Association between weight change and incidence of cardiovascular disease events and mortality among adults with type 2 diabetes: a systematic review of observational studies and behavioural intervention trials

Aims/hypothesis Weight loss is often recommended in the treatment of type 2 diabetes. While evidence has shown that large weight loss may lead to diabetes remission and improvement in cardiovascular risk factors, long-term impacts are unclear. We performed a systematic review of studies of weight loss and other weight changes and incidence of CVD among people with type 2 diabetes. Methods Observational studies of behavioural (non-surgical and non-pharmaceutical) weight changes and CVD events among adults with type 2 diabetes, and trials of behavioural interventions targeting weight loss, were identified through searches of MEDLINE, EMBASE, Web of Science, CINAHL, and The Cochrane Library (CENTRAL) until 9 July 2019. Included studies reported change in weight and CVD and/or mortality outcomes among adults with type 2 diabetes. We performed a narrative synthesis of observational studies and meta-analysis of trial data. Results Of 13,227 identified articles, 17 (14 observational studies, three trials) met inclusion criteria. Weight gain (vs no change) was associated with higher hazard of CVD events (HRs [95% CIs] ranged from 1.13 [1.00, 1.29] to 1.63 [1.11, 2.39]) and all-cause mortality (HRs [95% CIs] ranged from 1.26 [1.12, 1.41] to 1.57 [1.33, 1.85]). Unintentional weight loss (vs no change) was associated with higher risks of all-cause mortality, but associations with intentional weight loss were unclear. Behavioural interventions targeting weight loss showed no effect on CVD events (pooled HR [95% CI] 0.95 [0.71, 1.27]; I2 = 50.1%). Risk of bias was moderate in most studies and was high in three studies, due to potential uncontrolled confounding and method of weight assessment. Conclusions/interpretation Weight gain is associated with increased risks of CVD and mortality, although there is a lack of data supporting behavioural weight-loss interventions for CVD prevention among adults with type 2 diabetes. Long-term follow-up of behavioural intervention studies is needed to understand effects on CVD and mortality and to inform policy concerning weight management advice and support for people with diabetes. PROSPERO registration CRD42019127304. Graphical abstract

Long-term effectiveness of behavioural intervention in preschool children with attention deficit hyperactivity disorder in Southeast China – a randomized controlled trial

Background Attention-deficit hyperactivity disorder (ADHD) is the most common behavioral disorder. Behavioural intervention in preschool children with ADHD is considered effective. This study discussed the long-term effectiveness of behavioural intervention in the context of nondrug therapy. Methods The study was a prospective, randomised controlled trial in which 201 preschoolers diagnosed with ADHD who were not receiving any treatment were assigned to two groups from January 2018 to May 2019, 101 were assigned to the conventional group and 100 to the behavioural intervention group. The behavioural intervention group included parental training, behavioural therapy, attention training, relief therapy and game therapy, in addition to the conventional group offerings. Children were evaluated at a baseline, at the end of the 12-month intervention and six months after the intervention. The primary and secondary outcome variables included attention time, the impulse-hyperactivity and hyperactivity index from Conners parent symptom questionnaire (PSQ), full-scale attention quotient (FAQ) and full-scale response control quotient (FRCQ) from integrated visual and auditory comprehensive continuous performance tests. The attention time was observed and recorded by parents, and others were performe(PSQ)d by physicians in the clinic. All statistical analyses were conducted using SPSS V26.0 (IBM), including the descriptive statistics and mixed-effects models and so on. Results The participants’ mean age was (66.17±9.00) months in the behavioural group and (67.54±6.22) months in the conventional group .A total of 190 participants completed a follow-up six months after the intervention. The attention time, Conners parent symptom questionnaire (PSQ), full-scale attention quotient (FAQ) and full-scale response control quotient (FRCQ) increased significantly over time, and the behavioural group improvements were higher than those of conventional group. There was a significant main effect of time (pretest/posttest/follow-up) and group on all outcome measures (t =-12.549-4.069, p<0.05), and a significant interaction of time and group on attention time, impulsivity/hyperactivity, FAQ and FRCQ (t =-3.600-3.313, p<0.05). Conclusion Behavioural intervention can effectively improve behaviour management and relieve symptoms in children with ADHD. These effects lasted at least six months. This study provides a promising approach for improving clinical efficacy with preschool children with ADHD.

