Effectiveness of prolonged exposure (PE) after implementation at a crime victim support centre.

Background: Recent practice guidelines strongly recommend evidence-based psychotherapies (EBPs) as the first-line treatment for post-traumatic stress disorder (PTSD). However, previous studies found barriers to the implementation of EBPs and a relatively high dropout rate in clinical settings. After proving the efficacy of prolonged exposure (PE) in Japan [Asukai, N., Saito, A., Tsuruta, N., Kishimoto, J., & Nishikawa, T. (2010). Efficacy of exposure therapy for Japanese patients with posttraumatic stress disorder due to mixed traumatic events: A randomized controlled study. Journal of Traumatic Stress, 23(6), 744-750. https://doi.org/10.1002/jts.20589], we began implementing PE in a real-world clinical setting at the Victim Support Center of Tokyo (VSCT).Objective: We aimed to investigate the effectiveness and benefit of PE for crime-induced PTSD among VSCT clients and what causes dropout from treatment.Method: Of 311 adult clients who received counselling from clinical psychologists at VSCT due to violent or physical crime victimization from April 2008 through December 2019, 100 individuals received PE and participated in this study. Their PTSD symptoms were evaluated before and after treatment using the Impact of Event Scale-Revised and the Clinician-Administered PTSD Scale for DSM-IV.Results: A total of 93 participants completed PE and seven dropped out after six sessions or less. The completers group improved in PTSD symptoms with significant score differences between pre- and post-treatment in IES-R and CAPS-IV. Participants' symptoms did not exacerbate after treatment. Forty of 49 completers who left their workplace or college/school after victimization returned to work or study shortly after treatment. Compared to the completers, all dropout participants were women and younger. The majority were rape survivors, with significantly shorter intervals between victimization and treatment. The reasons for dropout were difficulty scheduling treatment between work/study schedules and manifestation of bipolar disorder or physical illness.Conclusions: PE can be implemented with significant effectiveness and a low dropout rate in a real-world clinical setting if advantages in the system and policies, local organizational context, fidelity support and patient engagement are fortified.

We conducted prolonged exposure (PE) with a low dropout rate for crime-induced PTSD in a non-Western real-world practice setting.Patient outcomes and low dropout rate of PE for PTSD in this study may be due to advantages in the following areas: system and policies, local organizational context, fidelity support and patient engagement.When introducing PE for PTSD, it is important to confirm that patients can be reasonably engaged with PE, and to carefully assess the status of other psychiatric and physical illnesses.

The impact of early mobility on functional recovery after hip fracture surgery.

PURPOSE: To examine the effect of early mobility (EM) on functional recovery after hip fracture surgery, and to investigate the potential factors that delay mobility. METHODS: In this retrospective observational study, 110 hip fracture patients were divided into two groups according to the days between surgery and mobility referred to as the EM and the delayed mobility groups. Demographic data, perioperative data, functional outcomes, and discharge destination were compared statistically between the groups using univariate analysis and logistic regression analysis. As a sensitivity analysis, the factors associated with the timing of physiotherapy were also assessed. RESULTS: The EM group had significantly better walking ability and Barthel index (p < 0.05), and home discharge rate (p = 0.004). The factors associated with delayed mobility (odds ratio; 95% confidence interval) were delayed postoperative physiotherapy initiation (3.59; 1.76-7.33), days from admission to surgery (1.23; 1.04-1.46), and postoperative CRP (1.14; 1.01-1.29) and hemoglobin level (0.72; 0.54-0.96). Furthermore, patients who received surgery on the day before any holiday were significantly delayed in physiotherapy intervention (p = 0.006). CONCLUSIONS: This study demonstrated that EM after hip fracture surgery was associated with improving functional recovery and home discharge rate, and early physiotherapy intervention was associated with EM.

Early mobility on the first day after hip fracture surgery was associated with improving walking ability and independence of daily activities on postoperative days 7 and 14, as well as on the time to discharge to own home.Early mobility was specifically associated with the timing of physiotherapy intervention, the days from admission to surgery and the medical condition including perioperative anemia. In particular, patients who received surgery on the day before any holiday were significantly delayed in physiotherapy intervention.

Effectiveness of trauma-focused cognitive behavioral therapy for Japanese children and adolescents in community settings: a multisite randomized controlled trial.

