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JAMA Network Open Jun 2024Most individuals with problem gambling or gambling disorder remain untreated due to barriers to treatment. Limited research exists on alternative treatments. (Randomized Controlled Trial)
Randomized Controlled Trial
IMPORTANCE
Most individuals with problem gambling or gambling disorder remain untreated due to barriers to treatment. Limited research exists on alternative treatments.
OBJECTIVE
To investigate the efficacy of a self-guided internet-based intervention for individuals with gambling problems and to identify potential outcome moderators.
DESIGN, SETTING, AND PARTICIPANTS
This single-center randomized clinical trial was conducted from July 13, 2021, to December 31, 2022, at the University Medical Center Hamburg-Eppendorf. Participants were recruited across Germany for 2 assessments (before intervention [t0] and 6 weeks after intervention [t1]). Eligible participants were individuals aged 18 to 75 years with gambling problems, internet access, German proficiency, and willingness to participate in 2 online assessments.
INTERVENTION
The self-guided internet-based intervention was based on cognitive behavioral therapy, metacognitive training, acceptance and commitment therapy, and motivational interviewing.
MAIN OUTCOME AND MEASURES
The primary outcome was change in gambling-related thoughts and behavior as measured with the pathological gambling adaption of the Yale-Brown Obsessive-Compulsive Scale. Secondary outcomes were change in depressive symptoms, gambling severity, gambling-specific dysfunctional thoughts, attitudes toward online interventions, treatment expectations, and patient satisfaction.
RESULTS
A total of 243 participants (154 [63.4%] male; mean [SD] age, 34.73 [10.33] years) were randomized to an intervention group (n = 119) that gained access to a self-guided internet-based intervention during 6 weeks or a wait-listed control group (n = 124). Completion at t1 was high (191 [78.6%]). Results showed a significantly greater reduction in gambling-related thoughts and behavior (mean difference, -3.35; 95% CI, -4.79 to -1.91; P < .001; Cohen d = 0.59), depressive symptoms (mean difference, -1.05; 95% CI, -1.87 to -0.22; P = .01; Cohen d = 0.33), and gambling severity (mean difference, -1.46; 95% CI, -2.37 to -0.54; P = .002; Cohen d = 0.40) but not in gambling-specific dysfunctional thoughts (mean difference, -1.62; 95% CI, -3.40 to 0.15; P = .07; Cohen d = 0.23) favoring the intervention group. Individuals in the intervention group who had a positive treatment expectation and more severe gambling-specific dysfunctional thoughts and gambling symptoms benefited more on the primary outcome relative to the control group.
CONCLUSIONS AND RELEVANCE
In this randomized clinical trial, the effectiveness of a self-guided internet-based intervention for individuals with self-reported problematic gambling behavior was demonstrated when measured 6 weeks after start of the intervention. The study's findings are particularly relevant given the increasing need for accessible and scalable solutions to address problematic gambling.
TRIAL REGISTRATION
bfarm.de Identifier: DRKS00024840.
Topics: Humans; Male; Gambling; Female; Middle Aged; Adult; Internet-Based Intervention; Cognitive Behavioral Therapy; Treatment Outcome; Germany; Motivational Interviewing; Aged; Young Adult; Internet
PubMed: 38904962
DOI: 10.1001/jamanetworkopen.2024.17282 -
Frontiers in Psychiatry 2024COVID-19 necessitated a rapid move from face-to-face services to remote care for eating disorders/eating distress (EDs). This study explores the advantages and...
INTRODUCTION
COVID-19 necessitated a rapid move from face-to-face services to remote care for eating disorders/eating distress (EDs). This study explores the advantages and challenges of remote care, identifying future implications for service provision. Remote care has been considered in the broadest of terms, including therapeutic care (e.g., Cognitive Behavioural Therapy, peer support, forums, one-to-one and group care options).
METHODS
Using a mixed methods approach, data were collected from 211 people with lived experience of EDs (PWLE), with and without formal diagnosis. 27 participants took part in semi-structured interviews/workshops and a further 184 participants took part via an online survey. Participants reported on their ED status, the impact of the pandemic on symptoms, the benefits, and challenges of remote care (and type of support accessed), and any reasons for not accessing support. Participants were invited to make future care recommendations.
