Making Come-Alive and Keeping Un-Alive: How People Relate to Self-Guided Web-Based Health Interventions.

Health interventions delivered online (self-guided web-based interventions) may become more helpful through a person-to-program "working alliance." In psychotherapy, the working alliance signifies a therapeutically useful client-therapist relationship and includes an emotional bond. However, there exist no theories of how program users relate to online programs, or that explain a person-to-program bond theoretically. Addressing this gap, we conducted qualitative interviews with and collected program data from users of a self-guided web-based intervention. Taking a grounded theory approach, the analysis arrived at a model of relating based on two relational modes-making come-alive and keeping un-alive. Different combinations of these modes could describe a range of ways of relating to the program, including a nonsocial interaction, a semi-social interaction, and a semi-social relationship. A person-to-program bond is explained by the model as an experienced supportive social presence, enabled by making come-alive and a positive program interaction.

Qualitative Interview Studies of Working Mechanisms in Electronic Health: Tools to Enhance Study Quality.

Future development of electronic health (eHealth) programs (automated Web-based health interventions) will be furthered if program design can be based on the knowledge of eHealth's working mechanisms. A promising and pragmatic method for exploring potential working mechanisms is qualitative interview studies, in which eHealth working mechanisms can be explored through the perspective of the program user. Qualitative interview studies are promising as they are suited for exploring what is yet unknown, building new knowledge, and constructing theory. They are also pragmatic, as the development of eHealth programs often entails user interviews for applied purposes (eg, getting feedback for program improvement or identifying barriers for implementation). By capitalizing on these existing (applied) user interviews to also pursue (basic) research questions of how such programs work, the knowledge base of eHealth's working mechanisms can grow quickly. To be useful, such interview studies need to be of sufficient quality, which entails that the interviews should generate enough data of sufficient quality relevant to the research question (ie, rich data). However, getting rich interview data on eHealth working mechanisms can be surprisingly challenging, as several of the authors have experienced. Moreover, when encountering difficulties as we did, there are few places to turn to, there are currently no guidelines for conducting such interview studies in a way that ensure their quality. In this paper, we build on our experience as well as the qualitative literature to address this need, by describing 5 challenges that may arise in such interviews and presenting methodological tools to counteract each challenge. We hope the ideas we offer will spark methodological reflections and provide some options for researchers interested in using qualitative interview studies to explore eHealth's working mechanisms.

Effects of nicotine administration in rats on MMP2 and VEGF levels in periodontal membrane.

BACKGROUND: Nicotine is associated with increased incidence of periodontal disease and poor response to therapy. This article aimed at identifying the expression of matrix metalloproteinases 2 (MMPs2) and vascular endothelial growth factor (VEGF) proteins on extracellular matrix, fibrous distribution and angiogenetic development in periodontitis caused by nicotine effects on periodontal membrane. MATERIALS AND METHODS: In this experimental study, rats were divided into nicotine and control groups. While the rats in the nicotine group (n = 6) were administered 2 mg/kg nicotine sulphate for 28 days, the animals in the control group (n = 6) were only administered 1.5 mL physiologic saline solution subcutaneously for 28 days. RESULTS: Histological sections were prepared and immunohistochemically stained for MMP2 and VEGF. The sections stained with Trichrome-Masson were observed under light microscope. VEGF and MMP2 immunoreactivity of periodontal gingiva and dentin was assessed by immunohistochemical staining. CONCLUSIONS: Nicotine reduces MMP production, disrupts collagen synthesis and causes periodontitis. We observed that nicotine increases periodontitis by disrupting periodontal membrane and prevents tooth to anchor in dental alveoli by disrupting epithelial structure.

Microleakage of glass ionomer based restorative materials in primary teeth: An In vitro study.

