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PURPOSE Consent processes are critical for clinical care and research and may benefit from incorporating digital strategies. We compared an electronic informed consent (eIC) option to paper consent across four outcomes: (1) technology burden, (2) protocol comprehension, (3) participant agency (ability to self-advocate), and (4) completion of required document fields. METHODS We assessed participant experience with eIC processes compared with traditional paper-based consenting using surveys and compared completeness of required fields, over 3 years (2019-2021). Participants who consented to a clinical trial at a large academic cancer center via paper or eIC were invited to either pre-COVID-19 pandemic survey 1 (technology burden) or intrapandemic survey 2 (comprehension and agency). Consent document completeness was assessed via electronic health records. RESULTS On survey 1, 83% of participants (n = 777) indicated eIC was easy or very easy to use; discomfort with technology overall was not correlated with discomfort using eIC. For survey 2, eIC (n = 262) and paper consenters (n = 193) had similar comprehension scores. All participants responded favorably to at least five of six agency statements; however, eIC generated a higher proportion of positive free-text comments (P < .05), with themes such as thoroughness of the discussion and consenter professionalism. eIC use yielded no completeness errors across 235 consents versus 6.4% for paper (P < .001). CONCLUSION Our findings suggest that eIC when compared with paper (1) did not increase technology burden, (2) supported comparable comprehension, (3) upheld key elements of participant agency, and (4) increased completion of mandatory consent fields. The results support a broader call for organizations to offer eIC for clinical research discussions to enhance the overall participant experience and increase the completeness of the consent process. [ABSTRACT FROM AUTHOR]

Background: Mild cognitive impairment (MCI) is commonly defined as a transitional subclinical state between normal aging and dementia. A growing body of research indicates that health behaviors may play a protective role against cognitive decline and could potentially slow down the progression from MCI to dementia. The aim of this study is to conduct a bibliometric analysis of literature focusing on health behaviors and MCI to summarize the factors and evidence regarding the influence of health behaviors on MCI. Methods: The study performed a bibliometric analysis by retrieving publications from the Science Citation Index and Social Sciences Citation Index subdatabases within the Web of Science Core Collection. Utilizing VOSviewer and CiteSpace software, a total of 2,843 eligible articles underwent co-citation, cokeywords, and clustering analyses. This methodology aimed to investigate the current status, trends, major research questions, and potential future directions within the research domain. Results: The bibliometric analysis indicates that research on healthy behaviors in individuals with MCI originated in 2002 and experienced rapid growth in 2014, reflecting the increasing global interest in this area. The United States emerged as the primary contributor, accounting for more than one-third of the total scientific output with 982 articles. Journals that published the most articles on MCI-related health behaviors included "Journal of Alzheimer's Disease," "Neurobiology of Aging," "Frontiers in Aging Neuroscience," and other geriatricsrelated journals. High-impact papers identified by VOSviewer predominantly cover concepts related to MCI, such as diagnostic criteria, assessment, and multifactorial interventions. Co-occurrence keyword analysis highlights five research hotspots in health behavior associated with MCI: exercise, diet, risk factors and preventive measures for dementia, cognitive decline-related biomarkers, and clinical trials. Conclusion: This study provides a comprehensive review of literature on health behavior in individuals with MCI, emphasizing influential documents and journals. It outlines research trends and key focal points, offering valuable insights for researchers to comprehend significant contributions and steer future studies. [ABSTRACT FROM AUTHOR]

This paper focuses on the development and feasibility of a digitally-based educational intervention, titled Recognize & Resist (R&R), for writers of One Direction (1D) fanfiction on Wattpad.com. The goal of R&R is to reduce the prevalence of social norms that are supportive of sexual violence within 1D fanfiction. 1D fanfictions, or fictional romance stories written by fans of this British boy band, have hundreds of millions of views on Wattpad.com. Formative research has found that social norms supportive of sexual violence are prevalent in 1D fanfictions and that some authors have internalized these norms. R&R aims to motivate 1D fanfiction writers to highlight sexual consent and egalitarian gender roles in their writing. To evaluate the intervention’s feasibility, 15 1D fanfiction authors completed a survey and participated in an interview or focus group. Results demonstrate R&R’s feasibility, with high ratings of its acceptability and demand. Insights from the interviews and focus groups provide suggestions for revising R&R before rigorously evaluating its efficacy. Additionally, results demonstrate the utility of using popular culture as a vehicle for attitude-change regarding sensitive health issues. [ABSTRACT FROM AUTHOR]

