Acceptance and Commitment Therapy for people living with motor neuron disease: an uncontrolled feasibility study

BACKGROUND

Motor neuron disease (MND) is a fatal, progressive neurodegenerative disease that causes progressive weakening and wasting of limb, bulbar, thoracic and abdominal muscles. Clear evidence-based guidance on how psychological distress should be managed in people living with MND (plwMND) is lacking. Acceptance and Commitment Therapy (ACT) is a form of psychological therapy that may be particularly suitable for this population. However, to the authors' knowledge, no study to date has evaluated ACT for plwMND. Consequently, the primary aim of this uncontrolled feasibility study was to examine the feasibility and acceptability of ACT for improving the psychological health of plwMND.

METHODS

PlwMND aged ≥ 18 years were recruited from 10 UK MND Care Centres/Clinics. Participants received up to 8 one-to-one ACT sessions, developed specifically for plwMND, plus usual care. Co-primary feasibility and acceptability outcomes were uptake (≥ 80% of the target sample [N = 28] recruited) and initial engagement with the intervention (≥ 70% completing ≥ 2 sessions). Secondary outcomes included measures of quality of life, anxiety, depression, disease-related functioning, health status and psychological flexibility in plwMND and quality of life and burden in caregivers. Outcomes were assessed at baseline and 6 months.

RESULTS

Both a priori indicators of success were met: 29 plwMND (104%) were recruited and 76% (22/29) attended ≥ 2 sessions. Attrition at 6-months was higher than anticipated (8/29, 28%), but only two dropouts were due to lack of acceptability of the intervention. Acceptability was further supported by good satisfaction with therapy and session attendance. Data were possibly suggestive of small improvements in anxiety and psychological quality of life from baseline to 6 months in plwMND, despite a small but expected deterioration in disease-related functioning and health status.

CONCLUSIONS

There was good evidence of acceptability and feasibility. Limitations included the lack of a control group and small sample size, which complicate interpretation of findings. A fully powered RCT to evaluate the clinical and cost-effectiveness of ACT for plwMND is underway.

TRIAL REGISTRATION

The study was pre-registered with the ISRCTN Registry (ISRCTN12655391).

Species of Metarhizium anisopliae complex implicated in human infections: retrospective sequencing study

OBJECTIVES

Fungi belonging to the Metarhizium anisopliae complex comprise ubiquitous arthropod pathogenic moulds used as mycopesticides. Rare cases of human infections due to M. anisopliae have been reported. We hypothesize misidentifications of fungal strains implicated in these cases or used in mycopesticides.

METHODS

A review of the literature was conducted to identify previously published cases. We collected some of these previous described strains and reported new cases, and a French mycopesticide containing M. anisopliae. All identifications were performed based on elongation factor-1α gene sequencing.

RESULTS

We report eight new cases of Metarhizium infection in humans (three from France and five from Australia). The strains isolated from these cases, and three others from already published cases and reported as M. anisopliae, were molecularly identified based on elongation factor-1α (Ef1-α) gene sequencing as follows: Metarhizium robertsii (six), Metarhizium guizhouense (three), Metarhizium brunneum (one) and Metarhizium pingshaense (one).

CONCLUSIONS

In this study, we report new human cases of Metarhizium infections, and, based on Ef-1α gene sequencing, we demonstrate the misidentification of species in case reports. We also correct the species identification of a strain reported as M. anisopliae used in a commercially available mycopesticide. According to our results, none of the strains from the human infection reports reviewed belongs to the species M. anisopliae.

Outcome of a tobacco use cessation randomized trial with high-school students

This study analyzed quantitative data on tobacco use and dependency for 3,589 high-school students, qualitative data for 448 students, and outcome data for a randomized trial comparing the efficacy of two cessation interventions and a control condition for 337 students. Data were collected from 1988 through 1992 in California and Illinois as part of a larger longitudinal study. Smokeless tobacco users, but not smokers, were more likely than controls to maintain cessation for 4 months: biochemically validated cessation at 4 months was 6.5% versus 3.2% for smokers and 14.3% versus 0.0% for smokeless tobacco users. Implications and limitations are discussed.

Does parental involvement make a difference? The impact of parent interactive activities on students in a school-based AIDS prevention program

OBJECTIVES

In this study, we test the effectiveness of involving parents in school-based AIDS education with respect to altering AIDS-related knowledge, attitudes, behavioral intentions, communications patterns, and behavior of students.

METHODS

Fifteen high risk school districts (pre-test N = 2,392) were randomly assigned to one of three conditions: parent-interactive (classroom curricula + parent-interactive component); parent non-interactive (classroom curricula only); control (basic AIDS education ordinarily provided by the school). Students were tested over time in grades 7, 8 and 9.