AIM: Using AutoCAD, we examined the microleakage of dye at the edges of primary-teeth restorations using three glass ionomer-based restorative materials. MATERIALS AND METHODS: A total of 30 extracted noncarious primary molars were used. Class V cavities were adjusted on the buccal surfaces. The teeth were randomly divided into three groups of 10 teeth each as follows: Group A (Ketac Molar), Group B (Photac Fil), and Group C (Dyract XP). All specimens were stored for 24 h at 37°C in distilled water. The teeth were thermocycled 1000 times between 5°C ± 2°C and 55°C ± 2°C before immersion in 0.5% basic fuchsin for 24 h. Two mesiodistal cuts of each tooth were photographed under a stereomicroscope equipped with a digital camera. The dye-infiltrated surface area was measured. Statistical evaluations were performed by the Kolmogorov-Smirnov test, Levene test, one-way analysis of variance, and Tukey's honestly significant difference test. RESULTS: The mean microleakage ratio differed significantly among the groups (P < 0.05). Group C exhibited a significantly smaller area (P < 0.001) than the other groups. Group A had a nonsignificantly higher mean microleakage value than Group B (P > 0.05). CONCLUSIONS: Polyacid-modified composite resin may be a useful restorative material in primary teeth in terms of minimizing microleakage.

Key Intervention Characteristics in e-Health: Steps Towards Standardized Communication.

PURPOSE: This paper reports expert opinion on e-health intervention characteristics that enable effective communication of characteristics across the diverse field of e-health interventions. The paper presents a visualization tool to support communication of the defining characteristics. METHODS: An initial list of e-health intervention characteristics was developed through an iterative process of item generation and discussion among the 12 authors. The list was distributed to 123 experts in the field, who were emailed an invitation to assess and rank the items. Participants were asked to evaluate these characteristics in three separate ways. RESULTS: A total of 50 responses were received for a response rate of 40.7%. Six respondents who reported having little or no expertise in e-health research were removed from the dataset. Our results suggest that 10 specific intervention characteristics were consistently supported as of central importance by the panel of 44 e-intervention experts. The weight and perceived relevance of individual items differed between experts; oftentimes, this difference is a result of the individual theoretical perspective and/or behavioral target of interest. CONCLUSIONS: The first iteration of the visualization of salient characteristics represents an ambitious effort to develop a tool that will support communication of the defining characteristics for e-health interventions aimed to assist e-health developers and researchers to communicate the key characteristics of their interventions in a standardized manner that facilitates dialog.

Constructivist Simultaneous Treatment of Borderline Personality Disorder, Trauma, and Addiction Comorbidity: A Qualitative Case Study.

This qualitative case study explored one client's recovery from borderline personality disorder, trauma, and problem gambling. The client attended 18 months of integrative treatment and was followed for 5 years. The study included 106 data points of both client and therapist data. We identified three phases to treatment. First, alliance formation and normalization appeared as mechanisms, and the client experienced dependence. Second, working alliance and countertransference appeared as mechanisms, and the client experienced reduced gambling and suicidal ideation. Third, external controls and increased opportunity appeared as mechanisms, and "moving into the world" was the client experience. The findings give preliminary support to a phase-based constructivist treatment including trauma assessment to normalize self-feelings, countertransference work to support motivation for restraint, and case management principles to support continuity of change efforts.

Leakage testing for different adhesive systems and composites to permanent teeth.