PURPOSE There are numerous barriers to cancer clinical trial participation in the United States. This paper describes the approach and outcomes of The Leukemia & Lymphoma Society's Clinical Trial Support Center (CTSC), whose nurse navigators assist patients with a blood cancer and their oncologists by identifying all appropriate trials based on clinical data and patient preference, facilitating informed and shared decision making, and minimizing enrollment barriers. METHODS Data on patients served from October 2017 to October 2019 were analyzed using bivariate and multivariate analyses to determine demographic and clinical characteristics associated with enrollment. Reasons for nonenrollment were examined. RESULTS The CTSC opened 906 patient cases during this time frame. Among all US patients with a closed case (n 5 750), the clinical trial enrollment rate was 16.1%. Among those with a known enrollment outcome after a trial search (n5 537), the enrollment rate was 22.5%. Multivariate analysis controlling for variables significant in bivariate analyses (insurance, treatment status, Eastern Cooperative Oncology Group performance status, and urban or rural residence) revealed that patients with Medicaid were less likely to enroll than those with private or commercial insurance (adjusted odds ratio, 0.054; CI, 0.003 to 0.899), and patients in treatment ormaintenance were less likely to enroll than those relapsed or refractory tomost recent therapy (adjusted odds ratio, 0.312; CI, 0.139 to 0.702). Primary reasons for nonenrollment were preference for standard of care (66.3%) and patient passed away (16.1%). CONCLUSION The CTSC is an effective, replicable model for addressing multilevel barriers to clinical trial participation. The findings highlight the need to increase opportunities for trial participation sooner after diagnosis and among patients with Medicaid. [ABSTRACT FROM AUTHOR]

Simple Summary: The manuscript discusses the administration of proton therapy to the first 13 pediatric patients in the prospective SJWT21 clinical trial to assess the efficacy of proton therapy in treating children with stage III-V Wilms' tumor. The group of 13 patients received abdominal irradiation after undergoing a nephrectomy or partial nephrectomy. A key aspect of the study highlighted in the manuscript is the rigorous daily monitoring of changes in bowel gas and analyzing how these changes affect the quality of the treatment plan. Additionally, the manuscript investigates the potential inaccuracies in the proton range caused by varying gantry beam angles. It aims to pinpoint the most advantageous gantry angles that would reduce deviations from the intended treatment plan, thereby improving the safety and effectiveness of proton therapy for these young patients. (1) Background: Proton therapy, a precise form of radiation treatment, can be significantly affected by variations in bowel content. The purpose was to identify the most beneficial gantry angles that minimize deviations from the treatment plan quality, thus enhancing the safety and efficacy of proton therapy for Wilms' tumor patients. (2) Methods: Thirteen patients with Wilms' tumor, enrolled in the SJWT21 clinical trial, underwent proton therapy. The variations in bowel gas were systematically monitored using daily Cone Beam Computed Tomography (CBCT) imaging. Air cavities identified in daily CBCT images were analyzed to construct daily verification plans and measure water equivalent path length (WEPL) changes. A worst-case scenario simulation was conducted to identify the safest beam angles. (3) Results: The study revealed a maximum decrease in target dose (ΔD100%) of 8.0%, which corresponded to a WEPL variation (ΔWEPL) of 11.3 mm. The average reduction in target dose, denoted as mean ΔD100%, was found to be 2.8%, with a standard deviation (SD) of 3.2%. The mean ΔWEPL was observed as 3.3 mm, with an SD of 2.7 mm. The worst-case scenario analysis suggested that gantry beam angles oriented toward the patient's right and posterior aspects from 110° to 310° were associated with minimized WEPL discrepancies. (4) Conclusions: This study comprehensively evaluated the influence of bowel gas variability on treatment plan accuracy and proton range uncertainties in pediatric proton therapy for Wilms' tumor. [ABSTRACT FROM AUTHOR]

