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Background: Although Cognitive Behavioural Therapy (CBT) is effective for 60% of adolescents with anxiety disorders, only 36% are in remission post‐intervention. This indicates that more effective treatments are needed which should be reflected in the NICE guidelines. We hypothesised that Single‐case experimental designs (SCEDs) may provide a framework for accelerating the development of novel interventions. The primary purpose of this review was to investigate whether SCEDs are currently followed by randomised controlled trials (RCTs) of CBT intervention for adolescent anxiety disorders named in the NICE guidelines. The secondary objective was to investigate whether using SCEDs prior to RCTs could be a helpful approach. Method: For the primary search of SCEDs five databases were used (PsycINFO, PubMed, PsycArticles, Web of Science and ProQuest). Nineteen articles met eligibility criteria including a total of 107 participants. For the secondary search of RCTs named in the NICE guidelines for adolescent anxiety disorders 53 articles met inclusion criteria and were included in the systematic review. Results: The 19 SCED studies included in the review were conducted with participants with a diverse range of anxiety disorders and across a range of CBT formats. Two of the SCEDs were followed by RCTs, but neither of these were named in the NICE guidelines for anxiety disorders. All of the SCEDs identified were rated as low quality with none meeting the criteria for the highest or second highest quality rating. From the secondary searches, none of the RCTs named in the NICE guide were preceded by SCEDs. Conclusions: It was concluded that currently SCEDs were not followed by RCTs of CBT interventions named in the NICE guidelines for adolescent anxiety disorders. However, it was suggested that SCEDs may provide an important framework for the development of more effective interventions for adolescents with anxiety. [ABSTRACT FROM AUTHOR]

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Pain is a universal experience, but it has been challenging to adequately define. The revised definition of pain recently published by the International Association for the Study of Pain addressed important shortcomings of the previous version; however, it remains narrow in its focus on sensory and emotional features of pain, failing to capture the substantial roles of cognitive and social core components of the experience and their importance to advances in pain management. This paper reviews evidence and theoretical models for the significant role social and cognitive factors play in pain experience and we argue that without explicit recognition of these core components in the definition, significant nuances are lost at a cost to understanding and clinical management of pain. A focus on sensory and emotional features perpetuates biomedical interventions and research, whereas recognition of cognitive and social features supports a multidimensional model of pain, advances in interdisciplinary care, and the benefits of cognitive behavioral therapy and self‐management interventions. We also explore the six Key Notes that accompany the new definition of pain, discuss their application to the understanding of pain in childhood, and, in doing so, further explore social and cognitive implications. Considerations are also described for assessment and treatment of pain in pediatric populations. [ABSTRACT FROM AUTHOR]

Objective: This paper reviews the literature pertaining to the structure and content of intensive lifestyle interventions (ILIs) for overweight/obesity since Richard Stuart described this new treatment approach in 1967. A consensus opinion has formed that behavioral/lifestyle treatment of overweight and obesity should be viewed as a mainstream intervention for the treatment and prevention of type 2 diabetes and medical complications associated with obesity.Methods: The development of modern ILIs and demonstration of their efficacy are compared by structure, content, and efficacy of four major randomized controlled trials: Diabetes Prevention Program (DPP), Look AHEAD, POUNDS Lost, and CALERIE.Results: The results of these studies indicated that modification of lifestyle behaviors related to nutrition and physical activity can yield weight loss and prevention or improvement of a variety of medical conditions associated with obesity in a variety of subpopulations.Conclusions: Recommendations for the structure and length of behavioral/lifestyle interventions have been recently adopted by agencies and institutions that approve reimbursement for medical services. These recommendations represent a giant step in the effort to recognize ILIs as a mainstream approach for the treatment of obesity and comorbid medical conditions. Nevertheless, they do not adequately represent advances made since the publication of the DPP results. [ABSTRACT FROM AUTHOR]

Introduction: High levels of HIV stigma as well as stigma directed towards sexual and/or gender minorities (SGMs) are well documented in the African setting. These intersecting stigmas impede psychosocial wellbeing and HIV prevention and care. Yet, there are few if any evidence‐based interventions that focus on reducing internalized stigma and promoting mental health and HIV wellness for SGMs in Africa. We developed and evaluated a group‐based intervention drawing on cognitive behavioural therapy (CBT) strategies for men who have sex with men (MSM) and transgender women (TGW) at risk for or living with HIV in Lagos, Nigeria. Methods: The intervention comprised four weekly in‐person group sessions facilitated by community health workers. We conducted a delayed intervention group randomized controlled trial (April−September 2022), with pre‐post surveys plus 3‐month follow‐up (immediate group only), as well as qualitative research with participants and programme staff. Outcomes included internalized stigma related to SGM and HIV status, depression, resiliency/coping and pre‐exposure prophylaxis (PrEP)/HIV treatment use. Results: Mean age of the 240 participants was 26 years (range 18−42). Seventy‐seven percent self‐identified as MSM and 23% TGW; 27% were people with HIV. Most (88%) participants attended all four sessions, and 98% expressed high intervention satisfaction. There was significant pre‐post improvement in each psychosocial outcome, in both the immediate and delayed arms. There were further positive changes for the immediate intervention group by 3‐month follow‐up (e.g. in intersectional internalized stigma, depression). While baseline levels of ever‐PrEP use were the same, 75% of immediate‐group participants reported currently using PrEP at 3 months post‐intervention versus 53% of delayed‐group participants right after the intervention (p<0.01). Participants post‐intervention described (in qualitative interviews) less self‐blame, and enhanced social support and resilience when facing stigma, as well as motivation to use PrEP, and indicated that positive pre‐intervention changes in psychosocial factors found in the delayed group mainly reflected perceived support from the study interviewers. Conclusions: This study demonstrated the feasibility and acceptability of a group‐based CBT model for MSM and TGW in Nigeria. There were also some indications of positive shifts related to stigma, mental health and PrEP, despite issues with maintaining the randomized design in this challenging environment. [ABSTRACT FROM AUTHOR]

This is the protocol for an updated Campbell systematic review. The objectives are as follows: To evaluate the effect of behavioral interventions on smoking cessation among homeless individuals. [ABSTRACT FROM AUTHOR]

This paper applies an implementation framework, based on a behavior change model, to compare four case studies of complementary feeding programs. It aims to expand our understanding of how to design and implement behavior change interventions aimed at improving complementary feeding practices. Four programs met the selection criteria of scale and documented improvements: Bangladesh, Malawi, Peru, and Zambia. We examined commonalities and differences in the design and implementation of social and behavior change approaches, use of program delivery platforms, challenges encountered, and lessons learned. We conclude that complementary feeding practices, in particular dietary diversity, can be improved rapidly in a variety of settings using available program platforms if interventions focus on specific constraints to food access and use effective strategies to encourage caregivers to prepare and feed appropriate foods. A five-step process is presented that can be applied across a range of complementary feeding programs to strengthen their impacts., (© 2017 John Wiley & Sons Ltd.)

