Efficacy of behavioral interventions to increase engagement in sexual health services among LatinX youth in the United States: A meta-analysis for post-pandemic implications.

INTRODUCTION: LatinX youth in the U.S. are disproportionately affected by HIV and STIs, commonly attributed to a lack of diagnostic testing and regular physician consultations to address sexual health. These disparities have been exacerbated by the COVID-19 pandemic. This meta-analysis seeks to assess the efficacy of behavioral interventions among LatinX youth in the U.S. that aim to increase engagement in sexual health services (i.e., STI/HIV testing, physician consultations). CONTENT: Following PRISMA guidelines, seven electronic databases were searched. We systematically extracted data with a coding form, and effect sizes were obtained from each study on HIV/STI testing outcomes and physician consultation. Moderator analyses were run for demographic and intervention characteristics. SUMMARY AND OUTLOOK: Of nine included studies, the interventions created a small-to-moderate effect on increased engagement of sexual health services (d +=0.204, 95 % CI=0.079, 0.329). Moderator analyses showed that interventions including the following characteristics were most efficacious at facilitating care services: community-based or online setting, access to diagnostic testing, social media/remote components, parental involvement, and longer session duration. This meta-analysis provides informative results regarding behavioral interventions that have proven efficacious in facilitating engagement in sexual health services among LatinX youth. Most prominently, interventions that are remote or through social media, community-based, and incorporated parents had large positive effects. These findings prove useful for the ongoing COVID-19 pandemic situation and provide guidance for targeting LatinX youth to engage them in sexual health services as primary and secondary STI and HIV prevention.

Analysis of the Effectiveness of an Affective-Sexual Education Program for Adults with Intellectual Disabilities.

In recent years, the number of programs to improve sex education for people with intellectual disabilities has increased. However, in most cases, these programs do not provide any evidence of their impact. In the present study we analyzed the effectiveness of the SALUDIVERSEX affective-sexual education program for people with intellectual disabilities using a controlled trial design. 246 individuals from eastern Spain completed a battery of questionnaires before and after the intervention. Multilevel statistical analyses showed that the risk of experiencing sexual abuse had significantly decreased and knowledge about sexuality significantly increased among those who received the intervention compared to those who did not. The evaluation of the professionals who worked daily with the participants agreed on how knowledge about sexuality and intimacy increased and concerns about sexuality decreased among those in the intervention group. The SALUDIVERSEX program is a powerful educational strategy to promote better sexual health and quality of life for people with intellectual disabilities.

People with intellectual disabilities' sexuality from three different perspectives: Parents, professionals, and themselves.

BACKGROUND: A positive conception of sexuality among people with intellectual disabilities is crucial and relies on several social and interpersonal contexts. The goal of this study is to analyse the interaction and impact of three different contextual groups: individuals with intellectual disabilities, their parents, and professionals working with them. METHODS: Survey data were collected from 330 people with intellectual disabilities attending occupational centres in eastern Spain, 330 parents, and 100 professionals. RESULTS: Correlation and variance analyses of dyad-level data show significant differences among the three groups in all variables. Professionals perceived people with intellectual disabilities to have higher knowledge of socio-sexual norms than people with intellectual disabilities actually appear to be, but they are also more concerned about aspects related to this area of people with intellectual disabilities. Compared to people with intellectual disabilities and professionals, parents perceived people with intellectual disabilities to have lower sexual knowledge. CONCLUSIONS: Our study demonstrates inconsistent perceived knowledge of people with intellectual disabilities' socio-sexual norms and sexual knowledge among the three groups, leading to disparate levels of concern regarding people with intellectual disabilities sexuality. Thus, the need to collect information from different perspectives for more accurate reporting and the critical need for sex education programs that involve the target population, but also parents and professionals who frequently interact with people with intellectual disabilities are highlighted.

Feasibility, Acceptability, and Preliminary Outcomes of a Father-Focused Childhood Obesity Prevention Program for Low-Income Families with Preschool-Age Children.