RESULTS
ED symptoms were reported as worsening during the pandemic with contributing factors including isolation, lack of routine, negative emotions, and feeling like the external situation was outside of one's control. Remote care was positively attributed to increased flexibility and facilitation of social connection. Identified barriers to access included lack of awareness about support availability, digital access/literacy, and competing commitments. Further challenges included approaches being perceived as too clinical (e.g., ED information and support presented using clinical language and/or limited to support within medical care settings, without acknowledging the broader context of disordered eating), uncertainty around remote care quality, and concerns that remote platforms may facilitate masking of symptoms. Participants reported distress caused by online platforms where self-view is the default during video calls. They expressed a need for more holistic approaches to remote care, including: "real stories" of recovery, and hybrid (online and offline) options for greater flexibility and widening of access and choice. Participants also expressed a need for appropriate digital literacy training.
DISCUSSION
Future recommendations emphasise user-centred holistic and hybrid approaches to ED remote support, with training to address digital literacy barriers and facilitate user control of platform functionalities (e.g., self-view). This study underscores the need for continued remote care with a focus on inclusivity and user empowerment.
PubMed: 38903648
DOI: 10.3389/fpsyt.2024.1383080 -
Frontiers in Psychiatry 2024Unexplained physical signs and symptoms represent a significant portion of patient presentations in acute care settings. Even in cases where a patient presents with a...
Optimizing outcomes when treating functional neurological disorder in acute care settings: case reports depicting the value of diagnostic precision and timely and appropriate psychological interventions using an interdisciplinary framework.
INTRODUCTION
Unexplained physical signs and symptoms represent a significant portion of patient presentations in acute care settings. Even in cases where a patient presents with a known medical condition, functional or somatic symptoms may complicate the diagnostic and treatment processes and prognostic outcome. One umbrella category for neurologically related somatic symptoms, functional neurological disorder (FND), presents as involuntary neurological symptoms incompatible with another medical condition. Symptoms may include weakness and/or paralysis, movement disorders, non-epileptic seizures, speech or visual impairment, swallowing difficulty, sensory disturbances, or cognitive symptoms (1). While FND presents as neuropsychiatric, providers commonly report feeling hesitant to diagnose these disorders. Inexperience or lack of appropriate education on relevant research regarding evidence-based practices or standard of practice (SOP) may result in over- or underperforming diagnostic workups and consultations, utilizing inappropriate medications, and failing to offer evidence-based psychological interventions. Being mindful of these challenges when treating patients presenting with functional symptoms in acute care settings can help to support and protect the patients and care team and appropriately control healthcare costs.
METHODS
The University of Alabama at Birmingham Medical Center identified cases representing categories of quality and safety problems that arise in treating FND in acute care settings. Patients signed a consent form to participate in the case report. The case information for each was presented without identifying information.
DISCUSSION
The cases highlight potential challenges when caring for patients presenting with FND in acute care settings. The challenges covered include over- or underutilization of diagnostic workups and consultation, over- or underutilization of psychopharmacological medications, and over- or undertreating a medical condition when a functional symptom is present. In each case, these lapses and errors caused the patient distress, additional treatments, care delays, and delayed symptom remission. Additionally, these challenges have direct and indirect fiscal costs, which can be mitigated with the appropriate education and training, resources, and protocols. Hospitals can benefit from system-wide SOP to improve the identification and management of FND to prevent harm to patients. An SOP commonly presents to specific specialties and ensures the appropriate diagnostic workup, consultations, and timely evidence-based interventions.
PubMed: 38903638
DOI: 10.3389/fpsyt.2024.1288828 -
Frontiers in Psychology 2024The increasingly digital and multicultural 21st-century society requires future teachers to be prepared for the changes and challenges they may encounter. Not only...
