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Examining Behavioral Interventions for Infancy and Early Toddlerhood: A Systematic Review of Intervention Effects, Parameters, and Participants.

Rapid advancement is paving the way to identify children who would likely benefit from early intervention during the first years of life, prior to the onset of significant delays in development. With the widely acknowledged benefits of early intervention, key questions arise: Does behavioral intervention targeted to infancy and early toddlerhood improve developmental outcomes? What procedures might be used, and under what circumstances? Who do these interventions work for? The current review comprehensively examined the literature on behavioral interventions based in operant learning, focused on key developmental areas with children in the first two years of life. We located and synthesized 69 studies with unique participant cohorts that included 1735 children. The search revealed many studies focused on the first year of life, of which a large proportion investigated approaches to increase communication. We provide implications, limitations, and future directions on how behavioral interventions for infants and young toddlers can inform current practice and future intervention research this population.

Humans

Intervention Without Borders - an Automated Self-Guided AI-Enhanced Psychoeducation Intervention for Dementia Caregivers: Parallel-Group Randomized Waitlist-Controlled Trial.

OBJECTIVE: To examine whether a fully automated, self-guided intervention (PDC30) could improve caregiver well-being over a 1-month waitlist control in an international sample. DESIGN: Randomized waitlist-controlled trial. SETTING: Web-based platform accessible globally. PARTICIPANTS: 441 individuals responded to study promotion on the internet, of whom 274 from 43 countries met the study criteria and were randomized. Eligible participants were adults providing ≥10 care hours weekly to community-dwelling relatives with dementia, scoring ≥5 on Patient Health Questionnaire-9 (PHQ-9), and without recent caregiver intervention. INTERVENTION: Available 24/7, PDC30 is a self-guided, automated intervention consisting of a Guidebook, an AI-powered counseling chatbot, and interactive applications for cognitive-behavioral techniques, relaxation, and caregiver-recipient bonding. MEASUREMENTS: At baseline and follow-ups at 1, 2, and 3 months, depression was assessed by PHQ-9. Secondary outcomes were measured with validated brief versions of anxiety, burden, and positive gains. RESULTS: Intent-to-treat analysis using mixed-effects regression showed treatment x time2 effects on all outcomes except anxiety. At 1-month follow-up, coinciding with exclusive access to PDC30, intervention caregivers showed significant improvements in depression (d = -0.37), burden (d = -0.34), and positive gains (d = 0.42). The differences mostly disappeared after control participants received the intervention, while improvements in both groups were sustained thereafter. Participants reported using the website several times weekly, were generally satisfied with it, and found the chatbot most helpful. CONCLUSIONS: The effects on depression and other outcomes were consistent with those observed for in-person programs, suggesting the viability of well-designed automated intervention. The study demonstrates the feasibility, acceptability, and potential global health impact of PDC30.

Humans

Acceptability and Feasibility of an Educational Intervention to Improve Researcher-Participant Interactions in a Neonatal Intensive Care Unit Clinical Trial: Research Team Feedback on the BRIEF Intervention.

OBJECTIVE: Interactions with families are essential to successful recruitment conversations that promote informed decision-making about clinical research enrollment. However, there is little evidence about how to implement communication-oriented recruitment training among pediatric clinical research teams. Our objective was to evaluate the feasibility and acceptability of Better Research Interactions for Every Family (BRIEF), a multipart educational intervention to improve relationship-based conversations about clinical trial enrollment with families in the neonatal setting. STUDY DESIGN: We piloted BRIEF in partnership with a neonatal clinical research team. Research team members completed surveys following the BRIEF intervention's online module and the BRIEF group training session. They completed self-assessments after consent discussions before and after the BRIEF intervention, in which they rated their achievement of recruitment skills taught in BRIEF. Research team members also completed a final study interview to provide feedback on the intervention components, training content, and use of skills in practice. RESULTS: All nine research team members completed all components of BRIEF. Survey responses showed moderate to low satisfaction with previous recruitment training before BRIEF and high satisfaction with the BRIEF training. Self-assessments showed significant increases in reported partnership with bedside nursing (p = 0.02) and confirmation of family names (p = 0.05) after BRIEF training. Interviews provided further evidence of overall satisfaction with the BRIEF training, its content, and the skills learned, as well as opportunities for improvement, particularly in supporting challenging conversations. CONCLUSION: This pilot study demonstrated the feasibility and acceptability of the BRIEF intervention, as well as opportunities for improvement in future training. KEY POINTS: · It was feasible to implement the BRIEF researcher training in a single-site NICU trial.. · BRIEF training was acceptable to research team members.. · BRIEF training shows potential to improve relationship-based research communication..

