Cognitive Behavioral Therapy vs. Eye Movement Desensitization and Reprocessing for Treating Panic Disorder: A Randomized Controlled Trial

Objective: Cognitive Behavioral Therapy (CBT) is an effective intervention for patients with panic disorder (PD). From a theoretical perspective, Eye Movement Desensitization and Reprocessing (EMDR) therapy could also be useful in the treatment of PD because: (1) panic attacks can be experienced as life threatening; (2) panic memories specific to PD resemble traumatic memories as seen in posttraumatic stress disorder (PTSD); and (3) PD often develops following a distressing life event. The primary objective of this Randomized Controlled Trial (RCT), was to compare EMDR therapy with CBT for PD and determine whether EMDR is not worse than CBT in reducing panic symptoms and improving Quality Of Life (QOL). Methods: Two-arm (CBT and EMDR) parallel RCT in patients with PD (N = 84). Patients were measured at baseline (T1), directly after the last therapy session (T2), and 3 months after ending therapy (T3). Non-inferiority testing (linear mixed model with intention-to-treat analysis) was applied. Patients were randomly assigned to 13 weekly 60-min sessions of CBT (N = 42) or EMDR therapy (N = 42). Standard protocols were used. The primary outcome measure was severity of PD at T3, as measured with the Agoraphobic Cognitions Questionnaire (ACQ), the Body Sensations Questionnaire (BSQ), and the Mobility Inventory (MI). The secondary outcome measure was QOL, as measured with the World Health Organization Quality of Life short version (WHOQOL-Bref), at T3. Results: The severity of PD variables ACQ and BSQ showed non-inferiority of EMDR to CBT, while MI was inconclusive (adjusted analyses). Overall QOL and general health, Psychological health, Social relationships, and Environment showed non-inferiority of EMDR to CBT, while Physical health was inconclusive. Conclusion: EMDR therapy proved to be as effective as CBT for treating PD patients. Trial Registration: Dutch Trial Register, Nr. 3134 http://www.trialregister.nl/trialreg/admin/rctview.asp?TC=3134

Experiences and outcomes of the intervention Slim Leven Vinkhuizen on health, perceived health, physical activity levels and social cohesion of the participants

Introduction: The current study is about the lifestyle intervention Slim Leven that takes place in Vinkhuizen, a neighbourhood of the city Groningen. The main goal of the intervention is to increase the health of the inhabitants of the neighbourhood and to increase the social cohesion. Aim: The aim of this study is to assess the experiences and outcomes of the intervention Slim Leven on health, perceived health, physical activity levels and the social cohesion of the participants. Method: This study uses both a quantitative and qualitative research methods. Every participant has to fill in an intake form when he or she starts with Slim Leven and an evaluation form three months later. Data of both forms are used to analyse if there is a change in health, perceived health and social cohesion and if there is an association between these topics. Interviews are used to obtain information about the experiences and the physical activity levels of the participants and about the reasons why they are active at Slim Leven. Results: Data shows no significant changes in health, perceived health and social cohesion three months after starting Slim Leven. Besides, there is no significant association between the different topics. Not every participant mentions an increase in physical activity levels. But almost every participant mentions that they are regularly physical active. Reasons most mentioned by the participants to stay active at Slim Leven are cosiness and motivated coach. Conclusion: The experiences of the participants of Slim Leven are mainly positive but the results show no improvements in health, perceived health and social cohesion. Slim Leven might have influence on the regularity of physical activities

Psychometric properties of the psychosocial screening instrument for physical trauma patients (PSIT)