Evaluation of low-intensity therapy and parent training for young children with autism based on the early start Denver model

<p>Autism spectrum disorder (ASD) is a pervasive developmental disorder that is characterised by deficits in social communication and restricted and repetitive behaviours, interests and activities. Recent developments in identification techniques mean that many children can be reliably diagnosed with ASD before the age of 2. Early identification creates the opportunity for early intervention. In fact, some research suggests that the earlier a child with ASD receives intervention, the greater the progress he or she is likely to make. Naturalistic developmental behavioural interventions are a relatively recent method of early intervention for children with ASD, which combine elements of previous intervention approaches (behavioural, naturalistic behavioural, and developmental/relationship-focused intervention). One such naturalistic developmental behavioural intervention is the early start Denver model (ESDM), which is designed for children with or at risk for ASD between the ages of 12 and 60 months (5 years). Research suggests that ESDM intervention may improve a range of child outcomes when delivered for at least 15 hours per week over at least 10 months. However, many families may not be able to access or afford such intensive intervention. Therefore, the two studies in this thesis evaluated the effectiveness of two ESDM delivery approaches that required relatively few hours of professional input per week. Specifically, low-intensity therapist delivered ESDM intervention, and ESDM parent training. Study 1 used a multiple probe across participants design to evaluate the effectiveness of 3 hours per week of home-based ESDM therapy for 12 weeks for improving imitation, communication, and engagement for four young children with ASD. It also examined whether children showed increases in these outcomes with their mothers following the intervention. The results of this study suggest that, following the intervention, all four children increased their imitation skills and their engagement with the therapist. In addition three of the children had more functional utterances and one child increased his use of intentional vocalisations. These results were maintained four weeks after intervention and generalised to a lesser degree to each child’s mother. This suggests that low-intensity therapist delivered ESDM intervention may improve outcomes for children with ASD. The results of Studies 1 and 2 suggest that both low-intensity therapist delivered ESDM intervention and ESDM parent training may be promising intervention approaches for young children with ASD. This is particularly encouraging as both approaches involved relatively few hours of professional input per week. In theory, this could increase the number of families who are able to access such intervention. More research is needed to identify the most effective low-intensity ESDM intervention method, or combination of methods.</p>

From formative research to cultural adaptation of a face-to-face and internet-based cognitive-behavioural intervention for Arabic-speaking refugees in Germany

Background This study aims to provide a transparent and replicable documentation approach for the cultural adaptation of a cognitive-behavioural transdiagnostic intervention (Common Elements Treatment Approach, CETA) for Arabic-speaking refugees with common mental disorders in Germany. Method A mixed-methods approach was used, including literature review, interviews, expert decisions and questionnaires, in order to adapt the original CETA as well as an internet-based guided version (eCETA). The process of cultural adaptation was based on a conceptual framework and was facilitated by an adaptation monitoring form as well as guidelines which facilitate the reporting of cultural adaptation in psychological trials (RECAPT). Results Consistent with this form and the guidelines, the decision-making process of adaptation proved to be coherent and stringent. All specific CETA treatment components seem to be suitable for the treatment of Arabic-speaking refugees in Germany. Adaptations were made to three different elements: 1) Cultural concepts of distress: a culturally appropriate explanatory model of symptoms was added; socially accepted terms for expressing symptoms (for eCETA only) and assessing suicidal ideation were adapted; 2) Treatment components: no adaptations for theoretically/empirically based components of the intervention, two adaptations for elements used by the therapist to engage the patient or implement the intervention (nonspecific elements), seven adaptations for skills implemented during sessions (therapeutic techniques; two for eCETA only) and 3) Treatment delivery: 21 surface adaptations (10 for eCETA only), two eCETA-only adaptations regarding the format. Conclusion The conceptual framework and the RECAPT guidelines simplify, standardise and clarify the cultural adaptation process.