Introduction: The paediatric radiation therapy group (PRTG) provided a multidisciplinary network to support patients accessing radiation therapy (RT). This study aims to evaluate the use and efficacy of behaviour therapy practices used by the PRTG. Methods: A retrospective cross‐sectional review of general anaesthetic (GA) utilisation for paediatric patients was completed between 1 January 2010 and 30 June 2014. The PRTG incorporated behavioural therapy techniques into all appointments but offered additional play appointments to children unable to comply with the requirements of RT. This aimed to increase their compliance and minimise GA use. Results: Two‐hundred and seventy‐four patients had 5402 occasions of service, of which 1361 were delivered under GA (25.2%). Two‐hundred and fifty‐seven patients met the eligibility criteria. Patients under 8 years who required GA for their entire treatment reduced for each year of increase in age (odds ratio 0.37, 95% confidence interval 0.27–0.51, P < 0.001). Participants 3 years and younger were shown not as likely to change their GA requirements with the use of play appointments. Seventy‐eight per cent (83/106) of 3–8‐year‐olds used no GA or ceased GA during treatment. Conclusions: Most paediatric patients <3 years will gain minimal benefit to reduce GA use from additional play appointments. Children older than nine were not likely to require play appointments to be compliant with RT. Encouragingly, 53.3% of 3–8‐year‐olds who were categorised as full GA after CT planning did not continue to a full course of GA due to the behavioural therapy interventions of the PRTG. [ABSTRACT FROM AUTHOR]

This is the protocol for an evidence and gap map. The objectives are as follows: To map available randomized control trials, economic evaluations, and systematic reviews that assess the effectiveness and cost‐effectiveness of non‐pharmacological interventions for older people with a diagnosis of depression and identify any existing gaps in the evidence that can inform future research. [ABSTRACT FROM AUTHOR]

Background: People who use drugs (PWUD) frequently delay or avoid obtaining medical care in traditional healthcare settings. Through a randomized controlled trial, we investigated facilitated telemedicine for hepatitis C virus (HCV) integrated into opioid treatment programmes. We sought to understand the experiences and meanings of facilitated telemedicine and an HCV cure among PWUD. Methods: We utilized purposive sampling to interview 25 participants, 6–40 months after achieving an HCV cure. We interpreted and explicated common meanings of participants' experiences of an HCV cure obtained through facilitated telemedicine. Results: Participants embraced facilitated telemedicine integrated into opioid treatment programmes as patient‐centred care delivered in 'safe spaces' (Theme 1). Participants elucidated their experiences of substance use and HCV while committing to treatment for both entities. Facilitated telemedicine integrated into opioid treatment programmes enabled participants to avoid stigma encountered in conventional healthcare settings (Theme 2). Participants conveyed facing negative perceptions of HCV and substance use disorder. Improved self‐awareness, acquired through HCV and substance use treatment, enabled participants to develop strategies to address shame and stigma (Theme 3). An HCV cure, considered by PWUD as a victory over a lethal infectious disease, promotes self‐confidence, enabling participants to improve their health and lives (Theme 4). Conclusions: Integrating facilitated telemedicine into opioid treatment programmes addresses several healthcare barriers for PWUD. Similarly, obtaining an HCV cure increases their self‐confidence, permissive to positive lifestyle changes and mitigating the negative consequences of substance use. Patient and Public Contribution: In this study of patient involvement, we interviewed patient‐participants to understand the meaning of an HCV cure through facilitated telemedicine. Participants from a facilitated telemedicine pilot study provided essential input on the design and outcomes of a randomized controlled trial. Pilot study participants endorsed facilitated telemedicine in a testimonial video. They attended site initiation meetings to guide trial implementation. A Patient Advisory Committee (PAC) ensured that patient participants were active members of the research team. The PAC represented patients' voices through feedback on study procedures. A Sustainability Committee supported public involvement in the research process, including educational opportunities, feedback on implementation, and future sustainability considerations. [ABSTRACT FROM AUTHOR]

The risk factors for childhood overweight and obesity are known and can be identified antenatally or during infancy, however, the majority of effective interventions are designed for older children. This review identified interventions designed to reduce the risk of overweight/obesity that were delivered antenatally or during the first 2 years of life, with outcomes reported from birth to 7 years of age. Six electronic databases were searched for papers reporting randomised controlled trials of interventions published from January 1990 to September 2013. A total of 35 eligible studies were identified, describing 27 unique trials of which 24 were behavioural and three were non‐behavioural. The 24 behavioural trials were categorised by type of intervention: (1) nutritional and/or responsive feeding interventions targeted at parents of infants, which improved feeding practices and had some impact on child weight (n = 12); (2) breastfeeding promotion and lactation support for mothers, which had a positive effect on breastfeeding but not child weight (n = 5); (3) parenting and family lifestyle (n = 4); and (4) maternal health (n = 3) interventions that had some impact on feeding practices but not child weight. The non‐behavioural trials comprised interventions manipulating formula milk composition (n = 3). Of these, lower/hydrolysed protein formula milk had a positive effect on weight outcomes. Interventions that aim to improve diet and parental responsiveness to infant cues showed most promise in terms of self‐reported behavioural change. Despite the known risk factors, there were very few intervention studies for pregnant women that continue during infancy which should be a priority for future research. [ABSTRACT FROM AUTHOR]

We aimed to review and synthesise the evidence of the interventions of patients' and informal caregivers' engagement in managing chronic wounds at home. The research team used a systematic review methodology based on an updated guideline for reporting systematic reviews (PRISMA) and recommendations from the Synthesis Without Meta‐analysis. Cochrane Central Register of Controlled Trial of the Cochrane Library, Pubmed, Embase, CINAHL, Wanfang (Chinese), and CNKI database (Chinese) were searched from inception to May 2022. The following MESH terms were used: wound healing, pressure ulcer, leg ulcer, diabetic foot, skin ulcer, surgical wound, educational, patient education, counselling, self‐care, self‐management, social support, and family caregiver. Experimental studies involving participants with chronic wounds (not at risk of wounds) and their informal caregivers were screened. Data were extracted and the narrative was synthesised from the findings of included studies. By screening the above databases, 790 studies were retrieved, and 16 met the inclusion and exclusion criteria. Studies were 6 RCTs and ten non‐RCTs. Outcomes of chronic wound management included patient indicators, wound indicators, and family/caregiver indicators. Home‐based interventions of patients or informal caregivers' engagement in managing chronic wounds at home may effectively improve patient outcomes and change wound care behaviour. What's more, educational/behavioural interventions were the primary type of intervention. Multiform integration of education and skills training on wound care and aetiology‐based treatment was delivered to patients and caregivers. Besides, there are no studies entirely targeting elderly patients. Home‐based chronic wound care training was important to patients with chronic wounds and their family caregivers, which may advance wound management outcomes. However, the findings of this systematic review were based on relatively small studies. We need more exploration of self and family‐oriented interventions in the future, especially for older people affected by chronic wounds. [ABSTRACT FROM AUTHOR]

