Effects of Integrative Behavioral Couple Therapy on Infertility Self-efficacy, Dyadic Adjustment, and Sexual Satisfaction in Infertile Couples

Background: Given the rising rate of infertility, the prevalence of mental health disorders in infertile couples is undeniable. The present study aimed to investigate the effects of Integrative Behavioral Couple Therapy (IBCT) on infertility self-efficacy, dyadic adjustment, and sexual satisfaction in infertile couples. Methods: The present single-case experimental study used a multiple-baseline design. The statistical population of the study included all infertile couples referring to infertility centers in Ahvaz City, Iran, in 2019. The research instruments included the Infertility Self-Efficacy Scale (ISE), the Dyadic Adjustment Scale (DAS), and the Sexual Satisfaction Questionnaire (SSQ). Following a diagnostic interview, 3 couples were selected using the convenience sampling technique. Integrative behavioral couple therapy was conducted in twelve 120-minute sessions for the intervention group. The second couple entered the study in the second session of the first couple; the third couple enrolled the treatment plan in the third session of the first couple and the second session of the second couple. All questionnaires were completed in the first, third, sixth, eighth, and tenth sessions; the study participants were followed up and re-assessed two months later. The collected data were analyzed in SPSS using chart analysis, reliable change index, and significance statistics. Results: The provided IBCT increased infertility self-efficacy (39.04%), dyadic adjustment (25.91%), and sexual satisfaction (55.01%) in infertile couples. Besides, the improvement lasted throughout the follow-up which indicated the effectiveness of IBCT on infertility self-efficiency, dyadic adjustment, and sexual satisfaction in the study subjects. Conclusion: IBCT can be effective in improving personal and marital variables in infertile couples with infertility problems in addition to their marital problems.

Cognitive Sequelae of Silent Ischemic Lesions Following Carotid Artery Stenting: Possible Role of Age-Related Moderation

Background: The occurrence of ischemic lesions is common in patients receiving carotid artery stenting (CAS), and most of them are clinically silent. However, few studies have directly addressed the cognitive sequelae of these procedure-related silent ischemic lesions (SILs).Objective: In this study, we attempted to investigate the effects of SILs on cognition using a comprehensive battery of neuropsychological tests.Method: Eighty-five patients with unilateral carotid stenosis and 25 age-matched healthy volunteers participated in this study. Brain MRI was performed within 1 week before and 1 week after CAS to monitor the occurrence of post-CAS SILs. A comprehensive battery tapping reading ability, verbal and non-verbal memory, visuospatial function, manual dexterity, executive function, and processing speed was administered 1 week before and 6 months after CAS. To control for practice effects on repeated cognitive testing, the reliable change index (RCI) derived from the healthy volunteers was used to determine the cognitive changes in patients with carotid stenosis.Results: Among the 85 patients with carotid stenosis, 21 patients received medical treatment (MED group), and procedure-related SILs were noted in 17 patients (SIL+ group) but not observed in 47 patients (SIL– group) after undergoing CAS. Two-way (group × phase) ANOVA revealed that the volunteer group showed improved scores in most cognitive tests while only limited improvement was noted in the SIL– group. The MED and control groups tended to show improvement in the follow-up cognitive testing than the SIL+ group. However, most of the cognitive changes for each patient group did not exceed the upper or lower limits (z = ±1.0) of the RCI.Conclusions: Although the occurrence of procedure-related SILs is common in patients undergoing CAS, their impacts on cognitive changes after CAS may be limited. The practice effect should be taken into consideration when interpreting cognitive changes following CAS.

