Oral Health Education for Children: Development of a Serious Game with a User-Centered Design Approach.

Background: Children can learn efficiently with well-designed serious games. The use of applications to promote health has proliferated, but there is a lack of scientific studies on educational games in oral health. Materials and Methods: We developed the Brazilian version of a British and Jordanian oral health education game for children from the perspectives of Brazilian specialists and users. This descriptive study, with a qualitative and quantitative approach, comprised three phases: I-Experts' discussion of the appropriateness of the previous version of the game to Brazil; II-Development of the first Brazilian version of the game; and III-Evaluation of the first version with 15 children from 4 to 8 years of age. Results: In Phase I, the specialists agreed with the development of the Brazilian version of the game, with minor adjustments on: advice on eating; advice on oral hygiene habits, users' age group, game characters, and game purpose. Phase II: a version with a few changes in images and recommendations, written and spoken in Brazilian Portuguese. Phase III: The global average of correct answers in the game's tasks was 75.3%, ranging from 50.0% to 100%. Children reported having fun with the game, and most understood the content and its interface; their parents found the information relevant and enjoyed the gameplay with their children. Conclusions: The Oral Health Education Game offered basic information for preventing dental caries to Brazilian children aged 4-8 years old in an interactive and fun way; it could support professionals in improving oral health education.

Corrigendum: Efficacy of an ACT and compassion-based ehealth program for self-management of chronic pain (iACTwithPain): study protocol for a randomized controlled trial.

[This corrects the article DOI: 10.3389/fpsyg.2021.630766.].

Morphological aspects of rumen papillae of lambs fed agro-industrial wastes.

Sheep meet production systems require roughage feed of good nutritional quality. However, the production of sorghum or corn silage, besides expensive, also depends on large cultivable areas and favorable weather conditions. Thus, agro-industrial residues have stood out as a feed alternative that contribute to the reduction of production costs and to the conservation of the environment. Fragments of the ruminal mucosa of 30 healthy lambs fed with agro-industrial residues and slaughtered with a final weight of 36 kg were analyzed by light and scanning electron microscopy. We observed that the coproducts grape residue and wet brewery residue affected the shape, dimensions, and cytoarchitecture of the rumen epithelium in contrast to traditional sorghum silage. The rumen papillae of lambs fed grape waste were larger, and their epithelium was thinner when compared to the papillae of lambs fed wet brewery waste and sorghum silage. It can be assumed that the increased mucosal surface area of the rumen contributed to greater weight gain and reduced time to slaughter. The use of a greater variety of agro-industrial residues as a substitute for traditional feedstuffs contributes to the increase in animal protein production in many countries, making the confinement of sheep more viable and sustainable.

Genealogical analysis of Quaternary Prevention: between the use of Evidence-Based Medicine and care reformulation in Primary Health Care. / Genealogia da Prevenção Quaternária: entre o uso da Medicina Baseada em Evidências e a reformulação do cuidado na Atenção Primária à Saúde.

We conducted a genealogical analysis of quaternary prevention, an instrument of primary health care to address overmedicalization and iatrogenesis, based on related statements and interviews with the creators of this concept. This tool has been used in the reformulation of care and the doctor-patient relationship, but limited to the risk-benefit assessment by using current scientific evidence. In this study, we analyze the paradoxes of evidence-based medicine (EBM) and discuss the relationship of EBM and quaternary prevention and primary health care (PHC). Finally, we suggest questioning the truth of the evidence for the development of other health paradigms.

Realizamos uma análise genealógica da Prevenção Quaternária, instrumento da Atenção Primária à Saúde de enfrentamento à medicalização e a iatrogenia, a partir de seus enunciados e de entrevistas com seus formuladores. Identificamos que a ferramenta tem sido tanto apresentada como uma reformulação do cuidado e da relação médico-paciente, como também reduzida ao cálculo do risco-benefício por meio da aplicação atualizada de evidências científicas. Analisamos os paradoxos da Medicina Baseada em Evidências e problematizamos sua relação com a Prevenção Quaternária e a Atenção Primária à Saúde. Por fim, sugerimos questionar a verdade das evidências para o desenvolvimento de outros paradigmas de saúde.