AIM: To explore the microleakage of different adhesive systems and flowable composites to permanent teeth. SUBJECTS AND METHODS: In this study, a total of 84 human premolar teeth were used. Class V cavities were prepared on the buccal surfaces. The teeth were randomly assigned to six groups of 14 teeth each as follows: The first group - etch-rinse adhesive applied and cavities filled with flowable composite, the second group - etch-rinse adhesive applied and cavities filled with bulk-fill resin composite, the third group - one-stage self-etch (SE) adhesive applied and cavities filled with flowable composite, the fourth group - one-stage SE adhesive applied and cavities filled with bulk-fill resin composite, the fifth group - two-stage SE adhesive applied and cavities filled with flowable composite, and the sixth group - two-stage SE adhesive applied and cavities filled with bulk-fill resin composite. All specimens were then stored for 24 h at 37°C in distilled water. Teeth were then thermocycled for 500 cycles between 5°C and 55°C prior to immersion in 0.5% basic fuchsin for 24 h. Two mesiodistal cuts of each tooth were photographed for leakage with a digital camera. The dye infiltrated surface for each specimen was measured and data were collected with a software program. Statistical evaluations were done by nonparametric Kruskal-Wallis test and Mann-Whitney U-test. RESULTS: There were statistically significant differences in mean microleakage ratio among the groups (P < 0.05). The first group had shown significantly increased microleakage areas than the other four groups (third, fourth, fifth, and sixth groups) (P < 0.05), except for the second group (P > 0.05). It was also no significant different between the mean microleakage areas of group fourth and group fifth (P > 0.05). The sixth group had exhibited the lowest microleakage areas, and it was statistically significant (P < 0.05) compared to the other groups. CONCLUSION: In this study, it has been found that the use of total etch adhesive systems resulted in high leakage values.

Neural markers of negative symptom outcomes in distributed working memory brain activity of antipsychotic-naive schizophrenia patients.

Since working memory deficits in schizophrenia have been linked to negative symptoms, we tested whether features of the one could predict the treatment outcome in the other. Specifically, we hypothesized that working memory-related functional connectivity at pre-treatment can predict improvement of negative symptoms in antipsychotic-treated patients. Fourteen antipsychotic-naive patients with first-episode schizophrenia were clinically assessed before and after 7 months of quetiapine monotherapy. At baseline, patients underwent functional magnetic resonance imaging while performing a verbal n-back task. Spatial independent component analysis identified task-modulated brain networks. A linear support vector machine was trained with these components to discriminate six patients who showed improvement in negative symptoms from eight non-improvers. Classification accuracy and significance was estimated by leave-one-out cross-validation and permutation tests, respectively. Two frontoparietal and one default mode network components predicted negative symptom improvement with a classification accuracy of 79% (p = 0.003). Discriminating features were found in the frontoparietal networks but not the default mode network. These preliminary data suggest that functional patterns at baseline can predict negative symptom treatment-response in schizophrenia. This information may be used to stratify patients into subgroups thereby facilitating personalized treatment.

Practical support aids addiction recovery: the positive identity model of change.

BACKGROUND: There is a need for studies that can highlight principles of addiction recovery. Because social relationships are involved in all change processes, understanding how social motivations affect the recovery process is vital to guide support programs. METHODS: The objective was to develop a model of recovery by examining addicted individuals' social motivations through longitudinal assessment of non-professional support dyads. A qualitative, longitudinal study design was used, combining focus groups and in-depth interviews with addicted individuals and their sponsors. Data were analyzed using the principles of grounded theory: open coding and memos for conceptual labelling, axial coding for category building, and selective coding for theory building. The setting was an addiction recovery social support program in Oslo, Norway. The informants included nine adults affected by addiction, six sponsors, and the program coordinator. The participants were addicted to either alcohol (2), benzodiazepines (1), pain killers (1) or polydrug-use (5). The sponsors were unpaid, and had no history of addiction problems. RESULTS: Support perceived to be ineffective emerged in dyads with no operationalized goal, and high emotional availability with low degree of practical support. Support perceived to be effective was signified by the sponsor attending to power imbalance and the addict coming into position to help others and feel useful. CONCLUSIONS: The findings appear best understood as a positive identity-model of recovery, indicated by the pursuit of skill building relevant to a non-drug using identity, and enabled by the on-going availability of instrumental support. This produced situations where role reversals were made possible, leading to increased self-esteem. Social support programs should be based on a positive identity-model of recovery that enable the building of a life-sustainable identity.

Brain connectivity studies in schizophrenia: unravelling the effects of antipsychotics.