Feasibility and clinical usefulness of the Unified Protocol in women survivors of violence

Violence against women is a serious public health problem. Worldwide, one in three women experiences violence throughout their lives. According to the triple vulnerability theory, being a survivor of violence could constitute a psychological vulnerability that would favor the appearance of emotional disorders, affecting their health, their style of parenting, and family well-being. The objective of this study is to verify the feasibility and usefulness of Unified Protocol (UP) in a group format for improving emotion regulation in women survivors of violence attended in the Specific Child and Adolescent Intervention Team (SCAIT), a social community service. The sample consists of 11 women who have experienced different types of violence who received the UP through 11 weekly, two-hour long and in group format sessions. Assessments were conducted at pre and post intervention and at 3, 6, and 12 months follow-up. The results of the Multivariate Analysis of Variance (MANOVA) show an increase in quality of life (including family relationships), self-esteem and extraversion scores, and a reduction in interference (including family life), neuroticism, somatization, anxiety, emotional lack of control, negative affect, depression, and emotional rejection scores. This evolution of the scores with the MANOVA takes into account all the evaluation time points (post, and follow-up at 3, 6 and 12 months). The results were statistically significant (p < 0.05), and had large effect sizes (η2p > 0.14). In addition, the reliable change index was calculated to assess the change at an individual level of each of the participants for the different outcomes. 90.9% of the participants rated the quality of the program received as “excellent” and we obtained a high rate of session attendance (82.64%). These results justify the need for randomized controlled clinical studies to demonstrate the feasibility and clinical efficacy of the UP in this context. This intervention would allow to address the needs of this population, by offering them comprehensive care and improving their mental health from a biopsychosocial model. Likewise, it might indirectly improve the well-being of the rest of the family members.

Infrequent intranasal oxytocin followed by positive social interaction improves symptoms in autistic children: a randomized clinical trial

There are currently no approved drug interventions for social behavior dysfunction in autism spectrum disorder (ASD). Previous trials investigating effects of daily intranasal oxytocin treatment have reported inconsistent results and have not combined it with positive social interaction. However, In two preclinical studies we established that treatment every-other-day rather than daily is more efficacious in maintaining neural and behavioral effects by reducing receptor desensitization. We aimed to establish whether 6-weeks of intranasal oxytocin compared with placebo treatment, followed by a period of positive social interaction, would produce greater symptom improvements in children with ASD. A double-blind, randomized, cross over design trial was completed including 41 children with ASD aged 3-8 years. Primary outcomes were the Autism Diagnostic Observation Schedule-2 (ADOS-2) and social responsivity scale-2 (SRS-2). Secondary measures included other autism-related questionnaires and social attention assessed using two eye-tracking paradigms. A clinical reliable change index analysis revealed improvements in ADOS-2 total scores in 44% of children. Improvements in SRS-2 and behavioral adaptability scores were also found and correlated with increased basal saliva oxytocin concentrations. Additionally, oxytocin improved restrictive and repetitive behavior scores and increased time spent viewing dynamic social compared to geometric stimuli and the eye region of angry, happy and neutral expression faces. There were no adverse side-effects of oxytocin treatment. Overall, our results demonstrate that 6 weeks of intranasal oxytocin treatment administered every other day and followed by positive social interactions can improve clinical, eye-tracking and questionnaire-based assessments of symptoms in young autistic children.

Early Treatment Change in Perpetrators of Sexual Versus Non-Sexual Violence

The purpose of this study is to assess treatment change at both a group and individual level in a sample of 81 Dutch male patients who received mandated care for either violent (non-sexual) behavior or sexual violent behavior. Psychiatric nurses rated patients’ social skills, insight, hostility, physical violence with the BEST-Index every 6 months over the course of 2 years after patients were admitted to hospital. Mixed analysis of covariances and the reliable change index indicated that patients, irrespective of offense type, showed treatment change over time with exception of physical violence. This study shows that general treatment may be useful in the first 18 month for risk factors common to different types of offenses, but that specialized treatment is needed to establish further change.

