n = 794) showed consistent and significant reduced spasticity by Modified Ashworth Scale (MAS) or electromyography (EMG). Electrical muscle stimulation (1-8 weeks; 6 studies, n = 335) showed lower MAS/Composite Spasticity Scale scores in 4 studies. Transcranial stimulation (3 studies; n = 131), oral spasmolytics (1 study; n = 38), shockwave (1 study; n = 40), orthotics (3 studies; n = 197 and robot-assisted therapy (3 studies; n = 123) showed inconclusive results. Effects on ICF activity domain could not be established due to limited data and large outcome measures heterogeneity. One out of two studies showed significant benefit for early compared to late BoNT intervention (< 90 vs> 90 days). CONCLUSION: This study provides evidence for early applied (<3 months) BoNT to effectively reduce spasticity and probable effectiveness of electrical stimulation. Establishing effects of interventions in the acute/hospitalization phase (<7 days) needs further work, specifically on the ICF activity domain. Standardization of outcome measures is required.

Spasticity, which may develop in the first weeks after stroke, is now mostly treated in the chronic phase.This study shows that early applied Botulinum Toxin (within three months after stroke) effectively reduces spasticity and suggests that electrical stimulation may reduce spasticity.Early application of treatment with Botulinum Toxin should be considered when spasticity occurs within three months post-stroke.

IDEA tool: Establishing a prioritisation matrix for oral health improvement interventions.

Initial impetus for action: Oral health is not equitably distributed. More deprived areas experience appreciably worse oral health outcomes. Oral health improvement programmes in Local Authorities (LA) seek to reduce these inequalities but have diminished in recent years following the COVID-19 pandemic. LAs have also endured funding cuts to public health budgets, placing a greater emphasis on the need for establishing a clear prioritisation matrix for oral health improvement interventions. Solution: A prioritisation matrix that considered both the importance and do-ability of oral health improvement interventions was developed. Both are composite measures. The importance comprised evidence of benefit, impact on inequalities, alignment with national/local priorities and cost-effectiveness of the intervention. The do-ability considered the available support from stakeholders, building/equipment requirements, workforce issues and investment funding. A working group was necessary to inform the do-ability aspect of the prioritisation matrix. Scores were assigned to each criterion, the sum of the scores informed whether the intervention was eliminated, aspirational or implemented based on predetermined thresholds. Outcome: The prioritisation matrix ensured a transparent and systematic approach for intervention selection, which reflected local resources and priorities. Moreover, this tool should help ensure the most effective, equitable, practical and sustainable interventions are chosen having the greatest impact on improving oral health outcomes.

First pill hardest to swallow: An evaluation study of cardiovascular nurse-led follow-up phone calls.

INTRODUCTION: Screening for cardiovascular disease (CVD) followed by preventive medication is expected to reduce CVD (2,3,5). However, insufficient medication adherence may affect screening effectiveness (11-12). It remains uncertain which interventions are suitable to support citizens in their decision-making about taking CVD preventive medication. OBJECTIVE: We evaluated if and how three nurse-led telephone follow-up (TFU) calls supported citizens in making informed decisions regarding CVD preventive medication and thereby potentially strengthened their medication adherence. METHODS: Employing a theory-based evaluation design inspired by Dahler-Larsen (39-41), we developed and tested a programme theory describing if and how the TFU calls supported medical decision-making and potentially improved medication adherence. Data were collected via telephone. FINDINGS: We analysed 61 TFU calls collected between May 2017 and April 2019 and found that TFU calls supported participants' reflections on preventive medication. TFU calls supported informed decision-making regarding initiating medication, allowing participants to consider personal preferences and values, including both opting for and abstaining from medication. The content of the TFU calls revolved around four crucial themes: I) understanding the purpose of taking the medicine; II) meaningfulness and joint reflection support the decision; III) relation to healthcare professionals; and IV) taking medication for the first time. CONCLUSION: TFU calls effectively supported citizens' understanding and addressed their needs. Trusted healthcare professionals' recommendations were preferred for decisional support. Initiating CVD preventive medication was particularly challenging for citizens who had not previously taken such medication. We recommend scheduling TFU calls early: the first after one week, the second after one month and the third after six months.

Disseminated Enteric Salmonella Infection Associated With Empyema and Septic Arthritis in an Immunocompromised Patient.