Background. Culturally relevant exercises may help improve health and address disparities faced by older immigrants due to language and cultural barriers. Few studies have focused on such exercise interventions among older Chinese immigrants at US daycare centers. Methods. We conducted a 10-week nonrandomized controlled trial in older Chinese immigrants in Philadelphia, US. The intervention group practiced Chinese Qigong (Baduanjin) 5 days a week guided by trained research assistants and video instructions. The control group maintained their usual daily activities. We collected self-report assessments on overall health, sleep, and fatigue and implemented two computerized cognitive tests measuring psychomotor vigilance task (PVT) and memory twice, preintervention and postintervention. Repeated measures general linear model (GLM) and paired samples t-tests were used for data analyses. Results. Eighty-eight older adults (Qigong, n = 53; control, n = 35) with an average age of 78.13 (SD = 5.05) were included. Groups showed no significant differences at baseline evaluation. After the 10-week exercise, the intervention group showed significant improvements in overall health (p = 0.032), fatigue (p < 0.001), and cognitive functions including memory (p = 0.01), response speed (p = 0.002), and response time (p = 0.012) on the PVT, as well as marginally significant benefits in sleep (p = 0.058). Between-group comparisons identified significant group-by-time interactions in health (p = 0.024), sleep (p = 0.004), fatigue (p = 0.004), and memory (p = 0.004). Conclusion. We revealed significant positive effects of Qigong in older Chinese immigrants across multiple health domains. Findings highlight the potential of a culturally relevant exercise in addressing health disparities. [ABSTRACT FROM AUTHOR]

Background: An 8-week educational intervention co-taught by medical students and faculty was designed to foster communication between clinical researchers and populations of interest to ultimately increase participation in clinical research by older adults, including underrepresented groups. Weekly topics focused on age-related changes and health conditions, socio-contextual factors impacting aging populations, and wellness strategies. Objectives: To evaluate the successes and weaknesses of an educational intervention aimed at increasing the participation of older adults in clinical research. Design: A focus group was assembled after an 8-week educational intervention, titled DREAMS, to obtain participants' feedback on the program, following a pre-formulated interview guide. Settings: Participants were interviewed in a health center office environment in the United States of America in April of 2016. Participants: A post-intervention focus group was conducted with a group of eight older adults (mean age = 75.8 ± 11.4 years) from 51 total participants who completed the intervention. Methods: The focus group was interviewed loosely following a pre-formed question guide. Participants were encouraged to give honest feedback. The conversation was recorded, transcribed verbatim, and analyzed using thematic analyses. Results: While participants viewed most aspects of the study as a success and stated that it was a productive learning experience, most participants had suggestions for improvements in the program content and implementation. Specifically, the composition of and direction to small breakout groups should be carefully considered and planned in this population, and attention should be paid to the delivery of sensitive topic such as death and dementia. A clear main benefit of this programmatic approach is the development of a rapport amongst participants and between participants and clinical researchers. Conclusions: The results provide useful insights regarding improving participation among hard-to-reach and historically underrepresented groups of older adults in clinical research. Future iterations of this program and similar educational interventions can use these findings to better achieve the programmatic objectives. [ABSTRACT FROM AUTHOR]

Purpose: The primary purpose of this study was to obtain preliminary evidence for a communication coaching intervention, Dementia Collaborative Coaching. The secondary aim of this study was to assess the acceptability, appropriateness, and feasibility of the intervention according to routine care providers. Method: In a pre-/posttest design, speech-language pathologists (SLPs) delivered Dementia Collaborative Coaching to certified nursing assistants (CNAs) and people living with dementia (PLWD) in six different skilled nursing facilities over a period of 6 weeks. A self-perceived knowledge and efficacy measure regarding the use of external memory aids to support communication in PLWD was administered to CNA and SLP participants. The Cohen-Mansfield Agitation Inventory was administered to PLWD participants. The Acceptability of Intervention Measure, Intervention Appropriateness Measure, and Feasibility of Intervention Measure were administered post-intervention. Results: For CNAs, self-perceived knowledge and efficacy increased from preintervention (M = 3.73, SD = 0.69) to post-intervention (M = 4.07, SD = 0.44), t(11) = -1.97, one-sided p = .037. There was a significant improvement (e.g., reduction) in scores on the Cohen-Mansfield Agitation Inventory for PLWD (n = 10) from pre-intervention (M = 73.10, SD = 29.98) to post-intervention (M = 58.6, SD = 18.82), t(9) = 2.83, p = .01. CNA participants (n = 12) rated the intervention as acceptable (M = 4.48, SD = 0.48), appropriate (M = 4.33, SD = 0.61), and feasible (M = 4.19, SD = 0.48). SLPs rated the intervention as slightly more acceptable, appropriate, and feasible than CNAs with scores of M = 4.54, SD = 0.51; M = 4.54, SD = 0.51; and M = 4.46, SD = 0.51, respectively. Conclusions: Dementia Collaborative Coaching showed preliminary positive outcomes for CNAs and PLWD. The intervention was acceptable, appropriate, and feasible for routine providers and warrants further study. [ABSTRACT FROM AUTHOR]

