[Preventive early intervention strategies for neurodevelopmental disorders of high-risk infants]

Neurodevelopmental disorders in children have become a significant global public health concern, impacting child health worldwide. In China, the current intervention model for high-risk infants involves early diagnosis and early treatment. However, in recent years, overseas studies have explored novel preventive early intervention strategies for neurodevelopmental disorders in high-risk infants, achieving promising results. This article provides a comprehensive review of the optimal timing, methods, and intervention models of the preventive early intervention strategies for neurodevelopmental disorders in high-risk infants. The aim is to enhance the awareness and knowledge of healthcare professionals regarding preventive early intervention strategies for neurodevelopmental disorders in high-risk infants, facilitate clinical research and application of such interventions in China, and ultimately reduce the incidence of neurodevelopmental disorders in this high-risk population.

The genetics and disease mechanisms of rhegmatogenous retinal detachment

Rhegmatogenous retinal detachment (RRD) is a sight threatening condition that warrants immediate surgical intervention. To date, 29 genes have been associated with monogenic disorders involving RRD. In addition, RRD can occur as a multifactorial disease through a combined effect of multiple genetic variants and non-genetic risk factors. In this review, we provide a comprehensive overview of the spectrum of hereditary disorders involving RRD. We discuss genotype-phenotype correlations of these monogenic disorders, and describe genetic variants associated with RRD through multifactorial inheritance. Furthermore, we evaluate our current understanding of the molecular disease mechanisms of RRD-associated genetic variants on collagen proteins, proteoglycan versican, and the TGF-β pathway. Finally, we review the role of genetics in patient management and prevention of RRD. We provide recommendations for genetic testing and prophylaxis of at-risk patients, and hypothesize on novel therapeutic approaches beyond surgical intervention.

Engagement in a Preventive Intervention for Preadolescent Children in Foster Care: Considerations for Intervention Design

Engagement in mental health-focused preventive interventions is understudied. Demographic, child, and system-level predictors of engagement were explored in a study with children in foster care (N = 222, Mage = 10.3) who participated in a 30-week intervention. Attendance and engagement in mentor visits and skills groups were rated weekly. Only 4 of 21 predictors showed bivariate associations with attendance/engagement: child sex, IQ, behavior problems, and trauma symptoms. SEM models with these three variables and a measure of adverse childhood experience (ACEs), were used to develop a model of engagement. Males had poorer mentor visit and group engagement. Group attendance was positively associated with trauma symptoms and negatively associated with ACEs. Group engagement was associated with higher IQ and fewer behavior problems. A contextually-sensitive intervention can result in high engagement for a vulnerable and diverse population, yet a few child factors still impacted engagement, and when identified could be ameliorated.Trial Registration ClinicalTrials.gov, Identifiers: NCT00809315 & NCT00810056.

Social Support Coping for African American Adolescents: Effect of a Culturally Grounded Randomized Controlled Trial Intervention

The effect of the Adapted-Coping with Stress (A-CWS) intervention on social support coping was examined, using a randomized controlled trial design. The participants were 410 ninth-grade students (ages 14 to 16 years and mostly African American) living in low-resourced neighborhoods. Participants were randomly assigned 1:1 to either the A-CWS intervention or a standard care control condition. All participants were assessed at their schools before implementation of the intervention, at intervention completion, and again at 6- and 12-month post-intervention. Engagement in social support coping was examined in both intention-to-treat and treatment-as-received samples (i.e., intervention participants who attended at least 12 A-CWS treatment sessions and participants in the standard care control condition), using latent growth models. In intention-to-treat analyses, no significant treatment effects were identified. In treatment-as-received analyses, results revealed a significant association between social support coping and treatment condition; levels of social support coping decreased over time in the control condition, but they remained relatively stable in the treatment condition. The results indicate adequate intervention adherence and efficacy of the A-CWS to sustain social support coping within a sample of youth at high risk for stress exposure and associated disorders.Clinical Trial Registration: clinicaltrials.gov identifier: NCT0395445.

Study protocol: development and randomized controlled trial of a preventive blended care parenting intervention for parents with PTSD

BACKGROUND

Children of parents with post-traumatic stress disorder (PTSD) are at increased risk of adverse psychological outcomes. An important risk mechanism is impaired parental functioning, including negative parenting behavior, perceived incompetence, and lack of social support. Several parenting interventions for trauma-exposed parents and parents with psychiatric disorders exist, but none have specifically targeted parents with PTSD. Our objective is to evaluate the effectiveness of a blended care preventive parenting intervention for parents with PTSD.

METHODS

The intervention was adapted from an existing online intervention, KopOpOuders Self-Help. In co-creation with parents with PTSD and partners, the intervention was adapted into KopOpOuders-PTSD, by adding PTSD-specific content and three in-person-sessions with a mental health prevention professional. Effectiveness will be tested in a randomized controlled trial among N = 142 parents being treated for PTSD at Arkin Mental Health Care (control condition: treatment as usual, n = 71; intervention condition: treatment as usual + intervention, n = 71). Online questionnaires at pretest, posttest, and three-month follow-up and ecological momentary assessment at pretest and posttest will be used. Intervention effects on primary (parenting behavior) and secondary outcomes (perceived parenting competence, parental social support, parenting stress, child overall psychological problems and PTSD symptoms) will be analyzed using generalized linear mixed modeling. We will also analyze possible moderation effects of parental PTSD symptoms at pretest on primary and secondary outcomes.

DISCUSSION

This study protocol describes the randomized controlled trial of KopOpOuders-PTSD, a blended care preventive parenting intervention for parents with PTSD. Findings can contribute to understanding of the effectiveness of parenting support in clinical practice for PTSD.

TRIAL REGISTRATION

This protocol (Version 1) was registered on 11-02-2022 at ClinicalTrials.gov under identification number NCT05237999.

Substance use prevention during adolescence: Study protocol for a large-scale cluster randomized trial of Botvin High School LifeSkills Training

BACKGROUND

Concerns about the rise in adolescent vaping and cannabis use suggest the need for effective substance use prevention programs. Botvin LifeSkills Training (LST) has a strong evidence base at the middle school level for preventing or reducing tobacco use and related problems. A high school (grades 9-10) version of the LST program was also developed and shows promising initial evidence for reducing tobacco use in a single pilot study. However, the high school version of LST has not been sufficiently tested in an experimental trial, despite being widely implemented in high schools across the U.S. This paper outlines the study protocol for a large-scale cluster randomized trial of Botvin High School LST, with objectives of documenting the design of prospective research and promoting transparency.