Impaired brain connectivity is a hallmark of schizophrenia brain dysfunction. However, the effect of drug treatment and challenges on the dysconnectivity of functional networks in schizophrenia is an understudied area. In this review, we provide an overview of functional magnetic resonance imaging studies examining dysconnectivity in schizophrenia and discuss the few studies which have also attempted to probe connectivity changes with antipsychotic drug treatment. We conclude with a discussion of possible avenues for further investigation.

Processing of Positive Visual Stimuli Before and After Symptoms Provocation in Posttraumatic Stress Disorder - A Functional Magnetic Resonance Imaging Study of Trauma-Affected Male Refugees.

BACKGROUND: Symptoms of anhedonia are often central to posttraumatic stress disorder (PTSD), but it is unclear how anhedonia is affected by processes induced by reliving past traumatic memories. METHODS: Sixty-nine male refugees (PTSD = 38) were interviewed and scanned with functional magnetic resonance imaging while viewing positive, neutral and Scrambled Pictures after being read personalized scripts evoking an emotionally neutral memory and a traumatic memory. We further measured postprovocation state symptoms, physiological measures and PTSD symptoms. We tested whether neural activity associated with positive picture viewing in participants with PTSD was differentially affected by symptom provocation compared to controls. RESULTS: For the pictures > scrambled contrast (Positive contrast), PTSD participants had significantly less activity than controls in fusiform gyrus, right inferior temporal gyrus and left middle occipital gyrus. The Positive contrast activity in fusiform gyrus scaled negatively with anhedonia symptoms in PTSD participants after controlling for total PTSD severity. Relative to the emotionally Neutral Script, the Trauma Script decreased positive picture viewing activity in posterior cingulate cortex, precuneus and left calcarine gyrus, but there was no difference between PTSD participants and controls. CONCLUSIONS: We found reduced responsiveness of higher visual processing of emotionally positive pictures in PTSD. The significant correlation found between positive picture viewing activity and anhedonia suggests the reduced responsiveness to be due to the severity of anhedonia.

Three-year clinical evaluation of endodontically treated anterior teeth restored with a polyethylene fibre-reinforced composite.

BACKGROUND: Polyethylene fibre-reinforced composites (FRCs) have been under development for some time. However, there is a lack of data on the clinical performance of these restorations. The purpose of this descriptive study was to evaluate the clinical performance of endodontically treated anterior teeth restored using polyethylene FRCs. METHODS: Eighty-seven endodontically treated anterior teeth in 65 patients were restored with polyethylene FRCs. The restorations were placed by three operators. The patients were recalled for examinations every year for up to three years. The restorations were evaluated using modified Ryge and USPHS criteria. RESULTS: A statistical analysis showed no significant difference in marginal irregularity, marginal discolouration, surface texture, wear/anatomic form, fracture and retention, radiographic appearance, or debonding between the baseline and three-year results. CONCLUSIONS: Based on our three-year examination results, polyethylene FRC restorations appear to be clinically successful.

Secondary traumatic stress in Norwegian SUD-therapists: Symptoms and related factors.

This study examined the prevalence of secondary traumatic stress (STS) among substance-abuse therapists in relation to burnout, work-related stressors, as well as peer and leader support. METHODS: A quantitative cross-sectional design examining 383 Norwegian substance-abuse therapists. Electronic surveys were distributed to practitioners in Norway via email and social media. RESULTS: A total 22% of the respondents reported experience of secondary trauma, with the most frequently reported symptoms being flashbacks (13%) and intrusive thoughts (13%). More than 72% of therapists had also been exposed to patient direct threats. Female therapists estimated the level of trauma among their patients as higher than did male therapists. Male therapists (32%) were more likely to report secondary trauma than females (19%). CONCLUSIONS: The findings indicate a high prevalence of trauma symptoms in substance-abuse therapists, and suggest increased focus on the role of patient direct threats when treating patients with substance-abuse disorder. The study also highlights the need for research that examines variables that interact with gender in predicting STS in therapists treating substance abuse, as well as trauma.