Evaluation of low-intensity therapy and parent training for young children with autism based on the early start Denver model

<p>Autism spectrum disorder (ASD) is a pervasive developmental disorder that is characterised by deficits in social communication and restricted and repetitive behaviours, interests and activities. Recent developments in identification techniques mean that many children can be reliably diagnosed with ASD before the age of 2. Early identification creates the opportunity for early intervention. In fact, some research suggests that the earlier a child with ASD receives intervention, the greater the progress he or she is likely to make. Naturalistic developmental behavioural interventions are a relatively recent method of early intervention for children with ASD, which combine elements of previous intervention approaches (behavioural, naturalistic behavioural, and developmental/relationship-focused intervention). One such naturalistic developmental behavioural intervention is the early start Denver model (ESDM), which is designed for children with or at risk for ASD between the ages of 12 and 60 months (5 years). Research suggests that ESDM intervention may improve a range of child outcomes when delivered for at least 15 hours per week over at least 10 months. However, many families may not be able to access or afford such intensive intervention. Therefore, the two studies in this thesis evaluated the effectiveness of two ESDM delivery approaches that required relatively few hours of professional input per week. Specifically, low-intensity therapist delivered ESDM intervention, and ESDM parent training. Study 1 used a multiple probe across participants design to evaluate the effectiveness of 3 hours per week of home-based ESDM therapy for 12 weeks for improving imitation, communication, and engagement for four young children with ASD. It also examined whether children showed increases in these outcomes with their mothers following the intervention. The results of this study suggest that, following the intervention, all four children increased their imitation skills and their engagement with the therapist. In addition three of the children had more functional utterances and one child increased his use of intentional vocalisations. These results were maintained four weeks after intervention and generalised to a lesser degree to each child’s mother. This suggests that low-intensity therapist delivered ESDM intervention may improve outcomes for children with ASD. The results of Studies 1 and 2 suggest that both low-intensity therapist delivered ESDM intervention and ESDM parent training may be promising intervention approaches for young children with ASD. This is particularly encouraging as both approaches involved relatively few hours of professional input per week. In theory, this could increase the number of families who are able to access such intervention. More research is needed to identify the most effective low-intensity ESDM intervention method, or combination of methods.</p>

Messagerunner: Gamifying Behavioural Change Through Mobile Media

<p>This research proposes a design solution that integrates gamification and behavioural change theories into a mobile fitness application to promote and maintain physical activity for young adults. This research proposes that the usability of mobile apps on behavioural modification can be improved by integrating psychological interventional methods into the product design. The design output, Messagerunner, will provoke critical reflection about the future design of mobile fitness applications. During the design process, I identified and collected related theories to analyse existing precedents, and then extracted design methods and criteria. Various methodologies including literature analysis, contextual inquiry, and iterative prototyping support the design solution. Messagerunner seeks to balance the tedious exercise routine with the enjoyment from gamification. It uses widely accepted theories and methods on behavioural intervention to promote physical activity. This research was started by analysing the benefits and cost of behavioural intervention counselling and mobile persuasive technologies. Mobile applications have the benefits of being low cost and easy to access, compared to counselling. However, the existing applications have limits compared to professional intervention. Design solutions that combine intervention methods with persuasive technologies could lead to a better management for sedentary lifestyles. Messagerunner adopts activity promotion methods drawn from a range of theories. These includes the transtheoretical model (TTM), the theory of planned behaviour (TPB) , and flow theory. The design of the app is inspired by three precedents: Pokémon Go, Habitica, and Run An Empire. To test the method, the design process includes contextual inquiry, prototyping, and user testing. The design outcomes apply to users worldwide and reflect on the design of current commercial fitness apps. The outputs produce a concept and UI design for the final iteration of Messagerunner. This research will provide insightful perspectives for future designs for fitness applications.</p>

