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Positive psychiatry offers an unique approach to promote brain health and well-being in aging populations. Minimal interventions through behavioral activation to promote wellness are increasingly available using self-guided apps, yet little is known about the effectiveness of app technology or the difference between clinician-supported behavioral activation versus self-guided app methodologies.
Investigate the difference in users and outcomes between two methods of the Fountain of Health (FoH) positive psychiatry intervention for behavioral activation to promote brain health and well-being: (1) clinician-assisted and (2) independent app use for behavioral self-management.
Design and setting:
As part of a larger knowledge translation intervention in positive psychiatry, two specific methods of a behavioral activation intervention were retrospectively compared.
Two subsets of patients were compared; 254 clinician-assisted patients; 333 independent app users.
A minimal positive psychiatry intervention in frontline care using the FoH health and behavior change clinical tools
Main outcomes were changes in psychological (health and resilience, well-being scores) and behavioral indices (goal attainment, items of goal SMART-ness). User profiles (age, sex and completion rates) were also compared.
Clinician-assisted patients were more likely to be male, older, and have lower health and resilience scores at baseline. Clinician-assisted patients had notably higher completion rates (99.2% vs. 10.8%). Psychological outcomes (improved health and resilience, and well-being) were similar regardless of intervention method for those who completed the intervention. Behavioral outcomes revealed clinician-assisted patients set goals that better adhered to key goal-setting items.
Clinician–patient relationships appear to be an important factor for intervention completion and behavioral outcomes, while further exploration of best practices for intervention completion using health apps in clinical practice is needed. A preliminary goal-setting methodology for effective behavioral activation, to promote brain health and wellness, is given.
San José 520 is a Classic period hamlet of single-family residences in the urban periphery of Teotihuacan, just beyond the southeast edge of the city. Three burial features were associated with one of the residences, AF2. One of the features contained the burial of a single adult, another the successive burials of eight adults and one neonate, and the third held a neonate. We analyzed 29 bone and enamel samples from the adults for bioapatite phosphate oxygen-isotope composition; we also considered isotopic data for another five bone samples analyzed in a separate project. The isotopic results suggest a pattern of birth in the Teotihuacan region and then movement in early childhood to a “relocation” region, the geographic location of which is unknown. Later, probably in adolescence, the individuals returned to live, and eventually die, in San José 520. Without knowing more about the occupation of the relocation region, it is difficult to say what concerns or beliefs underlay this unusual but long-established settlement system.
Cognitive neuroscientists have started to uncover the neural substrates, systems, and mechanisms enabling us to prioritize the processing of certain sensory information over other, currently less-relevant, inputs. However, there is still a large gap between the knowledge generated in the laboratory and its application to real-life problems of attention as when, for example, interface operators are multi-tasking. In this Element, laboratory studies on crossmodal attention (both behavioural/psychophysical and cognitive neuroscience) are situated within the applied context of driving. We contrast the often idiosyncratic conditions favoured by much of the laboratory research, typically using a few popular paradigms involving simplified experimental conditions, with the noisy, multisensory, real-world environments filled with complex, intrinsically-meaningful stimuli. By drawing attention to the differences between basic and applied studies in the context of driving, we highlight a number of important issues and neglected areas of research as far as the study of crossmodal attention is concerned.
Continuing isotopic investigation of the sacrificial burials and trophies beneath the Feathered Serpent Pyramid (Temple of Quetzalcoatl) in ancient Teotihuacan, Mexico, has produced new results. Isotopic proveniencing using bioapatite strontium and structural carbonate oxygen isotopes in tooth enamel was applied to 39 samples, 24 from the sacrificial victims and 15 from the trophy jaws. Both the strontium and oxygen isotope ratios suggest that most or all of the sacrificial victims came from the central highlands of Mexico, which includes the area of Teotihuacan. In this sense, we find somewhat less multiethnicity represented among the military at Teotihuacan than previously thought. Analysis of carbon isotope ratios in enamel structural carbonate indicated a childhood diet dominated by maize, relatively homogeneous among the victims at the pyramid, and typical for much of pre-Hispanic Mesoamerica.
