A Nudge-Based Intervention to Reduce Problematic Smartphone Use: Randomised Controlled Trial

Problematic smartphone use is rising across the world. We tested an intervention with ten strategies that nudge users to reduce their smartphone use, for example by disabling non-essential notifications and changing their display to greyscale. Participants first completed baseline measures of smartphone use, well-being, and cognition before choosing which intervention strategies to follow for 2 to 6 weeks. Study 1 (N = 51) used a pre–post design while study 2 (N = 70) compared the intervention to a control group who monitored their screen time. Study 1 found reductions in problematic smartphone use, screen time, and depressive symptoms after 2 weeks. Study 2 found that the intervention reduced problematic smartphone use, lowered screen time, and improved sleep quality compared to the control group. Our brief intervention returned problematic smartphone use scores to normal levels for at least 6 weeks. These results demonstrate that various strategies can be combined while maintaining feasibility and efficacy

“Ready-to-use” two-week home exercise program targeting depressive symptoms: pilot study

Exercise is an evidence-based treatment for depressive symptoms, yet it often requires specialised knowledge, equipment, or professional supervision. Lay people in certain contexts, for example in remote locations or under pandemic restrictions, often lack these resources and thus cannot use exercise to manage their depressive symptoms. We developed a two-week home exercise program that bypasses these barriers and tested it in university students during pandemic restrictions. In an online study, we recruited 49 participants to complete a week of baseline symptom monitoring then follow the exercise program for 2 weeks (6 sessions) at home. The exercise program involved aerobic and resistance training; each session lasted approximately 45 min. After 2 weeks of the intervention, participants reported lower depressive (standardised β = −0.71 [−1.05, −0.38]) and anxiety (β = −0.87 [−1.19, −0.55]) symptoms. Although we cannot make causal conclusions, our results suggest that the brief home exercise program may have potential to reduce depressive symptoms in young adults

Imprinting: expanding the extra-pharmacological model of psychedelic drug action to incorporate delayed influences of sets and settings

BackgroundPsychedelic drug experiences are shaped by current-moment contextual factors, commonly categorized as internal (set) and external (setting). Potential influences of past environments, however, have received little attention.AimsTo investigate how previous environmental stimuli shaped the experiences of patients receiving ketamine for treatment-resistant depression (TRD), and develop the concept of “imprinting” to account for such time-lagged effects across diverse hallucinogenic drugs.MethodsRecordings of treatment sessions and phenomenological interviews from 26 participants of a clinical trial investigating serial intravenous ketamine infusions for TRD, conducted from January 2021 to August 2022, were retrospectively reviewed. A broad literature search was undertaken to identify potentially underrecognized examples of imprinting with both serotonergic and atypical psychedelics, as well as analogous cognitive processes and neural mechanisms.ResultsIn naturalistic single-subject experiments of a 28-year-old female and a 34-year-old male, subjective ketamine experiences were significantly altered by varying exposures to particular forms of digital media in the days preceding treatments. Higher levels of media exposure reduced the mystical/emotional qualities of subsequent psychedelic ketamine experiences, overpowering standard intention-setting practices and altering therapeutic outcomes. Qualitative data from 24 additional patients yielded eight further spontaneous reports of past environmental exposures manifesting as visual hallucinations during ketamine experiences. We identified similar examples of imprinting with diverse psychoactive drugs in past publications, including in the first-ever report of ketamine in human subjects, as well as analogous processes known to underly dreaming.Conclusions/interpretationPast environmental exposures can significantly influence the phenomenology and therapeutic outcomes of psychedelic experiences, yet are underrecognized and understudied. To facilitate future research, we propose expanding the contextual model of psychedelic drug actions to incorporate imprinting, a novel concept that may aid clinicians, patients, and researchers to better understand psychedelic drug effects.Clinical trial registrationClinicalTrials.gov, identifier NCT04701866

Mortality from gastrointestinal congenital anomalies at 264 hospitals in 74 low-income, middle-income, and high-income countries: a multicentre, international, prospective cohort study