Humans

Community Intervention Trial for Smoking Cessation (COMMIT): summary of design and intervention. COMMIT Research Group.

The Community Intervention Trial for Smoking Cessation (COMMIT) is a multicenter project created to test a comprehensive smoking control intervention. COMMIT was designed to effectively reach cigarette smokers, especially heavy smokers, and to aid them in achieving and maintaining long-term cessation of cigarette smoking. COMMIT was also designed to work through communities, using existing media channels, major organizations, and social institutions capable of influencing smoking behavior in large groups of people. This ongoing trial was begun in 1989 in 11 matched pairs of communities. Each pair consists of one community randomized to intervention conditions and one community randomized to comparison conditions. A comprehensive set of mandated activities is organized around four task forces encompassing health care providers, work sites and organizations, cessation resources and services, and public education. Intervention activities are adapted and implemented in each community through a local community board that provides oversight and management of COMMIT activities. Cessation rates will be assessed in randomly selected cohorts of heavy cigarette smokers, identified at the baseline survey and tracked for 5 years, as estimators of the overall quit rates in both intervention and comparison communities. Various data collection methods will be used to provide intermediate outcome measurement and to evaluate implementation. These methods include cross-sectional community surveys and surveys of health providers, work sites, religious organizations, cessation resource providers, and other systems used to track smoking control activities. The trial will have an impact on more than 200 000 adult smokers.

Adult

Some aspects of family interventions in schizophrenia. I: Adherence to intervention programmes.

Although family intervention programmes to instruct relatives in management and coping skills are often effective in reducing schizophrenic relapse, many families either fail to be engaged or withdraw from treatment at an early stage. Some possible reasons for this are described and some suggestions for increasing adherence are made. Adherence with interventions may be viewed as a complex behaviour pattern, and factors increasing or decreasing the probability of such behaviour occurring and being maintained can and should be investigated to maximise the clinical potential of family intervention programmes.

Caregivers

[General practitioners and interventions against smoking: a critical review of interventions].

In this review we considered smoking cessation interventions delivered by general practitioners in consideration of their privileged position as health promoters. We selected 11 randomized trials on: a) counselling; b) nicotine gum; c) perception of health hazards in relationship with cigarette smoking. The interventions were delivered to smokers during clinical encounters. Amount of time spent by physicians during clinical encounters and number of reinforcing sessions emerged as the most important factors in a successful intervention. Nicotine gum prescription and perception of health hazards did not show any significant effect but the opportunity as reinforcing sessions.

Adolescent

Symposium on sensorineural hearing loss in children: early detection and intervention. The rationale for early identification and intervention.

The normal hearing child utilizes auditory data to trigger his innate propensity for language learning and begins to use these stored auditory images long before he says his first word. The auditory modality appears to provide the input from which he abstracts and regularizes the rule of grammar both from outside sources and in an auditory feedback arrangement from his own utterances. The development of expressive language appears to occur rapidly once the first word is said, and by age three he appears to be using all the basic structures of speech. The child with severe hearing impairment, on the other hand, deprived of auditory input, either does not develop speech or may with some training develop very limited speech. Since most hearing impaired children can benefit from amplification, hearing aids can provide a means to maximize the auditory channel. Many such children, however, do not receive hearing aids until three to four years of age, and so have already been deprived of these key years in language development. They have already missed the critical periods in language learning and thus are apt to remain severely depressed in language skills at best. The results of one study reported in this discussion appear to substantiate the observation that a good program of early intervention, including effective parent training and early use of hearing aids to exploit auditory potential, can help hearing impaired children to generate spontaneous spoken language more comparable to that used by their normal hearing peers in both type and level of utterance. Although this language may be more immature or less syntactically and morphologically correct than that of their normal hearing peers, it compares in syntactical structure much more favorably than does the language of hearing impaired children who have not received such special help until about two years later. The study further demonstrates the importance of early intervention and illustrates the positive effects of a good early management program on the language and resulting educational achievement of hearing impaired children.

