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The International Journal of Behavioral... Feb 2020Preliminary evaluations of behavioral interventions, referred to as pilot studies, predate the conduct of many large-scale efficacy/effectiveness trial. The ability of a... (Meta-Analysis)
Meta-Analysis
BACKGROUND
Preliminary evaluations of behavioral interventions, referred to as pilot studies, predate the conduct of many large-scale efficacy/effectiveness trial. The ability of a pilot study to inform an efficacy/effectiveness trial relies on careful considerations in the design, delivery, and interpretation of the pilot results to avoid exaggerated early discoveries that may lead to subsequent failed efficacy/effectiveness trials. "Risk of generalizability biases (RGB)" in pilot studies may reduce the probability of replicating results in a larger efficacy/effectiveness trial. We aimed to generate an operational list of potential RGBs and to evaluate their impact in pairs of published pilot studies and larger, more well-powered trial on the topic of childhood obesity.
METHODS
We conducted a systematic literature review to identify published pilot studies that had a published larger-scale trial of the same or similar intervention. Searches were updated and completed through December 31st, 2018. Eligible studies were behavioral interventions involving youth (≤18 yrs) on a topic related to childhood obesity (e.g., prevention/treatment, weight reduction, physical activity, diet, sleep, screen time/sedentary behavior). Extracted information included study characteristics and all outcomes. A list of 9 RGBs were defined and coded: intervention intensity bias, implementation support bias, delivery agent bias, target audience bias, duration bias, setting bias, measurement bias, directional conclusion bias, and outcome bias. Three reviewers independently coded for the presence of RGBs. Multi-level random effects meta-analyses were performed to investigate the association of the biases to study outcomes.
RESULTS
A total of 39 pilot and larger trial pairs were identified. The frequency of the biases varied: delivery agent bias (19/39 pairs), duration bias (15/39), implementation support bias (13/39), outcome bias (6/39), measurement bias (4/39), directional conclusion bias (3/39), target audience bias (3/39), intervention intensity bias (1/39), and setting bias (0/39). In meta-analyses, delivery agent, implementation support, duration, and measurement bias were associated with an attenuation of the effect size of - 0.325 (95CI - 0.556 to - 0.094), - 0.346 (- 0.640 to - 0.052), - 0.342 (- 0.498 to - 0.187), and - 0.360 (- 0.631 to - 0.089), respectively.
CONCLUSIONS
Pre-emptive avoidance of RGBs during the initial testing of an intervention may diminish the voltage drop between pilot and larger efficacy/effectiveness trials and enhance the odds of successful translation.
Topics: Bias; Diet; Exercise; Humans; Pediatric Obesity; Pilot Projects; Research Design; Sedentary Behavior; Sleep; Treatment Outcome; Weight Reduction Programs
PubMed: 32046735
DOI: 10.1186/s12966-020-0918-y -
The International Journal of Behavioral... Nov 2019Due to their central position in the modern food system, food stores present a unique opportunity to promote healthy dietary behaviour. However, there is a lack of...
BACKGROUND
Due to their central position in the modern food system, food stores present a unique opportunity to promote healthy dietary behaviour. However, there is a lack of insight into the factors that impede or enhance the implementation of nutritional interventions in food stores. We applied a systems innovation and implementation science framework to the identification of such barriers and facilitators.
METHODS
We conducted a systematic literature review. A search string was developed to identify qualitative and quantitative articles on environmental nutritional interventions in the food store. Four databases were systematically searched for studies published between 2000 and 2018. Eligible publications described study designs or original studies, focused on stimulating healthier dietary behaviour through environmental changes in retail settings and contained information on the perceptions or experiences of retailers or interventionists regarding the implementation process of the intervention. Context-descriptive data was extracted and a quality assessment was performed.