Objective: Behavioral obesity treatment implemented in primary care is efficacious but typically involves face-to-face or phone contact. This study evaluated enrollment, engagement, and 12-week weight loss in a fully automated online behavioral weight-loss intervention implemented pragmatically in a primary care network.Methods: As part of routine primary care, providers and nurse care managers offered a no-cost online obesity treatment program to 1,721 patients. Of these, 721 consented and were eligible (aged 18-75 years with BMI ≥ 25 kg/m2 and internet access), and 464 started the program. The program included 12 weekly online lessons, a self-monitoring platform, and automated feedback.Results: More than one-quarter of patients who were offered the program (26%) initiated treatment. In intent-to-treat analyses using all data available, mean 12-week weight change was -5.10% (SE = 0.21). Patients who submitted their weights on all 12 weeks (37% of 464) lost an estimated 7.2% body weight versus 3.4% in those submitting less frequently.Conclusions: This fully automated online program, implemented into the routine workflow of a primary care setting without any human counseling or researcher involvement, produced clinically meaningful short-term weight loss. Greater program engagement was associated with greater weight loss; efforts are needed to understand barriers to engagement. [ABSTRACT FROM AUTHOR]

Context: Kidney transplant is superior to dialysis for the treatment of end‐stage kidney disease, but accessing transplant requires high patient engagement to overcome barriers. We sought to develop an educational counselling intervention for patients along with their social support networks to help patients access the waiting list. Methods: Utilizing an Intervention Mapping approach, we established a conceptual framework to develop a behavioural intervention that can be reproduced across kidney transplant centres. The approach includes needs assessment, identifying behavioural determinants and process objectives and integrating targeted behavioural change theory. Results: The Intervention Mapping process resulted in the development of a group counselling session, titled Journey to Transplant (JtT). This intervention was designed for kidney transplant candidates along with members of their social support networks and guided by a transplant healthcare professional. The session begins with standardized educational information to improve knowledge and normalize emotional barriers to transplant. This education is followed by a tailored counselling intervention, including the presentation of the individual patient's calculated likely outcomes on the kidney transplant waiting list. Finally, JtT incorporates patient and support network goal setting to address the specific barriers for that patient in accessing kidney transplantation. Conclusion: A systematic Intervention Mapping approach to develop the JtT intervention helps ensure the intervention is efficacious, acceptable and feasible for transplant centres to implement. JtT engages the patient's social support network, targeting known barriers to transplant and utilizing established behaviour change theory to motivate concrete actions to improve the likelihood of kidney transplantation. Patient or Public Contribution: This study includes a patient and family advisory committee comprised of kidney transplant candidates and their family members to guide the final language and content of the intervention guide, and the conduct of the implementation and pilot testing of the intervention. However, patients and family members were not involved in the intervention mapping development process itself described in this manuscript, which was informed by focus group data from patient and family study participants. [ABSTRACT FROM AUTHOR]

With the rise of the mobile Internet, APP treatment models for autism have also emerged. In China, there are not many applications of health education for children with autism. Its functions are mainly focused on prevention and improvement of knowledge. Many behavioral therapies include applying pressure to the invisible external pressure of autism to achieve appropriate stimulation and correction. This has brought great injustice to the wishes of the children. When children with autism strongly oppose this unfair behavior, it may lead to other extreme behaviors in children with autism. This article adopts the method of letting children with autism actually apply this APP for comprehensive intervention treatment, and let this APP combine with their daily courses: comprehensive sports training, speech training, cognitive training, game training, self‐care training. For courses such as art training and computer games, the children were evaluated for the first time before training, and then evaluated every 2 months. Data were collected to compare whether the children's background factors had a significant impact on the rehabilitation effect of comprehensive interventions. The results of the experiment proved that in the five assessments of perception, gross motor, fine motor, language and communication, cognition, the children had statistically significant differences in the three scores (P < 0.05). This also shows from the side that our APP has a certain effect on children with autism, and is of great strategic significance for adjuvant treatment of autism. [ABSTRACT FROM AUTHOR]

Objective: The aim of the present study was to evaluate the effect of a brief version of the behavioral intervention Acceptance and Commitment Therapy (ACT) on reducing gingivitis and plaque levels after 18 weeks. Materials and methods: One hundred thirty‐five caries‐active young adults (18–25 years of age), recruited from two public dental clinics, participated in this parallel group randomized control trial (RCT). Participants in the intervention (n = 67) received two ACT sessions in combination with standard information on oral health, and participants allocated to the control group (n = 68) received standard information only. Gingivitis and plaque levels were recorded at baseline and at the 9‐ and 18‐week follow‐ups. The effect of the intervention versus standard information alone was analyzed by intention‐to‐treat and per protocol, applying the General Linear Model (GLM). Exploratory analyses for the intervention and control groups were conducted to evaluate the effect of gender and smoking habits on the gingivitis and plaque outcome. The CONSORT guidelines for RCT were followed. Results: A significant decrease in gingivitis and plaque levels was observed over time, irrespective of treatment allocation. However, the ACT intervention was not significantly more effective at reducing gingivitis and plaque scores than standard information alone, even though the intervention participants had maintained their improvement to a greater extent. The exploratory analysis revealed that females improved their gingivitis and plaque levels significantly more than the males in the intervention group (p = 0.025 for gingivitis and p = 0.013 for plaque). Conclusion: A brief ACT intervention was not proven to be more effective than standard information alone at improving oral health in a sample of young adults with poor oral health. However, ACT seems to have a positive effect on oral health among females. (TRN ISRCTN15009620). [ABSTRACT FROM AUTHOR]

Objective: This study aimed to test the efficacy of self-monitoring and feedback (SM+FB) versus SM without FB (SM) in a behavioral weight-loss intervention at 6 months.Methods: This was a randomized clinical trial. Eligibility criteria included the following: ≥18 years of age, BMI ≥ 27 and ≤43, smartphone user, and ability to engage in moderate physical activity. All participants received a 90-minute 1:1 counseling session, a Fitbit Charge 2, and a digital scale for SM. SM+FB participants were provided access to a customized smartphone application that provided three daily FB messages. The primary outcome was percentage of weight change from 0 to 6 months.Results: The sample (N = 502) was 45 (SD 14.4) years old, BMI was 33.7 (SD 4.00) kg/m2 , 79.5% of participants were female (n = 399), and 84.3% were White (n = 423). At 6 months, there was 85.86% retention and a significant percentage of weight change in both groups (SM+FB: -3.16%, 95% CI: -3.85% to -2.47%, p < 0.0001; SM: -3.20%, 95% CI: -3.86% to -2.54%, p < 0.0001) but no significant between-group mean difference (-0.04%, 95% CI: -0.99% to 0.91%, p = 0.940). A ≥5% weight loss was achieved by 31.9% of the SM+FB group and 28.3% of the SM group.Conclusions: There was no significant between-group difference in weight loss at 6 months. [ABSTRACT FROM AUTHOR]

