Evaluation of the Parent Centre's positive parenting skills training programme: a randomised controlled trial

Includes bibliographical referencesThis dissertation is both an assessment of the fidelity, and outcomes, of a parenting programme. The programme is implemented by The Parent Centre, a non-profit organisation (NPO) which provides a range of support services for caregivers of children. The primary audience for this dissertation includes programme stakeholders such as the organisation's director, programme manager and programme facilitators. The programme theory underpinning this intervention was created in collaboration with programme stakeholders and expert opinion. Briefly, this theory assumes that by participating in the parenting programme, caregivers are likely to benefit from learning positive parenting techniques which, when used, will catalyse improvements in the relationship they have with their children, and their children's behaviour. A literature review of similar programmes' effectiveness was conducted to assess its plausibility. This review found evidence which largely supported the programme's theory. This programme theory helped guide the focus of the evaluation. A total of nine evaluation questions were formulated. Two of these aimed to determine whether the programme was implemented with fidelity. The remaining seven aimed to determine the extent to which the programme was effective in improving its intended parent and child outcomes. A range of measures were employed to answer these questions. Implementation fidelity was assessed through asking programme facilitators to complete sessional checklists, collect programme attendance and participant homework checklists for each session. A randomised controlled trial design was used to assess programme outcomes; pre and post-test interviews were conducted in people's homes which utilised a range of measures. The programme was found to be implemented with high levels of fidelity. Despite high levels of engagement also being demonstrated by those who attended, attendance rates were overall quite low. Limited evidence for programme effectiveness was found using both an intention to treat analysis, and after conducting a second analysis which took into consideration a moderator of programme effectiveness i.e., programme attendance. Poor levels of programme attendance, as well as ceiling effects on some measures at pre-test , changes in the control group over time due to control group participants accessing other parenting assistance, reactivity to the questionnaire, and finally having the post-test conducted immediately after the programme was completed , are all factors which likely contributed to one finding limited evidence for programme effectiveness. Despite these factors hindering one's ability to determine programme effectiveness, further analyses are tentatively recommended based on the results that were found. Once participants have been allowed further time to practice programme skills, it is possible that programme effects may be found. Therefore, a long-term follow-up will likely allow one to come to a stronger conclusion regarding programme effectiveness. Finally, a few recommendations are made with regards to programme design, content, delivery and monitoring of outcomes. Continued emphasis on praise, and some coverage of consistent discipline may increase the programme's effectiveness. Keeping group sizes smaller and including only parents of children of the specified ages will help ensure it is relevant to programme participants. Introducing a basic pre and post programme completion questionnaire will allow The Parent Centre to track outcome achievement over time and facilitate an understanding of participant demographics. More recommendations will be able to be made once the one-year follow-up is completed. This dissertation addresses the gaps in the literature regarding parenting programme effectiveness in South Africa, and low and middle-income countries in general

Effects of Telehealth on Dropout and Retention in Care among Treatment-Seeking Individuals with Substance Use Disorder: A Retrospective Cohort Study

Background: During the COVID-19 pandemic, telehealth became a widely used method of delivering treatment for substance use disorders (SUD), but its impact upon treatment engagement and dropout remains unknown. Methods: We conducted a retrospective analysis of adult SUD patients (n = 544) between October 2020 and June 2022 among a cohort of treatment-seeking patients at a nonprofit community behavioral health center in Southwestern Ohio. We estimated the likelihood of treatment dropout using survival curves and Cox proportional hazard models, comparing patients who used telehealth with video, telephone, or solely in-person services within the first 14 days of diagnosis. We also compared the likelihood of early treatment engagement. Results: Patients who received services through telehealth with video in the initial 14 days of diagnosis had a lower hazard of dropout, compared to patients receiving solely in-person services (0.64, 95% CI [0.46, 0.90]), while there was no difference in hazards of dropout between patients who received telephone and in-person services. Early use of telehealth, both via video (5.40, 95% CI [1.92, 15.20]) and telephone (2.12, 95% CI [1.05, 4.28]), was associated with greater odds of treatment engagement compared to in-person care. Conclusion: This study adds to the existing literature related to telehealth utilization and engagement in care and supports the inclusion of telehealth in SUD treatment programs for treatment-seeking individuals