RESULTS

Results indicate that both treatment conditions (parent-interactive and non-interactive) had a strong positive impact in enhancing student's knowledge, attitudes, communication patterns and behavioral intentions. Further, results indicate that there were no behavioral outcome differences between the treatment groups and the control condition. Results demonstrate few outcome differences between the two experimental conditions.

CONCLUSIONS

In the two treatment groups (parent-interactive and parent non-interactive), the program effects appear to be the result of school-based curricula and of student self-determined intentions and behaviors, rather than the presence or absence of planned parental involvement. Whether or not structured or planned parental involvement becomes part of a school-based educational activity should perhaps be determined by (a) the existing level of parent-school interaction based on the nature of the community, (b) the amount of money readily available to follow through on a program of parent involvement without compromising on student programs, (c) the age of the child and the sensitivity of the issue, and (d) the ability of the parent/family to be involved effectively without extraordinary expense or sacrifice by either parent or school. Our findings speak to the positive role of the school regardless of parent participation.

Immunoreactivities of m-calpain, calpastatin, nitric oxide synthase, myelin basic protein and dynamin II in baker's yeast, wheat germ and lobster tail muscle

Vertebrate m-calpain, calpastatin, constitutive nitric oxide synthase, myelin basic protein, and dynamin I are substrates of protein kinase C (PKC). The presence/absence of similar/related protein in nonvertebrate was investigated by immunological methods, including (1) affinity chromatography on agarose-secondary antibodies and agarose IgG for removal of nonspecific immunoreactivities from crude extracts; (2) omitting beta-mercaptoethanol treatment and boiling prior to SDS-PAGE to increase the immunoreactivity; (3) immunoreactivity comparisons of nonspecific IgG as controls with specific anti-(vertebrate PKC-substrates/related proteins) in Western blots. It was found that (a) m-calpain and dynamin I were absent in baker's yeast, wheat germ and lobster tail muscle, (b) m-calpain, nitric oxide synthase, myelin basic protein and dynamin II were present in all three samples, and (c) calpastatin was present in baker's yeast and lobster tail muscle. The presence and absence of these proteins suggest evolutionary conservation and divergence, respectively, of these PKC substrates.

Impact of a school-based AIDS prevention program on risk and protective behavior for newly sexually active students

This project assessed the impact of a school-based AIDS prevention program on student participation in sexual risk and protective behaviors such as use of condoms and use of condoms with foam and intention to participate in such behaviors. The paper focuses on students who became sexually active for the first time between the seventh and eighth grade ("changers," n = 312). The school-based intervention was developed using social cognitive theory and the social influences model of behavior change. Using an experimental, longitudinal design, 15 high-risk school districts were divided randomly into two treatment (10 districts) and one control (five districts) conditions. Students in both treatment conditions received a 10-lesson classroom program in the seventh grade with a five-lesson booster in the eighth grade, while control students received basic AIDS education (current practice in their districts) in compliance with state mandates. Results indicated classroom programs had an impact on certain protective behaviors and on frequency of sexual activity the past month. Post-intervention measures also indicated the program affected students' intentions to perform specific protective behaviors.

A longitudinal comparison of the AIDS-related attitudes and knowledge of parents and their children

As part of an evaluation of an experimental school-based AIDS risk-reduction program, data from 2,392 middle-school students in 15 high-risk school districts and from 1,627 of their parents were compared to examine how young adolescents and their parents differ with respect to AIDs-related knowledge and attitudes. At the time of the seventh-grade pretest, parents knew significantly more about AIDS than their children did. At the eighth-grade posttest, students who participated in the program knew either more than or at least as much as their parents in several subject areas, while among those not exposed to the program, parents still knew more than their children in most areas. The intervention had a positive impact on students' attitudes toward people with AIDS and on their degree of comfort about discussing with their parents such issues as drug use and sexuality.

Correlates of HIV risk among young adolescents in a large metropolitan midwestern epicenter

This paper examines levels of participation in and correlates of AIDS-related risk behavior for young adolescents in high-risk communities as determined by proxy indicators such as rates of reported STDs and adolescent pregnancies. Seventh and eighth grade students from two middle schools and ninth grade students from the receiving high school were surveyed. Descriptive and inferential techniques examined grade, racial, behavioral, and gender differences in participation in risk (substance use and sexual activity) and protective (use of condoms and use of condoms and foam) behaviors. Grade, race, and sexual activity were significant correlates of both licit and illicit drug use. Gender, grade, race, and licit and illicit drug use were significant correlates of sexual activity. Results demonstrate that not only are adults and older teens at risk in these communities, but younger adolescents also are at risk. Findings indicate a need for comprehensive HIV prevention programs at younger ages.