METHODS

A total of 60 high schools in Colorado and Ohio were randomized to the 10-session, teacher-led intervention group (n = 33 schools) or business-as-usual control group (n = 27 schools). Across two cohorts of schools, 9th-grade students complete self-report surveys at pretest, immediate posttest, 1-year follow-up, and 21-month follow-up. Primary outcomes are tobacco (nicotine) use and cannabis use. Secondary outcomes are alcohol use, illicit drug use, psychosocial behaviors (e.g., violence and mental health), and academic achievement. Intent-to-treat analyses will use multilevel modeling to estimate intervention effects across assessment points.

CONCLUSION

This independent evaluation will help to determine whether the intervention is appropriate for large-scale adoption. This trial is preregistered with the Open Science Framework (https://osf.io/dnz5q/).

A Preventive Intervention to Reduce Risk of Online Grooming Among Adolescents

Sexual abuse of adolescents by adults on the Internet is a severe risk with negative consequences for the victims. However, there is an important gap in the development of preventive interventions to address this problem. This study evaluated the efficacy of a brief (less than one hour) educational intervention on online grooming (less than one hour) in reducing adolescents' sexual interaction behaviors with adults when they are sexually solicited. A sample of 856 Spanish adolescents (48% girls, ages 11-17 years) was randomized into two intervention conditions (educational intervention about online grooming and a resilience control intervention). Adolescents completed measures of online sexual solicitation by adults and sexualized interactions with adults at pretest and at three- and six-month follow-ups. Measures of their knowledge about online grooming were taken at pretest, postintervention, and at three- and six-month follow-ups. The results of multilevel analyses indicated that the intervention reduced sexualized interactions when adolescents were sexually solicited by adults (β = -.16, SD = .07, t = -2.44, p = .015). Moreover, the intervention increased adolescents' knowledge about online grooming over time (β = 1.95, SD = .19, t = 10.52, p < .001). These findings suggest that a brief educational intervention about online grooming may be a promising, low-cost intervention to reduce the risks of sexual abuse on the Internet.

Parent and Child Risk Profiles as Predictors of Response to a Conduct Problem Preventive Intervention

Current evidence-based prevention programming targeting child externalizing problems demonstrates modest overall effect sizes and is largely ineffective for a sizable proportion of youth who participate. However, our understanding of the youth and family characteristics associated with response to specific programming is quite limited. The current study used child and family risk profiles as predictors of response trajectories to the Early Risers conduct problem preventive intervention. A sample of 240 kindergarten-aged youth displaying elevated school-based aggression were randomized by school to either the Early Risers intervention or a control condition. Using a number of child and family risk variables, a latent profile analysis produced a solution consisting of five unique risk profiles. Three low and mixed risk profiles were associated with a limited response to the intervention. One high-risk profile characterized by maladaptive parenting and elevated child externalizing demonstrated notably improved trajectories of externalizing behavior over a 3-year period relative to the control condition. Another high-risk profile characterized by inconsistent discipline, high parental distress, and elevated child internalizing and externalizing symptoms seemed to have positive developmental trends disrupted by the intervention relative to the control condition, potentially consistent with an iatrogenic effect relative to the control condition. The study results support continued efforts to use broader risk profiles to examine heterogeneity in response to preventive interventions and, with replication, will have implications for intervention tailoring.

The Positive Effect of the Rational Addiction Prevention Program (RAPP) on Adolescents with High Risk for Drug Consumption

The aim of this longitudinal study was to determine the effect of an original prevention program (RAPP) on the behavioral and cognitive characteristics of adolescents with high risk for substance consumption. Seventy-six Mexican adolescents 12-15 years old (38 with high risk (HR) and 38 with low risk (LR)) were selected. RAPP was applied for 3 months. Resilience, social skills, attitudes towards substance use, ability to delay a reward, and inhibitory control were assessed in these adolescents, before and after the RAPP intervention. Both groups improved their scores; however, HR achieved greater changes than LR. Findings suggest that HR have behavioral characteristics that can be considered as risk factors for substance consumption (low levels of resilience, low social skills, little family support, positive attitudes towards substance use). RAPP proved to be an effective program for preventing these risk factors for substance use in adolescents.

A pilot randomized controlled trial of the shogi-assisted cognitive behavioral therapy (S-CBT) preventive stress management program

Background

Shogi is a traditional board game in Japan. A preventive stress management program based on Shogi-assisted cognitive behavioral therapy (S-CBT) was applied in the Japanese municipality of Kakogawa City. The study aimed to develop an S-CBT preventive stress management program for the elderly and determine its efficacy.

Methods

The participants were 67 elderly men with amateur-level Shogi skills. They were randomly assigned to either the S-CBT group (n = 33) or the waiting-list control group (n = 34). The S-CBT program was conducted over six 90-min sessions. The outcome measures were recorded using K6 instrument, the Japanese version of the abbreviated Lubben Social Network Scale, five items on cognitive behavioral functioning, and subjective well-being scale.

Results and conclusions

The dropout rates of the S-CBT group and waiting-list control groups were 36.4 and 44.1%, respectively. Effect sizes (Cohen’s d) and 95% confidence intervals (CIs) were calculated for each group. Domains that changed immediately after the S-CBT intervention were problem-solving skills, self-reinforcement, and negative automatic thoughts. Future research should promote mental and physical health through the design of intervention programs using familiar materials.

Trial registration

University Hospital Medical Information Network (UMIN CTR) UMIN000036003.

The development and application of a prediction model for postpartum depression: optimizing risk assessment and prevention in the clinic

BACKGROUND

Preventive intervention can significantly reduce the human and economic costs of postpartum depression (PPD) compared with treatment post-diagnosis. However, identifying women with a high PPD risk and making a judgement as to the benefits of preventive intervention is a major challenge.

METHODS

This is a retrospective study of parturients that underwent a cesarean delivery. Control group was used as development cohort and validation cohort to construct the risk prediction model of PPD and determine a risk threshold. Ketamine group and development cohort were used to verify the risk classification of parturients by evaluating whether the incidence of PPD decreased significantly after ketamine treatment in high-risk for PPD population.