Cholinergic Modulation of Locomotion and Striatal Dopamine Release Is Mediated by α6α4* Nicotinic Acetylcholine Receptors

Dopamine (DA) release in striatum is governed by firing rates of midbrain DA neurons, striatal cholinergic tone, and nicotinic ACh receptors (nAChRs) on DA presynaptic terminals. DA neurons selectively express α6* nAChRs, which show high ACh and nicotine sensitivity. To help identify nAChR subtypes that control DA transmission, we studied transgenic mice expressing hypersensitive α6^(L9’S*) receptors. α6^(L9’S) mice are hyperactive, travel greater distance, exhibit increased ambulatory behaviors such as walking, turning, and rearing, and show decreased pausing, hanging, drinking, and grooming. These effects were mediated by α6 α4* pentamers, as α6^(L9’S) mice lacking α4 subunits displayed essentially normal behavior. In α6^(L9’S) mice, receptor numbers are normal, but loss of α4 subunits leads to fewer and less sensitive α6* receptors. Gain-of-function nicotine-stimulated DA release from striatal synaptosomes requires α4 subunits, implicating α6α4β2* nAChRs in α6^(L9’S) mouse behaviors. In brain slices, we applied electrochemical measurements to study control of DA release by α6^(L9’S) nAChRs. Burst stimulation of DA fibers elicited increased DA release relative to single action potentials selectively in α6^(L9’S), but not WT or α4KO/ α6^(L9’S), mice. Thus, increased nAChR activity, like decreased activity, leads to enhanced extracellular DA release during phasic firing. Bursts may directly enhance DA release from α6^(L9’S) presynaptic terminals, as there was no difference in striatal DA receptor numbers or DA transporter levels or function in vitro. These results implicate α6α4β2* nAChRs in cholinergic control of DA transmission, and strongly suggest that these receptors are candidate drug targets for disorders involving the DA system

What keeps FLAME lit? Comparing two modes of implementation of a physical education-based intervention to improve motor competence among Irish adolescents

Background: Adequate levels of motor competence (MC) have been associated with multiple health outcomes. Despite the preponderance of effective MC interventions, globally, levels of MC in children and adolescents are low. There is a gap in understanding what leads to effective implementation of MC interventions into routine practice, to benefit the wider population. Purpose: This study aims to compare implementation outcomes of two versions of Project FLAME: one group of teachers implementing Project FLAME as per the original efficacy trial (‘Original FLAME’), a second group of teachers implementing Project FLAME incorporating three additional implementation strategies (‘Modified FLAME’). Methods: A mixed method, two-group pre-and-post design, lasting six weeks during the period of September to November 2021. Three implementation evaluation outcomes were assessed: (i) PE teacher’s self-efficacy in delivering Project FLAME; (ii) Fidelity and adaptation to the project protocol; and (iii) Teachers’ and students’ responsiveness to the project. Data were collected at student and teacher levels using online survey and interviews. Nine PE teachers and their classes from eight schools consented to participate. Descriptives were reported for quantitative online survey data, and qualitative data were analysed thematically. Results: The final analytical sample included data from 9 teachers and 127 students pre- and post-study. Irrespective of implementation group, teachers with low levels of self-efficacy at the baseline improved after the six-week intervention. Teachers’ fidelity to the use of pedagogical external cues and error identification were high in both groups, with more adaptations made in the Modified FLAME group. Students’ satisfaction towards the intervention was high in both groups, with the use of pedagogical external cues reported as highly preferable. Conclusion: Findings provide evidence on the ‘non-negotiable’ features of Project FLAME that have the potential to be implemented for a longer-term in Physical Education settings (e.g. external teaching cues). The documented implementation of Project FLAME provide knowledge on what adaptations may be needed to translate an effective MC intervention into real-world practice. The study reaffirms that documenting the implementation (especially fidelity and adaptation) of MC interventions is beneficial.</p