Background: Early advance care planning (ACP) conversations are essential to deliver patient-centered care. While primary care is an ideal setting to initiate ACP, such as Serious Illness Conversations (SICs), many barriers exist to implement such conversations in routine practice. An interprofessional team approach holds promises to address barriers. Objective: To develop and evaluate SIC training for interprofessional primary care teams (IP-SIC). Design: An existing SIC training was adapted for IP-SIC and then implemented and evaluated for acceptability and effectiveness. Setting/Context: Interprofessional teams in 15 primary care clinics in five US states. Measures: Acceptability of the IP-SIC training and participants' self-reported likelihood to engage in ACP after the training. Results: The 156 participants were a mix of physicians and advanced practice providers (APPs) (44%), nurses and social workers (31%), and others (25%). More than 90% of all participants rated the IP-SIC training positively. While nurse/social worker and other groups were less likely than physician and APP group to engage in ACP before training (4.4, 3.7, and 6.4 on a 1–10 scale, respectively), all groups showed significant increase in likelihood to engage in ACP after the IP-SIC training (8.5, 7.7, and 9.2, respectively). Both physician/APP and nurse/social worker groups showed significant increase in likelihood to use the SIC Guide after the IP-SIC training, whereas an increase in likelihood to use SIC Guide among other groups was not statistically significant. Conclusion: The new IP-SIC training was well accepted by interprofessional team members and effective to improve their likelihood to engage in ACP. Further research exploring how to facilitate collaboration among interprofessional team members to maximize opportunities for more and better ACP is warranted. ClinicalTrials.gov ID: NCT03577002 [ABSTRACT FROM AUTHOR]

Background: Negative symptoms such as blunted facial expressivity are characteristic of schizophrenia. However, it is not well-understood if and what abnormalities are present in individuals at clinical high-risk (CHR) for psychosis. Methods: This experimental study employed facial electromyography (left zygomaticus major and left corrugator supercilia) in a sample of CHR individuals (N = 34) and healthy controls (N = 32) to detect alterations in facial expressions in response to emotionally evocative film clips and to determine links with symptoms. Results: Findings revealed that the CHR group showed facial blunting manifested in reduced zygomatic activity in response to an excitement (but not amusement, fear, or sadness) film clip compared to controls. Reductions in zygomatic activity in the CHR group emerged in response to the emotionally evocative peak period of the excitement film clip. Lower zygomaticus activity during the excitement clip was related to anxiety while lower rates of change in zygomatic activity during the excitement video clip were related to higher psychosis risk conversion scores. Conclusions: Together, these findings inform vulnerability/disease driving mechanisms and biomarker and treatment development. [ABSTRACT FROM AUTHOR]

Objective: A sizeable minority of patients with binge‐eating disorder (BED) do not fully respond to evidence‐based treatments. Evidence to guide refinements of treatments is needed. Conceptualizing BED as arising from a network of symptom‐to‐symptom interactions allows for identification of the most strongly connected symptoms, which could inform intervention targets. This study estimated networks of BED features at pretreatment and posttreatment to assess whether cognitive behavioral therapy (CBT) and interpersonal psychotherapy (IPT) differentially impacted the interrelationships of BED symptoms/features. Methods: Participants were 392 adults (83% women, 88% white) with BED who received CBT (n = 236) or IPT (n = 156) and assessed at pretreatment and posttreatment. Networks were estimated across timepoints and treatments. Expected influence (EI) was calculated; symptoms with the highest EI have the most strong and frequent associations with other symptoms. We also assessed whether the symptoms with the highest and lowest EI predicted posttreatment remission indicators. Results: In the CBT and IPT networks, shape concern, weight concern, and eating concern had the highest EI at pretreatment and posttreatment. EI significantly increased from pretreatment to posttreatment for some symptoms in CBT but did not change for any symptoms in IPT. Shape concern significantly and positively predicted BED remission indicators in CBT and IPT. Conclusions: CBT and IPT similarly impacted interrelations among BED features. Pretreatment EI predicted posttreatment remission indicators, indicating that pretreatment centrality could signal meaningful intervention targets. Clinical implications and avenues for future research are discussed including how personalized network analysis may advance the understanding of the clinical utility of centrality. Public Significance: Cognitive behavioral therapy and interpersonal therapy for binge‐eating disorder, which are two leading evidence‐based treatments for binge‐eating disorder that are quite different in their models and approaches, similarly impacted interrelations among binge‐eating disorder symptoms. In addition, the most strongly interconnected symptom predicted indicators of remission. Studying the interrelations among symptoms may provide new insight on how treatments impact symptom relationships and inform intervention targets. [ABSTRACT FROM AUTHOR]