RESULTS

The AUC for the development cohort and validation cohort of the PPD prediction model were 0.751 (95%CI:0.700-0.802) and 0.748 (95%CI:0.680-0.816), respectively. A threshold of 19% PPD risk probability was determined, with a specificity and sensitivity in the validation cohort are 0.766 and 0.604, respectively. After matching the high-risk group and the low-risk group by propensity score, the results demonstrated that PPD incidence significantly reduced in the high-risk group following ketamine, versus non-ketamine, intervention (p < 0.01). In contrast, intervention in the low-risk group showed no significant difference in PPD outcomes (p > 0.01).

LIMITATION

Randomized trials are needed to further verify the feasibility of the model and the thresholds proposed.

CONCLUSION

This prediction model developed in this study shows utility in predicting PPD risk. Ketamine intervention significantly lowers PPD incidence in parturients with a risk classification threshold greater than 19%.

Does a brief work-stress intervention prevent sick-leave during the following 24 months? A randomized controlled trial in Swedish primary care

BACKGROUND:

Work-related stress (WRS) presents a risk for sick leave. However, effective methods to identify people at risk for sick leave due to WRS at an early stage are lacking in primary health care.

OBJECTIVE:

To evaluate whether a systematic early identification of WRS can prevent sick leave over 24 months after the intervention.

METHODS:

Study participants (n = 132 intervention; n = 139 control) were employed, non-sick-listed persons seeking care at primary health care centres. The intervention included early identification of WRS by a validated instrument, general practitioner (GP) awareness supported by a brief training session, patients’ self-reflection by instrument completion, GP giving the patient feedback at consultation and GP identifying preventive measures. The control group received treatment as usual. Outcome data were retrieved from the Swedish Social Insurance Agency.

RESULTS:

The intervention group had less registered median sick leave days (n = 56) than the control group (n = 65) but the difference was not statistically significant.

CONCLUSIONS:

The brief intervention was not proven effective in preventing sick leave in the following 24 months compared to treatment as usual. Further research on how to identify, advice and treat those at high risk for sick leave in primary health care is needed.

Promoting Strong Latino Families Within an Emerging Immigration Context: Results of a Replication and Extension Trial of a Culturally Adapted Preventive Intervention

We conducted a randomized controlled trial (RCT) of Nuestras Familias: Andando Entre Culturas, a culturally adapted evidence-based parent management training (PMT) preventive intervention, with a sample of 241 Spanish-speaking Latino parents and their middle-school-aged children residing in an emerging immigration context. Scientifically rigorous studies of programs designed for this setting are rare. The intervention was designed to promote prosocial parenting practices and to prevent youth substance use and related problem behaviors. The RCT was designed as an extension and replication of a prior trial (Martinez & Eddy in Journal of Consulting and Clinical Psychology, 73, 841-851, 2005) which was also conducted in an emerging immigration context. Two key issues were of primary interest: intervention feasibility and intervention efficacy. Intervention feasibility was assessed through weekly session attendance, participation, and parent-reported session satisfaction as well as overall program satisfaction. Intervention efficacy was assessed by comparing changes within the intervention and control groups on parenting practices and youth adjustment from pre-intervention baseline to post-intervention termination 6 months later. Results provided support for the feasibility of delivering the intervention on a large scale within communities. Consistent with the prior trial, positive effects of the intervention were detected on parenting practices and on youth outcomes. Differential effects of the intervention were detected based on youth gender and nativity status, such that girls benefited the most with respect to tobacco use likelihood, and foreign-born youth benefited the most with respect to decreased depressive symptoms.Findings provide additional evidence for Nuestras Familias as an efficacious family-based intervention for Latino families within communities that are sites of emerging immigration in terms of both improving parenting practices and decreasing risk for youth substance use and related problem behaviors.

Digital mental health literacy -program for the first-year medical students' wellbeing: a one group quasi-experimental study

BACKGROUND

Medical students are prone to mental disorders, such as depression and anxiety, and their psychological burden is mainly related to their highly demanding studies. Interventions are needed to improve medical students' mental health literacy (MHL) and wellbeing. This study assessed the digital Transitions, a MHL program for medical students that covered blended life skills and mindfulness activities.

METHODOLOGY

This was a one group, quasi-experimental pretest-posttest study. The study population was 374 first-year students who started attending the medical faculty at the University of Turku, Finland, in 2018-2019. Transitions was provided as an elective course and 220 students chose to attend and 182 agreed to participate in our research. Transitions included two 60-minute lectures, four weeks apart, with online self-learning material in between. The content focused on life and academic skills, stress management, positive mental health, mental health problems and disorders. It included mindfulness audiotapes. Mental health knowledge, stigma and help-seeking questionnaires were used to measure MHL. The Perceived Stress Scale and General Health Questionnaire measured the students' stress and health, respectively. A single group design, with repeated measurements of analysis of variance, was used to analyze the differences in the mean outcome scores for the 158 students who completed all three stages: the pre-test (before the first lecture), the post-test (after the second lecture) and the two-month follow-up evaluation.

RESULTS

The students' mean scores for mental health knowledge improved (-1.6, 95% Cl -1.9 to -1.3, P<.001) and their emotional symptoms were alleviated immediately after the program (0.5, 95% Cl 0.0 to 1.1, P=.040). The changes were maintained at the two-month follow up (-1.7, 95% Cl -2.0 to -1.4, P<.001 and 1.0, 95% Cl 0.2 to 1.8, P=.019, respectively). The students' stress levels reduced (P=.022) and their attitudes towards help-seeking improved after the program (P<.001), but these changes were not maintained at the two-month follow up. The stigma of mental illness did not change during the study (P=.13).

CONCLUSIONS

The digital Transitions program was easily integrated into the university curriculum and it improved the students' mental health literacy and wellbeing. The program may respond to the increasing global need for universal digital services, especially during the lockdowns due to the COVID-19 pandemic.

TRIAL REGISTRATION

The trial was registered at the ISRCTN registry (26 May 2021), registration number 10.1186/ ISRCTN10565335 ).