Exploring online problem gamblers' motivation to change.

BACKGROUND: In order to improve interventions for problem gambling, there is a need for studies that can highlight psychological factors that support the desire to reduce gambling. OBJECTIVE: To explore online problem gamblers' motivation for change by studying participants' reactions to an online treatment referral website designed to motivate at-risk gamblers to seek help. DESIGN: A qualitative evaluation study, combining focus groups and in-depth interviews. Data were analyzed using the general inductive approach. INFORMANTS: The informants included 19 male, treatment- and non-treatment seeking, online gamblers who played a variety of games, including poker, sports betting and online casino. RESULTS: Motivation to change emerged as two processes including (a) empathy with others, which included projection of their thoughts and feelings onto others, and (b) dissonance between gambling behavior and ideal self-image. Dissonance included two subthemes: (i) dissonance due to positive feelings towards sports and athletics, and (ii) dissonance due to gambling among family. CONCLUSIONS: The findings have implications for interventions designed to evoke motivation early in treatment of online problem gambling. Inducing problem gamblers to reflect on the thoughts and feelings of concerned significant others, real or fictional, could be a viable strategy to motivate online problem gamblers to consider change.

Medial prefrontal disengagement during self-focus in formerly depressed patients prone to rumination.

BACKGROUND: Medial prefrontal cortex (MPFC) activity during self-referential processing has been associated with rumination and found aberrant in depression. We investigated whether this aberrant activity reflects a trait marker that persists in remitted patients. METHODS: Twenty-five patients fully remitted from major depression for at least 6 months, and 29 matched healthy controls were scanned with fMRI while presented with personality trait words in two conditions: Self condition asked whether the trait described themselves; General condition asked whether the trait was generally desirable. Contrasts-of-interest were examined in a factorial model and rumination correlates were examined in 2-sample t-tests with Ruminative Response Style score as covariate. All findings were reported at a conservative p < 0.05, with whole-brain peak-level family-wise error correction. RESULTS: Self-referential processing increased anterior cortical midline activity to a similar extent in both groups. Dorsal anterior cingulate cortex (MNI(x,y,z) = -12,20,26) and dorsal MPFC (MNI(x,y,z) = -6,46,40) activity during self-referential processing was positively associated with rumination in healthy control subjects and negatively associated with rumination in remitted patients. LIMITATIONS: A longitudinal design tracking the relationship between rumination and MPFC activity would have aided the interpretation of our findings as to whether high ruminators are exhibiting an adaptive process to maintain remission or whether it represents a maladaptive process considering that high ruminators have an increased vulnerability for relapse. CONCLUSIONS: The association between increased anterior cortical midline activity during self-referential processing and rumination differentiated healthy controls from formerly depressed patients. Self-referential neural processing during remission from depression may depend on the cognitive tendencies to ruminate.

The Danish High Risk and Resilience Study-VIA 11: Study Protocol for the First Follow-Up of the VIA 7 Cohort -522 Children Born to Parents With Schizophrenia Spectrum Disorders or Bipolar Disorder and Controls Being Re-examined for the First Time at Age 11.