Despite promising results from individual-level studies, state-level studies of the effectiveness of comprehensive background-check (CBC) policies in reducing firearm fatalities have yielded null results in multiple states. These prior studies focused on CBC laws adopted in the 1990s, when record keeping was far less complete. We estimated the effect of the implementation of CBC policies on state-level firearm homicide and suicide rates in states implementing CBC policies from 2013 to 2015 (Colorado, Delaware, Oregon, and Washington). We compared age-adjusted firearm homicide and suicide rates, measured annually from 15 years prior to policy implementation until 2019, in each treated state to rates in control groups constructed using the synthetic control group method. Differences in firearm homicide rates for Colorado, Oregon, and Washington post treatment were all small (0.09 to 0.18 per 100,000 residents per year) and not well distinguished from natural variation. Oregon had on average 0.80 per 100,000 fewer firearm suicides per year than did synthetic Oregon post treatment. However, these results were inconsistent across modeling approaches and not well distinguished from natural variation. Our models produced poor fit for Delaware. Coupled with previous null results from Indiana, California, Maryland, Pennsylvania, and Tennessee, the present results suggest that extending background check requirements to private transfers alone and implementing these policies as is currently done is not sufficient to achieve significant state-level reductions in firearm fatalities. [ABSTRACT FROM AUTHOR]

Objectives: To evaluate self‐reported outcomes and serious adverse events following self‐managed medication abortion using misoprostol alone provided from an online service. Study Design: We conducted a retrospective record review of self‐managed abortion outcomes using misoprostol obtained from Aid Access, an online telemedicine organization serving United States (US) residents, between June 1, 2020, and June 30, 2020. The main outcomes were the proportion of people who reported ending their pregnancy without instrumentation intervention and the proportion who received treatment for serious adverse events. Results: During the study period, 1016 people received prescriptions for misoprostol. We obtained follow‐up information for 610 (60%) of whom 568 confirmed use of the medication and 42 confirmed non‐use. When taking the medication, 96% were at or less than 10 weeks' gestation and 4% were more than 10 weeks. Overall, 88% (95% CI: 84.6–90.2) reported successfully ending their pregnancy without instrumentation intervention. Of the 568 who took the misoprostol, 12 (2%) reported experiencing one or more serious adverse events and 20 (4%) reported experiencing a symptom of a potential complication. Conclusions: Self‐managed medication abortion using misoprostol provided by an online telemedicine service has a high rate of effectiveness and a low rate of serious adverse events. Outcomes compare favorably to other service delivery models using a similar regimen. As mifepristone continues to be over‐regulated and the 2022 US Supreme Court ruling allows states to severely restrict access to in‐clinic abortion care, this regimen is a promising option for self‐managed abortion in the US. [ABSTRACT FROM AUTHOR]

Three cycles of NHANES (2013–2018) were used to assess protein intake, protein quality (protein digestibility-corrected amino acid score; PDCAAS), protein cost, and nutrient intakes across quartiles of plant protein intake (Q1: <28.2%; Q2: 28.2% to <32.1%; Q3: 32.1 to <36.2%; Q4: ≥36.2%) over a 24 h period (≥19 years, n = 14 888). Grains represented the primary source of plant protein across quartiles and increased from 5.01% (Q1) to 13.5% (Q4). Across all the USDA's Food and Nutrient Database for Dietary Studies (FNDDS) food groups, grains were the most economical source of protein (24.3–26 g protein/$1). Legumes were the most economical plant-based protein (28–37.7 g protein/$1) within the "Protein Foods" FNDDS group. Absolute protein intake (96.6 g/day) and PDCAAS (0.91) of diets were progressively lower from Q1 to 72.0 g/day and 0.8 in Q4, respectively. Modelling the replacement of 50% of amino acids from grains in the diet with amino acids from legumes increased the PDCAAS by 10% in Q4. Intake levels of fibre, folate, iron, and zinc, were higher in Q2–Q4 compared to Q1 but had lower intakes of vitamins B12 and D. Amino acid complementation is required to effectively integrate higher levels plant protein into US diets. [ABSTRACT FROM AUTHOR]