Background: Few childhood obesity prevention interventions have focused exclusively on fathers, particularly in low-income families. The objectives of this study were to determine feasibility, acceptability, and preliminary outcomes of a father-focused childhood obesity prevention program for low-income families with preschool children (ages 3-5 years old). Methods: Father-child pairs (n = 45) enrolled in a community-based intervention in a Northeastern US state and were assigned within groups to intervention (n = 31) or a delayed comparison group (n = 14). The 8-week (2 h/week) program included nutrition, cooking, and parent education. Feasibility (enrollment, retention, and attendance) and acceptability (quality and value of program) of the program were assessed. Pre/Post measures included the Meals in our Household, Comprehensive Feeding Practices, Healthy Kids, and the Cooking Matters questionnaires. T-tests were conducted and Hedge's g was calculated to estimate effect sizes. Significance was set at p ≤ 0.10. Results: Results indicated feasibility and acceptability of the program for intervention fathers, but recruitment and retention of comparison fathers proved challenging. Small to medium effect sizes were detected for improvements in fathers' feeding pressure (g = 0.48, p = 0.005), confidence in cooking skills (g = 0.25, p = 0.09), ability to cook healthy foods on a budget (g = 0.33, p = 0.10), and frequency that fathers cooked dinner (g = 0.15, p = 0.06). There was a large effect size detected in the increase of green salad consumption (g = 0.75, p = 0.01) by fathers and a small effect size for frequency of children eating vegetables (g = 0.13, p = 0.07). Conclusions: While results are promising, further research should evaluate impact of a larger scale father-focused intervention on diet and obesity risk. The project was registered on ClinicalTrials.gov as NCT03071419.

Analysis of the Differential Efficacy of the Reduced Version Over the Extended Version of an Affective-Sexual Education Program for Adults with Intellectual Disabilities.

Recently, with the increase in demand, multiple intervention proposals aimed at improving the sexual health of people with intellectual disabilities have emerged. Among them is the SALUDIVERSEX program, which takes a positive approach to sexuality. It has an extended version, consisting of 16 sessions and whose efficacy has already been proven, and a reduced version of 10 sessions. Thus, the present study aimed to test the differential efficacy of the two versions. A total of 208 participants (103 women and 105 men) aged between 19 and 67 years (M = 37.23, SD = 10.66) completed a battery of instruments before and after the intervention. Statistical analyses showed that users who participated in the reduced version of the program presented a significantly higher rate of improvement in their sexual behaviors compared to those who participated in the extended version (Sexual response: ß10 = - 0.46 ± 0.19, p = .034; Sex practices: ß10 = - 0.52 ± 0.23, p = .037; Use condoms: ß10 = - 1.56 ± 0.59, p = .017), as well as a significantly higher decrease in the risk of suffering sexual abuse (ß10 = 3.95 ± 0.64, p < .001). However, no statistically significant differences in sexuality knowledge were obtained with respect to the improvement between the two versions (ß10 = - 0.09 ± 1.21, p = .94). Meanwhile, the professionals who applied the program found that those who participated in the reduced version, although they presented a significantly greater increase in their knowledge about privacy (ß10 = - 0.48 ± 0.08, p < .001), did not improve their concerns about their inappropriate sexual behaviors as much as the users of the extended version (ß10 = - 1.35 ± 0.21, p < .001). Thus, although both versions were effective, the reduced version seems to do so to a greater extent and in a shorter time, which makes it the more recommendable option.

Cognitive Coping Reduces Posttraumatic Stress Symptoms, Especially in the Context of Self-Blame.

Following a traumatic event, coping strategies may affect the natural course of posttraumatic stress symptoms (PTSS). In particular, cognitive coping strategies (how one thinks about stressors) may reduce PTSS by increasing individuals' perceived control over events, appraising them as less threatening, particularly for individuals who experience self-blame after trauma. Individuals who experience a traumatic event (n =344) completed assessments at baseline (T1), one month (T2), and two months (T3). We tested whether T1 cognitive coping strategies (positive reinterpretation, acceptance, religious coping) predicted reduced T3 PTSS and whether this reduction was mediated by increased perceived control at T2. We tested whether this effect was particularly strong for individuals experiencing self-blame. Positive reinterpretation predicted decreases in, religious coping predicted increases in, and acceptance had no direct effect on PTSS. Overall, acceptance showed the greatest potential for reducing PTSS through increased perceived control over one's life. In a fully moderated mediation model, positive reinterpretation significantly interacted and acceptance marginally interacted with self-blame to predict increased perceived control and, subsequently, decreased T3 PTSS. Specifically, acceptance and positive reinterpretation were most helpful for those with higher levels of self-blame. Religious coping interacted with self-blame to predict decreased perceived control and subsequent increased PTSS. For trauma survivors experiencing self-blame, cognitive coping strategies that utilize compassionate self-talk, such as positive reinterpretation and acceptance, may be particularly helpful at increasing perceived control after trauma, while religious coping may have deleterious effects.

