Cognitive Behavioural Therapy for schizophrenia - outcomes for functioning, distress and quality of life : A meta-analysis

Background: The effect of cognitive behavioural therapy for psychosis (CBTp) on the core symptoms of schizophrenia has proven contentious, with current meta-analyses finding at most only small effects. However, it has been suggested that the effects of CBTp in areas other than psychotic symptoms are at least as important and potentially benefit from the intervention. Method: We meta-analysed RCTs investigating the effectiveness of CBTp for functioning, distress and quality of life in individuals diagnosed with schizophrenia and related disorders. Data from 36 randomised controlled trials (RCTs) met our inclusion criteria- 27 assessing functioning (1579 participants); 8 for distress (465 participants); and 10 for quality of life (592 participants). Results: The pooled effect size for functioning was small but significant for the end-of-trial (0.25: 95% CI: 0.14 to 0.33); however, this became non-significant at follow-up (0.10 [95%CI -0.07 to 0.26]). Although a small benefit of CBT was evident for reducing distress (0.37: 95%CI 0.05 to 0.69), this became nonsignificant when adjusted for possible publication bias (0.18: 95%CI -0.12 to 0.48). Finally, CBTp showed no benefit for improving quality of life (0.04: 95% CI: -0.12 to 0.19). Conclusions: CBTp has a small therapeutic effect on functioning at end-of-trial, although this benefit is not evident at follow-up. Although CBTp produced a small benefit on distress, this was subject to possible publication bias and became nonsignificant when adjusted. We found no evidence that CBTp increases quality of life post-intervention.Peer reviewedFinal Published versio

Weight loss attitudes and social forces in urban poor Black and White women

OBJECTIVE: To explore differences between Blacks and Whites in perceived influences on weight-related behaviors among obese urban poor women. METHODS: Participants (N = 27) received physician referrals to a weight loss program located in Federally Qualified Health Centers and either never attended or stopped attending. We conducted in-depth, in home interviews using a script informed by focus groups, pilot discussions, and the theory of planned behavior (TPB) to learn about participants' weight loss attitudes, social forces and perceived behavioral control. RESULTS: White women reported having more social support and social pressure for weight management activities. Black women reported eating for positive reasons whereas white women associated eating with negative emotions. CONCLUSION: Social networks and emotions may be critical factors in weight management and lifestyle program participation

Manipulating target size influences perceptions of success when learning a dart-throwing skill but does not impact retention

Positive feedback or experiences of success during skill acquisition have been shown to benefit motor skill learning. In this study, our aim was to manipulate learners’ success perceptions through a minor adjustment to goal criterion (target size) in a dart-throwing task. Two groups of novice participants practiced throwing at a large (easy) or a small (difficult) target from the same distance. In reference to the origin/centre of the target, the practice targets were alike in objective difficulty and indeed participants in both groups were not different in their objective practice performance (i.e. radial error from the centre). Although the groups experienced markedly different success rates, with the large target group experiencing more hits and reporting greater confidence (or self-efficacy) than the small target group, these practice effects were not carried into longer-term retention, which was assessed after a one-week delay. For success perceptions to moderate or benefit motor learning, we argue that unambiguous indicators of positive performance are necessary, especially for tasks where intrinsic feedback about objective error is salient

Reducing Physical Activity Disparities Among Vulnerable Minorities: Methods and Preliminary Outcomes

INTRODUCTION: Vulnerable minorities experience high rates of chronic disease. Physical Activity (PA) is an effective preventive behavior to mitigate multiple diseases. Vulnerable minorities have low PA participation. Finding ways to engage PA in vulnerable minorities is imperative. PURPOSE: To describe the baseline data from a community-based wait-list pilot PA trial for vulnerable minorities. METHOD: Forty-five participants from a Midwest urban community were randomized to an experimental (EXP) or wait-list control (WLC) group. EXP participants were counseled to engage in regular PA (>4d/wk for >30 mins). EXP participants received a fitness center membership, trainer, and on-site monthly education to help them develop exercise identity and habit formation. The WLC group could engage in PA if desired but did not have the same research resources. Both groups completed monthly surveys assessing exercise identity, social support, and habit formation. Baseline data included one week of moderate-to-vigorous PA (MVPA) and health-related fitness assessments (measured by accelerometry and fitness tests, respectively). CONCLUSIONS: Data show baseline measures did not vary between groups. Moreover, our team experienced difficulties recruiting vulnerable minorities. Participant-stated barriers to participation in our study included: 1) Schedule (work, child’s school, etc.) and conflicting life demands; 2) Fear of getting ill or getting immediate family ill (COVID, flus, etc.); 3) Disruption of routine (e.g., children going on school break); 4) The limited hours of the fitness center; 5) Inflation & rising costs of goods (e.g., gasoline, food, etc.); and 6) Issues interacting with PARCS staff, lack of trust. Next steps include reporting final outcomes and developing refined recruitment methods