RESULTS
We included 41 articles, of which the majority was conducted in the USA and involved single stores or a mix of single and multi-store organisations. We categorized barriers and facilitators into 18 themes, under five domains. In the 'outer setting' domain, most factors related to consumers' preferences and demands, and the challenge of establishing a supply of healthy products. In the 'inner setting' domain, these related to conflicting values regarding health promotion and commercial viability, store lay-out, (insufficient) knowledge and work capacity, and routines regarding waste avoidance and product stocking. In the 'actors' domain, no major themes were found. For the 'intervention 'domain', most related to intervention-context fit, money and resource provision, material quality, and the trade-offs between commercial costs and risks versus commercial and health benefits. For the 'process' domain, most factors related to continuous engagement and strong relationships.
CONCLUSIONS
This review provides a comprehensive overview of barriers and facilitators to be taken into account when implementing nutritional interventions in food stores. Furthermore, we propose a novel perspective on implementation as the alignment of intervention and retail interests, and a corresponding approach to intervention design which may help avoid barriers, and leverage facilitators.
TRIAL REGISTRATION
PROSPERO; CRD42018095317.
Topics: Cardiovascular Diseases; Consumer Behavior; Diabetes Mellitus, Type 2; Food Preferences; Food Supply; Health Promotion; Humans; Nutritive Value
PubMed: 31752885
DOI: 10.1186/s12966-019-0867-5 -
Brain and Behavior Dec 2019The current systematic and methodological review aimed to critically review existing literature utilizing implicit processing, or automatic approach- and/or...
OBJECTIVE
The current systematic and methodological review aimed to critically review existing literature utilizing implicit processing, or automatic approach- and/or avoidance-related attentional biases between eating disorder (ED) and nonclinical samples, which (a) highlights how psychophysiological methods advance knowledge of ED implicit bias; (b) explains how findings fit into transdiagnostic versus disorder-specific ED frameworks; and (c) suggests how research can address perfectionism-related ED biases.
METHOD
Three databases were systematically searched to identify studies: PubMed, Scopus, and PsychInfo electronic databases. Peer-reviewed studies of 18- to 39-year-olds with both clinical ED and healthy samples assessing visual attentional biases using pictorial and/or linguistic stimuli related to food, body, and/or perfectionism were included.
RESULTS
Forty-six studies were included. While behavioral results were often similar across ED diagnoses, studies incorporating psychophysiological measures often revealed disease-specific attentional biases. Specifically, women with bulimia nervosa (BN) tend to approach food and other body types, whereas women with anorexia nervosa (AN) tend to avoid food as well as overweight bodies.
CONCLUSIONS
Further integration of psychophysiological and behavioral methods may identify subtle processing variations in ED, which may guide prevention strategies and interventions, and provide important clinical implications. Few implicit bias studies include male participants, investigate binge-eating disorder, or evaluate perfectionism-relevant stimuli, despite the fact that perfectionism is implicated in models of ED.
Topics: Adult; Anorexia Nervosa; Attentional Bias; Binge-Eating Disorder; Body Image; Bulimia Nervosa; Feeding Behavior; Female; Food; Humans; Male; Perfectionism; Psychophysiology
PubMed: 31696674
DOI: 10.1002/brb3.1458 -
International Journal of Environmental... Jul 2019Increasing pressure on limited healthcare resources has necessitated the development of measures promoting early discharge and avoiding inappropriate hospital...