Thoracic empyema is a collection of infectious material (pus) in the pleural cavity. Salmonella enterica species rarely cause pleuropulmonary infections. This condition poses a significant challenge in diagnosis and management due to its atypical presentation and potential for severe complications. This is a case of an immunocompromised host with glioblastoma who presented with a large loculated fluid collection in the left pleural space. The patient received broad-spectrum antibiotics and underwent urgent chest tube placement and drainage of pus, which grew Salmonella enterica subspecies enterica. He was also found to be bacteremic with the same organism. Subsequently, he underwent video-assisted thoracoscopic surgery (VATS) with decortication and evacuation of the empyema. Even though the prognosis for empyema is generally unfavorable, with increased morbidity and mortality, due to timely intervention, a successful outcome was achieved in this patient with an atypical presentation of salmonella infection.

'Life should go on': a qualitative inquiry of parental reactions, experiences, and perceived needs following adolescents' recent traumatic exposure.

Background: Parents have a significant role in supporting children who have been exposed to traumatic events. Little is known about parental experiences and needs in the wake of traumatic exposure, which could help in designing tailored early interventions.Objective: This qualitative study explored experiences, perceived needs, and factors impacting those needs being met, in parents of adolescents aged 11-16 years who had been exposed in the past 3 months to a potentially traumatic event, in the city of Montpellier, France.Method: We purposively sampled 34 parents of 25 adolescents aged 11-16 years meeting the inclusion criteria and used semi-structured in-depth interviews. Thematic analysis was applied using a multistage recursive coding process.Results: Parents lacked trauma-informed explanations to make sense of their child's reduced functioning. They experienced stigma attached to the victim label and were reluctant to seek help. School avoidance and lack of collaboration with schools were major obstacles experienced by parents. Parents trying to navigate conflicting needs fell into two distinct categories. Those who experienced distressing levels of shame and guilt tended to avoid discussing the traumatic event with their child, pressuring them to resume life as it was before, despite this perpetuating conflictual interactions. Others adapted by revisiting their beliefs that life should go on as it was before and by trying to come up with new functional routines, which improved their relationship with their child and helped them to restore a sense of agency and hope, but at the cost of questioning their parental role.Conclusions: Key domains of parental experiences could provide potential early intervention targets, such as psychoeducation on traumatic stress, representations about recovery and the victim status, parent-child communication, and involvement of schools and primary caregivers. Further research is needed to validate the impact of these domains in early post-traumatic interventions.

Parents of teenagers exposed to traumatic events struggle to understand trauma and feel isolated.Parents feel pressured to resume life as it was before, leading to conflictual child­parent interaction.Psychoeducation, stigma, and school involvement could be early intervention targets.

Impact of gaming disorder on first episode psychosis patients' evolution: Protocol for a multicentered prospective study.

AIMS: The objective of this study is to underline the impact of Gaming Disorder on the clinical evolution of patients with First Episode Psychosis. The specific aims of the study are to determine the prevalence of gaming disorder among those patients and assess the consequences of gaming on their clinical trajectory. METHODS: This is a prospective multicenter cohort study that will enrol 800 patients diagnosed with a first episode psychosis, with a follow-up period of up to 3 years. Using a systematic screening procedure for gaming disorder, the clinical staff will assess patients gaming habits at admission and every 6 months thereafter. Information from patients' medical records will also be extracted using the same timeframe. RESULTS: The patients' characteristics at admission and during follow-up will be presented in the form of descriptive statistics and compared between different subgroups of patients using uni- and multivariate logistic regression models. Repeated measures ANCOVA will also be performed to analyse the impact of gaming disorders on patients' clinical path as assessed by the Positive and Negative Syndrome Scale and the Clinical Global Impression scale, considering covariates such as psychiatric diagnosis, pharmacological treatment, age, sex/gender, and duration of untreated psychosis. CONCLUSION: These findings will guide the development of prevention, detection, and treatment strategies for the comorbidity between gaming disorder and first episode psychosis, ultimately improving the patients' recovery.

Unveiling Gender Dysphoria Experiences in Turkish Young Adults: Challenges, Perspectives, and Implications in Health Care Settings.