Background: Side effects of medications for opioid use disorder (MOUD) such as weight gain contribute to their stigma. Substantial evidence suggests that women have a more severe side effect profile to MOUD than men, and concerns about weight gain during treatment are prevalent. However, the few studies reporting sex differences in weight gain during treatment show conflicting results and are restricted to methadone. In addition, little is known about possible sex differences in weight gain to buprenorphine, which is the most commonly prescribed MOUD in the United States.Methods: To address these issues, we performed a systematic review and meta-analysis on the few studies reporting longitudinal data on sex differences in body mass index (BMI) gain during methadone treatment (Study 1). In a separate study, we also re-analyzed data from trial CTN-0030 of the National Institute on Drug Abuse Clinical Trial Network (NIDA CTN), which involved a 12-week buprenorphine treatment regimen (Study 2; n = 360; 209 Male, 151 Female).Results: For Study 1, across all papers reporting longitudinal data (k = 4, n = 362 OUD patients), there were BMI increases that ranged from 2.2 to 5.4 BMI after at least one year of methadone treatment, but there were no significant sex differences in BMI increases (Standardized Mean Difference, Female > Male = 0.352, SE =0.270; 95 % CI = [-0.18 0.88]; p = .193). Study 2 showed no significant differences in weight before and after 12 weeks of buprenorphine treatment nor did it show sex differences in weight change with treatment (β = 2.34, p = .511).Conclusion: These analyses corroborate evidence of weight gain with methadone treatment but did not observe a sex-based disparity in weight gain with methadone or buprenorphine treatment for OUD. [ABSTRACT FROM AUTHOR]

Background: The opioid crisis has necessitated new approaches to managing chronic pain. The Veterans Health Administration (VHA) Whole Health model of care, with its focus on patient empowerment and emphasis on nonpharmacological approaches to pain management, is a promising strategy for reducing patients' use of opioids. We aim to assess whether the VHA's Whole Health pilot program impacted longitudinal patterns of opioid utilization among patients with chronic musculoskeletal pain.Methods: A cohort of 4,869 Veterans with chronic pain engaging in Whole Health services was compared with a cohort of 118,888 Veterans receiving conventional care. All patients were continuously enrolled in VHA care from 10/2017 through 3/2019 at the 18 VHA medical centers participating in the pilot program. Inverse probability of treatment weighting and multivariate analyses were used to adjust for observable differences in patient characteristics between exposures and conventional care. Patients exposed to Whole Health services were offered nine complementary and integrative health therapies alone or in combination with novel Whole Health services including goal-setting clinical encounters, Whole Health coaching, and personal health planning.Main Measures: The main measure was change over an 18-month period in prescribed opioid doses starting from the six-month period prior to qualifying exposure.Results: Prescribed opioid doses decreased by -12.0% in one year among Veterans who began complementary and integrative health therapies compared to similar Veterans who used conventional care; -4.4% among Veterans who used only Whole Health services such as goal setting and coaching compared to conventional care, and -8.5% among Veterans who used both complementary and integrative health therapies combined with Whole Health services compared to conventional care.Conclusions: VHA's Whole Health national pilot program was associated with greater reductions in prescribed opioid doses compared to secular trends associated with conventional care, especially when Veterans were connected with complementary and integrative health therapies. [ABSTRACT FROM AUTHOR]

