Evaluating the efficacy and mechanisms of a ketogenic diet as adjunctive treatment for people with treatment-resistant depression: A protocol for a randomised controlled trial.

BACKGROUND: One-third of people with depression do not respond to antidepressants, and, after two adequate courses of antidepressants, are classified as having treatment-resistant depression (TRD). Some case reports suggest that ketogenic diets (KDs) may improve some mental illnesses, and preclinical data indicate that KDs can influence brain reward signalling, anhedonia, cortisol, and gut microbiome which are associated with depression. To date, no trials have examined the clinical effect of a KD on TRD. METHODS: This is a proof-of-concept randomised controlled trial to investigate the efficacy of a six-week programme of weekly dietitian counselling plus provision of KD meals, compared with an intervention involving similar dietetic contact time and promoting a healthy diet with increased vegetable consumption and reduction in saturated fat, plus food vouchers to purchase healthier items. At 12 weeks we will assess whether participants have continued to follow the assigned diet. The primary outcome is the difference between groups in the change in Patient Health Questionnaire-9 (PHQ-9) score from baseline to 6 weeks. PHQ-9 will be measured at weeks 2, 4, 6 and 12. The secondary outcomes are the differences between groups in the change in remission of depression, change in anxiety score, functioning ability, quality of life, cognitive performance, reward sensitivity, and anhedonia from baseline to 6 and 12 weeks. We will also assess whether changes in reward sensitivity, anhedonia, cortisol awakening response and gut microbiome may explain any changes in depression severity. DISCUSSION: This study will test whether a ketogenic diet is an effective intervention to reduce the severity of depression, anxiety and improve quality of life and functioning ability for people with treatment-resistant depression.

The state of evidence for social and emotional learning: A contemporary meta-analysis of universal school-based SEL interventions.

This article provides a systematic review and meta-analysis of the current evidence for universal school-based (USB) social and emotional learning (SEL) interventions for students in kindergarten through 12th grade available from 2008 through 2020. The sample includes 424 studies from 53 countries, reflecting 252 discrete USB SEL interventions, involving 575,361 students. Results endorsed that, compared to control conditions, students who participate in USB SEL interventions experienced significantly improved skills, attitudes, behaviors, school climate and safety, peer relationships, school functioning, and academic achievement. Significant heterogeneity in USB SEL content, intervention features, context, and implementation quality moderated student experiences and outcomes. Strengths and limitations of this evidence and implications for future USB SEL research, policy, and practice are discussed.

Clinical Assessment of Eye Movement Desensitization and Reprocessing in Memory Distress: Protocol for a Double-Blinded Randomized Controlled Trial.

BACKGROUND: Exposures to "traumatic" events are widespread and can cause posttraumatic stress disorder (PTSD). Cognitive behavioral therapy and eye movement desensitization and reprocessing (EMDR) are frequently used and validated behavioral PTSD treatments. Despite demonstrated effectiveness, highly upsetting memory reactions can be evoked, resulting in extensive distress and, sometimes, treatment dropout. In recent years, multiple treatment approaches have aimed at reducing such upsetting memory reactions to traumatic memories while therapeutic progress proceeds. One of these methods, the flash technique (FT), a modification of standard EMDR (S-EMDR), appears effective in distressing memory reduction. This study will examine FT-EMDR and S-EMDR efficacies when both methods are delivered via web-based video. OBJECTIVE: This study aims to assess the relative efficacy of (web-based) FT-EMDR versus S-EMDR in reducing the PTSD symptoms, anxieties, and depression associated with traumatic memories at postintervention and 1-month follow-up. METHODS: This double-blinded, web-based, 2-arm randomized controlled trial will employ self-report outcomes. A total of 90 participants will be identified from the web-based CloudResearch platform and randomly allocated to the experimental or comparison group. Inclusion criteria are as follows: (1) approved for engagement by the CloudResearch platform; (2) 25-60 years of age; (3) residing in Canada or the United States; (4) a recalled disturbing memory of an event >2 years ago that has not repeated and was moderately or more upsetting during occurrence; (5) memory moderately or more upsetting at baseline and not linked to an earlier memory that is equally or more than equally disturbing. Exclusion criteria are bipolar disorder, borderline personality disorder, obsessive-compulsive disorder, schizophrenia, substance abuse or addiction in the past 3 months, suicidal ideation, and suicide attempt in the past 6 months. Interventions include guided video instruction of full FT or guided video of EMDR. Outcome measures are as follows: Primary outcome is PTSD symptoms that are measured by the PTSD Checklist for DSM-5 (Diagnostic and Statistical Manual of Mental Disorders-5) at 1-month follow-up. Secondary outcomes are State Anxiety subscale of State-Trait Anxiety Inventory at baseline, postintervention, and 1-month follow-up; Trait Anxiety subscale of State-Trait Anxiety Inventory; depression (Patient Health Questionnaire-9); and Positive and Negative Affect Schedule measured at 1-month follow-up. RESULTS: If, at 1-month follow-up, the web-based FT-EMDR intervention is more effective in reducing PTSD symptoms (as measured by the PTSD Checklist for DSM-5) than EMDR, it may help reduce traumatic memory distress in multiple contexts. CONCLUSIONS: This randomized controlled trial will advance current understandings of PTSD symptoms and interventions that target traumatic memory-related distress. TRIAL REGISTRATION: ClinicalTrials.gov NCT05262127; https://clinicaltrials.gov/ct2/show/NCT05262127.