‘Munchausen's syndrome by proxy’ characteristically describes women alleged to have fabricated or induced illnesses in children under their care, purportedly to attract attention. Where conclusive evidence exists the condition's aetiology remains speculative, where such evidence is lacking diagnosis hinges upon denial of wrong-doing (conduct also compatible with innocence). How might investigators obtain objective evidence of guilt or innocence? Here, we examine the case of a woman convicted of poisoning a child. She served a prison sentence but continues to profess her innocence. Using a modified fMRI protocol (previously published in 2001) we scanned the subject while she affirmed her account of events and that of her accusers. We hypothesized that she would exhibit longer response times in association with greater activation of ventrolateral prefrontal and anterior cingulate cortices when endorsing those statements she believed to be false (i.e., when she ‘lied’). The subject was scanned 4 times at 3 Tesla. Results revealed significantly longer response times and relatively greater activation of ventrolateral prefrontal and anterior cingulate cortices when she endorsed her accusers' version of events. Hence, while we have not ‘proven’ that this subject is innocent, we demonstrate that her behavioural and functional anatomical parameters behave as if she were.
The aim of this study was to examine the relationship between nurses’ exposure to workplace bullying and PTSD symptomology and the protective role of intrapersonal resources (psychological capital).
Workplace bullying has serious organizational and health effects in healthcare which threaten the quality of patient care. Few studies have examined the relation of workplace bullying to serious mental health outcomes, such as PTSD. In addition, the buffering effect of intrapersonal resources to protect nurses from effects of workplace bullying has not been studied.
A provincial survey of hospital nurses (n = 1205) was conducted to study the relationship between workplace bullying and PTSD and whether intrapersonal resources (Psycap) influenced this relationship. Nurses completed 3 standardized measures of bullying, PTSD, and Psycap.
A moderated regression analysis revealed that more frequent exposure to workplace bullying was significantly related to PTSD symptomology (R2 = .38). Psycap was not a significant moderator. Bullying exposure and Psycap were significant independent predictors of PTSD symptoms (β = .52 and -.21, respectively).
Workplace bullying appears to have a positive relationship with PTSD, a serious mental health outcome. This effect was not mitigated by Psycap, posited to be a protective against workplace stressors. This suggests that workplace bullying is a serious threat to nurses’ health requiring attention of hospital management.
We evaluated a cohort of 35 children diagnosed with long QT syndrome, catecholaminergic polymorphic ventricular tachycardia, hypertrophic cardiomyopathy, or arrhythmogenic right ventricular cardiomyopathy with regard to physical and psychosocial well-being.
Material and Methods:
Patients wore an accelerometer to record their time involved in moderate- to vigorous-intensity physical activity and completed the Pediatric Quality of Life Inventory and the Pediatric Cardiac Quality of Life Inventory. Parents were also asked to describe if their child had changed their physical activity because of their diagnosis and how difficult and upsetting it was for the child to adapt to the physical activity recommendations.
Patients were involved in less moderate- to vigorous-intensity physical activity per day (35 min/day versus 55 min/day) and had lower Pediatric Quality of Life Inventory total health scores (79 versus 84) compared to normative data. Overall, 51% of the cohort modified their physical activity in some way because of their diagnosis and changing physical activity was associated with lower Pediatric Quality of Life Inventory and Pediatric Cardiac Quality of Life Inventory scores.
Our cohort was involved in less moderate- to vigorous-intensity physical activity and had lower Pediatric Quality of Life Inventory total health scores compared to normative paediatric data. Modifying one’s physical activity was associated with worse health-related quality of life scores, highlighting a vulnerable sub-group of children. These findings are useful for families and healthcare professionals caring for children who are adjusting to a new cardiac diagnosis of an inherited arrhythmia or cardiomyopathy.
To propose a new anthropometric index that can be employed to better predict percent body fat (PBF) among young adults and to compare with current anthropometric indices.
All measurements were taken in a controlled laboratory setting in Seoul (South Korea), between 1 December 2015 and 30 June 2016.