[Analysis of the effect of preventive intervention on occupational exposure of nurses after tumor particle implantation in thoracic surgery]

Objective: To study the effect of preventive intervention on occupational exposure of nurses after tumor particle implantation in thoracic surgery. Methods: In March 2020, 99 nurses who were engaged in postoperative nursing of tumor particle implantation in thoracic surgery department of our hospital from February 2019 to February 2020 were selected as the research objects. According to different preventive interventions, they were divided into observation group (51 cases) and control group (48 cases) . The observation group received preventive intervention, while the control group received routine intervention. The differences of radiation dose, psychological state and abnormal rate of important organ function between the two groups were analyzed. Results: Compared with the control group, the radiation dose of the observation group was significantly less, and the scores of anxiety and depression were lower after the intervention, the difference were statistically significant (P<0.05) . There was no significant difference of the abnormal rate of important organ function between the two groups (P>0.05) . Conclusion: Preventive intervention can reduce the risk of occupational exposure and improve the psychological status of nurses after tumor particle implantation in thoracic surgery.

The Acid-Dependent and Independent Effects of Lactobacillus acidophilus CL1285, Lacticaseibacillus casei LBC80R, and Lacticaseibacillus rhamnosus CLR2 on Clostridioides difficile R20291

Clostridioides difficile infections (CDI) result from antibiotic use and cause severe diarrhea which is life threatening and costly. A specific probiotic containing Lactobacillus acidophilus CL1285, Lacticaseibacillus casei LBC80R, and Lacticaseibacillus rhamnosus CLR2 has demonstrated a strong inhibitory effect on the growth of several nosocomial C. difficile strains by production of antimicrobial metabolites during fermentation. Though there are several lactobacilli shown to inhibit C. difficile growth by processes relying on acidification, this probiotic has demonstrated potency for CDI prevention among hospitalized patients. Here, we describe the acid-dependent and independent mechanisms by which these strains impair the cytotoxicity of a hypervirulent strain, C. difficile R20291 (CD). These bacteria were co-cultured in a series of experiments under anaerobic conditions in glucose-rich and no-sugar medium to inhibit or stimulate CD toxin production, respectively. In glucose-rich medium, there was low CD toxin production, but sufficient amounts to cause cytotoxic damage to human fibroblast cells. In co-culture, there was acidification by the lactobacilli resulting in growth inhibition as well as ≥ 99% reduced toxin A and B production and no observable cytotoxicity. In the absence of glucose, CD produced much more toxin. In co-culture, the lactobacilli did not acidify the medium and CD growth was unaffected; yet, the amount of detected toxin A and B was decreased by 20% and 41%, respectively. Despite the high concentration of toxin, cells exposed to the supernatant from the co-culture were able to survive. These results suggest that in addition to known acid-dependent effects, the combination of L. acidophilus CL1285, L. casei LBC80R, and L. rhamnosus CLR2 can interfere with CD pathogenesis without acidification: (1) reduced toxin A and B production and (2) toxin neutralization. This might explain the strain specificity of this probiotic in potently preventing C. difficile-associated diarrhea in antibiotic-treated patients compared with other probiotic formulae.

The Role of Perspective Taking and Self-Control in a Preventive Intervention Targeting Childhood Disruptive Behavior

Prevention studies typically focus on outcome variables such as reductions in problem behavior, rather than targeted factors (e.g., cognitions), or the relation between change in targeted factors and outcomes. Therefore, the current study examined the effect of a targeted prevention program for childhood disruptive behavior on targeted factors (i.e., perspective taking and self-control) and associations between change in targeted factors and outcomes (i.e., aspects of disruptive behavior). The sample consisted of 173 children (Mage = 10.2 years) who were randomly assigned to an intervention condition (n = 70) or waitlist control condition (n = 103). Assessment took place at pre-, post- and follow-up measurements. For ethical considerations, follow-up data was not available for children on the waitlist. Findings revealed a direct intervention effect on self-control. From pre-test to follow-up, children who received the intervention improved in perspective taking and self-control. Moreover, improvements in self-control were associated with and predicted reductions in teacher-reported symptoms of oppositional defiant disorder. No associations were found between changes in perspective taking and disruptive behavior. These findings suggest that self-control may be an important target factor in reducing childhood disruptive behavior in targeted prevention.

EDDAMAP: efficient data-dependent approach for monitoring asymptomatic patient

Background

A pandemic affects healthcare delivery and consequently leads to socioeconomic complications. During a pandemic, a community where there lives an asymptomatic patient (AP) becomes a potential endemic zone. Assuming we want to monitor the travel and/or activity of an AP in a community where there is a pandemic. Presently, most monitoring algorithms are relatively less efficient to find a suitable solution as they overlook the continuous mobility instances and activities of the AP over time. Conversely, this paper proposes an EDDAMAP as a compelling data-dependent technique and/or algorithm towards efficient continuous monitoring of the travel and/or activity of an AP.

Methods

In this paper, it is assumed that an AP is infected with a contagious disease in which the EDDAMAP technique exploits a GPS-enabled mobile device by tagging it to the AP along with its travel within a community. The technique further examines the Spatio-temporal trajectory of the AP to infer its spatial time-bounded activity. The technique aims to learn the travels of the AP and correlates them to its activities to derive some classes of point of interests (POIs) in a location. Further, the technique explores the natural occurring POIs via modelling to identify some regular stay places (SP) and present them as endemic zones. The technique adopts concurrent object feature localization and recognition, branch and bound formalism and graph theory to cater for the worst error-guaranteed approximation to obtain a valid and efficient query solution and also experiments with a real-world GeoLife dataset to confirm its performance.

Results

The EDDAMAP technique proofs a compelling technique towards efficient monitoring of an AP in case of a pandemic.

Conclusions

The EDDAMAP technique will promote the discovery of endemic zones and hence some public healthcare facilities can rely on it to facilitate the design of patient monitoring system applications to curtail a global pandemic.

Preventive intervention for trauma reactions in young injured children: results of a multi-site randomised controlled trial

BACKGROUND

Young children are at particular risk for injury. Ten per cent to twenty-five per cent develop posttraumatic stress disorder (PTSD). However, no empirically supported preventive interventions exist. Therefore, this study evaluated the efficacy of a standardised targeted preventive intervention for PTSD in young injured children.