Summary Background Congenital anomalies are the fifth leading cause of mortality in children younger than 5 years globally. Many gastrointestinal congenital anomalies are fatal without timely access to neonatal surgical care, but few studies have been done on these conditions in low-income and middle-income countries (LMICs). We compared outcomes of the seven most common gastrointestinal congenital anomalies in low-income, middle-income, and high-income countries globally, and identified factors associated with mortality. Methods We did a multicentre, international prospective cohort study of patients younger than 16 years, presenting to hospital for the first time with oesophageal atresia, congenital diaphragmatic hernia, intestinal atresia, gastroschisis, exomphalos, anorectal malformation, and Hirschsprung’s disease. Recruitment was of consecutive patients for a minimum of 1 month between October, 2018, and April, 2019. We collected data on patient demographics, clinical status, interventions, and outcomes using the REDCap platform. Patients were followed up for 30 days after primary intervention, or 30 days after admission if they did not receive an intervention. The primary outcome was all-cause, in-hospital mortality for all conditions combined and each condition individually, stratified by country income status. We did a complete case analysis. Findings We included 3849 patients with 3975 study conditions (560 with oesophageal atresia, 448 with congenital diaphragmatic hernia, 681 with intestinal atresia, 453 with gastroschisis, 325 with exomphalos, 991 with anorectal malformation, and 517 with Hirschsprung’s disease) from 264 hospitals (89 in high-income countries, 166 in middleincome countries, and nine in low-income countries) in 74 countries. Of the 3849 patients, 2231 (58·0%) were male. Median gestational age at birth was 38 weeks (IQR 36–39) and median bodyweight at presentation was 2·8 kg (2·3–3·3). Mortality among all patients was 37 (39·8%) of 93 in low-income countries, 583 (20·4%) of 2860 in middle-income countries, and 50 (5·6%) of 896 in high-income countries (p<0·0001 between all country income groups). Gastroschisis had the greatest difference in mortality between country income strata (nine [90·0%] of ten in lowincome countries, 97 [31·9%] of 304 in middle-income countries, and two [1·4%] of 139 in high-income countries; p≤0·0001 between all country income groups). Factors significantly associated with higher mortality for all patients combined included country income status (low-income vs high-income countries, risk ratio 2·78 [95% CI 1·88–4·11], p<0·0001; middle-income vs high-income countries, 2·11 [1·59–2·79], p<0·0001), sepsis at presentation (1·20 [1·04–1·40], p=0·016), higher American Society of Anesthesiologists (ASA) score at primary intervention (ASA 4–5 vs ASA 1–2, 1·82 [1·40–2·35], p<0·0001; ASA 3 vs ASA 1–2, 1·58, [1·30–1·92], p<0·0001]), surgical safety checklist not used (1·39 [1·02–1·90], p=0·035), and ventilation or parenteral nutrition unavailable when needed (ventilation 1·96, [1·41–2·71], p=0·0001; parenteral nutrition 1·35, [1·05–1·74], p=0·018). Administration of parenteral nutrition (0·61, [0·47–0·79], p=0·0002) and use of a peripherally inserted central catheter (0·65 [0·50–0·86], p=0·0024) or percutaneous central line (0·69 [0·48–1·00], p=0·049) were associated with lower mortality. Interpretation Unacceptable differences in mortality exist for gastrointestinal congenital anomalies between lowincome, middle-income, and high-income countries. Improving access to quality neonatal surgical care in LMICs will be vital to achieve Sustainable Development Goal 3.2 of ending preventable deaths in neonates and children younger than 5 years by 2030

Table_1_“Ready-to-use” two-week home exercise program targeting depressive symptoms: pilot study.pdf

Exercise is an evidence-based treatment for depressive symptoms, yet it often requires specialised knowledge, equipment, or professional supervision. Lay people in certain contexts, for example in remote locations or under pandemic restrictions, often lack these resources and thus cannot use exercise to manage their depressive symptoms. We developed a two-week home exercise program that bypasses these barriers and tested it in university students during pandemic restrictions. In an online study, we recruited 49 participants to complete a week of baseline symptom monitoring then follow the exercise program for 2 weeks (6 sessions) at home. The exercise program involved aerobic and resistance training; each session lasted approximately 45 min. After 2 weeks of the intervention, participants reported lower depressive (standardised β = −0.71 [−1.05, −0.38]) and anxiety (β = −0.87 [−1.19, −0.55]) symptoms. Although we cannot make causal conclusions, our results suggest that the brief home exercise program may have potential to reduce depressive symptoms in young adults.</p

Table_1_“Ready-to-use” two-week home exercise program targeting depressive symptoms: pilot study.DOCX

Exercise is an evidence-based treatment for depressive symptoms, yet it often requires specialised knowledge, equipment, or professional supervision. Lay people in certain contexts, for example in remote locations or under pandemic restrictions, often lack these resources and thus cannot use exercise to manage their depressive symptoms. We developed a two-week home exercise program that bypasses these barriers and tested it in university students during pandemic restrictions. In an online study, we recruited 49 participants to complete a week of baseline symptom monitoring then follow the exercise program for 2 weeks (6 sessions) at home. The exercise program involved aerobic and resistance training; each session lasted approximately 45 min. After 2 weeks of the intervention, participants reported lower depressive (standardised β = −0.71 [−1.05, −0.38]) and anxiety (β = −0.87 [−1.19, −0.55]) symptoms. Although we cannot make causal conclusions, our results suggest that the brief home exercise program may have potential to reduce depressive symptoms in young adults.</p

A nudge-based intervention to reduce problematic smartphone use: Randomised controlled trial

Problematic smartphone use is rising across the world. We tested an intervention with ten strategies that nudge users to reduce their smartphone use, for example by disabling non-essential notifications and changing their display to greyscale. Participants first completed baseline measures of smartphone use, well-being, and cognition before choosing which intervention strategies to follow for two to six weeks. Study 1 (N = 51) used a pre–post design while Study 2 (N = 70) compared the intervention to a control group who monitored their screen time. Study 1 found reductions in problematic smartphone use, screen time, and depressive symptoms after two weeks. Study 2 found that the intervention reduced problematic smartphone use, lowered screen time, and improved sleep quality compared to the control group. Our brief intervention returned problematic smartphone use scores to normal levels for at least six weeks. These results demonstrate that various strategies can be combined while maintaining feasibility and efficacy