Promoting ADL independence in vulnerable, community-dwelling older adults: a pilot RCT comparing 3-Step Workout for Life versus resistance exercise

BACKGROUND: Resistance exercise is effective to increase muscle strength for older adults; however, its effect on the outcome of activities of daily living is often limited. The purpose of this study was to examine whether 3-Step Workout for Life (which combines resistance exercise, functional exercise, and activities of daily living exercise) would be more beneficial than resistance exercise alone. METHODS: A single-blind randomized controlled trial was conducted. Fifty-two inactive, community-dwelling older adults (mean age =73 years) with muscle weakness and difficulty in activities of daily living were randomized to receive 3-Step Workout for Life or resistance exercise only. Participants in the 3-Step Workout for Life Group performed functional movements and selected activities of daily living at home in addition to resistance exercise. Participants in the Resistance Exercise Only Group performed resistance exercise only. Both groups were comparable in exercise intensity (moderate), duration (50-60 minutes each time for 10 weeks), and frequency (three times a week). Assessment of Motor and Process Skills, a standard performance test on activities of daily living, was administered at baseline, postintervention, and 6 months after intervention completion. RESULTS: At postintervention, the 3-Step Workout for Life Group showed improvement on the outcome measure (mean change from baseline =0.29, P=0.02), but the improvement was not greater than the Resistance Exercise Only Group (group mean difference =0.24, P=0.13). However, the Resistance Exercise Only Group showed a significant decline (mean change from baseline =-0.25, P=0.01) 6 months after the intervention completion. Meanwhile, the superior effect of 3-Step Workout for Life was observed (group mean difference =0.37, P<0.01). CONCLUSION: Compared to resistance exercise alone, 3-Step Workout for Life improves the performance of activities of daily living and attenuates the disablement process in older adults

Screening, referral, and participation in a weight management program implemented in five CHCs

Community health centers have the potential to lessen obesity. We conducted a retrospective evaluation of a quality improvement program that included electronic body mass index (BMI) screening with provider referral to an in-clinic lifestyle behavior change counselor with weekly nutrition and exercise classes. There were 26,661 adult patients seen across five community health centers operating the weight management program. There were 23,593 (88%) adult patients screened, and 12,487 (53%) of these patients were overweight or obese (BMI >or=25). Forty percent received a provider referral, 15.6% had program contact, and 2.1% had more than 10 program contacts. A mean weight loss of seven pounds was observed among those patients with more than 10 program contacts. No significant weight change was observed in patients with less contact. Achieving public health impact from guideline recommended approaches to CHC-based weight management will require considerable improvement in patient and provider participation

Comparison Between Dance-Based and Traditional Exercise on Health-Related Quality of Life: A Cross-Sectional Analysis

Health-related quality of life (HRQoL) includes physical health, cognitive well-being, and the presence of social support. Declines in HRQoL can result in physical impairment, social isolation, and impaired cognition. Regular exercise (EX) participation may lead to better HRQoL among older adults. Dance-oriented group fitness classes (DANCE) can provide participants with structured EX that involves high levels of coordination and social comradery. DANCE EX may be a viable alternative to traditional EX (TRAD) for the maintenance of HRQoL. PURPOSE: To determine whether participation in regular DANCE EX displays higher HRQoL in older adults when compared to those who participate in TRAD EX. METHODS: Twenty-nine older adults (age 69.8 ± 9.6 yrs; 28 females; 93.1% white) enrolled in a cross-sectional study examining those who either participated in DANCE EX or TRAD EX at the time of enrollment. All participants completed the following assessments: the Medical Outcomes Study Short Form 36 subscale for physical functioning (SF-36); the International Physical Activity Questionnaire (IPAQ); the Mini Mental State Examination (MMSE); the Duke Social Support Index (DSSI); and the Senior Fitness Test (SFT). RESULTS: A MANOVA test demonstrated a statistically significant difference in SFT scores between groups (F(2,29) = 3.11 p 0.05). Weekly MET-mins of moderate (DANCE: 2,487.7 ± 2,226.3, TRAD: 1,752.0 ± 1,734.5) and vigorous (DANCE: 2,870.8 ± 2,829.8, TRAD: 1,920.0 ± 3,301.5) physical activity did not differ between groups (p > 0.05). CONCLUSIONS: DANCE EX supported higher levels of physical health—and no effect on cognitive well-being and social support—when compared to TRAD EX. DANCE EX may be a viable form of EX to support HRQoL in older adults