METHODS

Injured children (1-6 years) were enrolled in a multi-site parallel-group superiority prospective randomised controlled trial (RCT) in Australia and Switzerland. Screening for PTSD risk occurred 6-8 days postaccident. Parents of children who screened 'high-risk' were randomised to a 2-session CBT-based intervention or treatment-as-usual (TAU). Primary outcomes were PTSD symptom (PTSS) severity, and secondary outcomes were PTSD diagnosis, functional impairment and behavioural difficulties at 3 and 6 months postinjury using blinded assessments. Trials were registered with the Australian New Zealand Clinical Trials Registry (ACTRN12614000325606) and ClinicalTrials.gov (NCT02088814). Trial status is complete.

RESULTS

One hundred and thirty-three children screened 'high-risk' were assigned to intervention (n = 62) or TAU (n = 71). Multilevel intention-to-treat analyses revealed a significant intervention effect on PTSS severity over time (b = 60.06, 95% CI: 21.30-98.56). At 3 months, intervention children (M = 11.02, SD = 10.42, range 0-47) showed an accelerated reduction in PTSS severity scores compared to control children (M = 17.30, SD = 13.94, range 0-52; mean difference -6.97, 95% CI: -14.02 to 0.08, p adj. = .055, d = 0.51). On secondary outcomes, multilevel analyses revealed significant treatment effects for PTSD diagnosis, functional impairment and behavioural difficulties.

CONCLUSIONS

This multi-site RCT provides promising preliminary evidence for the efficacy of a targeted preventive intervention for accelerating recovery from PTSS in young injured children. This has important clinical implications for the psychological support provided to young children and parents during the acute period following a single-event trauma.

An early intervention to promote maternal sensitivity in the perinatal period for women with psychosocial vulnerabilities: study protocol of a randomized controlled trial

BACKGROUND

Maternal mental well-being and social circumstances during pregnancy and early childhood impact the child's well-being and development. Supportive and sensitive parenting is one of the strongest predictors of positive emotional, social and behavioral outcomes for the child. Knowledge is needed about how to detect and support vulnerable families already during pregnancy and in the postnatal period. The aim of this study is to assemble and evaluate an interdisciplinary cross-sectoral intervention to promote maternal sensitivity among women with psychological or social vulnerabilities.

METHODS/DESIGN

This randomized controlled trial tests the efficacy of an intervention program in the perinatal period compared to care as usual in enhancing maternal sensitivity in a group of psychologically or socially vulnerable women in the Capital Region of Denmark. The intervention consists of four components: 1) detecting symptoms of mental illness in vulnerable pregnant women and initiating treatment if indicated, 2) strengthening parenting skills using the Circle of Security Parenting program, 3) supporting breastfeeding, and 4) sharing knowledge and organizing treatment pathways for families across sectors. Seventy-six families will be randomly assigned to the intervention or care-as-usual. Data will be obtained at study inclusion at 3-5 months of pregnancy, eight weeks after childbirth, and nine months after childbirth. The primary outcome is maternal sensitivity. Secondary outcomes include infant's socio-emotional development, parents' mentalization, parental stress, depressive symptoms, and parental wellbeing. Qualitative data will provide insight into the implementation process.

DISCUSSION

This paper presents the rational and background for developing the intervention. Furthermore, the design and protocol of the randomized controlled trial. It is hypothesized that the intervention will be associated with positive changes in primary and secondary outcomes. If effective, the intervention will provide insights into prenatal risk profiles among an identified group of psychosocial vulnerable women important for early screening and point to effective preventive interventions that can support women in the perinatal period, increase maternal sensitivity and promote positive child development -starting before the child is born.

TRIAL REGISTRATION

ClinicalTrials.gov: ID: NCT03190707. Registered June 16, 2017.

Test of an Anxiety Sensitivity Amelioration Program for at-risk youth (ASAP-Y)

OBJECTIVE

Adult research supports the efficacy of targeting the malleable risk factor of anxiety sensitivity (AS) in preventing anxiety and related psychopathology. However, very little work has evaluated the impact of AS reduction among youth, which is unfortunate given adolescence is a "core risk" period in terms of disorder onset.

METHOD

The primary project aim was to test the effects of an Anxiety Sensitivity Amelioration Program for Youth (ASAP-Y) among a sample of 88 youth aged 10-14 years with elevated AS. High AS youth and a parent were randomly assigned to either the ASAP-Y, which consisted of psychoeducation and experimenter-led and parent-led exposures, or a general health information control condition.

RESULTS

Youth in the intervention condition sustained low AS levels across the intervention period, and although AS levels in both conditions decreased from baseline to the one-month assessment, this decrease was more pronounced at one-month for youth in the intervention condition. Further, significant indirect effects of condition on one-month anxiety and depression symptoms via reduced AS were detected. Homework compliance rates and self-report data support the acceptability of the ASAP-Y. Contrary to hypotheses, differences between conditions in emotional reactivity elicited using experimental psychopathology methods were not observed.

CONCLUSIONS

The current findings offer preliminary support for the ASAP-Y as an acceptable selective preventive intervention for at-risk youth, with specific anxiety- and depression-related effects through reduced AS.

Adaptation and implementation of the German social-emotional learning programme Papilio in Finland: A pilot study

This study investigated the cross-national adaptation and implementation of Papilio, a German social-emotional learning programme, in Finnish early childhood education and care (ECEC) centres. Papilio is a developmentally focused, scientifically based intervention programme focused on preventing behavioural problems and fostering social-emotional competence in children aged 3-7. The aim of this study was to investigate and evaluate the cross-national adaptation and cross-cultural adaptation and implementation of Papilio in the Finnish ECEC context. Results from qualitative interviews with one Finnish Papilio trainer, 11 early childhood education (ECE) teachers, two ECE special education teachers and two nursery nurses are supplemented with teachers' and nursery nurses' (N = 75) questionnaire data. Qualitative thematic analysis revealed that cultural adaptations were necessary on four levels: accommodation of materials, adaptation of the contents of the materials, structure and delivery. The materials and training contents were culturally adapted, whereas the delivery of the intervention was adapted according to Finnish ECEC practices. The structural adaptation included discarding timeout, due to opposition by some educators. The educators were committed to implementing the programme as instructed and resolving the practical difficulties they encountered. Their motivation to implement Papilio increased as they observed improvements in the children's social-emotional competence during intervention.