Genealogia da Prevenção Quaternária: entre o uso da Medicina Baseada em Evidências e a reformulação do cuidado na Atenção Primária à Saúde / Genealogical analysis of Quaternary Prevention: between the use of Evidence-Based Medicine and care reformulation in Primary Health Care

Resumo Realizamos uma análise genealógica da Prevenção Quaternária, instrumento da Atenção Primária à Saúde de enfrentamento à medicalização e a iatrogenia, a partir de seus enunciados e de entrevistas com seus formuladores. Identificamos que a ferramenta tem sido tanto apresentada como uma reformulação do cuidado e da relação médico-paciente, como também reduzida ao cálculo do risco-benefício por meio da aplicação atualizada de evidências científicas. Analisamos os paradoxos da Medicina Baseada em Evidências e problematizamos sua relação com a Prevenção Quaternária e a Atenção Primária à Saúde. Por fim, sugerimos questionar a verdade das evidências para o desenvolvimento de outros paradigmas de saúde.

Abstract We conducted a genealogical analysis of quaternary prevention, an instrument of primary health care to address overmedicalization and iatrogenesis, based on related statements and interviews with the creators of this concept. This tool has been used in the reformulation of care and the doctor-patient relationship, but limited to the risk-benefit assessment by using current scientific evidence. In this study, we analyze the paradoxes of evidence-based medicine (EBM) and discuss the relationship of EBM and quaternary prevention and primary health care (PHC). Finally, we suggest questioning the truth of the evidence for the development of other health paradigms.

Questões da saúde digital para o SUS: a "saúde móvel" e a automação algorítmica do saber-poder da medicina / Digital health issues for the SUS: "mobile health" and the algorithmic automation of medical knowledge-power

Resumo A pandemia de covid-19 acelerou a chamada transformação digital da saúde. Uma de suas faces pode ser vista no uso progressivo de aplicativos móveis dedicados à prevenção de doenças e à promoção à saúde (mSaúde). Todavia, ainda há muitas lacunas de conhecimento e problematizações sobre saúde digital para subsidiar seu uso e implementação no âmbito da saúde coletiva. Este ensaio pretende se somar às caracterizações e análises das consequências assistenciais, sociais, políticas, legais e éticas da saúde digital. A hipótese a ser defendida é que a transformação digital da saúde acarreta a automação algorítmica do saber-poder da medicina. Para desenvolver este ensaio, foram realizadas extensa revisão bibliográfica, investigação e descrição de aplicativos de mSaúde, a partir de estudos críticos sobre saúde digital propostos por Deborah Lupton.

Abstract The current pandemic has accelerated digital health transformation. One of its faces refers to the progressive use of mobile applications dedicated to care, disease prevention, and health promotion - e.g., mHealth. However, many gaps in the knowledge and questions about digital health to support its use and implementation persist in the scope of Public Health. With that in mind, this study aims to contribute to their assistance, social, political, legal, and ethical characterizations and analyses. The hypothesis we intend to test is that the digital transformation of health care leads, for better or for worse, to the algorithmic automation of the knowledge-power of medicine. To conduct this study, we carried out an extensive literature review and investigated and described mHealth apps based on the critical studies of digital health proposed by Deborah Lupton.

Carcass traits and meat quality of lambs slaughtered during different seasonal conditions.