Purpose: Gender dysphoria (GD) emerged as a focal area in child and adolescent development research. While the intricacies of diagnosis and interventions for GD intertwine with diverse socio-cultural challenges, a notable dearth of knowledge exists about the experiences of transgender (TG) individuals during their formative years in Turkey. This study aims to unveil these experiences, shedding light on the challenges, perspectives, and implications in health care settings. Patients and Methods: Our study encompassed 125 participants: 62 TGs under clinical follow-up, and a control group of 63 cisgender individuals. Surveys tailored to TG participants addressed early GD experiences, gender-typed activity participation, and psychosocial challenges from childhood through adolescence. Additionally, both cohorts contributed to a survey on attitudes towards community-based interventions, allowing for a comparative analysis of their perspectives. Results: TGs identified their GD around age 10.77. Female-to-male TGs showed more involvement in traditionally male-associated activities, whereas male-to-female engaged more in female-associated domestic role-plays (p<0.001). Over a third (37.09%) faced ostracization or bullying due to GD, 45.16% encountered verbal abuse, and 12.90% reported physical violence. Additionally, 40.32% had undergone treatment for depression and anxiety disorders. Most participants supported awareness initiatives, advocating for open gender expression, and normalizing the experiences of TG youth. Furthermore, 88.71% of TGs emphasized the importance of enhancing the expertise of professional groups, such as medical and mental health practitioners, in GD matters, a sentiment echoed by 68.25% of cisgender participants (p=0.030). While medical interventions were the least favored strategy at 32.80% overall, 46.78% of TGs supported it, compared to 19.05% of controls (p=0.010). Conclusion: Our study underscores the challenges faced by TG individuals during development. Early recognition, societal awareness, enhanced training in professional healthcare environments, and comprehensive support are crucial for fostering acceptance and reducing adversity among children and adolescents navigating GD.

Preventive interventions for individuals at risk of developing bipolar disorder: A systematic review and meta-analysis.

BACKGROUND: This systematic review and meta-analysis aimed to explore whether early interventions can reduce affective symptoms and have long-term benefits among individuals at risk of bipolar disorder (BD). METHODS: The PubMed, Embase, and Web of Science databases were searched. The primary outcome was continuous symptom scores before and after treatment. Random effects meta-analyses were conducted for each outcome arm studied and pooled mean difference estimates were calculated. RESULTS: The search identified 10 controlled studies involving 425 participants and 6 single-arm studies involving 90 participants. For controlled trials, meta-analysis showed that the interventions led to greater reduction in clinical global score than placebo (standardized mean differences (SMD) = -0.96, 95 % CI:-1.32, -0.60), and supported a long-term longitudinal effect for pharmacotherapy (SMD = -0.42, 95 % CI: -0.79, -0.05). For single-arm trials, both pharmacotherapy and psychotherapy showed efficacy for depressive symptoms, while pharmacotherapy only showed efficacy for hypomania symptoms (effect size (ES) = -9.16, 95 % CI:-11.29, -7.04). Discontinuation of pharmacotherapy due to adverse effects did not show a difference. LIMITATIONS: The primary limitations are the small number of RCTs and the influence of medication dosage. CONCLUSIONS: Based on the limited available data, early interventions show efficacy for individuals at risk of BD. Psychological therapy might be more beneficial for depressive symptoms and have long-term benefits for hypomania. Pharmacotherapy may be appropriate in situations of severe hypomanic symptoms and the poor functioning. Large, well-designed, double-blind -controlled trials are needed to make solid conclusions about the efficacy of early interventions.

Prevention of Parkinson's disease: from risk factors to early interventions.

Parkinson's disease (PD) is a debilitating neurological disorder characterized by progressively worsening motor dysfunction. Currently, available therapies merely alleviate symptoms, and there are no cures. Consequently, some researchers have now shifted their attention to identifying the modifiable risk factors of PD, with the intention of possibly implementing early interventions to prevent the development of PD. Four primary risk factors for PD are discussed including environmental factors (pesticides and heavy metals), lifestyle (physical activity and dietary intake), drug abuse, and individual comorbidities. Additionally, clinical biomarkers, neuroimaging, biochemical biomarkers, and genetic biomarkers could also help to detect prodromal PD. This review compiled available evidence that illustrates the relationship between modifiable risk factors, biomarkers, and PD. In summary, we raise the distinct possibility of preventing PD via early interventions of the modifiable risk factors and early diagnosis.

Identifying early intervention opportunities for illicit stimulant use: A cross-sectional study of factors associated with illicit stimulant use among young people accessing integrated youth services in British Columbia, Canada.