Promoting early autism detection and intervention in underserved communities: study protocol for a pragmatic trial using a stepped-wedge design

BACKGROUND

Despite the known benefits of early, specialized intervention for toddlers with Autism Spectrum Disorder (ASD), access to such intervention remains limited. This pragmatic trial examines a novel healthcare delivery model (Screen-Refer-Treat [SRT]), which capitalizes upon existing health care and early intervention (EI) infrastructure to increase community capacity for ASD detection and treatment before age 3, when it is likely to have the greatest impact. This model comprises three components: (1) universal use of Stage 1 ASD screening by primary care providers (PCPs) at 18-month well-child visits (i.e., Screen); (2) immediate referral of positive screens to a community-based EI program (i.e., Refer); and (3) provision of an inexpensive, evidence-based ASD-specialized treatment by EI providers, after verifying ASD risk with a Stage 2 screen (i.e., Treat). This paper describes our research design and the initial successes, challenges, and adaptations made during the early implementation phase.

METHOD/DESIGN

A stepped-wedge cluster RCT was used to implement the SRT model sequentially in four diverse Washington State counties ("clusters"). Counties are randomly assigned to the time of receipt of the SRT intervention, which comprises training workshops and technical assistance focused on the use of evidence-based ASD screening and intervention tools. Separate cohorts of families with toddlers (16-35 months old) with and without ASD concerns are recruited before and after the SRT intervention from participating PCP practices and EI programs. PCPs and EI providers complete measures on their screening, referral, and intervention practices before and after the SRT intervention. Each family cohort completes surveys about their well-being, parenting efficacy, health care satisfaction, and toddler's social-communicative behaviors.

CONCLUSION

This trial is the first of its kind to work simultaneously with two service delivery systems with the goal of improving early detection and treatment for ASD. Our approach was successful in attaining buy-in from PCPs and EI providers, building and maintaining partnerships with providers, and achieving high levels of retention and survey completion. Fostering provider engagement and problem-solving issues together as partners were integral to overcoming the main challenges. Numerous lessons have been learned thus far, which have applicability for implementation researchers in ASD and those in other fields.

TRIAL REGISTRATION

The registration number for this trial is NCT02409303 and it was posted on ClinicalTrials.gov on April 6, 2015.

Translating Prevention Research for Evidence-Based Policymaking: Results from the Research-to-Policy Collaboration Pilot

The importance of basing public policy on sound scientific evidence is increasingly being recognized, yet many barriers continue to slow the translation of prevention research into legislative action. This work reports on the feasibility of a model for overcoming these barriers-known as the Research-to-Policy Collaboration (RPC). The RPC employs strategic legislative needs assessments and a rapid response researcher network to accelerate the translation of research findings into usable knowledge for policymakers. Evaluation findings revealed that this model can successfully mobilize prevention scientists, engage legislative offices, connect policymakers and experts in prevention, and elicit congressional requests for evidence on effective prevention strategies. On average, the RPC model costs $3510 to implement per legislative office. The RPC can elicit requests for evidence at an average cost of $444 per request. The implications of this work, opportunities for optimizing project elements, and plans for future work are discussed. Ultimately, this project signals that the use of scientific knowledge of prevention in policymaking can be greatly augmented through strategic investment in translational efforts.

PROSPER Intervention Effects on Adolescents' Alcohol Misuse Vary by GABRA2 Genotype and Age

Preventive intervention effects on adolescent alcohol misuse may differ based on genotypes in gene-by-intervention (G x I) interactions, and these G x I interactions may vary as a function of age. The current study uses a novel statistical method, time-varying effect modeling (TVEM), to test an age-varying interaction between a single nucleotide polymorphism in the GABRA2 gene (rs279845) and a preventive intervention in predicting alcohol misuse in a longitudinal study of adolescents (ages 11-20). The preventive intervention was PROSPER, a community-based system for delivery of family and school programs selected from a menu of evidence-based interventions. TVEM results revealed a significant age-varying GABRA2 x intervention interaction from ages 12 to 18, with the peak effect size seen around age 13 (IRR = 0.50). The intervention significantly reduced alcohol misuse for adolescents with the GABRA2 TT genotype from ages 12.5 to 17 but did not reduce alcohol use for adolescents with the GABRA2 A allele at any age. Differences in intervention effects by GABRA2 genotype were most pronounced from ages 13 to 16-a period when drinking is associated with increased risk for alcohol use disorder. Our findings provide additional evidence that intervention effects on adolescent alcohol misuse may differ by genotype, and provide novel evidence that the interaction between GABRA2 and intervention effects on alcohol use may vary with age. Implications for interventions targeting adolescent alcohol misuse are discussed.

Mothers and Toddlers Exposed to Political Violence: Severity of Exposure, Emotional Availability, Parenting Stress, and Toddlers' Behavior Problems

This study examined the potential risks of maternal and child exposure to traumatic events resulting from political violence, specifically those related to emotional availability, parenting stress and children's behavioral problems. It also evaluated the feasibility of mitigating these effects through a play-based group intervention for conjoint dyads of mothers and toddlers. Results from 54 dyads show that the higher maternal and especially child exposure to political violence and other trauma, the lower their emotional availability in dyadic interactions (r = .40, p < .01). Emotional availability was associated with the mother's parenting stress, and both parenting stress and emotional availability were associated with the mother's perceptions of her child's behavior problems. Comparisons of observed emotional availability, child behavior problems as perceived by the mother, and reported stress in 28 dyads before and after participating in the intervention suggest that it may be possible to bolster emotional availability and to reduce child's behavior problems.

Variation in Response to Evidence-Based Group Preventive Intervention for Disruptive Behavior Problems: A View from 938 Coping Power Sessions

Prior research suggests that under some conditions, interventions that aggregate high-risk youth may be less effective, or at worse, iatrogenic. However, group formats have considerable practical utility for delivery of preventive interventions, and thus it is crucial to understand child and therapist factors that predict which aggressive children can profit from group intervention and which do not. To address these questions we video-recorded group Coping Power intervention sessions (938 sessions), coded both leader and participant behavior, and analyzed both leader and children's behaviors in the sessions that predicted changes in teacher and parent, reports of problem behavior at 1-year follow up. The sample included 180 high-risk children (69% male) who received intervention in 30 separate Coping Power intervention groups (six children assigned per group). The evidence-based Coping Power prevention program consists of 32 sessions delivered during the 4th and 5th grade years; only the child component was used in this study. The behavioral coding system used in the analyses included two clusters of behaviors for children (positive; negative) and two for the primary group leaders (group management; clinical skills). Growth spline models suggest that high levels of children's negative behaviors predicted increases in teacher and parent rated aggressive and conduct problem behaviors during the follow-up period in the three of the four models. Therapist use of clinical skills (e.g., warmth, nonreactive) predicted less increase in children's teacher-rated conduct problems. These findings suggest the importance of clinical training in the effective delivery of evidence-based practices, particularly when working with high-risk youth in groups.