When (Not) to Rely on the Reliable Change Index

The reliable change index (RCI) is a widely used statistical tool designed to account for measurement error when evaluating difference scores. Because of its conceptual simplicity and computational ease, it persists in research and applied psychology. However, researchers have repeatedly demonstrated ways that the RCI is insufficient or invalid for various applications. This is a problem in research and clinical psychology since this common tool is potentially problematic. The aims of this manuscript are to non-technically describe the formulation and assumptions of the RCI, to offer guidance as to when the RCI is (and is not) appropriate, and to identify what is needed for proper calculation of the RCI when it is used. Several criteria are identified to help determine whether the RCI is appropriate for a specific use. It is apparent that the RCI is the best available method only in a small number of situations, is frequently miscalculated, and produces incorrect inferences more often than simple alternatives, largely because it is highly insensitive to real changes. Specific alternatives are offered which may better operationalize common inferential tasks, including when more than two observations are available and when false negatives are equally costly to false positives.

Impact of multimodal warming during general anaesthesia on postoperative cognitive dysfunction in elderly patients with gynaecological cancer: study protocol for a single-blinded randomised controlled trial

BackgroundCognitive impairment after anaesthesia and surgery is a recognised consequence. This often leads to poor health outcomes and increases healthcare resource utilisation and associated costs, especially in elderly people. However, thus far, there have not been any effective therapies for managing postoperative cognitive dysfunction (POCD). Furthermore, research on the association of multimodal warming with POCD and the clinical outcomes in older patients after gynaecological surgery has not been rigorous. For these reasons, our investigation aims to evaluate whether perioperative multimodal warming would reduce the incidence of POCD and improve prognosis in elderly patients with gynaecological cancer.Methods and analysisThis is a single-centre, prospective, single-blinded randomised controlled trial. One hundred and fifty patients for gynaecological cancer surgery and 16 non-surgical controls aged 65 years or older will be studied in this trial. A series of neuropsychological tests will be completed to evaluate cognitive function in surgery patients before, at day 7 and 3 months after gynaecological cancer surgery. In addition, POCD and cognitive decline will be assessed using the reliable change index using the control group’s results. The primary outcome is the prevalence of POCD in elderly gynaecological cancer surgery patients and association between perioperative multimodal warming and POCD.Ethics and disseminationThe protocol for this prospective observational study was approved by the ethics committee of the West China Second University Hospital, Sichuan University (NO. KX215). Recruitment will commence in April 2021 and continue to April 2022. The findings of this trial will be disseminated in peer-reviewed journals and scientific meetings.Trial registration numberChiCTR2100041663.

Association Between Brain Substructure Dose and Cognitive Outcomes in Children With Medulloblastoma Treated on SJMB03: A Step Toward Substructure-Informed Planning

PURPOSE To characterize the association between neurocognitive outcomes (memory and processing speed) and radiation (RT) dose to the hippocampus, corpus callosum (CC), and frontal white matter (WM) in children with medulloblastoma treated on a prospective study, SJMB03. PATIENTS AND METHODS Patients age 3-21 years with medulloblastoma were treated at a single institution on a phase III study. The craniospinal RT dose was 23.4 Gy for average-risk patients and 36-39.6 Gy for high-risk patients. The boost dose was 55.8 Gy to the tumor bed. Patients underwent cognitive testing at baseline and once yearly for 5 years. Performance on tests of memory (associative memory and working memory) and processing speed (composite processing speed and perceptual speed) was analyzed. Mixed-effects models were used to estimate longitudinal trends in neurocognitive outcomes. Reliable change index and logistic regression were used to define clinically meaningful neurocognitive decline and identify variables associated with decline. RESULTS One hundred and twenty-four patients were eligible for inclusion, with a median neurocognitive follow-up of 5 years. Mean right and left hippocampal doses were significantly associated with decline in associative memory in patients without posterior fossa syndrome (all P < .05). Mean CC and frontal WM doses were significantly associated with decline in both measures of processing speed (all P < .05). Median brain substructure dose–volume histograms were shifted to the right for patients with a decline in associative memory or processing speed. The odds of decline in associative memory and composite processing speed increased by 23%-26% and by 10%-15% for every 1-Gy increase in mean hippocampal dose and mean CC or frontal WM dose, respectively. CONCLUSION Increasing RT dose to the CC or frontal WM and hippocampus is associated with worse performance on tests of processing speed and associative memory, respectively. Brain substructure–informed RT planning may mitigate neurocognitive impairment.