This study was conducted to evaluate the effects of slaughtering feedlot Texel lambs during different climatic conditions on carcass and meat quality traits. Twenty castrated male Texel lambs (21.8 ± 0.62 kg) were distributed to two treatments according to the climatic conditions during the finishing period and at pre-slaughter: warm season (WS; mean temperature of 23.4 °C and 77.5% relative humidity) and cool season (CS; mean temperature of 14.9 °C and 79.5% relative humidity). During the pre-slaughter, thermal comfort was evaluated through the variables: respiratory frequency, rectal temperature, temperature of the ocular region, and temperature-humidity index (THI). After the finishing period, lambs were slaughtered, and carcass and meat quality traits were assessed. The THI values indicate that animals harvested in the WS spent 13 h of the day under potential thermal discomfort conditions in the week before slaughter and in the pre-slaughter period, whereas lambs harvested in the CS did not experience any thermal discomfort. Slaughter weight, carcass weight, carcass dressing, and backfat thickness were greater (P ≤ 0.03), whereas cooling losses were lower (P < 0.01) for lambs slaughtered in the CS. Moreover, thawing losses were lower (P < 0.01), whereas cooking losses were greater (P < 0.01) for lambs harvested in the CS. Lambs slaughtered in the CS also showed greater meat redness, yellowness, and chroma values (P < 0.05). Although carcass traits were affected by the greater thermal discomfort exposure, meat quality of lambs was less impacted by the climatic conditions at slaughter.

Usability Study of the iACTwithPain Platform: An Online Acceptance and Commitment Therapy and Compassion-Based Intervention for Chronic Pain.

Background: This pilot study aims to test the usability of the iACTwithPain platform, an online ACT-based intervention for people with chronic pain, to obtain information on which intervention and usability aspects need improvement and on expected retention rates. Methods: Seventy-three Portuguese women with chronic pain were invited to complete the first three sessions of the iACTwithPain intervention assess their quality, usefulness and the platform's usability. Twenty-one accepted the invitation. Additionally, eight healthcare professionals working with chronic medical conditions assessed the platform and the intervention from a practitioner's point of view. Results: This study presented a considerable attrition rate (71.43%) among chronic pain participants, with six completers. There were no significant differences in demographic or clinical variables between dropouts and completers except for completed education (participants who dropped out presented less education than completers). Reasons for dropout were related to difficult personal events occurring during the time of the intervention, lack of time, or having forgotten. There seemed to be an overall satisfaction with both the intervention, its contents and form of presentation of information, and the platform, concerning its design, appearance, and usability. Real image videos were preferred over animations or audio by chronic pain participants. Healthcare professionals emphasized the appealing and dynamic aspects of the animation format. Conclusion: This study informs the ongoing improvement of the iACTwithPain platform and provides valuable information on aspects researchers should consider while developing online psychological interventions for chronic pain. Further implications are discussed.

Beyond the Centrality of Shame: How Self-Concealment and Fear of Receiving Compassion From Others Impact Psychological Suffering in Transgender Adults.

Shame-based social interactions are a minority social stressor commonly experienced by transgender individuals. However, few studies have explored the centrality of shame experiences in transgender identity and mental health. Also, the ability to receive care and soothing support may be influenced by intrapersonal shame- and fear-related factors, which may hinder openness, and support and care seeking, thus contributing to psychological distress. This study aims to examine the relationship between central shame experiences, fear of receiving compassion from others, self-concealment, and psychological distress (depression, anxiety, and stress symptoms) in a sample of Portuguese transgender adults. Following a cross-sectional design, data from a convenience sample of 70 self-identified transgender individuals undergoing gender-affirming medical interventions (GAMIs) were analyzed, using SPSS PROCESS, to determine whether the relationship between central shame experiences and psychological suffering occurred indirectly through fear of receiving compassion from others, and self-concealment. Results suggest that fear of receiving compassion from others, but not self-concealment, was the underlying factor between central shame experiences, and depression and anxiety. Results suggest that the centrality of shame experiences and stress symptomatology associate sequentially through fear of compassion and, in turn, through self-concealment. Clinical implications for mental health interventions with transgender individuals undergoing GAMI are discussed.

Corrigendum: The LIFEwithIBD Intervention: Study Protocol for a Randomized Controlled Trial of a Face-to-Face Acceptance and Commitment Therapy and Compassion-Based Intervention Tailored to People With Inflammatory Bowel Disease.

[This corrects the article DOI: 10.3389/fpsyt.2021.699367.].

Late-Season Sweet Orange Selections Under Huanglongbing and Citrus Canker Endemic Conditions in the Brazilian Humid Subtropical Region.