α6* Nicotinic Acetylcholine Receptor Expression and Function in a Visual Salience Circuit

Nicotinic acetylcholine receptors (nAChRs) containing α6 subunits are expressed in only a few brain areas, including midbrain dopamine (DA) neurons, noradrenergic neurons of the locus ceruleus, and retinal ganglion cells. To better understand the regional and subcellular expression pattern of α6-containing nAChRs, we created and studied transgenic mice expressing a variant α6 subunit with green fluorescent protein (GFP) fused in-frame in the M3-M4 intracellular loop. In α6-GFP transgenic mice, α6-dependent synaptosomal DA release and radioligand binding experiments confirmed correct expression and function in vivo. In addition to strong α6* nAChR expression in glutamatergic retinal axons, which terminate in superficial superior colliculus (sSC), we also found α6 subunit expression in a subset of GABAergic cell bodies in this brain area. In patch-clamp recordings from sSC neurons in brain slices from mice expressing hypersensitive α6* nAChRs, we confirmed functional, postsynaptic α6* nAChR expression. Further, sSC GABAergic neurons expressing α6* nAChRs exhibit a tonic conductance mediated by standing activation of hypersensitive α6* nAChRs by ACh. α6* nAChRs also appear in a subpopulation of SC neurons in output layers. Finally, selective activation of α6* nAChRs in vivo induced sSC neuronal activation as measured with c-Fos expression. Together, these results demonstrate that α6* nAChRs are uniquely situated to mediate cholinergic modulation of glutamate and GABA release in SC. The SC has emerged as a potential key brain area responsible for transmitting short-latency salience signals to thalamus and midbrain DA neurons, and these results suggest that α6* nAChRs may be important for nicotinic cholinergic sensitization of this pathway

Investigating the effect of providing monetary incentives to participants on completion rates of referred co-respondents: an embedded randomized controlled trial. Study within a trial (SWAT) protocol

Background Parent-report questionnaires are a common method of generating data on child outcomes in mental health studies. A second report from another person who knows the child (co-respondent) is implemented to reduce bias and increase objectivity. The success of this approach is dependent on the engagement of co-respondents, which can be difficult. Financial incentives are used to increase data return in clinical trials, and to promote referral rates in online marketing. This protocol describes the use of an embedded randomised controlled trial (RCT) to investigate the effect of financial incentives on rates of co-respondent data completion. In the host RCT (of an online intervention designed to reduce the impact of a parent's anxiety on their child) index participants (i.e. parents) are asked to invite a co-respondent to complete measures on the index child. This study will test the hypothesis that providing monetary incentives to index participants will increase the outcome measure completion rate of co-respondents. Methods Embedded RCT of two parallel groups. Participants in the intervention arm will be sent a £10 voucher if their chosen co-respondent completes online baseline measures. Participants in the control arm will not be offered payment regardless of their chosen co-respondent's behaviour. 1754 participants will take part. Analysis will compare co-respondent outcome measure completion rates between the two arms at baseline and follow-up. Conclusion Findings from this study will provide evidence on the impact of offering payment to index participants on return rates of co-respondent data. This will inform resource allocation within future clinical trials

The kidney failure risk equation:evaluation of novel input variables including eGFR estimated using the CKD-EPI 2021 equation in 59 cohorts