Background Early detection of psychosocial problems post-injury may prevent them from becoming chronic. Currently, there is no psychosocial screening instrument that can be used in patients surviving a physical trauma or injury. Therefore, we recently developed a psychosocial screening instrument for adult physical trauma patients, the PSIT. The aim of this study was to finalize and psychometrically examine the PSIT. Methods All adult (≥ 18 years) trauma patients admitted to a Dutch level I trauma center from October 2016 through September 2017 without severe cognitive disorders (n = 1448) received the PSIT, Impact of Events Scale-Revised (IES-R), Patient Health Questionnaire-9 (PHQ-9), Rosenberg Self-Esteem Scale (RSES), State-Trait Anxiety Inventory-State (STAI-S), and the World Health Organization Quality of Life-Abbreviated version (WHOQOL-Bref). After 2 weeks, a subgroup of responding participants received the PSIT a second time. The internal structure (principal components analysis, PCA; and confirmatory factor analysis, CFA), internal consistency (Cronbach’s alpha, α), test-retest reliability (Intraclass Correlation Coefficient, ICC), construct validity (Spearman’s rho correlations), diagnostic accuracy (Area Under the Curve, AUC), and potential cut-off values (sensitivity and specificity) were examined. Results A total of 364 (25.1%) patients participated, of whom 128 completed the PSIT again after 19.5 ± 6.8 days. Test-retest reliability was good (ICC = 0.86). Based on PCA, five items were removed because of cross-loadings ≥ 0.3. Three subscales were identified: (1) Negative affect (7 items; α = 0.91; AUC = 0.92); (2) Anxiety and Post-Traumatic Stress Symptoms (4 items; α = 0.77; AUC = 0.88); and (3) Social and self-image (4 items; α = 0.79; AUC = 0.92). CFA supported this structure (comparative fit index = 0.96; root mean square error of approximation = 0.06; standardized rood mean square residual = 0.04). Four of the five a priori formulated hypotheses regarding construct validity were confirmed. The following cut-off values represent maximum sensitivity and specificity: 7 on subscale 1 (89.6% and 83.4%), 3 on subscale 2 (94.4% and 90.3%), and 4 on subscale 3 (85.7% and 90.7%). Conclusion The final PSIT has good psychometric properties in adult trauma patients

Human Dendritic Cell Subsets Undergo Distinct Metabolic Reprogramming for Immune Response

Toll-like receptor (TLR) agonists induce metabolic reprogramming, which is required for immune activation. We have investigated mechanisms that regulate metabolic adaptation upon TLR-stimulation in human blood DC subsets, CD1c+ myeloid DCs (mDCs) and plasmacytoid DCs (pDCs). We show that TLR-stimulation changes expression of genes regulating oxidative phosphorylation (OXPHOS) and glutamine metabolism in pDC. TLR-stimulation increases mitochondrial content and intracellular glutamine in an autophagy-dependent manner in pDC. TLR-induced glutaminolysis fuels OXPHOS in pDCs. Notably, inhibition of glutaminolysis and OXPHOS prevents pDC activation. Conversely, TLR-stimulation reduces mitochondrial content, OXPHOS activity and induces glycolysis in CD1c+ mDC. Inhibition of mitochondrial fragmentation or promotion of mitochondrial fusion impairs TLR-stimulation induced glycolysis and activation of CD1c+ mDCs. TLR-stimulation triggers BNIP3-dependent mitophagy, which regulates transcriptional activity of AMPKα1. BNIP3-dependent mitophagy is required for induction of glycolysis and activation of CD1c+ mDCs. Our findings reveal that TLR stimulation differentially regulates mitochondrial dynamics in distinct human DC subsets, which contributes to their activation