The Brazilian citrus orchards are comprised by few genotypes, which increases the risk of pest and disease outbreaks. The diversification of sweet oranges (Citrus × sinensis) in orchards also generates off-season revenue and extend the fruit processing period. This study aimed to evaluate several horticultural traits of 19 late-season sweet orange selections under citrus canker and huanglongbing (HLB) endemic condition in northwestern Paraná state, Brazil, in a long-term field experiment. Tree size, yield, fruit quality for fresh fruit and industrial markets, estimates of tree density and yield, and citrus canker and huanglongbing (HLB) incidences were assessed. The experimental design was a randomized block with three replicates and five trees per unit. The orchard was drip-irrigated and arranged at tree spacing of 6.5 m × 4.5 m. All scions were graft-compatible with Rangpur lime (C. × limonia). Valencia selections had the tallest trees and largest canopies, particularly Olinda, Frost and #121 with heights and volumes greater than 4.20 m and 43 m3, respectively. Natal África do Sul and Whit's Late Valencia trees were the most productive with cumulative yields above 640 kg per tree. Most of the selections produced fruits of excellent physicochemical quality attending the fresh fruit and industrial market requirements. All selections showed similar horticultural characteristics for the fresh market, while Natal África do Sul and Charmute de Brotas were more suitable for juice processing. Frost Valencia and Valencia Late Fla. had the highest incidence of citrus canker on fruits (>20%), whereas IPR Folha Murcha, Charmute de Brotas and some Valencia selections (Chafeei Late, Campbell 479, Campbell 294, Olinda, Mutação and Whit's Late) exihibed low incidence (3.0-17.7%). At 9 years, Valencia Mutação trees had high HLB incidence (93%). In contrast, Natal IAC and Folha Murcha IAC showed the lowest HLB incidence (13%). Our results revealed that Natal IAC, Folha Murcha IAC, IPR Folha Murcha, Natal Murcha, Campbell 479 Valencia and Valencia Late Fla. had the best horticultural performance in addition to low HLB incidence. Together, these late-season sweet oranges are the most advantageous selections for citrus orchard diversification under citrus canker and HLB endemic conditions in humid subtropical regions.

Water stress signaling and hydraulic traits in three congeneric citrus species under water deficit.

Morpho-physiological strategies to deal with water deficit vary among citrus species and the chemical signaling through ABA and anatomical, hydraulic, and physiological traits were evaluated in saplings of Rangpur lime, Swingle citrumelo and Valencia sweet orange. Trunk and roots of Swingle citrumelo presented lower vessel diameter and higher vessel frequency as compared to the other species. However, relative water content at the turgor loss point (RWCTLP), the osmotic potential at full turgor (Ψ0), the osmotic potential at the turgor loss point (ΨTLP), bulk modulus of elasticity (ε) and the xylem water potential when hydraulic conductivity is reduced by 50% (Ψ50) and 88% (Ψ88) indicated similar hydraulic traits among citrus species, with Rangpur lime showing the highest hydraulic safety margin. Roots of Rangpur lime and Swingle citrumelo were more water conductive than ones of Valencia sweet orange, which was linked to higher stomatal conductance. Chemical signaling through ABA prevented shoot dehydration in Rangpur lime under water deficit, with this species showing a more conservative stomatal behavior, sensing, and responding rapidly to low soil moisture. Taken together, our results suggest that Rangpur lime - the drought tolerant species - has an improved control of leaf water status due to chemical signaling and effective stomatal regulation for reducing water loss as well as decreased root hydraulic conductivity for saving water resources under limiting conditions.

Self-Compassion and Mental Health in Sexual and Gender Minority People: A Systematic Review and Meta-Analysis.