Aim: To explore the best non‐pharmaceutical interventions for improving the behavioural and psychological symptoms in elders with dementia. Design: Bayesian network meta‐analysis. Methods: A comprehensive electronic literature search was performed in five English databases and four Chinese databases to identify relevant randomized controlled trials (RCTs) that were published up to 31 October 2019. Results: A total of 41 RCTs were included in this network meta‐analysis involving 5 different non‐pharmacological interventions: therapeutic recreation (TC), reminiscence therapy (RT), behaviour therapy (BT), massage therapy (MT) and individualized nursing (IN).The results of network meta‐analysis showed that individualized nursing was the best in improving depression, cognitive function, and activities of daily living of behavioural and psychological symptoms of dementia. Behaviour therapy was the best in improving anxiety symptoms. Reminiscence therapy was the best in improving neuropsychiatric symptoms. [ABSTRACT FROM AUTHOR]

Introduction: Major depressive disorder, highly prevalent among people with HIV (PWH) globally, including South Africa, is associated with suboptimal adherence to antiretroviral therapy. Globally, there are insufficient numbers of mental health providers and tested depression treatments. This study's aim was to test task‐shared cognitive‐behavioural therapy for adherence and depression (CBT‐AD) in HIV, delivered by clinic nurses in South Africa. Methods: This was a two‐arm randomized controlled effectiveness trial (recruitment: 14 July 2016 to 4 June 2019, last follow 9 June 2020). One‐hundred‐sixty‐one participants with clinical depression and virally uncontrolled HIV were recruited from primary care clinics providing HIV care, in Khayelitsha, South Africa. Arm 1 was task‐shared, nurse‐delivered CBT‐AD; and arm 2 was enhanced treatment as usual (ETAU). Primary outcomes (baseline to 4 months) were blinded Hamilton Depression Rating Scale (HAM‐D) scores, and weekly adherence via real‐time monitoring (Wisepill). Secondary outcomes were adherence and depression over 4‐, 8‐ and 12‐month follow‐ups, proportion of participants with undetectable viremia and continuous CD4 cell counts at 12 months. Additional analyses involved viral load and CD4 over time. Results: At 4 months, the HAMD scores in the CBT‐AD condition improved by an estimated 4.88 points more (CI: –7.86, –1.87, p = 0.0016), and for weekly adherence, 1.61 percentage points more per week (CI: 0.64, 2.58, p = 0.001) than ETAU. Over follow‐ups, CBT‐AD had an estimated 5.63 lower HAMD scores (CI: –7.90, –3.36, p < 0.001) and 23.56 percentage points higher adherence (CI: 10.51, 34.21, p < 0.001) than ETAU. At 12 months, adjusted models indicated that the odds of having an undetectable viremia was 2.51 greater at 12 months (CI: 1.01, 6.66, p = 0.047), and 3.54 greater over all of the follow‐ups (aOR = 3.54, CI: 1.59, 20.50; p = 0.038) for those assigned CBT‐AD. CD4 was not significantly different between groups at 12 months or over time. Conclusions: Task‐shared, nurse‐delivered, CBT‐AD is effective in improving clinical depression, ART adherence and viral load for virally unsuppressed PWH. The strategy of reducing depression to allow patients with self‐care components of medical illness to benefit from adherence interventions is one to extend. Implementation science trials and analyses of cost‐effectiveness are needed to translate findings into clinical practice. Trial Registration: ClinicalTrials.gov Identifier: NCT02696824 https://clinicaltrials.gov/ct2/show/NCT02696824 [ABSTRACT FROM AUTHOR]

The complex and dynamic interplay between an individual's psychophysiological processes and multilevel interactions with his/her group and environment during alcohol drinking events is analysed in this work. Our aim is to provide a system dynamics model to accurately represent a drinking event and provide guidelines for feedback‐based behavioural interventions. We employ a pharmacodynamics model of alcohol metabolism, with a self‐regulation approach of decision‐making to characterize the individual's drinking behaviour. The nonlinearities introduced by the acute effects of alcohol in cognition, along with social perception and influence, complete the individual's model, which serves as a basis for the group and environment's behaviour models. A sensitivity analysis revealed that influenceability and overestimation via descriptive social norms are key drivers of higher blood alcohol content levels. Furthermore, simulations showed that intervening early in the event, before cognition processes are inhibited, and targeting groups of individuals result in efficient implementations. [ABSTRACT FROM AUTHOR]

This report provides information for future clinicians who may be involved in treating patients with mitochondrial disorders manifesting with psychiatric problems, as literature in treatment is limited. The interventions focus on both carefully crafted medication therapy and nondrug methods to manage the challenging behaviors in a medically infirmed person. [ABSTRACT FROM AUTHOR]

A cluster randomized trial design was used to test the efficacy of a behaviour change communication intervention on the quality of the home environment and infant development at 15 months of age. Children (n = 600) in rural South India were followed from 3 through 15 months of age. The control group (C group) received the standard of care, the complementary feeding group (CF group) received recommendations on complementary foods and the responsive complementary feeding and play group (RCF&P group) received recommendations on complementary foods plus skills on responsive feeding and play. The intervention was delivered in biweekly home visits to caregivers using flip charts. At postintervention, infants (n = 521) were assessed for development (Bayley‐II scales) and their home environment was assessed (Home Observation for Measurement of the Environment [HOME] scale). Cluster adjusted analysis of variance showed no significant differences at baseline. The HOME score at 15 months differed by group, F(2, 38) = 6.41, P = 0.004; the CF and RCF&P groups had higher scores than the C group. Scores on subscales 'Opportunities for Variety in Daily Stimulation' and 'Caregiver Promotion of Child Development' (CPCD) were higher for the RCF&P group than for the C and CF groups. Mental development index (MDI) scores differed by group, F(2, 37) = 3.31, P = 0.04, with the RCF&P group showing higher scores than the C group (P < 0.04); no differences were noted in psychomotor development index (PDI) scores (P = 0.48). The subscales of HOME associated with MDI at 15 months were 'CPCD' and 'Cleanliness of Child' (R2 = 0.076). 'CPCD' was also associated with PDI (R2 = 0.039). A responsive complementary feeding and play intervention delivered through home visits benefitted children's mental development and caregiving environment at 15 months. [ABSTRACT FROM AUTHOR]