Background: Promoting health-enhancing and sustainable physical activity levels across childhood and adolescence contribute to positive health outcomes as an adult. This study will aim to: a) examine the immediate (pre- to post-intervention) and sustained (1-year post-intervention follow-up) effects of the Children's Health Activity Motor Program-Afterschool Program (CHAMP-ASP) on physical activity, motor competence, and perceived motor competence relative to the comparison ASP, b) examine the immediate and sustained effects of CHAMP-ASP on secondary health outcomes, specifically health-related physical fitness (i.e., cardiorespiratory fitness, muscular strength, percent body fat) and weight status compared to children in the comparison ASP, and c) determine if perceived motor competence mediates the effect of CHAMP-ASP on moderate-to-vigorous physical activity.Methods: This multicenter cluster randomized trial will be implemented by ASP staff and will be conducted in ASPs located in two city-based cohorts: East Lansing/Lansing and Ann Arbor/Ypsilanti, Michigan. Children (N = 264) who are K-2 graders will participate 35 min/day X 3 days/week for 19 weeks (1995 min) in their afterschool movement program (i.e., CHAMP-ASP vs. comparison). The research team will train ASP staff to implement the program, which will be delivered within the existing ASP offering. Measures of physical activity (accelerometer), motor competence (process and product measures of fundamental motor skills), health-related fitness, perceived motor competence, and anthropometry will be collected pre-, immediately post-, and one-year post-intervention. Random-effects models will be used to assess the clustered longitudinal effect of the intervention on outcome measures.Discussion: The long-term goal is to provide a sustainable, ecologically-relevant, and evidence-based program during the early elementary years that can be delivered by ASP staff, is health-enhancing, and increases physical activity in children. Findings hold the potential to help shape public health and educational policies and interventions that support healthy development and active living during the early years.Trial Registration: ClinicalTrials.gov Identifier NCT05342701 .Ethics and Dissemination: Ethical approval was obtained through the Health Sciences and Behavioral Sciences IRB, University of Michigan (HUM00208311). The CHAMP-ASP study is funded by the National Institutes of Health. Findings will be disseminated via print, online media, dissemination events, and practitioner and/or research journals. [ABSTRACT FROM AUTHOR]

Background: Cerebrovascular events, dementia, and cancer can contribute to physical disability with activities of daily living (ADL). It is unclear whether low-dose aspirin reduces this burden in aging populations. In a secondary analysis, we now examine aspirin's effects on incident and persistent ADL disability within a primary prevention aspirin trial in community-dwelling older adults.Methods: The ASPREE (ASPirin in Reducing Events in the Elderly) trial of daily 100 mg aspirin versus placebo recruited 19 114 healthy adults aged 70+ years (65+ years if U.S. minority) in Australia and the United States. Six basic ADLs were assessed every 6 months. Incident ADL disability was defined as inability or severe difficulty with ≥1 ADL; persistence was confirmed if the same ADL disability remained after 6 months. Proportional hazards modeling compared time to incident or persistent ADL disability for aspirin versus placebo; death without prior disability was a competing risk.Results: Over a median of 4.7 years, incident ADL disability was similar in those receiving aspirin (776/9525) and placebo (787/9589) with walking, bathing, dressing, and transferring the most commonly reported. Only 24% of incident ADL disability progressed to persistent. Persistent ADL disability was lower in the aspirin group (4.3 vs 5.3 events/1000 py; hazard ratio [HR] = 0.81, 95% confidence interval [CI]: 0.66-1.00), with bathing and dressing the most common ADL disabilities in both groups. Following persistent ADL disability, there were more deaths in the aspirin group (24 vs 12).Discussion: Low-dose aspirin in initially healthy older people did not reduce the risk of incident ADL disability, although there was evidence of reduced persistent ADL disability. [ABSTRACT FROM AUTHOR]

Difficulty controlling anger is a significant concern among combat veterans with posttraumatic stress disorder (PTSD), yet few controlled studies have examined the efficacy of anger treatments for this population. This study examined the effects of a group cognitive behavioral therapy (CBT) intervention compared with a group present-centered therapy (PCT) control condition in male and female combat veterans with PTSD. Thirty-six combat veterans with PTSD and anger difficulties began group treatment (CBT, n = 19; PCT, n = 17). Separate multilevel models of self-rated anger, PTSD symptoms, and disability were conducted using data from baseline, each of 12 treatment sessions, posttreatment, and 3- and 6-month follow-up time points. Significant decreases in anger and PTSD symptoms were observed over time, but no significant differences between CBT and PCT were observed on these outcomes. A significant interaction of therapy by time favoring the PCT condition was observed on disability scores. Gender differences were observed in dropout rates (i.e., 100% of female participants dropped out of CBT). Findings suggest that both CBT and PCT group therapy may be effective in reducing anger in combat veterans with PTSD. Results also highlight potential gender differences in response to group anger treatment. [ABSTRACT FROM AUTHOR]