INTRODUCTION: Illicit stimulant (cocaine and/or amphetamine) use among young people aged 12-24 is a public health priority given that substance use initiation tends to peak in this developmental period and significant associated immediate and long-term harms are associated with its use. Young people using stimulants must be engaged in services as early as possible to reduce these harms. To inform early intervention opportunities, this study aimed to identify the risk/protective factors associated with illicit stimulant use among young people. METHODS: We conducted a cross-sectional study on routinely collected self-reported data among young people accessing integrated youth services in British Columbia (Canada) between April 2018 and January 2022. Data were collected on young peoples' socio-demographic characteristics, and social, behavioral, and health profiles. Variable selection was guided by established risk/protective factors for substance use among young people. The study used multivariable logistic regression to identify risk/protective factors that were independently associated with past 30-day illicit stimulant use. RESULTS: The analytic sample included n = 5620 young people aged 12-24 and a total of 163 (2.9 %) reported past 30-day illicit cocaine and/or amphetamine use. Demographic characteristics that were independently associated with illicit stimulant use included older age (aOR = 1.27, 95 % CI = 1.17-1.38) and gender identity as man vs woman (aOR = 1.71, 95 % CI = 1.10-2.70). Social and environmental risk factors included recently witnessing or experiencing violence (aOR = 2.32, 95 % CI = 1.47-3.68) and higher past-year crime/violent behaviors score (aOR = 1.39, 95 % CI = 1.13-1.69). Finally, regular alcohol (aOR = 6.90, 95 % CI = 2.36-25.42), regular (aOR = 3.74, 95 % CI = 1.95-7.54) or social (aOR = 3.06, 95 % CI = 1.44-6.60) tobacco use, and lifetime hallucinogen (aOR = 3.24, 95 % CI = 1.8-5.91) and ecstasy/MDMA (aOR = 2.53, 95 % CI = 1.48-4.39) use were also statistically significant risk factors. CONCLUSIONS: These risk/protective factors support identification of young people who may benefit from further screening, assessment, and treatment for illicit stimulant use. This study also underscores the need to expand early intervention and harm reduction programs that can comprehensively respond to young peoples' stimulant use, health, and social needs.

The role of well-child visits in detecting developmental delay in preschool children.

BACKGROUND: Early detection of developmental delay (DD) in preschool children is crucial for counselling parents, initiating diagnostic work-up, and starting early intervention (EI). METHODS: We conducted a register study of all preschool children referred for EI in the Canton of Zurich, Switzerland, in 2017 (N = 1,785) and used an online survey among primary care physicians (PCPs, N = 271) to evaluate the care service of DD children. RESULTS: PCPs accounted for 79.5% of all referrals by physicians and had correctly referred over 90% of the children in need of EI at an average age of 39.3 months (SD 8.9). In the survey, which represents 59.2% of all pediatricians and 11.3% of all general practitioners in the Canton, PCPs reported performing a mean of 13.5 (range 0-50, SD 10.7) well-child visits per week to preschool children and estimated well-child visits to be the most frequent type of consultation (66.7%) for the identification of DD. Parents' hesitancy in accepting further evaluation or support were reported by 88.7%. CONCLUSIONS: Most preschool children with DD are identified in well-child visits. These visits represent an ideal opportunity for early detection of developmental impairment and initiation of EI. Carefully addressing parents' reservations could reduce the rate of refusal, thus improving early support for children with DD.

A Review on Early Intervention Systems.

Purpose of Review: Early intervention programs have been shown to increase the overall socio-emotional and physical wellbeing of children in early childhood and educational settings. The goal of this narrative review is to explore recent literature that describes implementation of these systems and highlights innovative practices in the early childhood intervention sector. Recent Findings: Twenty-three articles were included, and we identified three themes in this review. The literature addressed concepts of innovative techniques in relation to childhood disability interventions; policy practices that promote child, family, and practitioner wellbeing; and attention to the importance of trauma-informed care in education for children and families who face the impacts of social marginalization such as racism and colonization. Summary: Notable shifts in the current early intervention paradigms are approaches to understanding disability informed by intersectional and critical theories, as well as systems level thinking that goes beyond focusing on individual intervention by influencing policy to advance innovative practice in the sector.

What's In It for Me? Motivating the Untreated Abuser to Consider Treatment.