Oxytocin Receptor Gene Variant Interacts with Intervention Delivery Format in Predicting Intervention Outcomes for Youth with Conduct Problems

Coping Power is an evidence-based preventive intervention program for youth with aggressive behavior problems that has traditionally been delivered in small group formats. Because of concerns about iatrogenic effects secondary to aggregation of high risk youth, the current study examined whether genetic risk may moderate intervention outcome when youth were randomly assigned to group versus individual formats of an intervention. The oxytocin receptor gene (OXTR) has been associated with social behavior and may influence susceptibility to social reinforcement in general and deviant peer influence in particular. One variant of OXTR (rs2268493) was examined in 197 fourth-grade African-American children (64% male) who were randomly assigned to Group Coping Power or Individual Coping Power (Lochman et al. 2015). Longitudinal assessments of teacher- and parent-reported behavior were collected through a 1-year follow-up. Growth curve analyses revealed a genotype by delivery format interaction. Youth with the A/A genotype demonstrated reductions in externalizing problems over the course of the intervention regardless of intervention format. In contrast, carriers of the G allele receiving the group-based intervention showed little improvement during the intervention and a worsening of symptoms during the follow-up year, while those receiving the individual format demonstrated reductions in externalizing problems. Given the associations between this OXTR variant and social bonding, carriers of the G allele may be more sensitive to social rewards from deviant peers in the group setting. This study suggests that genetic factors may be useful in predicting which type of intervention will be most effective for a particular individual.

Developmental Pathways of Youth Gang Membership: A Structural Test of the Social Development Model

As a result of nearly 40 years of research using a risk and protective factor approach, much is known about the predictors of gang onset. Little theoretical work, however, has been done to situate this approach to studying gang membership within a more comprehensive developmental model. Using structural equation modeling techniques, the current study is the first to test the capacity of the social development model (SDM) to predict the developmental pathways that increase and decrease the likelihood of gang membership. Results suggest that the SDM provides a good accounting of the social developmental processes at age 13 that are predictive of later gang membership. These findings support the promotion of a theoretical understanding of gang membership that specifies both pro- and antisocial developmental pathways. Additionally, as the SDM is intended as a model that can guide preventive intervention, results also hold practical utility for designing strategies that can be implemented in early adolescence to address the likelihood of later gang involvement. Three key preventive intervention points to address gang membership are discussed, including promoting efforts to enhance social skills, increasing the availability of prosocial opportunities and rewarding engagement in these opportunities, and reducing antisocial socialization experiences throughout the middle- and high school years.

The effects of Promoting Alternative Thinking Strategies Preschool Program on teacher-children relationships and children's social competence in Turkey

This quasi-experimental study examined the effects of the Promoting Alternative Thinking Strategies (PATHS) Preschool Program on the outcomes of children's social-emotional competence, perceived relationships between teacher and children and teachers' ability to create a positive classroom atmosphere. Two hundred and eighty five children (48-72 months) and teachers in Izmir participated in the intervention, and 280 children (48-72 months) and teachers participated as comparison group. Intervention teachers implemented PATHS in their classrooms. For data triangulation, multiple sources of data were collected in the study. Classrooms were observed using two different scales. Teacher rated students using another two different scales. Children were assessed with an interview to evaluate their perceptions of relationships. Intervention group teachers reported greater improvement of children's social-emotional skills, interpersonal relationship skills and emotion regulation. Furthermore, when observed intervention group children showed higher levels of pro-social behaviour, increased levels of compliance, better problem solving skills and more positive feelings. Intervention group children also described their relationships with their teachers as significantly more positively. Finally, intervention group teachers perceived more dependency in their relationships with children.

Factors associated with the implementation of the Familias Unidas intervention in a type 3 translational trial

This study highlights how Familias Unidas, a Hispanic-specific, evidence-based, family centered preventive intervention, progressed from intervention development (type 1 translation; T1) through rigorous evaluation (T2) and examines the role of intervention fidelity-adherence and competence-in a T3 trial. Effects of participant, provider, and organizational variables on direct (observational) and indirect (self-reported) fidelity were examined as were effects of fidelity. Two structural equation models were estimated using data from 367 Hispanic parent-adolescent dyads randomized to Familias Unidas. Facilitator perceptions of parental involvement in schools, school performance grade, and school socioeconomic status predicted indirect adherence ratings, which were positively related to adolescent substance use. Facilitator openness to evidence-based practices was associated with indirect competence ratings, school performance grade and size were associated with direct competence ratings, and direct competence ratings were negatively associated with substance use. Findings highlight unique contributions of direct and indirect fidelity ratings in the implementation of Familias Unidas.

Effects of Adolescent Universal Substance Misuse Preventive Interventions on Young Adult Depression Symptoms: Mediational Modeling

Depression symptoms are associated with impairments in functioning and have substantial health and economic consequences. Universal substance misuse prevention programs have shown effects on non-targeted mental health-related symptoms, but long-term effects are understudied. This cluster randomized controlled trial examined effects of both the LifeSkills Training (LST) and Strengthening Families Program: For Parents and Youth 10-14 (SFP 10-14) interventions, delivered during seventh grade, on age 22 young adult depression symptoms. The study was conducted in US rural Midwestern communities with a randomly-selected sample from a larger study (N = 670). Experimental conditions were LST+SFP 10-14, LST-only, and a control condition. Effects on age 22 depression symptoms were hypothesized as mediated through effects on age 21 relationship problems and illicit use of substances. Structural equation modeling with manifest and latent variables was conducted to test hypotheses; the intervention conditions were combined and compared with the control condition because analyses indicated a comparable pattern of effects between intervention conditions. Significant indirect intervention effects were found on age 22 depression symptoms via effects on the mediating variables (indirect effect: β = -0.06, 95 % CI [-0.10, -0.01], p = 0.011). Effect sizes for the young adult variables were between d = 0.17 and 0.29, which can be considered small, but nontrivial, especially in the context of public health benefits. Results support scaled-up implementation of school-based and family-focused universal substance misuse preventive interventions.