BACKGROUND: Trauma-focused cognitive behavioural therapy (TF-CBT) is an efficacious treatment model for children and adolescents with trauma-related disorders. However, few studies have been conducted in community settings, and there have been no randomized controlled trials in Asian countries. OBJECTIVE: To evaluate the effectiveness of TF-CBT in regular community settings in Japan through comparison with a waitlist with minimal services control condition. METHOD: Thirty Japanese children and adolescents with posttraumatic stress disorder symptoms (22 females, eight males, mean age = 13.90, range = 6-18) were randomly assigned to 12 sessions of TF-CBT or the waitlist control condition. The primary outcome measure was the Kiddie Schedule for Affective Disorders and Schizophrenia score assessed by blinded evaluators one month later. RESULTS: The mean number of sessions was 12 (range: 11-13) in the TF-CBT group and 4.87 (range: 3-7) in the control group. Intention to treat analysis showed that the TF-CBT group achieved significantly greater symptom reduction than did the control group. The effect size (Cohen's d) between the TF-CBT and control groups was 0.96 (p =.014) for posttraumatic symptoms and 1.15 (p =.004) for depressive symptoms. However, the TF-CBT group did not show better results than the control group with regard to improvements in anxiety symptoms, psychosocial functioning, and behavioural problems. CONCLUSIONS: The findings provided preliminary evidence of the effectiveness of TF-CBT for treating youth with trauma in community mental health facilities. TF-CBT in the Japanese context proved identical to the original, demonstrating that it is also suitable for use with children and adolescents in non-Western settings.

Antecedentes: La Terapia Cognitivo Conductual Centrada en el Trauma (TF-CBT en su sigla en inglés) es un modelo de tratamiento eficaz para niños y adolescentes con trastornos relacionados con el trauma. Sin embargo, hasta la fecha solo se han realizado unos pocos estudios en entornos comunitarios y no se han realizado ensayos controlados aleatorios en países asiáticos.Objetivo: Este estudio buscó evaluar la efectividad de la TF-CBT en entornos comunitarios regulares en Japón, en comparación con el tratamiento habitual (TAU en su sigla en inglés).Métodos: Treinta niños y adolescentes japoneses (22 mujeres, 8 hombres, promedio de edad = 13.90, rango = 6-18) fueron asignados aleatoriamente a 12 sesiones de la TF-CBT o al grupo TAU. La medida de resultado primaria fue el puntaje K-SADS (Calendario Kiddie para Trastornos Afectivos y Esquizofrenia) evaluado por evaluadores cegados un mes después del tratamiento.Resultados: El análisis de 'intención de tratar' mostró que el grupo TF-CBT logró una reducción significativa de síntomas, mayor que el grupo control. El tamaño del efecto (d de Cohen) entre el grupo TF-CBT y el grupo TAU fue de 0.96 (p =.014) para los síntomas postraumáticos y 1.15 (p =.004) para los síntomas depresivos.Conclusión: Los hallazgos revelaron que la TF-CBT es eficaz para tratar a jóvenes traumatizados en centros comunitarios de salud mental y podría implementarse con éxito en Japón.

Confinement Effects on Polymer Dynamics: Thermo-Responsive Behaviours of Hydroxypropyl Cellulose Polymers in Phospholipid-Coated Droplets (Water-in-Oil Emulsion).

In order to construct the artificial cells and to understand the physicochemical properties of living cells, it is important to clarify the cell-sized confinement effect on the behaviours of bio-inspired polymers. We report the dynamic behaviours of aqueous hydroxypropyl cellulose (HPC) solution coated with phospholipids in oil (water-in-oil droplets, W/O droplets), accompanied by an increase in the temperature. We directly observed the beginning of phase separation of HPC solution using a fluorescence microscope and confirmed the dependence of such phenomena on droplet size. The results indicate that the start time of phase separation is decreased with an increase in droplet size. The experimental results suggest that the confinement situation accelerates the phase separation of aqueous HPC solutions.

Feasibility of trauma-focused cognitive behavioral therapy for traumatized children in Japan: a Pilot Study.

BACKGROUND: Trauma-focused cognitive behavioral therapy is used to treat children who have experienced traumatic events and suffer from trauma-related disorders. Its effectiveness has been demonstrated in several randomized controlled studies. However, most of these studies have been performed in the United States, with few studies conducted in Asian countries. Therefore, we aimed to evaluate the feasibility of trauma-focused cognitive behavioral therapy in children who have experienced traumatic events and who suffer from trauma-related disorders in Japan. FINDINGS: Thirty-five traumatized children (mean age = 10.9 years; range = 3-17 years; 74.3% girls) who received trauma-focused cognitive behavioral therapy were included. The effectiveness of the program was evaluated in each case using the University of California at Los Angeles Post-Traumatic Stress Disorder Reaction Index for DSM-IV for trauma-related symptoms and the Children's Global Assessment Scale for social functioning. Pre- and post-treatment outcome measures were analyzed using two-tailed paired t tests. The results for 35 participants indicate that post-traumatic stress symptoms were significantly improved following therapy [t(35) = 8.27; p < 0.01], whereas the assessment of social functioning supported the effectiveness of the program [t(35) = -14.68; p < 0.01]. The pre- to post-treatment effect sizes (Glass's delta) were 1.24 for the University of California at Los Angeles Post-Traumatic Stress Disorder Reaction Index and 1.96 for the Children's Global Assessment Scale. CONCLUSIONS: Our findings indicate that trauma-focused cognitive behavioral therapy is feasible for treating traumatized children of an Asian population. We discuss the implications of this result for clinical practice and future research.