This paper presents findings of a second trial evaluating telephone-based motivational enhancement therapy (MET) to motivate untreated and unadjudicated men who abuse their intimate partners to explore treatment options. Participants' perceptions of how their abuse is negatively affecting them personally are a highlight of the paper. One hundred forty-one adult men were recruited through social marketing and randomly assigned to the intervention (MET) or comparison (Mail) group. The MET condition consisted of two feedback sessions guided by a personalized feedback report on participants' intimate partner violence (IPV) and substance use. The Mail condition included a mailed educational brochure on IPV and substance use. Results supported the likely effectiveness of MET in short-term reduction of IPV behavior, marijuana use, and increasing motivation for treatment seeking particularly for participants who reported more adverse consequences of IPV to themselves. Findings emphasize the importance of including a focus in interventions on IPV's impact on the abusers themselves. The study's virtual participation and success in reaching and retaining a diverse population of male abusers can contribute to transformative justice and communities looking for alternative early interventions for men of color prior to encountering the criminal justice system.

Sex-dependent worsening of NMDA-induced responses, anxiety, hypercortisolemia, and organometry of early peripheral immunoendocrine impairment in adult 3xTg-AD mice and their long-lasting ontogenic modulation by neonatal handling.

The neuroimmunomodulation hypothesis for Alzheimer's disease (AD) postulates that alterations in the innate immune system triggered by damage signals result in adverse effects on neuronal functions. The peripheral immune system and neuroimmunoendocrine communication are also impaired. Here we provide further evidence using a longitudinal design that also studied the long-lasting effects of an early life sensorial intervention (neonatal handling, from postnatal day 1-21) in 6-month-old (early stages of the disease) male and female 3xTg-AD mice compared to age- and sex-matched non-transgenic (NTg) mice with normal aging. The behavioral patterns elicited by the direct exposure to an open field, and the motor depression response evoked by NMDA (25 mg/kg, i.p) were found correlated to the organometry of peripheral immune-endocrine organs (thymus involution, splenomegaly, and adrenal glands' hypertrophy) and increased corticosterone levels, suggesting their potential value for diagnostic and biomonitoring.The NMDA-induced immediate and depressant motor activity and endocrine (corticosterone) responses were sensitive to sex and AD-genotype, suggesting worse endogenous susceptibility/neuroprotective response to glutamatergic excitotoxicity in males and in the AD-genotype. 3xTg-AD females showed a reduced immediate response, whereas the NTg showed higher responsiveness to subsequent NMDA-induced depressant effect than their male counterparts. The long-lasting ontogenic modulation by handling was shown as a potentiation of NMDA-depressant effect in NTg males and females, while sex × treatment effects were found in 3xTg-AD mice. Finally, NMDA-induced corticosterone showed sex, genotype and interaction effects with sexual dimorphism enhanced in the AD-genotype, suggesting different endogenous vulnerability/neuroprotective capacities and modulation of the neuroimmunoendocrine system.

Cultural adaptation, content, and protocol of a feasibility study of school-based "Let's learn about emotions" intervention for Finnish primary school children.

Introduction: Emotional awareness and emotion regulation are crucial for cognitive and socio-emotional development in children. School-based interventions on socio-emotional skills have the potential to prevent these problems and promote well-being of children. The Japanese school-based program, Universal Unified Prevention Program for Diverse Disorders (Up2-D2), has shown preventive effects on mental health of children in Japan. The aims of this protocol paper are to describe the unique process of adapting the Up2-D2 from Eastern to Western context, and to present a feasibility study of the intervention, conducted in Finland. Methods: The cultural adaptation process started with the linguistic translation of materials, followed by the modification of language to fit the Finnish context. While the Japanese ideology was saved, some content was adapted to fit Finnish school children. Further modifications were made based on feedback from pupils and teachers. The Finnish version of the program was named "Let's learn about emotions" and consisted of 12 sessions and targeted 8- to 12-year-old pupils. A teacher education plan was established to assist Finnish teachers with the intervention, including a workshop, teachers' manual, brief introductory videos, and online support sessions. A feasibility study involving 512 4th graders in the City of Hyvinkää, South of Finland, was conducted. It assessed emotional and behavioral problems, classroom climate, bullying, loneliness, perception of school environment, knowledge of emotional awareness, and program acceptability. Discussion: The originality of this study underlies in the East-West adaptation of a cognitive behavioral therapy-based program. If promising feasibility findings are replicated in Finland, it could pave the way for further research on implementing such programs in diverse contexts and cultures, promoting coping skills, awareness, social skills and early prevention of child mental health problems. Ethics: The ethical board of the University of Turku gave ethics approval for this research. The educational board of the City of Hyvinkää accepted this study.