Effects of Rhythmic Interventions on Cognitive Abilities in Parkinson’s Disease

<b><i>Objective:</i></b> The objective of this study is to compare 2 different rhythmic, high-intensive interventions, that is, rhythmic speech-language therapy (rSLT) versus rhythmic balance-mobility training (rBMT), against a no-therapy (NT) condition in patients with Parkinson’s disease and against healthy controls (HCs) with regard to the change in or enhancement of cognitive abilities. <b><i>Methods:</i></b> The 4 groups (rSLT: <i>N</i> = 16; rBMT: <i>N</i> = 10; NT: <i>N</i> = 18; and HC: <i>N</i> = 17) were matched for age, sex, and educational level and were tested in 6 cognitive domains: working memory, executive function, visuo-construction, episodic memory, attention, and word retrieval. Assessments took place at baseline, at 4 weeks (T1), and at 6 months (T2). Rhythmic interventions were provided 3 times per week for 4 weeks in total. To analyze true intervention effects between groups and across time, statistical analyses included <i>reliable change index.</i> Intergroup differences were assessed with multivariate assessment of variance, while differences within groups were assessed with 95% confidence intervals of mean difference. <b><i>Results:</i></b> The rSLT improved <i>working memory</i> and <i>word retrieval</i> (<i>p</i> &#x3c; 0.05), possibly a beneficial transfer effect of the training method per se. In contrast, the NT group worsened in <i>phonemic</i> and <i>semantic shifting</i> (<i>p</i> &#x3c; 0.01). Observed improvements in <i>flexibility</i> and in <i>episodic memory</i> in the HC may be linked to training effects of retesting. <b><i>Conclusions:</i></b> Rhythmic cues are resistant to neurodegeneration and have a strong motivating factor. As thus, these may facilitate high-intensive and demanding training. Although both trainings were superior to NT, the improvement of cognitive abilities depends on the specific training method. Further, therapy may be more effective when delivered by a therapist rather than by an impersonal computer program.

Nostalgic conversations: The co-production of an intervention package for people living with dementia and their spouse

Objectives Nostalgic memories are more social than other forms of autobiographical recall, often refer to atypical events, express more positive affect and reflect life as meaningful. Recalling a nostalgic (compared to ordinary) memory increases self-esteem, self-growth, meaning in life and social connectedness for people living with dementia. We set two objectives: to work with people living with dementia to develop an intervention based on nostalgia, and to assess whether couples could engage in nostalgic conversations. Method Our research fell into three phases. Initially, we consulted with people living with dementia and with carers to identify the parameters for a nostalgic intervention. From this, we drafted a workbook that contained triggers for nostalgic conversations, which we then took back to the public contributors for refinement. Finally, we trialled the workbook over 5 weeks with six couples, each of which included a person living with dementia. We assessed pre- and post-intervention self-esteem, self-growth, meaning in life and social connectedness for participants with dementia and social connectedness for carers. We then calculated Reliable Change Index scores and established levels of clinically significant change. We also interviewed couples at the end of the intervention to explore its implementation and acceptability. Results All six couples could identify nostalgic memories, with five couples successfully integrating the nostalgic conversations into their day-to-day lives. A sixth couple found it difficult to engage fully with the intervention, but still considered it useful. All six couples manifested a reliable change in at least one outcome, with one couple showing reliable change across three outcomes. Conclusion The psychological benefits of nostalgia have been robustly demonstrated in laboratory-based studies. This co-production of an intervention that sets nostalgic recall into the context of a conversation has clinical potential but requires further investigation through a larger study.