Isobars, the coexistence curve, and the critical exponent ß of N-isopropylacrylamide gels obtained using a simple experimental method.

We have obtained "iso-osmobars," which refer to lines with constant osmotic pressures, and coexistence curve of the volume phase transition of N-isopropylacrylamide gel using a very simple method: hanging gels above NaCl solution having a given concentration in a sealed container that was placed in a temperature controlled bath. Since the chemical potential of the water molecules in the gel is equal to that of the water molecules in the NaCl solution, the osmotic pressure of the gel became the same value with that of the NaCl solution. Thus, air that separated the gel and the NaCl solution played a role of infinitely flexible semipermeable membrane. We have succeeded to obtain the coexistence curve and related critical exponent ß from the series of the iso-osmobars of the gel. The value of ß we obtained was 0.38(1.5).

Volume phase transition of N-isopropylacrylamide gels crosslinked by a crosslinker with six hands.

Crosslinkers play an essential role in determining the physical properties of gels. We synthesized a new type of crosslinker with three vinyl groups [trisacrylaminomethan (TRI), which joins six polymer chains per single molecule]. We found that N-isopropylacrylamide (NIPA) gels crosslinked with the new crosslinker gel at a much lower fraction of crosslinker than the gel crosslinked with popular N,N'-methylenebisacrylamide (BIS). We also found that the NIPA gels with TRI crosslinker displayed larger discrete volume changes at the volume phase transition. We discuss the effects of the average length of NIPA chains between two crosslinkers on the volume phase transition as well as the effects of inhomogeneity in gels caused by a low fraction of crosslinker.

Pilot study on traumatic grief treatment program for Japanese women bereaved by violent death.

This pilot study aimed to refine a treatment approach for traumatic grief due to violent loss. Our Traumatic Grief Treatment Program, a modification of Shear's complicated grief treatment (Shear et al., 2005), comprises psychoeducation, in vivo exposure, imaginal exposure, discussion of memories about and imaginal conversation with the deceased. Thirteen of 15 Japanese women suffering from posttraumatic stress disorder (PTSD) due to traumatic grief completed 12 to 16 weekly individual sessions based on their therapists' recommendations. Assessment scales included the Inventory of Complicated Grief, the Impact of Event Scale-Revised, and the Center for Epidemiologic Studies Depression Scale. There was significant reduction in symptom severity at treatment end, and symptom levels remained low throughout the 12-month follow-up period. Based on Jacobson's Reliable Change Index, 46% showed change on all 3 measures. These findings suggest that our treatment model may be feasible for treating traumatic grief with PTSD in non-Western settings.

Efficacy of exposure therapy for Japanese patients with posttraumatic stress disorder due to mixed traumatic events: A randomized controlled study.

The authors examined the efficacy of Prolonged Exposure (PE) therapy in Japanese patients with posttraumatic stress disorder (PTSD). Twenty-four patients (21 women, 3 men) with PTSD due to mixed trauma were randomly assigned to the PE group (PE with or without treatment as usual [TAU]) or the control group (TAU) only. The control group received PE after a 10-week period. Intention-to-treat analysis showed the PE group achieved significantly greater reduction than the control group at posttreatment in either PTSD or depressive symptoms. The control group had significantly decreased symptom severity after PE treatment. Symptom levels of 19 PE completers in the both groups remained low in 12-month follow-up assessments. The study's findings will promote the future dissemination and implementation of evidence-based treatment for PTSD in non-Western settings.

Pilot study on prolonged exposure of Japanese patients with posttraumatic stress disorder due to mixed traumatic events.

This pilot study investigated the feasibility of Prolonged Exposure (PE) treatment for Japanese patients with posttraumatic stress disorder (PTSD) due to mixed traumatic events. Among 12 participants in this study, 9 women and 1 man completed between 9 and 15 weekly individual PE sessions; 2 female participants dropped out in early sessions. Among completers, the authors identified a significant reduction of symptom severity scores from pretreatment to posttreatment in terms of PTSD and depression on therapist-rated and self-rated measurements. Symptom levels remained low in 3- and 6-month follow-up assessments. Our findings suggest that PE is feasible and can be accepted for PTSD patients not only in Western countries, but also for those in Japan.