Short-Term Intervention Effects of the PATHS Curriculum in Young Low-Income Children: Capitalizing on Plasticity

Deficits in behavioral and cognitive regulation are prevalent in children reared in poverty relative to more affluent children due to the effects of adverse conditions on the developmental underpinnings of these skills. Despite evidence to suggest that these emergent processes are susceptible to environmental inputs, research documenting short-term intervention program influences on these regulatory domains in young impoverished children is limited. We sought to determine the proximal effects of a universal school-based intervention (the PATHS Curriculum) on social, emotional, relational, and cognitive outcomes in urban poor kindergarten children. Four schools in high-poverty neighborhoods with similar demographic characteristics were randomly assigned to either PATHS or an attentional control. Teacher-reported measures of behavior (e.g., attention, concentration, aggression), peer nominations (e.g., likability, aggression, acceptance), and tasks gauging inhibitory control were administered in the fall of kindergarten and again in the spring after one academic year (about 6 months) of PATHS. Children who received PATHS exhibited significantly greater improvements than control students across all teacher-rated behavioral measures of social competence (i.e., emotion regulation, prosocial behavior, peer relations) and behavioral problems (i.e., aggression, internalizing behaviors, impulsivity and hyperactivity) at post-test as well as improvements in motor inhibition. This line of research constitutes an important frontier for prevention research given the implications for improving ultimate outcomes for otherwise disadvantaged children.

Copenhagen infant mental health project: study protocol for a randomized controlled trial comparing circle of security -parenting and care as usual as interventions targeting infant mental health risks

BACKGROUND

Infant mental health is a significant public health issue as early adversity and exposure to early childhood stress are significant risk factors that may have detrimental long-term developmental consequences for the affected children. Negative outcomes are seen on a range of areas such as physical and mental health, educational and labor market success, social network and establishing of family. Secure attachment is associated with optimal outcomes in all developmental domains in childhood, and both insecure and disorganized attachment are associated with a range of later problems and psychopathologies. In disadvantaged populations insecure and disorganized attachment are common, which points to the need of identifying early risk and effective methods of addressing such problems. This protocol describes an experimental evaluation of an indicated group-based parental educational program, Circle of Security-Parenting (COS-P), currently being conducted in Denmark.

METHODS/DESIGN

In a parallel randomized controlled trial of two intervention groups this study tests the efficacy of COS-P compared to Care as Usual (CAU) in enhancing maternal sensitivity and child attachment in a community sample in the City of Copenhagen, Denmark. During the project a general population of an estimated 17.600 families with an infant aged 2-12 months are screened for two known infant mental health risks, maternal postnatal depression and infant social withdrawal. Eligible families (N = 314), who agree to participate, will be randomly allocated with a ratio of 2:1 into the COS-P intervention arm and into CAU. Data will be obtained at inclusion (baseline) and at follow-up when the child is 12-16 months. The primary outcome is maternal sensitivity. Secondary outcomes include quality of infant attachment, language, cognitive and socioemotional development, family functioning, parental stress, parental mentalizing and maternal mental wellbeing.

DISCUSSION

The potential implications of the experimental evaluation of an indicated brief group-based parenting educational program to enhance parental sensitivity and attachment are discussed.

TRIAL REGISTRATION

ClinicalTrials.govID: NCT02497677 . Registered July 15 2015.

PROSPER partnership delivery system: Effects on adolescent conduct problem behavior outcomes through 6.5 years past baseline

We report long-term effects of the PROSPER delivery system for universal evidence-based preventive interventions on adolescent conduct problem behaviors (CPBs). A cluster randomized trial included 28 school districts assigned to PROSPER or a control condition. Community-based teams in PROSPER condition school districts selected evidence-based interventions-a family-focused intervention in sixth grade and a school-based intervention the next year; follow-up assessments were conducted through 12th grade. CPBs were measured with 12 self-report items derived from the National Youth Survey. Intervention-control differences were tested via a multi-level Zero-Inflated Poisson (ZIP) model. Differences were significant from 9th through 12th grades; Relative Reduction Rates were between 10.1% and 14.5%. The intervention group was delayed in reaching a 10th grade reference level of CPBs by 10.7 months. Moderation analyses indicated stronger effects for early substance initiators. Findings suggest that the PROSPER delivery system has the potential to reduce CPBs in general populations.

Liver diseases revealed by ultrasonic examination: 2846 cases in 13681 healthy individuals

AIM: To investigate the incidence of liver diseases in a healthy population in order to enhance their awareness of health care.

METHODS: The ultrasonic images obtained during a physical examination for 13 681 persons over 35 years of age were retrospectively reviewed.

RESULTS: The incidences of main liver diseases found in this population were as follows: fatty liver (6.43%), gallbladder stone (6.27%), gallbladder polyps (3.78%), hepatic cyst (2.33%), liver cirrhosis (1.07%), hemangiomas (0.84%), liver cancer (0.07%), and other disease (8.80%).

CONCLUSION: Common liver diseases, even early-stage cancer, could be found by ultrasonic examination in a population for healthy examination. Ultrasound is easily performed and represents a non-invasive and fast procedure for screening of liver diseases.

The Pyramid Club Primary School-Based Intervention: Evaluating the Impact on Children's Social-Emotional Health

BACKGROUND

  Children with poor social-emotional health are at risk of failing to reach their potential.

METHOD

  The impact of the Pyramid Club year 3 preventive intervention on children's social-emotional health was investigated. Children were allocated to an intervention or non-problem comparison group.

RESULTS

  Post-intervention both groups had improved Total Difficulty scores (Strengths and Difficulties Questionnaire) with the Pyramid group showing a significantly stronger effect size (r = .71) than the non-problem comparison group (r = .44).

CONCLUSIONS

  The Pyramid Club intervention improves the social-emotional health of vulnerable children. The need to evaluate such interventions and to extend research are discussed.