Increasing pressure on limited healthcare resources has necessitated the development of measures promoting early discharge and avoiding inappropriate hospital (re)admission. This systematic review examines the evidence for interventions in acute hospitals including (i) hospital-patient discharge to home, community services or other settings, (ii) hospital discharge to another care setting, and (iii) reduction or prevention of inappropriate hospital (re)admissions. Academic electronic databases were searched from 2005 to 2018. In total, ninety-four eligible papers were included. Interventions were categorized into: (1) pre-discharge exclusively delivered in the acute care hospital, (2) pre- and post-discharge delivered by acute care hospital, (3) post-discharge delivered at home and (4) delivered only in a post-acute facility. Mixed results were found regarding the effectiveness of many types of interventions. Interventions exclusively delivered in the acute hospital pre-discharge and those involving education were most common but their effectiveness was limited in avoiding (re)admission. Successful pre- and post-discharge interventions focused on multidisciplinary approaches. Post-discharge interventions exclusively delivered at home reduced hospital stay and contributed to patient satisfaction. Existing systematic reviews on tele-health and long-term care interventions suggest insufficient evidence for admission avoidance. The most effective interventions to avoid inappropriate re-admission to hospital and promote early discharge included integrated systems between hospital and the community care, multidisciplinary service provision, individualization of services, discharge planning initiated in hospital and specialist follow-up.
Topics: Delivery of Health Care; Humans; Patient Discharge; Patient Readmission
PubMed: 31295933
DOI: 10.3390/ijerph16142457 -
PloS One 2019Stigma and discrimination (SAD) related to HIV compromise access and adherence to treatment and support programs among people living with HIV (PLHIV). The ambitious goal...
INTRODUCTION
Stigma and discrimination (SAD) related to HIV compromise access and adherence to treatment and support programs among people living with HIV (PLHIV). The ambitious goal of ending the epidemic of HIV by 2030 set by the United Nations Joint Program of HIV/AIDS (UNAIDS) will thus only be achieved if HIV-related stigma and discrimination are reduced. The objective of this review was to locate, appraise and describe international literature reporting on interventions that addressed HIV-related SAD in healthcare settings.
METHODS
The databases searched were: Cumulative Index to Nursing and Allied Health (CINAHL), Excerpta Medica Database from Elsevier (EMBASE), PubMed and Psychological Information (PsycINFO) database. Two individuals independently appraised the quality of the papers using appraisal instruments from the Joanna Briggs Institute (JBI). Data were extracted from papers included in the review using the standardized data extraction tool from JBI. Quality of evidence for major outcomes was assessed using Grading of Recommendations, Assessment, Development and Evaluation (GRADE).
RESULTS
We retained 14 records reporting on eight studies. Five categories of SAD reduction (information-based, skills building, structural, contact-based and biomedical interventions) were identified. Training popular opinion leaders (POLs) resulted in significantly lower mean avoidance intent scores (MD = -1.87 [95% CI -2.05 to -1.69]), mean prejudicial attitude scores (MD = -3.77 [95% CI -5.4 to -2.09]) and significantly higher scores in mean compliance to universal precaution (MD = 1.65 [95% CI 1.41 to 1.89]) when compared to usual care (moderate quality evidence). The Summary of Findings table (SOF) is shown in Table 1.
CONCLUSIONS
Evidence of moderate quality indicates that training popular opinion leaders is effective in reducing avoidance intent and prejudicial attitude and improving compliance to universal precaution. Very low quality evidence indicates that professionally-assisted peer group interventions, modular interactive training, participatory self-guided assessment and intervention, contact strategy combined with information giving and empowerment are effective in reducing HIV-related stigma.Further Randomized Controlled Trials (RCTs) are needed. Future trials need to use up-to-date and validated instruments to measure stigma and discrimination.
Topics: Avoidance Learning; HIV Infections; Health Personnel; Health Services Accessibility; Humans; Malpractice; Program Evaluation; Social Stigma; Treatment Adherence and Compliance
PubMed: 30682131
DOI: 10.1371/journal.pone.0211298 -
Revista de Neurologia Jan 2019Kahneman and Tversky's prospect theory has become the main model for the study of decision-making. One of its cornerstones, the loss aversion bias (greater sensitivity...
INTRODUCTION
Kahneman and Tversky's prospect theory has become the main model for the study of decision-making. One of its cornerstones, the loss aversion bias (greater sensitivity to losses than to gains), has been demonstrated from the behavioural perspective.