UNLABELLED
The increasingly digital and multicultural 21st-century society requires future teachers to be prepared for the changes and challenges they may encounter. Not only language and digital competences, but critical-thinking and problem-solving skills are needed. Moreover, well developed socio-affective abilities, empathy among them, are also key when dealing with others. This is even more relevant when teachers are to work with a non-mainstream population, such as adult migrants with low literacy levels, and to design student-centered curricula or activities. Empathy is a multifaceted process involving, among others, perception, intellection, affect and other sensory aspects of the lived experience. It has been argued that the first-person perspective-taking involved in empathic engagement must necessarily involve rational computation and cognitively mediated processing. Training future teachers in the Pedagogy of Multiliteracies is a means to integrate multimodal digital instruction and aggregate cognitive as well as socio-emotional features to the education of future language teachers.
METHOD
A mixed-method pre-post study was conducted with 48 trainee teachers who participated in stand-alone digital multiliteracy interventions, in which they were encouraged to envisage themselves as future teachers of low-literate migrants. Policy documents such as the reference guide on Literacy and Second Language Learning for the Linguistic Integration of Adult Migrants, journal articles, audiovisual resources as well as examples of existing educational materials aimed at the target audience, were made available to them on an online platform. In two separate studies, trainees were encouraged to collaboratively produce two different multimodal outputs. The Revised Scale of Ethnocultural Empathy was administered before and after the intervention, subjecting the data obtained to quantitative analysis. Qualitative data was also collected to gain a better understanding of the affective and cognitive processes experienced by the participants.
RESULTS
Simple statistical analysis coupled with the comparison of means was used to respond to the research questions. Statistical hypothesis testing, including correlations and non-parametric statistics were used to analyze the relationship between each of the factors within the RSEE and the participants, considering the different interventions applied. Non-parametric tests (U-Mann Whitney) were used to compare the differences between the levels of ethnocultural empathy of the participants in the two studies. Significant differences were found in Factor 3 (Empathy) and Factor 5 (Anxiety) between the groups and their post-intervention results, with a value of 0.053 and 0.038, respectively. The effect size r was calculated, obtaining a size effect of 0.625 for Factor 3 (Empathy) and 0.674 for Factor 5 (Anxiety). These results indicate that the significant differences and the size effect between both groups are large. U-Mann Whitney non-parametric analysis also revealed gender differences in Factor 3 (Empathy), showing females higher levels than males. Effect size r analysis showed a large size effect of 0.708 for Factor 3 (Empathy). The findings pertaining to gender-related differences in empathy levels confirm the conclusions drawn by previous studies. When contrasting study 1 and 2, statistical differences were also shown after the intervention for the 'Anxiety and Lack of Multicultural Self-efficacy' factor. The qualitative data analysis was carried out with Atlas.ti v.8, in order to isolate and categorize the broader themes and the most significant explanatory quotes extracted from the participants' records and interviews. The results reveal the learning strategies that each group of learners applied to successfully complete the task at hand, as well as the participants' deployment of their critical thinking skills and the awakening of a sense of awareness of their own professional competence development process.
CONCLUSION
This study set out to compare how effective two digital multiliteracy interventions were in developing future language teachers' ethnocultural empathy and cognitive abilities when appraising the educational needs of low-literacy migrants. Despite the small sample size, the study certainly adds to our understanding of the impact of multimodal tasks involving critical thinking skills on trainees' cognitive and affective abilities. Besides, it expands the growing body of research that points to the desirability of embedding digitally-based content creation tasks in training curricula for future language teachers.
PubMed: 38903477
DOI: 10.3389/fpsyg.2024.1398457 -
Frontiers in Sports and Active Living 2024The present study aimed to evaluate the effect of acute aerobic exercise on certain cognitive functions known to be affected by Alzheimer's disease (AD), with a...
INTRODUCTION
The present study aimed to evaluate the effect of acute aerobic exercise on certain cognitive functions known to be affected by Alzheimer's disease (AD), with a particular emphasis on sex differences.