Debridement of diabetic foot ulcers: public health and clinical implications - a systematic review, meta-analysis, and meta-regression.

Background: Diabetic foot ulceration (DFU) has devastating complications and a lifetime occurrence of 15%-34%. Debridement of DFU is regarded as an intervention that accelerates ulcer healing and may reduce complications including amputations, infections, and poor quality of life (QoL), which have serious public health and clinical implications. A systematic review (SR) of SRs and of randomized controlled trials (RCTs) with meta-analyses (MAs) on debridement of DFU that synthesizes all human experimental evidence is warranted. Objectives: Are debridement methods in DFU beneficial over other forms and standard gauze dressings (control condition) in these outcomes? Study eligibility criteria: All SRs/MAs/RCTs comparing debridement methods for DFU with alternative methods of debridement and with control. Data sources: Cochrane Wounds Group Specialized Register, Cochrane Central Register of Controlled Trials (Cochrane Library), Ovid MEDLINE, PubMed, EMBASE, EBSCO, CINAHL, and Web of Science. Participants and interventions: Adults with type 1/2 diabetes with DFU and any debridement method compared with alternative debridement methods or control. Main Outcomes: Amputation rates, wound infections, QoL, proportion of ulcers healed, time to complete healing, ulcer recurrence, and treatment cost. Study selection and analysis: Data extraction/synthesis by two independent reviewers pooled using a random-effects model with sensitivity analysis. Results: 10 SRs were retrieved and reported qualitatively. Six SRs included MAs. This SR included 30 studies, with 2654 participants, using 19 debridement combinations. The debridement methods were compared with findings pooled into MAs. Meta-regression (MR) did not identify significant predictors/moderators of outcomes. Limitations: The studies may have been under-powered. The inclusion/exclusion criteria varied and the increased risk of bias contributed to low-quality evidence. Discussion/Conclusion: Weak evidence exists that debridement methods are superior to other forms of debridement or control in DFU. Implications: Researchers should follow standardized reporting guidelines (Consolidated Standards of Reporting Trials). Clinicians/investigators could use the findings from this SR/MA/MR in guiding patient-individualized decision making and designing future RCTs.

Is Social Media a New Type of Social Support? Social Media Use in Spain during the COVID-19 Pandemic: A Mixed Methods Study.

This study examines Spanish adults' social media use during the COVID-19 pandemic using mixed-methods to assess and understand frequency, context, and changes in social media use during two critical time points in Spain. We conducted semi-structured interviews in April 2020, and two waves of surveys (April 2020, April 2021) among Spanish adults. We coded and analyzed qualitative data related to social media use during the first lockdown period in Spain using Dedoose software; and ran descriptive statistics and chi-square tests to assess changes in social media use over the two survey waves related to perceived social support and loneliness. Participants ranged in age from 18-92 and were representative of the Spanish population's sociodemographics. Interview data show that WhatsApp was most commonly used, and that social media allowed for social support and engaging in healthy behaviors. Survey data show that women and individuals aged 18-34 had the greatest increases in social media use. Statistically significant associations were found between social support and loneliness with social media use. Our results show that promoting social media use as an emotional resource for social support in times of crisis or isolation can minimize loneliness and can be a beneficial tool for general worldwide crises.

Appraisal and Coping Link Sexual Victimization History to Emotional Experience: A Multilevel Daily Diary Study.