AIMS
To analyse the evidence from neuroeconomics and check whether it is consistent with the existence of a neural mechanism of loss aversion.
PATIENTS AND METHODS
A systematic review was performed, following the PRISMA guidelines, of the empirical studies found in PubMed and ScienceDirect, a total of 18 studies being included altogether.
RESULTS AND CONCLUSIONS
The results consistently point to the implication of two opposing neural systems in this bias: one appetitive, involving the striatum and the frontal regions, and one aversive, involving the amygdala and the insula, which interact with each other when it comes to making a decision about different monetary bets and display a higher sensitivity towards losses. Although their functioning is not yet clear, what does seem evident is that the consistent involvement of these structures lends support to prospect theory and the limited rationality approach.
Topics: Adolescent; Adult; Avoidance Learning; Brain Mapping; Decision Making; Economics, Behavioral; Female; Gambling; Games, Experimental; Humans; Male; Models, Neurological; Models, Psychological; Neuroimaging; Young Adult
PubMed: 30638254
DOI: No ID Found -
European Journal of Pain (London,... Jan 2019Previous mass media campaigns have aimed to influence how people manage back pain, with mixed success. Campaigns should target beliefs which are related to the...
Previous mass media campaigns have aimed to influence how people manage back pain, with mixed success. Campaigns should target beliefs which are related to the behaviours they aim to change. This systematic review brings together research that has measured the prevalence of beliefs about back pain in the general population and factors associated with these beliefs, including future pain-related outcomes. Five databases were searched up until April 2017. Quantitative studies which reported a measure of agreement with a belief about back pain, cross-sectional associations, or associations between beliefs and future outcomes were eligible. Eligibility was assessed and data extracted independently by two authors. Results were tabulated and narratively synthesized. Nineteen studies from 10 countries were eligible (median study n [IQR] = 990.5 [524.75-2387.5]). Beliefs were measured using eight questionnaires and 57 stand-alone items. Beliefs about back pain's negative consequences were common across countries and populations, whereas most samples did not hold fear-avoidance beliefs. Beliefs about back pain's consequences were associated with pain and disability, but only one study investigated this specific relationship prospectively. No studies investigated whether beliefs are associated with future pain management behaviours. Agreement with certain beliefs (e.g. about negative consequences) was associated with sociodemographic characteristics (e.g. older age) and poorer self-rated health. Interventions may benefit from targeting beliefs about the perceived negative consequences of back pain in these populations. However, future research should explore how beliefs prospectively influence the management of back pain. SIGNIFICANCE: This review brings together studies which have assessed the prevalence of beliefs about back pain, and factors associated with holding them. It highlights that whether or not these beliefs represent important determinants of how people manage pain remains unknown.
Topics: Attitude to Health; Back Pain; Fear; Health Behavior; Humans; Pain Management; Perception; Surveys and Questionnaires
PubMed: 29984553
DOI: 10.1002/ejp.1285 -
Clinical Psychology Review Apr 2019A growing body of research has implicated disgust in various psychopathologies, especially anxiety-related disorders. Although the observed role of disgust in many...
A growing body of research has implicated disgust in various psychopathologies, especially anxiety-related disorders. Although the observed role of disgust in many disorders is robust, the mechanisms that may explain this role are unclear. Cutting-edge research in cognitive science has the potential to elucidate such mechanisms and consequently improve our understanding of how disgust contributes to the etiology and maintenance of psychopathology. In this qualitative review, we systematically assess cognitive bias mechanisms that have been linked to disgust and its disorders. This review suggests that disgust-related biases may be observed in memory, interpretation, judgment of expectancies, and attention, as well as at implicit levels. Of these cognitive domains, the most robust bias appears to be observed at the level of attention. However, reliable moderators of attentional biases for disgust have not yet been identified, and this bias has not been systematically linked to other levels of analysis. Despite these limitations, the available research indicates that attentional avoidance rather than orienting or maintenance may be the most characteristic of disgust. Attentional avoidance of disgust may have important implications for etiological and treatment models of disorders characterized by excessive disgust reactions. The implications for advancing such models are discussed in the context of a combined cognitive bias hypothesis.