Messagerunner: Gamifying Behavioural Change Through Mobile Media

<p>This research proposes a design solution that integrates gamification and behavioural change theories into a mobile fitness application to promote and maintain physical activity for young adults. This research proposes that the usability of mobile apps on behavioural modification can be improved by integrating psychological interventional methods into the product design. The design output, Messagerunner, will provoke critical reflection about the future design of mobile fitness applications. During the design process, I identified and collected related theories to analyse existing precedents, and then extracted design methods and criteria. Various methodologies including literature analysis, contextual inquiry, and iterative prototyping support the design solution. Messagerunner seeks to balance the tedious exercise routine with the enjoyment from gamification. It uses widely accepted theories and methods on behavioural intervention to promote physical activity. This research was started by analysing the benefits and cost of behavioural intervention counselling and mobile persuasive technologies. Mobile applications have the benefits of being low cost and easy to access, compared to counselling. However, the existing applications have limits compared to professional intervention. Design solutions that combine intervention methods with persuasive technologies could lead to a better management for sedentary lifestyles. Messagerunner adopts activity promotion methods drawn from a range of theories. These includes the transtheoretical model (TTM), the theory of planned behaviour (TPB) , and flow theory. The design of the app is inspired by three precedents: Pokémon Go, Habitica, and Run An Empire. To test the method, the design process includes contextual inquiry, prototyping, and user testing. The design outcomes apply to users worldwide and reflect on the design of current commercial fitness apps. The outputs produce a concept and UI design for the final iteration of Messagerunner. This research will provide insightful perspectives for future designs for fitness applications.</p>

Transdiagnostic Behavioural Intervention for Children with Anxiety and Depressive Disorders: A Feasibility Study

There is increasing support for the efficacy of transdiagnostic cognitive behavioural interventions for anxiety and depression. However, little is known about the applicability of transdiagnostic behavioural interventions for children younger than 12 years old. This study was conducted to examine the feasibility and potential efficacy of Streamlined Transdiagnostic Intervention for Anxiety and Depression (STREAM) for children with anxiety and/or depressive disorders using a randomised controlled design with a wait-list control (WLC) condition and blind-assessments. Of the 22 potential participants, 16 Japanese children (M = 9.81; SD = 0.75; range 9–12 years) with principal anxiety or depressive disorder were eligible and enrolled. Then, the participants were randomly assigned to the STREAM or WLC condition. The dropout rates were 0% for both the conditions at post-assessment. Mixed model analyses showed that, although there were no significant interactions at post-assessment between both the conditions, both anxiety and depressive disorders significantly improved at 3 months compared with pre-assessment for the combined condition (the STREAM and WLC conditions). Therefore, this study demonstrated the feasibility of the STREAM in the Japanese clinical setting and potentially supported its efficacy for children with anxiety and depressive disorders at the follow-up assessment.

What roles do smart sensors play in citizens' water use? From the perspective of household water-saving

The rapid population growth has led to increasing demand for water resources. Studies have shown that the application of new technologies can effectively influence and promote citizens to save water. The application of smart water sensors can effectively monitor household water consumption and feedback the recorded data to citizens promptly, thereby influencing family members' water-saving attitudes and behaviours. For the widespread use of future water sensors in households, it can demonstrate its essential role in three aspects: water use information feedback to reduce water consumption, water information measurement helps to cultivate water conservation awareness, and water use information release as an effective means of behavioural intervention. This research provides some suggestions for the promotion and use of smart sensors in the home and points out the future research directions for the impact of water sensing on household water-saving behaviour.