Sexual victimization (SV) history is common among college students and has many adverse effects on health, but little is known about whether these effects are explained by everyday stress and coping. Further, most studies conflate between- and within-person effects, limiting our understanding of distinct trait- versus state-level pathways. To address these gaps, we examined the multilevel association of SV history with contemporary positive and negative affect and somatic symptoms via daily control appraisals and coping (problem-focused, meaning-focused, and avoidance) with daily stressors. Online daily diary surveys assessed stress, appraisals, coping, affect, and somatization among 261 undergraduates with and without SV history over 11 consecutive days. Between- and within-person differences in appraisals, coping, affect, and somatic symptoms were examined using multilevel covariance modeling in a causal system, testing daily stressor type as a moderator of within-person effects. Across days, SV history was indirectly linked only to average positive affect via meaning-focused coping, with no other between-person indirect effects. At the within-person level, greater negative affect was experienced in the context of interpersonal stress, driven by greater problem-focused coping, greater positive affect was experienced in the context of academic stress, driven by greater control appraisals, and less positive and negative affect were experienced in the context of intrapersonal stress, driven by lower control appraisals and less problem-focused coping. SV may influence daily stress processes at multiple levels, depending on stressor type. Appraised control and active coping are potentially important but understudied ways in which SV history informs contemporary stress management.

Debridement of Diabetic Foot Ulcers.

Diabetic foot ulcerations have devastating complications, including amputations, poor quality of life, and life-threatening infections. Diabetic wounds can be protracted, take significant time to heal, and can recur after healing. They are costly consuming health care resources. These consequences have serious public health and clinical implications. Debridement is often used as a standard of care. Debridement consists of both nonmechanical (autolytic, enzymatic) and mechanical methods (sharp/surgical, wet to dry debridement, aqueous high-pressure lavage, ultrasound, and biosurgery/maggot debridement therapy). It is used to remove nonviable tissue, to facilitate wound healing, and help prevent these serious outcomes. What are the various forms and rationale behind debridement? This article comprehensively reviews cutting-edge methods and the science behind debridement and diabetic foot ulcers.

Can Assessing Physical Activity Liking Identify Opportunities to Promote Physical Activity Engagement and Healthy Dietary Behaviors?

Improving our understanding of what physical activities are enjoyed and the factors that are associated with physical activity liking can promote participation in regular physical activity. We aimed to study physical activity (PA) liking in college women by modelling interactions between body size perception and dietary behaviors on PA liking, and by examining discrepancies between PA liking versus engagement on body size perception and dietary behaviors. Women (n = 251; 74% white) utilized an online survey to report their level of liking for PA types (scored into a PA liking index) and frequency of PA participation. They also reported their perceived body size, level of dietary restraint, and frequency of consuming foods (scored into a diet quality index). In multivariate analyses, a greater perceived body size was directly associated with lower PA liking and indirectly through greater dietary restraint but lower diet quality. Healthiest dietary behaviors were reported by women who both liked and engaged in PA. Women who reported high PA liking but low PA participation reported a higher dietary restraint and lower diet quality. These findings support the empowerment of women across all body sizes to identify physical activities that they enjoy. Health promotion efforts should encourage women to couple physical activity liking and engagement with a healthy level of dietary restraint and consumption of a healthy diet.

Factors Associated With Noncontact Injury in Collegiate Soccer: A 12-Team Prospective Study of NCAA Division I Men's and Women's Soccer.

BACKGROUND: Multiteam, multi-institution prospective studies of both women's and men's sports are essential for collectively investigating injury and primary to the generalization and individualization of injury prevention strategies. HYPOTHESIS: Characteristics of workload, sleep, and contextual factors will be associated with injury risk in collegiate soccer athletes. STUDY DESIGN: Cohort study; Level of evidence, 2. METHODS: Injuries, workload, and sleep characteristics were recorded daily throughout a complete season for 256 athletes from 12 separate National Collegiate Athletic Association Division I men's and women's soccer teams. Workload and contextual factors were assessed via multilevel Poisson regression to capture differences in injury incidence rate ratio (IRR). Paired t test and multilevel logistic regressions were used to assess the relationship between sleep behavior and injury. RESULTS: Collegiate soccer athletes had lower rates of noncontact injury in the in-season (IRR, 0.42) and postseason (IRR, 0.48) compared with preseason, lower rates of injury in training (IRR, 0.64) compared with matches, and higher injury rates with only 1 day of rest in the previous week (IRR, 1.58) compared with >1 day. Injury rates peaked when training occurred 4 days before a match (IRR, 2.24) compared with a match. Injury rate increased exponentially with increases in the number of noncontact injuries incurred throughout the season (IRR, 2.23). Lower chronic loading, higher training monotony, and acute spikes and lulls in workload were associated with higher noncontact injury rates. Alterations in previous week sleep quality were associated with injury, while chronic sleep behavior and acute alterations (<7 days) in sleep behavior were not (P > .05). CONCLUSION: Athlete and schedule-specific contextual factors, combined with characteristics of workload and weekly sleep behavior, are significantly associated with injury in collegiate soccer. Multiteam prospective cohort studies involving objective and subjective monitoring allow for the identification of multiple injury risk factors in sports, which can be used to guide injury prevention strategies. Maintaining higher chronic workloads, lowering training monotony, minimizing acute spikes or lulls in workloads, managing workloads during preseason and for athletes with previous injury, integrating more rest and recovery during congested periods, and optimizing sleep quality are all practical considerations for reducing injury risk in collegiate soccer.