Eighty-seven young adults (18–35 years) who underwent dual-energy x-ray absorptiometry (DXA) were used for analysis. Multiple regression analyses were conducted to develop a body fat index (BFI) using simple demographic and anthropometric information. Correlations of DXA measured PBF (DXA_PBF) with previously developed anthropometric indices and the BFI were analysed. Receiver operating characteristic curve analyses were conducted to compare the ability of anthropometric indices to identify obese individuals.
BFI showed a strong correlation with DXA_PBF (r = 0·84), which was higher than the correlations of DXA_PBF with the traditional (waist circumference, r = 0·49; waist to height ratio, r = 0·68; BMI, r = 0·36) and alternate anthropometric indices (a body shape index, r = 0·47; body roundness index, r = 0·68; body adiposity index, r = 0·70). Moreover, the BFI showed higher accuracy at identifying obese individuals (area under the curve (AUC) = 0·91), compared with the other anthropometric indices (AUC = 0·71–0·86).
The BFI can accurately predict DXA_PBF in young adults, using simple demographic and anthropometric information that are commonly available in research and clinical settings. However, larger representative studies are required to build on our findings.
Diet modifies the risk of colorectal cancer (CRC), and inconclusive evidence suggests that yogurt may protect against CRC. We analysed the data collected from two separate colonoscopy-based case–control studies. The Tennessee Colorectal Polyp Study (TCPS) and Johns Hopkins Biofilm Study included 5446 and 1061 participants, respectively, diagnosed with hyperplastic polyp (HP), sessile serrated polyp, adenomatous polyp (AP) or without any polyps. Multinomial logistic regression models were used to derive OR and 95 % CI to evaluate comparisons between cases and polyp-free controls and case–case comparisons between different polyp types. We evaluated the association between frequency of yogurt intake and probiotic use with the diagnosis of colorectal polyps. In the TCPS, daily yogurt intake v. no/rare intake was associated with decreased odds of HP (OR 0·54; 95 % CI 0·31, 0·95) and weekly yogurt intake was associated with decreased odds of AP among women (OR 0·73; 95 % CI 0·55, 0·98). In the Biofilm Study, both weekly yogurt intake and probiotic use were associated with a non-significant reduction in odds of overall AP (OR 0·75; 95 % CI 0·54, 1·04) and (OR 0·72; 95 % CI 0·49, 1·06) in comparison with no use, respectively. In summary, yogurt intake may be associated with decreased odds of HP and AP and probiotic use may be associated with decreased odds of AP. Further prospective studies are needed to verify these associations.
The association of MeHg exposure through fish consumption on human autoimmunity remains unclear. Fish also contain n-3 long chain polyunsaturated fatty acids (LCPUFA) that are known to regulate inflammation and mitigate autoimmune disease symptoms. We studied the association of low-level exposure to methylmercury (MeHg) through fish consumption in the SCDS. We examined this association at age 19 years in the SCDS Main Cohort (n = 497). We measured MeHg exposure at 3 time points [prenatal, weighted average (6 months to 19 years) and concurrent (19 years) and LCPUFA status and a panel of 13 autoimmune markers at age 19 years. The autoimmune markers included antinuclear antibodies (ANA), anti-dsDNA and anti-RNP, and total (non-specific) immunoglobulins (Ig) IgG, IgA, and IgM. A combined ANA variable was also calculated based on being within or above reference range for any of the ANA markers; 56% of the subjects met this criterion. Multivariable regression models adjusted for prenatal MeHg, sex and waist circumference, with and without adjustment for LCPUFA, were fit for the three MeHg exposure metrics and each immune marker. Mean (SD) prenatal, weighted average and concurrent MeHg was 6.84 (4.55), 7.46 (2.82), and 10.23 (6.02) ppm, respectively. Combined ANA was positively associated with concurrent MeHg following adjustment for the n6:n3 LCPUFA ratio (β = 0.036, 95%; CI: 0.001, 0.073). Prenatal and average MeHg exposures were not significantly associated with any individual ANA. IgM was negatively associated with concurrent (β = -0.016, 95%CI: -0.016, -0.002), and average (β = -0.042, 95%CI: -0.042, -0.009) MeHg exposure in the models adjusted for n-3, n-6 LCPUFA and when separately adjusted for the n6:n3 LCPUFA ratio. Total (19-year) n-3 PUFA status was negatively associated with anti-RNP (β = -20.355, 95%CI: -36.89, -4.34) and IgG (β = -1.384, 95%CI: -2.682, -0.087). Total n-3 LCPUFA was associated with lower markers of autoimmunity. MeHg exposure at 19 years was associated with higher ANA and lower IgM but only following adjustment for LCPUFA. The clinical significance of these findings is unclear and further research is warranted to determine if these associations precede autoimmune disease development.