Benefit of wearing an activity tracker in sarcoidosis

Sarcoidosis causes many disabling symptoms, including fatigue and exercise limitations, which have been shown to improve by physical activity programs. The aim of this study was to estimate the effect of continuous activity monitoring using an electronic activity tracker (AT) on exercise performance and fatigue of sarcoidosis patients, compared to controls (cohort study), and the effect of additional personal coaching (randomized trial) over a period of 3 months. Fifty-four sarcoidosis patients received an AT (Group Ia: 27 with coaching and Group Ib: 27 without). A historical group of sarcoidosis patients (Group II;n= 41) who did not follow a physical activity program served as controls. Exercise performance of patients wearing an AT (Group I) improved compared with controls (Group II), including the 6MWD, % predicted ( increment 4.4 +/- 9.1 versus increment 0.7 +/- 5.0, respectively), and fatigue levels decreased ( increment -3.9 +/- 5.7 versus increment -1.8 +/- 5.3). Patients with coaching (Group Ia) showed greater improvement of exercise capacity over time than patients without coaching (Group Ib) as shown by the Steep Ramp Test results (watts: increment 20.2 +/- 33.8 versus increment 5.7 +/- 26.4; and SRT, VO(2)max, % predicted: increment 1.6 +/- 2.6 versus increment 0.7 +/- 2.3). Sarcoidosis patients wearing an AT achieved improvement of exercise performance and reduction of fatigue. We therefore recommend encouraging sarcoidosis patients to wear an AT to stimulate physical activity and reduce fatigue. The additional benefit of coaching needs to be explored in future studies

Survey of intention among public health nurses in providing solution‐focused parenting support

OBJECTIVE: Parenting support has shifted from a problem‐focused to a strengths‐based solution‐focused approach. This study surveyed public health nurses to explain their intention to provide solution‐focused parenting support in their practice. DESIGN: The design of this study was cross‐sectional. SAMPLE: The initial sample included 781 public health nurses who were employed with various youth healthcare organizations in the Netherlands. MEASUREMENTS: Based on the Theory of Planned Behavior, a questionnaire was developed and administered to measure (a) behavioral, normative, and control beliefs, (b) attitudes, subjective norm, and perceived behavioral control, and (c) intention. The data were subjected to structural equation modeling. RESULTS: A total of 449 (57.5%) public health nurses completed questionnaires. Associations as indicated by the Theory of Planned Behavior were confirmed with the exception of that between perceived behavioral control and intention. Statistically significant paths and correlations were added. The final model accounted for 53% of the variance in the intention to perform solution‐focused parenting support. CONCLUSIONS: In this study, public health nurses strongly intended to provide solution‐focused parenting support, thus indicating their acceptance of the approach. Their intention was predominantly associated with subjective norm

Beliefs of public health nurses about solution-focused parenting support:A questionnaire study

Background Parenting support guidelines for public health nurses have shifted from a problem-focused to a solution-focused approach. Given the fundamental differences between these two approaches, implementation of solution-focused parenting support is assumed to be difficult. Since the way public health nurses provide parenting support is largely guided by their beliefs, knowledge about their beliefs concerning solution-focused parenting support is important for its actual implementation. This study aims to explore the behavioral, normative, and control beliefs of public health nurses about solution-focused parenting support for future design of implementation interventions and related research activities. Methods A theory of planned behavior questionnaire was systematically developed and tested using focus groups. Thematic analysis and nominal group technique were used to analyze the data and to reach consensus. Next, this questionnaire was conducted among 449 public health nurses in the Netherlands. Factor analysis and descriptive statistical analysis were performed. Results Factor analysis resulted in three distinguishing subscales: behavioral beliefs (α = 0.79), normative beliefs (α = 0.80), and control beliefs (α = 0.64). Beliefs of public health nurses about solution-focused parenting support were moderately positive to positive (means varying from 4.24 to 5.54, on a 1–7 scale), and differences were statistically significant for various background variables. Control beliefs were less positive than behavioral and normative beliefs. Public health nurses trained in solution-focused parenting support reported more positive control beliefs (M = 4.34, SD = 0.83) as compared to untrained public health nurses (M = 4.00, SD = 0.82). Conclusion This study is the first to provide insight into public health nurses’ beliefs about solution-focused parenting support. The overall moderately positive to positive beliefs of PHNs about solution-focused parenting support suggests that PHNs tend to accept solution-focused parenting support as a viable approach. Compared to behavioral and normative beliefs, PHNs score the lowest on control beliefs