Objective: Intensive behavioral obesity treatments face scalability challenges, but evidence is lacking about which treatment components could be cut back without reducing weight loss. The Optimization of Remotely Delivered Intensive Lifestyle Treatment for Obesity (Opt-IN) study applied the Multiphase Optimization Strategy to develop an entirely remotely delivered, technology-supported weight-loss package to maximize the amount of weight loss attainable for ≤$500.Methods: Six-month weight loss was examined among adults (N = 562) with BMI ≥ 25 who were randomly assigned to conditions in a factorial experiment crossing five dichotomous treatment components set to either low/high (12 vs. 24 coaching calls) or off/on (primary care provider reports, text messaging, meal replacements, and buddy training).Results: About 84.3% of participants completed the final assessment. The treatment package yielding maximum weight loss for ≤$500 included 12 coaching calls, buddy training, and primary care provider progress reports; produced average weight loss of 6.1 kg, with 57.1% losing ≥5% and 51.8% losing ≥7%; and cost $427 per person. The most expensive candidate-treatment component (24 vs. 12 coaching calls) was screened out of the optimized treatment package because it did not increase weight loss.Conclusions: Systematically testing each treatment component's effect on weight loss made it possible to eliminate more expensive but less impactful components, yielding an optimized, resource-efficient obesity treatment for evaluation in a randomized controlled trial. [ABSTRACT FROM AUTHOR]

Background: Patients with chronic noncancer pain (CNCP) present unique challenges to emergency department (ED) care providers and administrators. Their conditions lead to frequent ED visits for pain relief and symptom management and are often poorly addressed with costly, low‐yield care. A systematic review has not been performed to inform the management of frequent ED utilizing patients with CNCP. Therefore, we synthesized the available evidence on interventional strategies to improve care‐associated outcomes for this patient group. Methods: We searched Medline, EMBASE, CINAHL, CENTRAL, SCOPUS, and Web of Science from database inception to June 2018 for eligible interventional studies aimed at reducing frequent ED utilization among adult patients with CNCP. Articles were assessed in duplicate in accordance with methodologic recommendations from the Cochrane Handbook for Systematic Reviews of Interventions. Outcomes of interest were the frequency of subsequent ED visits, type and amount of opioids administered in the ED and prescribed at discharge, and costs. Methodologic quality was assessed using the Cochrane Risk of Bias in Non‐Randomized Studies of Interventions and Risk of Bias tools for nonrandomized and randomized studies, respectively. Results: Thirteen studies including 1,679 patients met the inclusion criteria. Identified interventions implemented pain policies (n = 4), individualized care plans (n = 5), ED care coordination (n = 2), chronic pain management pathways (n = 1), and behavioral health interventions (n = 1). All of the studies reported a decrease in ED visit frequency following their respective interventions. These reductions were especially pronounced in studies whose interventions were focused around individualized care plans and primary care involvement. Interventions implementing opioid restriction and pain management policies were largely successful in reducing the amounts of opioid medications administered and prescribed in the ED. Conclusions: Multifaceted interventions, especially those employing individualized care plans, can successfully reduce subsequent ED visits, ED opioid administration and prescription, and care‐associated costs for frequent ED utilizing patients with CNCP. [ABSTRACT FROM AUTHOR]

Objective: The obesity epidemic is a public health concern, warranting further research into pharmacological treatments for weight management (WM) as an adjunct to lifestyle interventions. The Semaglutide Treatment Effect in People with obesity (STEP) program aims to investigate the effect of semaglutide versus placebo on weight loss, safety, and tolerability in adults with obesity or overweight.Methods: Across five phase 3 trials (NCT03548935, WM; NCT03552757, WM in type 2 diabetes; NCT03611582, WM with intensive behavioral therapy; NCT03548987, sustained WM; and NCT03693430, long-term WM), ~5,000 participants are being randomly assigned to receive semaglutide 2.4 mg once weekly subcutaneously versus placebo. Results will be available in 2020/2021. For all trials, the primary end point is change from baseline to end of treatment in body weight.Results: Participants have a mean age of 46.2 to 55.3 years, are mostly female (mean: 74.1%-81.0%), and have a mean BMI of 35.7 to 38.5 kg/m2 and a mean waist circumference of 113.0 to 115.7 cm.Conclusions: The STEP program evaluates the efficacy and safety of semaglutide 2.4 mg subcutaneously once weekly in a broad population. The trials will provide insights on WM in people with obesity with and without type 2 diabetes and on long-term follow-up. [ABSTRACT FROM AUTHOR]

Background: Ejaculatory dysfunction (EjD) is a complex pathological condition compared to erectile dysfunction (ED). A definitive classification of EjD is not established, and treatment is often delayed. Owing to its association with infertility, EjD is a serious concern, particularly in men of reproductive age. Methods: The authors performed a literature search to identify the latest articles and overseas guidelines for review. Results: Our new classification categorizes men into two groups as follows: (1) men with inability to ejaculate (retrograde ejaculation, anejaculation, intravaginal ejaculatory dysfunction) and (2) men requiring an abnormal time for ejaculation (premature ejaculation, delayed ejaculation). In Japan, the number of men presenting with an inability to ejaculate is greater than those presenting with premature ejaculation. Pharmacotherapy is the first‐line treatment for the management of these EjD patients. Behavioral therapy is added to pharmacotherapy depending on the case. Penile vibratory stimulation or electroejaculation is indicated in some men with retrograde ejaculation and anejaculation. In cases who hope for a baby, assisted reproductive technology should be simultaneously considered not to waste time. Conclusion: It is important to distinguish between EjD and ED and accurately diagnose the type of EjD for optimal treatment of this condition. [ABSTRACT FROM AUTHOR]

Objective: The goal of the present study was to deconstruct the 17 treatment arms used in the Early Adult Reduction of weight through LifestYle (EARLY) weight management trials.Methods: Intervention materials were coded to reflect behavioral domains and behavior change techniques (BCTs) within those domains planned for each treatment arm. The analytical hierarchy process was employed to determine an emphasis profile of domains in each intervention.Results: The intervention arms used BCTs from all of the 16 domains, with an average of 29.3 BCTs per intervention arm. All 12 of the interventions included BCTs from the six domains of Goals and Planning, Feedback and Monitoring, Social Support, Shaping Knowledge, Natural Consequences, and Comparison of Outcomes; 11 of the 12 interventions shared 15 BCTs in common across those six domains.Conclusions: Weight management interventions are complex. The shared set of BCTs used in the EARLY trials may represent a core intervention that could be studied to determine the required emphases of BCTs and whether additional BCTs add to or detract from efficacy. Deconstructing interventions will aid in reproducibility and understanding of active ingredients. [ABSTRACT FROM AUTHOR]