A previous study has demonstrated that when people thought they were eating a low-calorie milkshake (versus a high-calorie labelled equivalent though same product) their physiological satiety, as measured by the gut peptide ghrelin, was consistent with what they believed they were consuming rather than the actual nutritional content (Crum et al., 2011). If replicated and shown for different food types, this finding could have implications for nutrient and health claims labelling and advertising. The aim of the study was to examine whether satiation (self-reported and physiological) varies depending on the mindset in which one approaches food consumption. On two separate visits (1 week between), participants (n = 50) were asked to consume a 380-calorie yoghurt and granola breakfast product under the pretence that it was either a 500-calorie ‘indulgent’ breakfast (high in fat and sugar) or a 250-calorie ‘sensible’ breakfast (low in fat and sugar). At each visit blood samples were collected at three timepoints to measure acylated ghrelin: after a 20-minute rest period (baseline), after 60-minutes (pre-consumption) and after 90-minutes (post-consumption). Self-reported appetite scales were completed 10 minutes prior to each blood sample. During the first interval (between 20 and 60 minutes) participants rated the breakfast label's appearance and perceived healthiness, and during the second interval (between 60 and 90 minutes) participants consumed the breakfast product while rating its sensory appeal. Participants (mean [SD]: 30.1 [10.4] yrs.) rated the ‘indulgent’ breakfast as more appealing than the ‘sensible’ breakfast (mean difference: 5.00 [95% CI: 0.71, 9.30]; P = 0.024), but felt less healthy when consuming the ‘indulgent’ breakfast (mean difference: -13.17 [95% CI: -18.75, -7.60]; P < 0.001). The breakfasts were not rated differently according to their taste, smell, overall palatability and enjoyment. Participants reported a higher mean change in self-reported fullness for the ‘indulgent’ breakfast than the ‘sensible’ breakfast from pre-consumption to post-consumption (mean difference: 7.19 [95% CI: -0.73, 13.6]; P = 0.030). This relationship was not observed between baseline and post-consumption, or for the other self-reported appetite measures (hunger, satiety, quantity and desire to eat). Mean change in acylated ghrelin was not significantly different between the breakfasts at any timepoint. This study demonstrated an increase in self-reported fullness after consuming the ‘indulgent’ breakfast compared to the ‘sensible’ breakfast despite the fact the two breakfast products were identical. A physiological response, however, was not observed.
How is partisan polarization affecting the modern administrative state. Research suggests that despite a polarized Congress and a (somewhat) polarized electorate, agency policy choices do not seem to be moving systematically toward the extremes. Some combination of moderating effects seem to be at work, including the effect of divided government on appointments, agency preferences driven by moderate statutory mandates and/or the norms of issue networks, and (at times) the influence of ideologically moderate presidents on the size of the gridlock interval. The Trump administration may represent a departure from these norms: conservatives in the Trump coalition may be freer to pursue policies disfavored by a majority because of populist loyalty to the administration. Regardless, polarization-induced congressional gridlock poses ongoing challenges for the administrative state. Agencies must address problems within their jurisdiction in the absence of congressional input, using statutes that may have been poorly designed for the purpose. Courts will continue to struggle, case by case, with the implications for the constitutional legitimacy of agency policymaking.