Attitudes toward people with AIDS and implications for school-based youth AIDS education

This study examines attitudes toward people with AIDS (PWAs) of a group of 853 7th, 8th, and 9th graders living in high-risk communities in the suburbs of a large Midwestern city. Females appear to be more tolerant than males, and whites appear to be more tolerant than other racial/ethnic groups with respect to attitudes toward PWAs. Although knowledge about actual modes of human immunodeficiency virus (HIV) transmission is not correlated with attitudes toward PWAs, students with greater knowledge about HIV transmission through casual contact, transmission of HIV through blood products, ways of preventing HIV infection, and myths about HIV prevention have more tolerant attitudes toward PWAs. Students who have ever had sexual intercourse are significantly less tolerant of PWAs. Implications of these findings for youth AIDS education are presented.

Use of community health workers with inner-city children who have asthma

Use of community health workers (CHWs) to obtain health, social, and environmental information from African-American inner-city children with asthma was one component of a larger intervention study designed to reduce morbidity in African-American children with asthma. A subset of 140 school-aged children with asthma was recruited and enrolled in a program to receive home visits by CHWs for the purposes of obtaining medical information and teaching basic asthma education to the families. Data obtained by the CHWs revealed low inhaled steroid use, high beta 2 agonist use, frequent emergency-room visits, decreased primary-care visits, and increased allergen and irritant exposure. Appropriately recruited and trained CHWs are effective in obtaining useful medical information from inner-city families with children with asthma and providing basic asthma education in the home.

Home environmental risk factors in urban minority asthmatic children

Urban minority families with children with asthma often live in homes with allergen and irritant exposures harmful to these children. We enrolled 392 African-American asthmatic children, male and female, aged 5 to 12, from 42 schools in Washington, DC and Baltimore, MD. The project is designed to test the effectiveness of school-based asthma education interventions, community-based asthma health workers' programs, and the combination on these children. Baseline telephone interviews were carried out with the primary home care-givers for demographic data and for environmental home exposures that exacerbated asthma. Exposures stated to cause wheezing in the children were cigarette smoke in 72%, dust in 53%, cats in 34%, dogs in 27%, and roach exposure in 15%. Fifty-six percent of children live with cigarette smoke exposure, 73% of which is from mothers. This was a highly symptomatic group with 44% reporting two or more days per week of restricted activity and 62% reporting two or more episodes of night symptoms per week. Those with mattress covers on beds had significantly fewer emergency department visits in the past 6 months than those without covers. Over one-third of parents reported children taking two bronchodilators without anti-inflammatory agents. Less than 20% were reported using anti-inflammatory medications. Decreasing asthma severity in this population entails the prevention and control of known risk factors in the home environment. Emphasis must be placed on cigarette smoking cessation programs, covering mattresses, and dust and animal dander control. Primary care physicians require education on the role of anti-inflammatory medications.

Young adolescent attitudes toward sex and substance use: implications for AIDS prevention

This paper explores differences in adolescents' attitudes, beliefs, and resistance skills regarding sexual behaviors and use of substances in the context of AIDS prevention. A total of 553 7th and 8th grade students completed a self-administered questionnaire as baseline data collection for a human immunodeficiency virus (HIV) prevention project. Students' attitudes about sexual behavior and substance use differed markedly. Teens in this sample reported feeling significantly more comfortable discussing substance use with their parents than discussing sex; they also reported that it is easier to say "no" to alcohol or marijuana than to resist pressures to have sex. Furthermore, these young adolescents believed that their parents would be less upset to discover that they were sexually active than to find out they were using drugs. Among students who had ever had sex and who had ever used alcohol, young adolescents indicated that their parents would be much less upset to find out they were having sex than to discover they were smoking, drinking alcohol, or using drugs. Implications of the findings for HIV/AIDS prevention efforts are discussed.

Influence of coralline hydroxyapatite used as an ocular implant on the dose distribution of external beam photon radiation therapy

Coralline hydroxyapatite spheres are used as buried integrated ocular implants after enucleation or evisceration surgery. Because such implants are used after surgery for intraocular malignancy and because some patients may require postoperative radiation therapy for orbital tumor recurrence, the radiation attenuation characteristics of the implant are of interest. The authors evaluated the attenuation and scattering properties of coralline hydroxyapatite implants using a 4 MV photon beam and film dosimetry. Optical density analyses indicate that coralline hydroxyapatite implants have no significant influence on the attenuation or scattering properties of the photon beam. As such, there is no basis for concern that such implants might adversely affect external beam photon irradiation.

Patterns of approximal wear in cheek teeth of a Romano-British population

The approximal surfaces of premolars and molars of 376 adult British-Romano skulls were examined for wear facets. The type of wear was designated as convex, concave, sigmoid, or flat, and the degree was categorised on a three-point scale. Concave wear facets were more frequently seen in the older age groups, but the type of wear was similar on right and left sides. Taking all teeth together or as individual tooth types, concave wear was significantly more likely on mesial rather than distal surfaces. The degree of wear was age related and similar on right and left sides in both males and females. It is suggested that the distribution of concave facets may be related to movements between adjacent teeth.