Purpose: Literature shows that sexual and gender minority (SGM) individuals are at higher risk of developing minority stress-related mental health problems. Recently, it has been suggested that promoting self-compassion through affirmative mental health care for SGM people can be beneficial. However, no systematic analysis has been published exploring the relationship between self-compassion and mental health indicators in SGM individuals. We aim to fill this gap by synthesizing and meta-analyzing studies that focus on the relationship between self-compassion and mental health in SGM people. Methods: After registering in PROSPERO (CRD42021254774), PubMed, PsycINFO, CENTRAL, and Web of Knowledge were systematically searched to identify studies assessing the association between self-compassion and mental health and/or minority stress indicators in SGM individuals. All screening steps and data extraction were performed independently by the two researchers. The quality of each study was assessed with the National Heart, Lung and Blood Institute tool, and meta-analysis was performed on R software. Results: Twenty-one studies were included in the meta-analysis, corresponding to a total of 6573 nonheterosexual and/or noncisgender participants. All meta-analytic models were significant: higher levels of self-compassion were associated with less depression, anxiety, psychological distress, suicidal ideation, internalized homophobia/transphobia, and stigma, and with more well-being, outness, and social support. Conclusion: This meta-analysis suggests that self-compassion is significantly associated with mental health indicators in SGM people, and this relationship is especially strong with internalized homophobia/transphobia in older SGM adults, and with suicidal ideation in younger SGM individuals. Results suggest that affirmative mental health care may benefit from promoting self-compassion.

Corrigendum: The LIFEwithIBD Intervention: Study Protocol for a Randomized Controlled Trial of a Face-to-Face Acceptance and Commitment Therapy and Compassion-Based Intervention Tailored to People With Inflammatory Bowel Disease.

[This corrects the article DOI: 10.3389/fpsyt.2021.699367.].

A pilot randomized controlled trial of online acceptance and commitment therapy versus compassion-focused therapy for chronic illness.

Literature suggests that acceptance and commitment therapy (ACT) is effective in improving well-being and in reducing psychopathological symptoms commonly experienced by people with chronic illness (CI). Compassion-focused therapy (CFT) reduces psychological distress, especially in individuals with high levels of shame and self-criticism, but few studies have explored CFT in CI. Additionally, studies almost exclusively compared ACT and CFT with inactive controls (wait-list; treatment as usual). Also, there is an interest in developing cost-effective mental health solutions, such as low-intensity online psychological interventions. This randomized controlled trial (RCT) aimed to assess the acceptability and compare the efficacy of four-session online ACT (n = 25) and CFT (n = 24) interventions in a sample of people with CI. Results showed both interventions were acceptable, with attrition rates at post-intervention comparable to those found in similar studies (around 50%). Intention-to-treat analyses showed that participants presented significantly less illness-related shame, less uncompassionate self-responding and more valued living after the intervention, although no difference was found between conditions. Results were sustained at 3- and 6-month follow-up. Results did not find statistical differences between conditions through reliable change index (RCI). Correlation between demographics and RCI showed that, at post-intervention, younger participants presented more behavioural awareness, men presented more valued action, and participants with CI for shorter periods presented less uncompassionate self-responding and less anxiety. Results suggest that low-intensity (four sessions) online ACT and CFT are cost-effective approaches to promote mental health of individuals with CI. Results and limitations are thoroughly discussed.

Self-compassion in Acceptance and Commitment Therapy for chronic pain: a pilot study.

OBJECTIVES: Evidence shows that Acceptance and Commitment Therapy (ACT) is an empirically supported psychological approach for chronic pain (CP) management. Although self-compassion is not explicitly a target of ACT, it seems to be one mechanism of change in ACT for CP. However, research is lacking on the benefits of including explicit self-compassionate exercises in ACT for CP. The current study pilot tested a Compassionate ACT 8-session group program (COMP.ACT; n=9), as well as an ACT-only 8-session group program (ACT; n=7), in a sample of women with CP. METHODS: The current study follows a quasi-experimental design, and conducts Reliable and Significant Change analyses comparing pre- to post-intervention scores of self-report measures. RESULTS: No differences were found between conditions at baseline, nor between completers and drop-outs. Although preliminary, results showed COMP.ACT led to greater clinical improvements in depression and anxiety, while ACT led to greater improvements in stress and uncompassionate self-responding. Reliable and Significant Change analysis showed that some participants improved significantly (in psychopathological symptoms, valued living and uncompassionate self-responding) in both conditions, while the majority did not change significantly. CONCLUSIONS: More research is needed to conclude whether explicit self-compassion exercises are useful in ACT for CP. Limitations and implications are further discussed.