Topics: Attentional Bias; Avoidance Learning; Cognitive Dysfunction; Cues; Disgust; Humans; Mental Disorders; Mental Recall
PubMed: 29909923
DOI: 10.1016/j.cpr.2018.06.002 -
PeerJ 2018Reward seeking and avoidance of punishment are key motivational processes. Brain-imaging studies often use the (MIDT) to evaluate motivational processes involved in...
BACKGROUND
Reward seeking and avoidance of punishment are key motivational processes. Brain-imaging studies often use the (MIDT) to evaluate motivational processes involved in maladaptive behavior. Although the bulk of research has been done on the MIDT reward events, little is known about the neural basis of avoidance of punishment. Therefore, we conducted a meta-analysis of brain activations during anticipation and receipt of monetary losses in healthy controls.
METHODS
All functional neuro-imaging studies using the MIDT in healthy controls were retrieved using PubMed, Google Scholar & EMBASE databases. Functional neuro-imaging data was analyzed using the Seed-based d Mapping Software.
RESULTS
Thirty-five studies met the inclusion criteria, comprising 699 healthy adults. In both anticipation and loss outcome phases, participants showed large and robust activations in the bilateral striatum, (anterior) insula, and anterior cingulate gyrus relatively to Loss > Neutral contrast. Although relatively similar activation patterns were observed during the two event types, they differed in the pattern of prefrontal activations: ventro-lateral prefrontal activations were observed during loss anticipation, while medial prefrontal activations were observed during loss receipt.
DISCUSSION
Considering that previous meta-analyses highlighted activations in the medial prefrontal cortex/anterior cingulate cortex, the anterior insula and the ventral striatum, the current meta-analysis highlighted the potential specificity of the ventro-lateral prefrontal regions, the median cingulate cortex and the amygdala in the loss events. Future studies can rely on these latter results to examine the neural correlates of loss processing in psychiatric populations characterized by harm avoidance or insensitivity to punishment.
PubMed: 29761060
DOI: 10.7717/peerj.4749 -
Neuroscience and Biobehavioral Reviews Sep 2018To explore effects of the brain renin-angiotensin system (RAS) on cognition.
OBJECTIVES
To explore effects of the brain renin-angiotensin system (RAS) on cognition.
DESIGN
Systematic review of experimental (non-human) studies assessing cognitive effects of RAS peptides angiotensin-(3-8) [Ang IV] and angiotensin-(1-7) [Ang-(1-7)] and their receptors, the Ang IV receptor (AT4R) and the Mas receptor.
RESULTS
Of 450 articles identified, 32 met inclusion criteria. Seven of 11 studies of normal animals found Ang IV had beneficial effects on tests of passive or conditioned avoidance and object recognition. In models of cognitive deficit, eight of nine studies found Ang IV and its analogs (Nle-Ang IV, dihexa, LVV-hemorphin-7) improved performance on spatial working memory and passive avoidance tasks. Two of three studies examining Ang-(1-7) found it benefited memory. Mas receptor removal was associated with reduced fear memory in one study.
CONCLUSION
Studies of cognitive impairment show salutary effects of acute administration of Ang IV and its analogs, as well as AT4R activation. Brain RAS peptides appear most effective administered intracerebroventricularly, close to the time of learning acquisition or retention testing. Ang-(1-7) shows anti-dementia qualities.
Topics: Angiotensin I; Angiotensin II; Animals; Cognition Disorders; Databases, Bibliographic; Dementia; Disease Models, Animal; Humans; Memory, Short-Term; Peptide Fragments
PubMed: 29733881
DOI: 10.1016/j.neubiorev.2018.05.005