Spatial analysis of borrow pits along the Platte River in south-central Nebraska, USA, in 1957 and 2016

The Central Platte River Valley (CPRV) of Nebraska provides critical habitat for wildlife, while serving agricultural, indus­trial, and other human uses. Mining of sand and gravel from the floodplain of the Platte River has supported construction of roads and other uses, and this extraction has created many borrow-pit ponds, lakes, and other small bodies of standing water (hereafter borrow-pits), further transforming riparian and prairie habitats. The objective of this study was to compare the abundance, size, and distribution of borrow pits before construction of Interstate 80 (1957) and at present (2016) from Lexington to Chapman, Nebraska, a length of river spanning about 146 km (90 mi) and sometimes referred to as the Big Bend Reach. Orthorectified aerial imagery of the Platte River was obtained for years 1957 and 2016, and we digitized the standing bodies of water within the floodplain in Arc­GIS. Total numbers of borrow pits and measures of pit shape were calculated and compared between floodplain regions where im­agery overlapped. From 1957 to 2016, the number of borrow pits increased from 300 to 786, total area occupied by pits expanded by 538%, and total shoreline of pits increased by 261%. In 2016, aerial imagery was available for a larger extent of the floodplain and contained a total of 1,062 borrow pits covering 16 km2 (6 mi2), with a total shoreline of 581 km (361 mi). For context, the Platte River channels’ approximate area was 45 km2 (17 mi2) and shoreline 1,582 km (983 mi) between Lexington and Chapman, Nebraska, in 2016. Results provide insight into historical and current presence, distribution, and shape of borrow pits along the Platte River, as well as serve as a reference point for future studies investigating regional landscape change and ecological effects of creating hun­dreds of borrow pits on the floodplain

Validity and reliability of the Self-Reported Physical Fitness (SRFit) survey

BACKGROUND: An accurate physical fitness survey could be useful in research and clinical care. PURPOSE: To estimate the validity and reliability of a Self-Reported Fitness (SRFit) survey; an instrument that estimates muscular fitness, flexibility, cardiovascular endurance, BMI, and body composition (BC) in adults ≥ 40 years of age. METHODS: 201 participants completed the SF-36 Physical Function Subscale, International Physical Activity Questionnaire (IPAQ), Older Adults' Desire for Physical Competence Scale (Rejeski), the SRFit survey, and the Rikli and Jones Senior Fitness Test. BC, height and weight were measured. SRFit survey items described BC, BMI, and Senior Fitness Test movements. Correlations between the Senior Fitness Test and the SRFit survey assessed concurrent validity. Cronbach's Alpha measured internal consistency within each SRFit domain. SRFit domain scores were compared with SF-36, IPAQ, and Rejeski survey scores to assess construct validity. Intraclass correlations evaluated test-retest reliability. RESULTS: Correlations between SRFit and the Senior Fitness Test domains ranged from 0.35 to 0.79. Cronbach's Alpha scores were .75 to .85. Correlations between SRFit and other survey scores were -0.23 to 0.72 and in the expected direction. Intraclass correlation coefficients were 0.79 to 0.93. All P-values were 0.001. CONCLUSION: Initial evaluation supports the SRFit survey's validity and reliability

Benefit-Cost Analysis of FEMA Hazard Mitigation Grants

Mitigation ameliorates the impact of natural hazards on communities by reducing loss of life and injury, property and environmental damage, and social and economic disruption. The potential to reduce these losses brings many benefits, but every mitigation activity has a cost that must be considered in our world of limited resources. In principle benefit-cost analysis (BCA) can be used to assess a mitigation activity’s expected net benefits (discounted future benefits less discounted costs), but in practice this often proves difficult. This paper reports on a study that refined BCA methodologies and applied them to a national statistical sample of FEMA mitigation activities over a ten-year period for earthquake, flood, and wind hazards. The results indicate that the overall benefit-cost ratio for FEMA mitigation grants is about 4 to 1, though the ratio varies according to hazard and mitigation type.