The interaction of fine motor, gesture, and structural language skills: The case of autism spectrum disorder.

Motor skill differences have been consistently reported in individuals with ASD. Associations between motor skill and social communication skills have been reported in both typical development (TD) and autism spectrum disorder (ASD). The current study extends these findings to characterize performance on a fine motor imitation task, probing skills as a predictor of social and communicative functioning, and co-speech gesture use. These research questions were addressed by a secondary analysis of data collected during a previous study characterizing a cohort of individuals who were diagnosed with ASD in early childhood but lost the autism diagnosis (LAD) by the time of adolescence. Fine motor imitation skills were compared between 14 individuals with LAD, 15 individuals with autism spectrum disorder (ASD), and 12 typically developing (TD) individuals. LAD and TD groups had more advanced fine motor imitation skills than the ASD group, and abilities were significantly associated with ASD symptoms and amount of gesture use (though there was a counterintuitive interaction between group and fine motor skill in the LAD and TD groups only, in which lower motor skills predicted more ASD symptoms; this relationship was of a small effect size and is likely driven by the compressed range of fine motor skills in these two groups). Findings suggest that fine motor skills normalize along with social communication skills and restricted and repetitive behaviors and interests in individuals who lose the ASD diagnosis, and that individuals with better fine motor abilities produce more co-speech gesture.

A Simple Liking Survey Captures Behaviors Associated with Weight Loss in a Worksite Program among Women at Risk of Type 2 Diabetes.

In a secondary analysis, we assessed the ability of dietary and physical activity surveys to explain variability in weight loss within a worksite-adapted Diabetes Prevention Program. The program involved 58 overweight/obese female employees (average age = 46 ± 11 years SD; average body mass index = 34.7 ± 7.0 kg/m2 SD) of four long-term care facilities who survey-reported liking and frequency of dietary and physical activity behaviors. Data were analyzed using a latent variable approach, analysis of covariance, and nested regression analysis to predict percent weight change from baseline to intervention end at week 16 (average loss = 3.0%; range-6% gain to 17% loss), and follow-up at week 28 (average loss = 2.0%; range-8% gain to 16% loss). Using baseline responses, restrained eaters (reporting liking but low intakes of high fat/sweets) achieved greater weight loss at 28 weeks than those reporting high liking/high intake (average loss = 3.5 ± 0.9% versus 1.0 ± 0.8% S.E., respectively). Examining the dietary surveys separately, only improvements in liking for a healthy diet were associated significantly with weight loss (predicting 44% of total variance, p < 0.001). By contrasting liking versus intake changes, women reporting concurrent healthier diet liking and healthier intake lost the most weight (average loss = 5.4 ± 1.1% S.E.); those reporting eating healthier but not healthier diet liking (possible misreporting) gained weight (average gain = 0.3 ± 1.4% S.E.). Change in liking and frequency of physical activity were highly correlated but neither predicted weight loss independently. These pilot data support surveying dietary likes/dislikes as a useful measure to capture dietary behaviors associated with weight loss in worksite-based programs. Comparing dietary likes and intake may identify behaviors consistent (appropriate dietary restraint) or inconsistent (misreporting) with weight loss success.