Child

[Parent counseling between crisis intervention and preventive intervention].

The presence of impairments in their newborn child entails parental mourning and coping processes, which are either accelerated, prolonged, or repressed by the professional help provided, depending on the nature and quality of such intervention. Based on Schuchardt's model of coping with crisis (1980), the interactional difficulties between professional helpers/parents and child in the various phases are set out, inferring potential modifications in this interaction, but also changes in training and research contents.

Adaptation, Psychological

Serum cholesterol level and mortality findings for men screened in the Multiple Risk Factor Intervention Trial. Multiple Risk Factor Intervention Trial Research Group.

BACKGROUND: With increased efforts to lower serum cholesterol levels, it is important to quantify associations between serum cholesterol level and causes of death other than coronary heart disease, for which an etiologic relationship has been established. METHODS: For an average of 12 years, 350,977 men aged 35 to 57 years who had been screened for the Multiple Risk Factor Intervention Trial were followed up following a single standardized measurement of serum cholesterol level and other coronary heart disease risk factors; 21,499 deaths were identified. RESULTS: A strong, positive, graded relationship was evident between serum cholesterol level measured at initial screening and death from coronary heart disease. This relationship persisted over the 12-year follow-up period. No association was noted between serum cholesterol level and stroke. The absence of an association overall was due to different relationships of serum cholesterol level with intracranial hemorrhage and nonhemorrhagic stroke. For the latter, a positive, graded association with serum cholesterol level was evident. For intracranial hemorrhage, cholesterol levels less than 4.14 mmol/L (less than 160 mg/dL) were associated with a twofold increase in risk. A serum cholesterol level less than 4.14 mmol/L (less than 160 mg/dL) was also associated with a significantly increased risk of death from cancer of the liver and pancreas; digestive diseases, particularly hepatic cirrhosis; suicide; and alcohol dependence syndrome. In addition, significant inverse graded associations were found between serum cholesterol level and cancers of the lung, lymphatic, and hematopoietic systems, and chronic obstructive pulmonary disease. No significant associations were found of serum cholesterol level with death from colon cancer, with accidental deaths, or with homicides. Overall, the inverse association between serum cholesterol level and most cancers weakened with increasing follow-up but did not disappear. The association between cholesterol level and death due to cancer of the lung and liver, chronic obstructive pulmonary disease, cirrhosis, and suicide weakened little over follow-up. CONCLUSIONS: The association of serum cholesterol with specific causes of death varies in direction, strength, gradation, and persistence. Further research on the determinants of low serum cholesterol level in populations and long-term follow-up of participants in clinical trials are necessary to assess whether inverse associations with noncardiovascular disease causes of death are consequences of noncardiovascular disease, whether serum cholesterol level and noncardiovascular disease are both consequences of other factors, or whether these associations are causal.

Adult

[Interventional radiology in the treatment of the complications from interventions on the lower urinary excretory tract].

Ureteral diversions may be complicated by strictures, hydronephrosis, pyelonephritis, lithiasis, fistulas, etc. In the last 10 years, 103 patients with 133 urological postoperative complications underwent percutaneous treatment. Most of the patients had been treated by percutaneous antegrade drainage; afterwards, stricture dilatation, ureteral stenting and stone extraction were performed. In one case a Strecker metallic stent was employed. We have successfully treated 101 of 133 complications (75.9%), with only 27 failures (20.3%). Five cases (3.8%) of lithiasis did not require percutaneous treatment. The good results obtained, the absence of major complications, the low cost and the little discomfort for the patients confirm the leading role of percutaneous treatment in complicated ureteral diversions.

Adolescent

Crisis intervention: effects of crisis intervention on family survivors of sudden death situations.

A controlled study that examined the effects of a short-term crisis service given to a group of families recently bereaved through a sudden death within the family is reported. The results reveal that sudden death does have a major impact on recently bereaved families in terms of increased risk of ill health, poor coping behavior, and disturbed social functioning when compared to nonbereaved families. However, the short-term crisis service appeared to have no major impact upon postbereavement adjustment. Discussion centered around possible reasons for failure of the short-term crisis services.

Adaptation, Psychological