Incontinência urinária masculina e a tecnologia digital: avaliação de aplicativos móveis disponíveis para download / Male urinary incontinence and the digital technology: evaluation of mobile applications available for download / Incontinencia urinaria masculina y tecnología digital: evaluación de aplicaciones móvilves disponíveis para download

RESUMO Objetivo avaliar a adequação e utilidade de aplicativos móveis voltados para reabilitação da incontinência urinária na população masculina. Método estudo descritivo, realizado com aplicativos direcionados à reabilitação da incontinência urinária masculina. Os aplicativos foram obtidos na Play Store e App Store. A busca foi realizada entre 3 e 10 de maio de 2021, em Minas Gerais, Brasil. Foram utilizados os termos "incontinência urinária", "incontinencia urinaria", "urinary incontinence" e "Kegel" para seleção. Os aplicativos foram descritos e avaliados conforme estabelecido nos itens da Applications Scoring System. Resultados Vinte e dois aplicativos foram selecionados. Três eram específicos para homens; três abordavam exercícios para fortalecimento da musculatura pélvica e diário miccional simultaneamente; e cinco eram compatíveis com ambas as lojas virtuais. Conclusão a maioria dos aplicativos disponíveis possui funcionalidades e informações limitadas acerca da incontinência urinária masculina. Espera-se que esse estudo contribua para o desenvolvimento de softwares mais abrangentes e adequados à população masculina com incontinência urinária.

ABSTRACT Objective to evaluate the suitability and usefulness of mobile apps aimed at urinary incontinence rehabilitation in the male population. Method descriptive study, carried out with apps directed to the rehabilitation of male urinary incontinence. The apps were obtained from the Play Store and App Store. The search was conducted between May 3 and 10, 2021, in Minas Gerais, Brazil. The terms "urinary incontinence", "incontinencia urinaria", "urinary incontinence", and "Kegel" were used for selection. The applications were described and evaluated as established in the Applications Scoring System items. Results Twenty-two apps were selected. Three were specific for men; three addressed exercises for pelvic muscle strengthening and voiding diary simultaneously; and five were compatible with both online stores. Conclusion most of the available apps have limited functionality and information about male urinary incontinence. This study is expected to contribute to the development of more comprehensive and appropriate software for the male urinary incontinent population.

RESUMEN Objetivo evaluar la idoneidad y utilidad de las aplicaciones móviles para la rehabilitación de la incontinencia urinaria en la población masculina. Método estudio descriptivo, realizado con aplicaciones dirigidas a la rehabilitación de la incontinencia urinaria masculina. Las aplicaciones se obtuvieron de Play Store y App Store. La búsqueda se realizó entre el 3 y el 10 de mayo de 2021 en Minas Gerais, Brasil. Para la selección se utilizaron los términos "incontinência urinária", "incontinencia urinaria", "urinary incontinence" e "Kegel". Las solicitudes fueron descritas y evaluadas según lo establecido en los ítems del Applications Scoring System. Resultados Se seleccionaron 22 aplicaciones. Tres eran específicos para hombres; tres abordaban ejercicios para fortalecer la musculatura pélvica y miccional simultáneamente; y cinco eran compatibles con ambas salas virtuales. Conclusión la mayoría de las aplicaciones disponibles tienen funcionalidades e información limitada sobre la incontinencia urinaria masculina. Se espera que este estudio contribuya al desarrollo de softwares más completos y adecuados para la población masculina con incontinencia urinaria.