Patient-provided e-support in reduced intensity obesity treatment: The INSPIRE randomized controlled trial.

OBJECTIVE: There are two types of patient supporters, peers (two individuals initiating health behavior change who support one another) and mentors (a previously successful patient who supports incoming patients). Social comparison theory suggests that peers and mentors may elicit social comparison processes (patients may compare their progress to that of their peer/mentor), and these social comparisons could impact treatment outcomes. This randomized controlled trial is the first to examine the differential impact of peers and mentors on obesity treatment outcomes and social comparison processes when added to reduced intensity treatment. METHOD: Participants (N = 278) were randomly assigned to reduced intensity behavioral weight loss treatment alone (rBWL), rBWL plus peer e-support (rBWL + Peer), or rBWL plus mentor e-support (rBWL + Mentor). rBWL involved periodic group sessions that decreased over time; when group sessions decreased, intensity of peer/mentor e-support increased. Weight and social comparison processes were assessed throughout the 12-month intervention. RESULTS: There was a significant treatment effect; when group sessions became less frequent and peer/mentor e-support became more frequent, rBWL + Peer had significantly greater weight loss than rBWL alone, and rBWL + Mentor was not significantly different from the other two. Social comparison processes differed by treatment arm; rBWL + Peer participants tended to report more lateral social comparisons ("my weight loss progress is 'similar' to my peer's"), whereas rBWL + Mentor participants reported more upward comparisons ("my weight loss progress is 'worse than' my mentor's"). Upward comparisons were associated with poorer weight loss outcomes. CONCLUSIONS: Peer e-support may be an effective, low-cost, sustainable method for improving longer-term weight loss outcomes in reduced intensity obesity treatment. (PsycInfo Database Record (c) 2020 APA, all rights reserved).

Episodic future thinking, delay discounting, and exercise during weight loss maintenance: The PACE trial.

OBJECTIVES: Weight loss maintenance (WLM) is the next major challenge in obesity treatment. While most individuals who lose weight intend to keep their weight off, weight regain is common. Temporal Self-Regulation Theory posits that whether intentions lead to behavior depends on self-regulatory capacity, including delay discounting (DD; the tendency to discount a larger future reward in favor of a smaller immediate reward). Episodic Future Thinking (EFT; mental imagery of a future event for which a health goal is important) may improve DD and promote behavior change. Described herein is a trial protocol designed to examine whether EFT improves DD within the context of weight loss maintenance. METHOD: Participants who lose ≥5% of initial body weight in an online behavioral weight loss intervention will be randomly assigned to a standard weight loss maintenance program (WLM-STD) or a weight loss maintenance program plus EFT (WLM + EFT). Both interventions involve periodic phone and in-person treatment sessions. Participants in WLM + EFT will engage in daily EFT training via smartphone. To control for contact, participants in WLM-STD will engage in daily Healthy Thinking (reviewing strategies for weight management) on their smartphone. Our primary hypothesis is that WLM + EFT will yield better improvements in DD compared to WLM-STD. We will also explore whether DD mediates the relationship between intervention allocation and physical activity (secondary outcome). Weight and contextual variables will be explored. CONCLUSIONS: This study is the first to test whether EFT improves DD within the context of weight loss maintenance; results from this experimental medicine approach could have important implications for understanding the impact of both EFT and DD on sustained behavior change. (PsycInfo Database Record (c) 2020 APA, all rights reserved).

Substance Use, HIV Serostatus Disclosure, and Sexual Risk Behavior in People Living with HIV: An Event-Level Analysis.