Introduction: Offspring of parents with severe mental illness have an increased risk of developing mental illnesses themselves. Familial high risk cohorts give a unique opportunity for studying the development over time, both the illness that the individual is predisposed for and any other diagnoses. These studies can also increase our knowledge of etiology of severe mental illness and provide knowledge about the underlying mechanisms before illness develops. Interventions targeting this group are often proposed due to the potential possibility of prevention, but evidence about timing and content is lacking. Method: A large, representative cohort of 522 7-year old children born to parents with schizophrenia, bipolar disorder or controls was established based on Danish registers. A comprehensive baseline assessment including neurocognition, motor functioning, psychopathology, home environment, sociodemographic data, and genetic information was conducted from January 1, 2013 to January 31, 2016. This study is the first follow-up of the cohort, carried out when the children turn 11 years of age. By assessing the cohort at this age, we will evaluate the children twice before puberty. All instruments have been selected with a longitudinal perspective and most of them are identical to those used at inclusion into the study at age 7. A diagnostic interview, motor tests, and a large cognitive battery are conducted along with home visits and information from teachers. This time we examine the children's brains by magnetic resonance scans and electroencephalograms. Measures of physical activity and sleep are captured by a chip placed on the body, while we obtain biological assays by collecting blood samples from the children. Discussion: Findings from the VIA 7 study revealed large variations across domains between children born to parents with schizophrenia, bipolar and controls, respectively. This study will further determine whether the children at familial risk reveal delayed developmental courses, but catch up at age 11, or whether the discrepancies between the groups have grown even larger. We will compare subgroups within each of the familial high risk groups in order to investigate aspects of resilience. Data on brain structure and physical parameters will add a neurobiological dimension to the study.

Chronic pain in a couples context: a review and integration of theoretical models and empirical evidence.

UNLABELLED: Researchers have become increasingly interested in the social context of chronic pain conditions. The purpose of this article is to provide an integrated review of the evidence linking marital functioning with chronic pain outcomes including pain severity, physical disability, pain behaviors, and psychological distress. We first present an overview of existing models that identify an association between marital functioning and pain variables. We then review the empirical evidence for a relationship between pain variables and several marital functioning variables including marital satisfaction, spousal support, spouse responses to pain, and marital interaction. On the basis of the evidence, we present a working model of marital and pain variables, identify gaps in the literature, and offer recommendations for research and clinical work. PERSPECTIVE: The authors provide a comprehensive review of the relationships between marital functioning and chronic pain variables to advance future research and help treatment providers understand marital processes in chronic pain.

Multilevel analysis of couple congruence on pain, interference, and disability.

Couple congruence on ratings of pain severity and disability were examined using hierarchical linear modeling. Older community Individuals with Chronic Pain (ICPs) and their spouses completed the Multidimensional Pain Inventory (pain severity, interference, negative spouse responses to pain), Sickness Impact Profile (physical disability, psychosocial disability), and the Mood and Anxiety Symptom Questionnaire (psychological distress). Both spouses reported on ICPs' pain and disability as well as their own psychological distress. Spousal incongruence was observed on interference and physical disability such that ICPs reported greater disability than their spouses reported for them. No significant incongruence was observed in pain severity or psychosocial disability. Predictors of couples' mean ratings of pain and disability were identified. Specifically, couples in which the ICP was female reported higher couples' ratings of pain severity and interference. ICP distress was related to higher couples' ratings of all pain and disability variables whereas spouse distress was related to higher psychosocial disability ratings. ICPs' perceptions of negative spouse responses were also positively associated with couples' ratings of physical and psychosocial disability. In terms of congruence, ICP distress was associated with incongruence on interference, physical disability, and psychosocial disability whereas spouse distress predicted incongruence on pain severity, and interference. This study suggests that understanding couples' pain outcome ratings involves an awareness of factors that might influence their perceptions and behaviors.

Spousal congruence on disability, pain, and spouse responses to pain.

We examined congruence between chronic pain patients and their spouses on their reports of patient pain severity, patient disability, and spouse responses to pain. Patients reported that they were more physically and psychosocially disabled than their spouses reported them to be. However, spouses reported that the patients' pain was more severe than patients reported. Depressive disorders in the patient and gender interacted with patient-spouse ratings. For physical and psychosocial disability, depressed patient couples reported significantly larger differences in disability ratings than non-depressed patient couples. In addition, female patients' disability was rated as more severe by the female patients than by their husbands. Male patient couples did not report differences on physical disability. Findings relating to other forms of disability and to spouse responses are also described. The results are discussed in the context of an interpersonal perspective of chronic pain and have implications for the assessment of pain and disability.