Leituras do governo neoliberal do Estado e da saúde / Readings of state and health neoliberal government

Resumo A Saúde Coletiva brasileira analisou frequentemente o neoliberalismo como um fenômeno de esvaziamento do papel do Estado e de ameaça à saúde pública e universal. Tomando como subsídio o pensamento governamental de Foucault, discutimos o neoliberalismo como uma profunda metamorfose, não apenas do Estado, mas dos modos de produção de saúde. Enquanto atualização permanente do liberalismo, o governo neoliberal modifica as fronteiras entre público e privado e fabrica novas formas de normalidade, risco e subjetividade, progressivamente subordinados à verdade da economia e do mercado. Esta racionalidade econômica cria ideais de saúde inspirados em técnicas gerenciais de empresas e produz novas verdades biológicas, sanitárias, psicológicas. Restrita a "empresários bem-sucedidos de si mesmos", a saúde pode se transformar em uma escolha moral e econômica em relação ao comportamento e ao risco individual, desresponsabilizando o Estado e criando um tipo de cidadania econômica destituída de solidariedade. Contudo, o jogo em torno de instituições e práticas de saúde não empresariais segue em aberto. Cabe-nos colocar em dúvida as formas de vida "responsáveis" e "seguras" que foram inventadas para nós, e desenvolver outras governamentalidades menos excludentes e desiguais em relação às que temos naturalizado e praticado.

Abstract Brazilian Public Health has often analyzed neoliberalism as a phenomenon of emptying the role of the State and a threat to public and universal health. Taking Foucault's governmental thought as a subsidy, we discuss neoliberalism as a profound metamorphosis, not only of the State, but of health production. As a permanent update of liberalism, the neoliberal government changes the boundaries between public and private and produces new forms of normality, risk and subjectivity, progressively subordinate to the truth of the logic of the economy and the market. This economic rationality creates new ideals of health, inspired by management techniques of corporations, and produces new biological, sanitary, psychological truths. Restricted to "successful self-entrepreneurs", health may become a moral and economic choice in relation to individual behavior and risk, making the State not responsible and creating a type of economic citizenship devoid of solidarity. However, the game around non-corporate health institutions and practices remains open. It is up to us to question the "responsible" and "safe" life forms that were invented for us and to develop other governmentalities that are less excluding and unequal compared to those that we have naturalized and practiced.

A Theory- and Evidence-Based Digital Intervention Tool for Weight Loss Maintenance (NoHoW Toolkit): Systematic Development and Refinement Study.

BACKGROUND: Many weight loss programs show short-term effectiveness, but subsequent weight loss maintenance is difficult to achieve. Digital technologies offer a promising means of delivering behavior change approaches at low costs and on a wide scale. The Navigating to a Healthy Weight (NoHoW) project, which was funded by the European Union's Horizon 2020 research and innovation program, aimed to develop, test, and evaluate a digital toolkit designed to promote successful long-term weight management. The toolkit was tested in an 18-month, large-scale, international, 2×2 factorial (motivation and self-regulation vs emotion regulation) randomized controlled trial that was conducted on adults with overweight or obesity who lost ≥5% of their body weight in the preceding 12 months before enrollment into the intervention. OBJECTIVE: This paper aims to describe the development of the NoHoW Toolkit, focusing on the logic models, content, and specifications, as well as the results from user testing. METHODS: The toolkit was developed by using a systematic approach, which included the development of the theory-based logic models, the selection of behavior change techniques, the translation of these techniques into a web-based app (NoHoW Toolkit components), technical development, and the user evaluation and refinement of the toolkit. RESULTS: The toolkit included a set of web-based tools and inputs from digital tracking devices (smart scales and activity trackers) and modules that targeted weight, physical activity, and dietary behaviors. The final toolkit comprised 34 sessions that were distributed through 15 modules and provided active content over a 4-month period. The motivation and self-regulation arm consisted of 8 modules (17 sessions), the emotion regulation arm was presented with 7 modules (17 sessions), and the combined arm received the full toolkit (15 modules; 34 sessions). The sessions included a range of implementations, such as videos, testimonies, and questionnaires. Furthermore, the toolkit contained 5 specific data tiles for monitoring weight, steps, healthy eating, mood, and sleep. CONCLUSIONS: A systematic approach to the development of digital solutions based on theory, evidence, and user testing may significantly contribute to the advancement of the science of behavior change and improve current solutions for sustained weight management. Testing the toolkit by using a 2×2 design provided a unique opportunity to examine the effect of motivation and self-regulation and emotion regulation separately, as well as the effect of their interaction in weight loss maintenance.