METHODS
A total of 53 patients, with a mean age of 70.54 ± 0.88 years and moderate AD, voluntarily participated in the study. Participants were randomly assigned to two groups: the experimental group (EG), which participated in a 20-min moderate-intensity cycling session (60% of the individual maximum target heart rate recorded at the end of the 6-min walk test); and the control group (CG), which participated in a 20-min reading activity. Cognitive abilities were assessed before and after the physical exercise or reading session using the Stroop test for selective attention, the forward and backward digit span test for working memory, and the Tower of Hanoi task for problem-solving abilities.
RESULTS
At baseline, both groups had comparable cognitive performance ( > 0.05 in all tests). Regardless of sex, aerobic acute exercise improved attention in the Stroop test ( < 0.001), enhanced memory performance in both forward ( < 0.001) and backward ( < 0.001) conditions, and reduced the time required to solve the problem in the Tower of Hanoi task ( < 0.001). No significant differences were observed in the number of movements. In contrast, the CG did not significantly improve after the reading session for any of the cognitive tasks ( > 0.05). Consequently, the EG recorded greater performance improvements than the CG in most cognitive tasks tested ( < 0.0001) after the intervention session.
DISCUSSION
These findings demonstrate that, irrespective to sex, a single aerobic exercise session on an ergocycle can improve cognitive function in patients with moderate AD. The results suggest that acute aerobic exercise enhances cognitive function similarly in both female and male patients, indicating promising directions for inclusive therapeutic strategies.
PubMed: 38903391
DOI: 10.3389/fspor.2024.1383119 -
Frontiers in Sports and Active Living 2024Professional athletes navigate a multitude of unique challenges associated to sport-specific factors (e.g., training, travel and competition) and non-sport factors...
BACKGROUND
Professional athletes navigate a multitude of unique challenges associated to sport-specific factors (e.g., training, travel and competition) and non-sport factors (e.g., performance pressure, stress and anxiety) that can interfere with healthy sleep behaviors. Sleep plays a key role in proper biopsychosocial development as well as short- and long-term biological, physical, psychological, and cognitive health. As poor sleep quality is known to impair proper brain function, this study aimed to investigate the effect of sleep quality on a professional athlete's ability to train, recover, and perform, as well as their overall emotional and physical well-being.
METHODS
A cohort study was performed in 40 professional male cricket athletes from the Dutch national cricket team (mean age 26.5 ± 5.1 years). The athletes were monitored across a 22 weeks in-season training period. Sleep quality and overall emotional and physical well-being were assessed using daily sleep diaries and questionnaires which scored the readiness to train, stress levels, fatigue, muscle soreness and flu symptoms respectively. Quality of sleep and subsequent association with the consecutive elements of the well-being questionnaire were assessed through statistical using the student -test and clinical differences with the methodology of Osoba and colleagues: <5% "no change", 5%-10% "little change"; 10%-20% "moderate change"; and >20% "very much change".
RESULTS
The results demonstrated that the professional athletes assessed their sleep quality as average with a mean score of 3.4 out of 5. Lower perceived quality of sleep (<75th percentile) was correlated with a decreased readiness to train (mean score 3.2 [IQR: 3.0-4.0] vs. 3.5 [IQR: 3.0-5.0]; < 0.001) and increased extent of muscle soreness (2.7 [IQR: 2.0-3.0] vs. 2.3 [IQR: 2-3]; < 0.001), stress level (mean score 2.3 [IQR: 2.0-3.0] vs. 1.9 [IQR: 1.0-2.0]; < 0.001) and perceived fatigue (mean score 2.9 [IQR: 2.0-3.0] vs. 2.3 [IQR: 2.0-3.0]; < 0.001). Likewise, in patients with lower perceived quality of sleep, the proportion of players presenting with flu symptoms increased over 4-fold (4.1% vs. 17%; < 0.001).
CONCLUSIONS
This study highlights that good sleep quality positively influences the overall emotional and physical well-being of professional athletes. Our results emphasize the importance of targeted sleep interventions to improve sleep quality and subsequently optimize psychological and physiological wellness.
PubMed: 38903388
DOI: 10.3389/fspor.2024.1389565 -
Frontiers in Sports and Active Living 2024Intermittent fasting (IF) represents a dietary intervention similar to caloric restriction, characterized by the strategic limitation of food consumption. Among the...