SIGNIFICANCE STATEMENT: The kidney failure risk equation (KFRE) uses age, sex, GFR, and urine albumin-to-creatinine ratio (ACR) to predict 2- and 5-year risk of kidney failure in populations with eGFR <60 ml/min per 1.73 m 2 . However, the CKD-EPI 2021 creatinine equation for eGFR is now recommended for use but has not been fully tested in the context of KFRE. In 59 cohorts comprising 312,424 patients with CKD, the authors assessed the predictive performance and calibration associated with the use of the CKD-EPI 2021 equation and whether additional variables and accounting for the competing risk of death improves the KFRE's performance. The KFRE generally performed well using the CKD-EPI 2021 eGFR in populations with eGFR <45 ml/min per 1.73 m 2 and was not improved by adding the 2-year prior eGFR slope and cardiovascular comorbidities. BACKGROUND: The kidney failure risk equation (KFRE) uses age, sex, GFR, and urine albumin-to-creatinine ratio (ACR) to predict kidney failure risk in people with GFR <60 ml/min per 1.73 m 2 . METHODS: Using 59 cohorts with 312,424 patients with CKD, we tested several modifications to the KFRE for their potential to improve the KFRE: using the CKD-EPI 2021 creatinine equation for eGFR, substituting 1-year average ACR for single-measure ACR and 1-year average eGFR in participants with high eGFR variability, and adding 2-year prior eGFR slope and cardiovascular comorbidities. We also assessed calibration of the KFRE in subgroups of eGFR and age before and after accounting for the competing risk of death. RESULTS: The KFRE remained accurate and well calibrated overall using the CKD-EPI 2021 eGFR equation. The other modifications did not improve KFRE performance. In subgroups of eGFR 45-59 ml/min per 1.73 m 2 and in older adults using the 5-year time horizon, the KFRE demonstrated systematic underprediction and overprediction, respectively. We developed and tested a new model with a spline term in eGFR and incorporating the competing risk of mortality, resulting in more accurate calibration in those specific subgroups but not overall. CONCLUSIONS: The original KFRE is generally accurate for eGFR <45 ml/min per 1.73 m 2 when using the CKD-EPI 2021 equation. Incorporating competing risk methodology and splines for eGFR may improve calibration in low-risk settings with longer time horizons. Including historical averages, eGFR slopes, or a competing risk design did not meaningfully alter KFRE performance in most circumstances

Randomised Trial of Text Messaging on Adherence to Cardiovascular Preventive Treatment (INTERACT Trial)

BACKGROUND: About one third of patients prescribed blood pressure or lipid-lowering drugs for the prevention of coronary heart disease and stroke do not take their medication as prescribed. We conducted a randomized trial to evaluate text messaging as a means of improving adherence to cardiovascular disease preventive treatment. METHODS: 303 patients taking blood pressure and/or lipid-lowering medications were randomly assigned to being sent text messages (Text group, 151) or not being sent them (No text group, 152). Texts were sent daily for 2 weeks, alternate days for 2 weeks and weekly thereafter for 22 weeks (6 months overall), using an automated computer programme. Patients were asked to respond on whether they had taken their medication, whether the text reminded them to do so if they had forgotten, and if they had not taken their medication to determine if there was a reason for not doing so. At 6 months, use of medication was assessed. RESULTS: Two patients were lost to follow-up, providing data on 301 for analysis. In the No text group 38/151 (25%) took less than 80% of the prescribed regimen (ie. stopped medication completely or took it on fewer than 22 of the last 28 days of follow-up) compared to 14/150 patients (9%) in the Text group - an improvement in adherence affecting 16 per 100 patients (95% CI 7 to 24), p<0.001. The texts reminded 98/151 patients (65%) to take medication on at least one occasion and lead to 20/151 (13%) who stopped taking medication because of concern over efficacy or side-effects, resuming treatment. CONCLUSIONS: In patients taking blood pressure or lipid-lowering treatment for the prevention of cardiovascular disease, text messaging improved medication adherence compared with no text messaging. TRIAL REGISTRATION: Controlled-Trials.com ISRCTN74757601