Objective: The Action for Health in Diabetes (Look AHEAD) research study was a randomized trial comparing the effects of an intensive lifestyle intervention (ILI) versus a diabetes support and education (DSE) control group in adults with type 2 diabetes and overweight or obesity. Functional magnetic resonance imaging was used to determine whether neural food cue reactivity differed for these groups 10 years after randomization.Methods: A total of 232 participants (ILI, n = 125, 72% female; DSE, n = 107, 64% female) were recruited at three of the Look AHEAD sites for functional magnetic resonance imaging. Neural response to high-calorie foods compared with nonfoods was assessed in DSE versus ILI. Exploratory correlations were conducted within ILI to identify regions in which activity was associated with degree of weight loss.Results: Voxel-wise whole-brain comparisons revealed greater reward-processing activity in left caudate for DSE compared with ILI and greater activity in attention- and visual-processing regions for ILI than DSE (P < 0.05, family-wise error corrected). Exploratory analyses revealed that greater weight loss among ILI participants from baseline was associated with brain activation indicative of increased cognitive control and attention and visual processing in response to high-calorie food cues (P < 0.001, uncorrected).Conclusions: These findings suggest there may be legacy effects of participation in a behavioral weight loss intervention, with reduced reward-related activity and enhanced attention or visual processing in response to high-calorie foods. [ABSTRACT FROM AUTHOR]

Objective: The Centers for Medicare and Medicaid Services (CMS) covers intensive behavioral therapy (IBT) for obesity. The efficacy, however, of the specific approach has never been evaluated in a randomized trial, as described here. The 1-year trial also assessed whether the addition to IBT of liraglutide 3.0 mg would significantly increase weight loss and whether the provision of meal replacements would add further benefit.Methods: A total of 150 adults with obesity were randomly assigned to: IBT (IBT-alone), providing 21 counseling visits; IBT combined with liraglutide (IBT-liraglutide); or IBT-liraglutide combined for 12 weeks with a 1,000- to 1,200-kcal/d meal-replacement diet (Multicomponent). All participants received weekly IBT visits in month 1, every-other-week visits in months 2 to 6, and monthly sessions thereafter.Results: Ninety-one percent of participants completed 1 year, at which time mean (± SEM) losses for IBT-alone, IBT-liraglutide, and Muticomponent participants were 6.1 ± 1.3%, 11.5 ± 1.3%, and 11.8 ± 1.3% of baseline weight, respectively. Fully 44.0%, 70.0%, and 74.0% of these participants lost ≥ 5% of weight, respectively. The liraglutide-treated groups were superior to IBT-alone on both outcomes. Weight loss in all three groups was associated with clinically meaningful improvements in cardiometabolic risk factors.Conclusions: The findings demonstrate the efficacy of IBT for obesity and the potential benefit of adding pharmacotherapy to this approach. [ABSTRACT FROM AUTHOR]

Objective: This study aims to describe geographic variation in veterans' prevalence of obesity, participation in Veterans Health Administration's behavioral weight management program (MOVE!), and receipt of bariatric surgery in fiscal year (FY) 2016.Methods: In this retrospective cohort study of veterans with obesity who received Veterans Health Administration care in FY2016, electronic health record data were obtained on weight, height, outpatient visits to the MOVE! program, and bariatric surgeries. For each Veterans Integrated Service Network (VISN) region, the prevalence rate of veterans with obesity (BMI ≥ 30 kg/m2 ), MOVE! participation rates, and bariatric surgery rates are presented.Results: The prevalence of obesity in veterans ranged from 30.5% to 40.5% across VISNs in FY2016. MOVE! participation among veterans with obesity was low (2.8%-6.9%) across all VISNs, but veterans with class II and III obesity (BMI ≥ 35) had higher MOVE! participation rates (4.3%-10.8%) than veterans with class I obesity. There was 20-fold variation across VISNs in receipt of bariatric surgery among veterans with BMI ≥ 35, ranging from 0.01% to 0.2%. Among veterans with BMI ≥ 35 participating in MOVE!, there was 46-fold variation in bariatric surgery provision, ranging from 0.07% to 3.27%.Conclusions: Despite veterans' high prevalence of obesity, behavioral and surgical weight management participation is low and varies across regions. [ABSTRACT FROM AUTHOR]

Objective: This study aimed to assess whether alcohol consumption decreases during an intensive lifestyle intervention (ILI) and whether alcohol consumption is associated with weight loss among participants with overweight or obesity and type 2 diabetes.Methods: Participants (n = 4,901) were from the Action for Health in Diabetes (Look AHEAD) study, a randomized controlled trial that compared an ILI with a diabetes support and education (DSE) control. Mixed-effects models were used to estimate the effect of the ILI on alcohol consumption and the influence of alcohol consumption on weight loss at year 4.Results: ILI and DSE participants did not differ in changes in alcohol consumption. Alcohol intake was not associated with weight loss at year 1 of the ILI. ILI participants who abstained from alcohol lost 5.1% ± 0.3% of initial weight at year 4 compared with a significantly (P = 0.04) smaller 2.4% ± 1.3% for consistent heavy drinkers. ILI participants who abstained from alcohol consumption over the 4 years lost 1.6% ± 0.5% more weight relative to individuals who drank alcohol at any time during the intervention (P = 0.003). DSE participants did not differ in weight loss by alcohol consumption.Conclusions: Heavy alcohol drinkers are at risk for suboptimal long-term weight loss. Decreasing alcohol consumption may improve weight management among individuals with diabetes. [ABSTRACT FROM AUTHOR]

Objective: The purpose of this study, "Fit Blue," was to compare a translation of the Look AHEAD (Action for Heath in Diabetes) intensive lifestyle intervention with a self-paced version of the same intervention among active duty military personnel.Methods: Active duty military personnel (N = 248; 49% male, 34% racial minority) with overweight or obesity were randomized to 12-month distance-based (i.e., phone and email) parallel programs, counselor-initiated (CI) condition or self-paced (SP) condition, from 2014 to 2016. Trained lay interventionists were retired military personnel or had extensive familiarity with the military.Results: The CI condition had greater weight loss at 4 months (CI: mean ± SD = -3.2 ± 3.4 kg; SP: -0.6 ± 2.9 kg; P < 0.0001) and at 12 months (CI: mean ± SD = -1.9 ± 4.1 kg; SP: -0.1 ± 3.8 kg; P < 0.001). Participants in the CI condition also had a greater percent weight loss at both 4 months (CI: 3.5% ± 3.8, SP: 0.6% ± 3.1; P < 0.0001) and 12 months (CI: 2.1% ± 4.7, SP: 0.0% ± 4.0; P < 0.001). In addition, a greater proportion of CI participants lost 5% or more at 4 months (CI: 29.8%, SP: 10.5%; P < 0.001) and at 12 months (CI: 29.5%, SP: 15.6%; P < 0.05).Conclusions: The CI behavioral weight loss intervention translated from Look AHEAD was well received and is a promising approach for managing weight in an active duty military population. [ABSTRACT FROM AUTHOR]