INTRODUCTION
Intermittent fasting (IF) represents a dietary intervention similar to caloric restriction, characterized by the strategic limitation of food consumption. Among the diverse array of practices for IF, Ramadan IF (RIF), a religious observance in Islam, mandates that healthy adult Muslims abstain from both food and drinks during daylight hours. In sports, researchers have extensively studied IF effects on health, including sleep and physical performance, but its impact on cognitive functions during RIF remains understudied. Therefore, this study was conducted to evaluate the influence of RIF on psychomotor and cognitive performance among young female athletes.
METHODS
To achieve this purpose, a cohort of 23 female handball players, aged 17.2 ± 0.5 years, participated in a series of six testing sessions: one conducted prior to Ramadan (R0), and others during the first (R1), second (R2), third (R3), and fourth (R4) weeks of Ramadan, followed by a session in the week after Ramadan (R5). Each session involved assessments using a Simple Reaction Time Test (SRT), Choice Reaction Time Test (CRT), Vigilance Test (VT), and Mental Rotation Test (MRT). Additionally, dietary intake, body composition, and Pittsburgh Sleep Quality Index (PSQI) scores were evaluated during these periods.
RESULTS AND DISCUSSION
The obtained data illustrated that there was a decrease in SRT, CRT, VT, and MRT performances during R1 in comparison to R0 (all < .001). This reduction was also observed in R2, R3, R4, and R5. Notably, during the fourth week of Ramadan (R4), these cognitive and psychomotor parameters were significantly lower than during the earlier weeks (R1, R2, R3; all < .001). Furthermore, a gradual decrease in total PSQI scores, sleep quality, and sleep duration was observed throughout the Ramadan period, reaching the lowest levels during R4. These findings illustrate that RIF has a significantly detrimental impact on neuromuscular and cognitive abilities as well as sleep quality in young female athletes. The study also highlights a fluctuating pattern in cognitive function across the four weeks of Ramadan, with the most pronounced decline observed during the final week of fasting illustrating the importance of conducting similar studies on normal individuals from both genders with larger sample size.
PubMed: 38903387
DOI: 10.3389/fspor.2024.1362066 -
Health Psychology Research 2024Executive function impairments are among the most common dialysis side effects. The present study aims to compare the efficiency of transcranial Direct Current...
A Comparison between the Effectiveness of computerized Cognitive Rehabilitation Training and transcranial Direct Current Stimulation on Dialysis Patients' Executive Functions.
PURPOSE
Executive function impairments are among the most common dialysis side effects. The present study aims to compare the efficiency of transcranial Direct Current Stimulation (tDCS) with computerized Cognitive Rehabilitation Training (cCRT) on dialysis patients' executive functions.
RESEARCH METHOD
The present study, a quasi-experimental effort, adopted a pre-test/post-test method that included a control (sham) group.
DESIGN
The study sample consisted of 30 participants, selected through the convenience sampling method, and categorized into three groups of cCRT, tDCS, and sham participants. The cCRT participants were asked to complete 8 tasks in Captain's Log MindPower Builder software. The tDCS participants were treated with a 0.06 mA/cm2 current with the anodal electrode on F3 and the cathodal electrode on Fp2. For the sham participants, the electrodes were put on the same regions but there was no current stimulation. The treatment lasted for 10 sessions carried out every other day.
RESULTS
The results of MANCOVA showed no significant difference between the sham group and the cCRT group in any of the executive function items. . However, between the sham group and the tDCS group was detected a significant difference in spatial working memory (p \< 0.05) and a marginally significant in cognitive flexibility (p = 0.091). No significant difference was reported between cCRT and tDCS groups in any item.
CONCLUSION
According to the findings of the study, given the efficacy of tDCS on spatial working memory and cognitive flexibility for dialysis patients, it can be used to improve these skills.
PubMed: 38903127
DOI: 10.52965/001c.118447 -
Scientific Reports Jun 2024Hearing problems are commonly diagnosed with the use of tonal audiometry, which measures a patient's hearing threshold in both air and bone conduction at various...