People living with HIV (PLWH) face difficult decisions about disclosing their HIV status to new sexual partners. Alcohol and other drug use could impact these decision-making processes and subsequent sexual risk behavior. We sought to examine the event-level relationships between substance use, HIV disclosure, and condom use in PLWH and their first-time HIV-negative or unknown status sexual partners. Adult PLWH were recruited from care settings in a southeastern U.S. city. Participants reported their sexual behavior for 28 consecutive days via text message prompts. We employed multilevel covariation in a causal system to examine the event-level relations between substance use and condom use. We proposed that this relationship would be mediated by HIV disclosure and moderated by viral suppression status. A total of 243 participants (83% male, 93% Black) reported 509 sexual events with first-time HIV-negative/unknown status sexual partners. Substance use at the time of sex was negatively associated with disclosure in PLWH with suppressed viral load (OR 0.29, ß = - 1.22, 95% CI [- 2.42, - 0.03], p = .045), but differentially associated with condom use in PLWH with detectable versus undetectable viral load. In PLWH with viral suppression, participants who always disclosed versus who never disclosed their HIV status were more likely to use condoms (ß = 1.84, 95% CI [0.35, 3.53], p = .017), but inconsistent disclosers were less likely to use a condom after disclosing (OR 0.22, 95% CI [0.07, 0.68], p = .008). Event-level analysis offers a more nuanced understanding of the proximal (substance use, HIV disclosure) and person-level (substance use, viral load) determinants of HIV transmission risk behavior in PLWH.

A randomized controlled trial of a theory-based weight-loss program for couples.

OBJECTIVE: Weight gain occurs during marriage, yet obesity treatment is focused on individuals. Outcomes may be improved by targeting joint weight loss and the interpersonal milieu that fosters spousal interdependence. Self-determination theory (SDT) posits that autonomy-supportive environments (e.g., promote meaningful choice, minimize control) produce better health outcomes. This trial tested an SDT-informed weight-loss intervention intended to facilitate autonomy support in couples. METHOD: Sixty-four couples were randomized to standard behavioral weight loss (BWL) that couples attended together or to a SDT-informed weight-loss intervention (SDT-WL) that aimed to bolster autonomy support (AS). Groups met weekly for 6 months with assessments at 0, 3, 6, and 12 months. RESULTS: Percent weight loss at 6 and 12 months was 10.4% ± 6.5% and 9.2% ± 8.2%. No differences were observed between the BWL and SDT-WL conditions in percent weight loss or changes in AS. Across conditions, higher baseline AS predicted greater weight loss at 6 and 12 months (ps <.001). Increases in AS over time predicted greater weight loss at 6 and 12 months (ps ≤ .02). Post hoc moderation analysis indicated that only participants with low (but not high) baseline AS achieved greater gains in AS at 12 months in SDT-WL than in the BWL conditions (p < .02). CONCLUSIONS: Although no differences were found between conditions on weight loss or changes in autonomy support behavior, autonomy support from one's spouse predicted weight loss in both couples-based weight-loss approaches. For couples with low levels of AS, an SDT-informed approach was effective at increasing this desirable interpersonal behavior. (PsycINFO Database Record (c) 2020 APA, all rights reserved).

Evaluation of an Experiential and Self-Learning Approach to Teaching Evidence-Based Decision Making to Dental Students.

The aim of this study was to evaluate the impact on predoctoral dental students of an experiential and self-learning pedagogical approach to evidence-based decision making. Dental students at one U.S. dental school in 2014 and 2015 participated in an evidence-based decision making course that consisted of minimal lecturing, learning through assigned readings and open-book online quizzes, and individual assignments to reach an evidence-based decision on a clinically relevant question. Before and after the course, each cohort completed a validated survey assessing students' knowledge, attitudes, access of evidence, and confidence related to evidence-based practice. In 2014, of 43 students enrolled in the course, all 43 (100%) completed the pre-course survey, and 33 (77%) completed the post-course survey. In 2015, of 35 students enrolled in the course, all 35 (100%) completed the pre-course survey, and 34 (97%) completed the post-course survey. Of those, the identifier codes for 23 students in 2014 and 25 students in 2015 matched for the pre-course and post-course surveys, allowing direct comparisons. Both cohorts of students showed a significant increase in knowledge regarding critical appraisal of the literature from the pre-course survey results to after the course (p<0.001). Students' reported frequency of accessing evidence from various sources also significantly increased from before to after the course for both cohorts (p<0.01). Students' confidence in evaluating various aspects of a published research report also increased significantly from before to after the course for both cohorts (p<0.001). However, no consistent change was found in students' attitudes about evidence-based practice. In this study, an experiential and self-learning approach to teaching evidence-based decision making in the classroom appeared to be successful in improving students' knowledge, use of evidence, and confidence in critical appraisal skills, though it did not have a consistent impact on their attitudes about evidence-based practice.