Abstract: Refusing consent to organ donation remains unacceptably high, and improving consent rates from family or next‐of‐kin is an important step to procuring more organs for solid organ transplantation in countries where this approval is sought. We have thus far failed to translate fully our limited understanding of why families refuse permission into successful strategies targeting consent in the setting of deceased organ donation, primarily because our interventions fail to target underlying cognitive obstacles. Novel interventions to overcome these hurdles, incorporating an understanding of cognitive psychology and behavioral change therapy, may be beneficial. One potential intervention is to use the concept of nudge theory, where decision‐making is influenced by encouraging positive reinforcement and indirect suggestion. Purposefully nudging families to given consent for organ donation by understanding, and then overcoming, their inherent cognitive biases is novel but also controversial. This article explores the roles of relatives in decisions about organ donation, how nudge theory translates to organ donation and discusses the arguments for and against its application. [ABSTRACT FROM AUTHOR]

Objective: To test the feasibility of a comprehensive behavioral intervention (CBI) program that combines intense exercises with an education program, to be implemented at a later stage (3 months) following total knee replacement (TKR), and to get a first impression of the effects of the CBI as compared to a standard of care exercise (SCE) program on the outcomes of physical function and physical activity.Methods: A total of 44 subjects participated in a 3-month program of either CBI or SCE, followed by 3 months of a home exercise program. Outcomes of physical function and physical activity were measured at baseline and at 6-month followup. Analysis of variance was used to compare statistical differences between groups, whereas responder analyses were used for clinically important differences.Results: The CBI was found to be safe and well tolerated. As compared to the SCE group, the CBI group had less pain (P = 0.035) and better physical function based on the Short Form 36 health survey (P = 0.017) and the single-leg stance test (P = 0.037). The other outcome measures did not demonstrate statistically significant differences between the 2 groups. Results from the responder analysis demonstrated that the CBI group had a 36% higher rate of responders in physical function as compared to the SCE group. Also, the CBI group had 23% more responders in the combined domains of physical function and physical activity.Conclusion: The CBI program is feasible and improves physical function and physical activity in patients several months after TKR. Larger pragmatic randomized trials are needed to confirm the results of this study. [ABSTRACT FROM AUTHOR]

Background: Obesity is highly prevalent in African American women, especially those in the rural southern USA, resulting in persistent health disparities.Objective: To test the effectiveness of an evidence-based behavioural weight loss intervention delivered by community health advisors to African American women in the rural south.Design and Methods: Overweight or obese African American women (30-70 years) from eight counties in Mississippi and Alabama participated in a 24-month randomized controlled trial of an evidence-based behavioural weight loss programme augmented with community strategies to support healthy lifestyles (Weight Loss Plus, N = 154) compared to the weight loss programme alone (Weight Loss Only, N = 255). This study reports on 6-month outcomes on primary (weight change) and secondary (waist circumference, blood pressure, lipids, fasting blood glucose) outcomes, coinciding with the completion of the intensive weight loss phase.Results: Weight Loss Only participants lost an average of 2.2 kg (P < 0.001). Weight Loss Plus participants lost an average of 3.2 kg (P < 0.001). The proportion of the total sample that lost at least 5% of their body weight was 27.1% with no difference between treatment groups. Similarly, we observed statistically significant reductions in blood pressure, waist circumference and triglycerides in each treatment group, with no statistical differences between groups.Conclusion: Trained lay health staff and volunteers from the rural southern USA were able to deliver a translation of a high-intensity behavioural intervention targeted to African American women, resulting in clinically meaningful weight loss and improvement in other metabolic outcomes in a significant proportion of participants. [ABSTRACT FROM AUTHOR]

Aim: Primary complex motor stereotypies (CMS) are persistent, patterned, repetitive, rhythmic movements in young people with typical development. This study evaluated the efficacy of an instructional DVD as a home-based, parent-administered, behavioral therapy for primary CMS.Method: Eighty-one children with primary CMS were enrolled. Primary outcome measures included the Stereotypy Severity Scale (SSS) - Motor and Impairment scores, and Stereotypy Linear Analog Scale (SLAS). Mean CMS onset was 13.4 months (SD 13.1). Eligibility required observed CMS. Psychiatric disorders were not exclusionary and a stable medication regimen was required. Intellectual disability, neurological disorder, autism spectrum disorder, and tics were exclusionary. Initial assessments were completed via REDCap before receipt of the DVD. Fifty-four of the 81 children (34 male, 20 female; mean age 8y 2mo, SD 1.42, range 7-14y) completed assessments at 1, 2, or 3 months after receiving the DVD.Results: Reductions (baseline to last assessment) in SSS Motor, SSS Impairment, and SLAS scores (all p<0.001) represented change ratios of -15%, -24%, and a -20% respectively. Greatest relative treatment benefit was observed by younger children (ages 7-8y), and by 1 month after receipt of DVD, while a parent global assessment scale showed progressive improvement throughout the study.Interpretation: An instructional DVD for parent-delivered behavioral therapy was a safe, effective intervention for primary CMS. [ABSTRACT FROM AUTHOR]

Objective: To examine neural mechanisms of action in behavioral weight loss treatment (BWL) and explore neural and genetic predictors of BWL.Methods: Neural activation to milkshake receipt and genetics were compared in 17 women with obesity who received 12 weeks of BWL and 17 women who received no intervention. Participants were scanned twice using functional magnetic resonance imaging at baseline and 12 weeks. Weight was assessed at baseline, 12, 36, and 60 weeks.Results: BWL participants lost more weight than controls at 12 weeks (-4.82% versus -0.70%). After 12 weeks, BWL had greater reduction in right caudate activation response to milk shake receipt than did controls. Among BWL participants, baseline to 12-week reduction in frontostriatal activation to milk shake predicted greater weight loss at 12, 36, and 60 weeks. Possessing the A/A or T/A genotype of the fat mass and obesity-associated (FTO) variant rs9939609 predicted greater weight loss at 12 and 36 weeks.Conclusions: These preliminary data reveal that reduction in right caudate activation may be a neural mechanism of weight loss in BWL, and baseline FTO variant and reduction in frontostriatal activation during BWL predict short- and long-term weight loss. These findings require replication in larger samples. [ABSTRACT FROM AUTHOR]