Hearing problems are commonly diagnosed with the use of tonal audiometry, which measures a patient's hearing threshold in both air and bone conduction at various frequencies. Results of audiometry tests, usually represented graphically in the form of an audiogram, need to be interpreted by a professional audiologist in order to determine the exact type of hearing loss and administer proper treatment. However, the small number of professionals in the field can severely delay proper diagnosis. The presented work proposes a neural network solution for classification of tonal audiometry data. The solution, based on the Bidirectional Long Short-Term Memory architecture, has been devised and evaluated for classifying audiometry results into four classes, representing normal hearing, conductive hearing loss, mixed hearing loss, and sensorineural hearing loss. The network was trained using 15,046 test results analysed and categorised by professional audiologists. The proposed model achieves 99.33% classification accuracy on datasets outside of training. In clinical application, the model allows general practitioners to independently classify tonal audiometry results for patient referral. In addition, the proposed solution provides audiologists and otolaryngologists with access to an AI decision support system that has the potential to reduce their burden, improve diagnostic accuracy, and minimise human error.
Topics: Humans; Audiometry, Pure-Tone; Neural Networks, Computer; Female; Male; Hearing Loss; Adult; Middle Aged; Hearing Loss, Sensorineural; Hearing Loss, Conductive
PubMed: 38902305
DOI: 10.1038/s41598-024-64310-2 -
JMIR Rehabilitation and Assistive... Jun 2024Impaired cognitive function is observed in many pathologies, including neurodegenerative diseases such as Alzheimer disease. At present, the pharmaceutical treatments...
BACKGROUND
Impaired cognitive function is observed in many pathologies, including neurodegenerative diseases such as Alzheimer disease. At present, the pharmaceutical treatments available to counter cognitive decline have only modest effects, with significant side effects. A nonpharmacological treatment that has received considerable attention is computerized cognitive training (CCT), which aims to maintain or improve cognitive functioning through repeated practice in standardized exercises. CCT allows for more regular and thorough training of cognitive functions directly at home, which represents a significant opportunity to prevent and fight cognitive decline. However, the presence of assistance during training seems to be an important parameter to improve patients' motivation and adherence to treatment. To compensate for the absence of a therapist during at-home CCT, a relevant option could be to include a virtual assistant to accompany patients throughout their training.
OBJECTIVE
The objective of this exploratory study was to evaluate the interest of including a virtual assistant to accompany patients during CCT. We investigated the relationship between various individual factors (eg, age, psycho-affective functioning, personality, personal motivations, and cognitive skills) and the appreciation and usefulness of a virtual assistant during CCT. This study is part of the THERADIA (Thérapies Digitales Augmentées par l'Intelligence Artificielle) project, which aims to develop an empathetic virtual assistant.
METHODS
A total of 104 participants were recruited, including 52 (50%) young adults (mean age 21.2, range 18 to 27, SD 2.9 years) and 52 (50%) older adults (mean age 67.9, range 60 to 79, SD 5.1 years). All participants were invited to the laboratory to answer several questionnaires and perform 1 CCT session, which consisted of 4 cognitive exercises supervised by a virtual assistant animated by a human pilot via the Wizard of Oz method. The participants evaluated the virtual assistant and CCT at the end of the session.
RESULTS
Analyses were performed using the Bayesian framework. The results suggest that the virtual assistant was appreciated and perceived as useful during CCT in both age groups. However, older adults rated the assistant and CCT more positively overall than young adults. Certain characteristics of users, especially their current affective state (ie, arousal, intrinsic relevance, goal conduciveness, and anxiety state), appeared to be related to their evaluation of the session.
CONCLUSIONS
This study provides, for the first time, insight into how young and older adults perceive a virtual assistant during CCT. The results suggest that such an assistant could have a beneficial influence on users' motivation, provided that it can handle different situations, particularly their emotional state. The next step of our project will be to evaluate our device with patients experiencing mild cognitive impairment and to test its effectiveness in long-term cognitive training.
PubMed: 38901017
DOI: 10.2196/48129