Objective: To review the metabolomic studies carried out so far to identify metabolic markers associated with surgical and dietary treatments for weight loss in subjects with obesity.Methods: The Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines were followed.Results: Thirty-two studies successfully met the eligibility criteria. The metabolic adaptations shared by surgical and dietary interventions mirrored a state of starvation ketoacidosis (increase of circulating ketone bodies), an increase of acylcarnitines and fatty acid β-oxidation, a decrease of specific amino acids including branched-chain amino acids (BCAA) and (lyso)glycerophospholipids previously associated with obesity, and adipose tissue expansion. The metabolic footprint of bariatric procedures was specifically characterized by an increase of bile acid circulating pools and a decrease of ceramide levels, a greater perioperative decline in BCAA, and the rise of circulating serine and glycine, mirroring glycemic control and inflammation improvement. In one study, 3-hydroxybutyrate was particularly identified as an early metabolic marker of long-term prognosis after surgery and proposed to increase current prognostic modalities and contribute to personalized treatment.Conclusions: Metabolomics helped in deciphering the metabolic response to weight loss treatments. Moving from association to causation is the next challenge to move to a further level of clinical application. [ABSTRACT FROM AUTHOR]

Objective: To evaluate the efficacy, as well as potential moderators and mediators, of a revised acceptance-based behavioral treatment (ABT) for obesity, relative to standard behavioral treatment (SBT).Methods: Participants with overweight and obesity (n = 190) were randomized to 25 sessions of ABT or SBT over 1 year. Primary outcome (weight), mediator, and moderator measurements were taken at baseline, 6 months, and/or 12 months, and weight was also measured every session.Results: Participants assigned to ABT attained a significantly greater 12-month weight loss (13.3% ± 0.83%) than did those assigned to SBT (9.8% ± 0.87%; P = 0.005). A condition by quadratic time effect on session-by-session weights (P = 0.01) indicated that SBT had a shallower trajectory of weight loss followed by an upward deflection. ABT participants were also more likely to maintain a 10% weight loss at 12 months (64.0% vs. 48.9%; P = 0.04). No evidence of moderation was found. Results supported the mediating role of autonomous motivation and psychological acceptance of food-related urges.Conclusions: Behavioral weight loss outcomes can be improved by integrating self-regulation skills that are reflected in acceptance-based treatment, i.e., tolerating discomfort and reduction in pleasure, enacting commitment to valued behavior, and being mindfully aware during moments of decision-making. [ABSTRACT FROM AUTHOR]

Objective: The SELF Trial examined the effect of adding individual self-efficacy (SE) enhancement sessions to standard behavioral weight loss treatment (SBT).Methods: Participants were randomly assigned to SBT or SBT plus SE sessions (SBT+SE). Outcome measures were weight loss maintenance, quality of life, intervention adherence, and self-efficacy at 12 and 18 months.Results: The sample (N = 130) was female (83.08%) with a mean (SD) body mass index of 33.15 (4.11) kg m(2) . There was a significant time effect for percent weight change (P = 0.002) yet no significant group or group-by-time effects. The weight loss for the SBT+SE group was 8.38% (7.48) at 12 months and 8.00% (7.87) at 18 months, with no significant difference between the two time points (P = 0.06). However, weight loss for the SBT group was 6.95% (6.67) at 12 months and 5.96% (7.35) at 18 months, which was significantly different between the two time points (P = 0.005), indicating that the SBT group had significant weight regain.Conclusions: Both groups achieved clinically significant weight loss. The group receiving an intervention targeting enhanced self-efficacy had greater weight loss maintenance whereas the SBT group demonstrated significant weight regain possibly related to the greater attention provided to the SBT+SE group. [ABSTRACT FROM AUTHOR]

Objective: Adiposity may be associated with poorer cognitive function in children. The purpose of the study was to examine the effects of an obesity intervention on cognitive function in children.Methods: One hundred and fifteen children were randomly allocated to either the Day Camp Intervention Arm (DCIA) or the Standard Intervention Arm (SIA). Children in the DCIA participated in a 6-week day camp intervention and a subsequent 46-week family-based intervention. The camp intervention mainly consisted of physical exercise and health classes. The SIA was offered one weekly physical exercise session for 6 weeks and one educational meeting. Anthropometrics and cognitive function were measured at baseline, 6 weeks, and 52 weeks.Results: At 6 weeks, the improvement in visuospatial construction skills was larger in the DCIA than the SIA (standardized mean difference, 0.47, 95% CI, 0.08 to 0.86, P = 0.02). At 52 weeks, the improvements in emotional control (standardized mean difference, -0.42, 95% CI, -0.68 to -0.16, P = 0.002) and monitoring (standardized mean difference, -0.32, 95% CI, -0.63 to -0.02, P = 0.04) were larger in the DCIA than the SIA. No group differences were observed in changes in other cognitive outcomes.Conclusions: The obesity intervention may benefit emotional control, monitoring, and visuospatial construction skills in children. [ABSTRACT FROM AUTHOR]

Aim Although the efficacy of cognitive behavioral therapy for insomnia has been confirmed, dissemination depends on the balance of benefits and costs. This study aimed to examine the cost-effectiveness of cognitive behavioral therapy for insomnia consisting of four weekly individual sessions. Methods We conducted a 4-week randomized controlled trial with a 4-week follow up in outpatient clinics in Japan. Thirty-seven patients diagnosed as having major depressive disorder according to DSM-IV and suffering from chronic insomnia were randomized to receive either treatment as usual ( TAU) alone or TAU plus cognitive behavioral therapy for insomnia. Effectiveness was evaluated as quality-adjusted life years ( QALY) over 8 weeks' time, estimated by bootstrapping of the observed total scores of the Hamilton Depression Rating Scale. Direct medical costs for cognitive behavioral therapy for insomnia and TAU were also evaluated. We calculated the incremental cost-effectiveness ratio. Results Over the 8 weeks of the study, the group receiving cognitive behavioral therapy for insomnia plus TAU had significantly higher QALY ( P = 0.002) than the TAU-alone group with an incremental value of 0.019 ( SD 0.006), and had non-significantly higher costs with an incremental value of 254 ( SD 203) USD in direct costs. The incremental cost-effectiveness ratio was 13 678 USD (95% confidence interval: −5691 to 71 316). Adding cognitive behavioral therapy for insomnia demonstrated an approximately 95% chance of gaining one more QALY if a decision-maker was willing to pay 60 000 USD, and approximately 90% for 40 000 USD. Conclusion Adding cognitive behavioral therapy for insomnia is highly likely to be cost-effective for patients with residual insomnia and concomitant depression. [ABSTRACT FROM AUTHOR]

This commentary is on the original article by Mahone et al. on pages 1001–1008 of this issue. [ABSTRACT FROM AUTHOR]