A Web-Based Cognitive Behavioral Therapy, Mindfulness Meditation, and Yoga Intervention for Posttraumatic Stress Disorder: Single-Arm Experimental Clinical Trial.

BACKGROUND: Posttraumatic stress disorder (PTSD) is a debilitating, undertreated condition. The web-based delivery of cognitive behavioral therapy supplemented with mindfulness meditation and yoga is a viable treatment that emphasizes self-directed daily practice. OBJECTIVE: This study aims to examine the effectiveness of a web-based cognitive behavioral therapy, mindfulness, and yoga (CBT-MY) program designed for daily use. METHODS: We conducted an 8-week, single-arm, experimental, registered clinical trial on adults reporting PTSD symptoms (n=22; aged 18-35 years). Each participant received web-based CBT-MY content and an hour of web-based counseling each week. Pre-post outcomes included self-reported PTSD symptom severity, depression, anxiety, chronic pain, and mindfulness. Pre-post psychophysiological outcomes included peak pupil dilation (PPD) and heart rate variability (HRV). HRV and PPD were also compared with cross-sectional data from a non-PTSD comparison group without a history of clinical mental health diagnoses and CBT-MY exposure (n=46). RESULTS: Pre-post intention-to-treat analyses revealed substantial improvements in PTSD severity (d=1.60), depression (d=0.83), anxiety (d=0.99), and mindfulness (d=0.88). Linear multilevel mixed models demonstrated a significant pre-post reduction in PPD (B=-0.06; SE=0.01; P<.001; d=0.90) but no significant pre-post change in HRV (P=.87). Overall, participants spent an average of 11.53 (SD 22.76) min/day on self-directed mindfulness practice. CONCLUSIONS: Web-based CBT-MY was associated with clinically significant symptom reductions and significant PPD changes, suggesting healthier autonomic functioning. Future randomized controlled trials are needed to further examine the gains apparent in this single-arm study. TRIAL REGISTRATION: ClinicalTrials.gov NCT03684473; https://clinicaltrials.gov/ct2/show/NCT03684473.

Meaning in life and vagally-mediated heart rate variability: Evidence of a quadratic relationship at baseline and vagal reactivity differences.

Higher meaning in life (MIL) consistently predicts better health, but the physiological processes underlying this relationship are not well understood. This study examined the relationship between MIL and vagally-mediated heart rate variability (VmHRV) under resting (N = 77), stressor (n = 73), and mindfulness intervention (n = 72) conditions. Regression was used for MIL-VmHRV analyses at baseline, and longitudinal mixed models were used to examine phasic changes in VmHRV as a function of MIL. Regression revealed a quadratic MIL-VmHRV relationship, and mixed models linked higher MIL to greater stress-reactivity but not enhanced stress-attenuation. MIL and mindfulness did not interact to influence VmHRV recovery after experimental stress. Findings suggest that cardiac vagal tone and cardiac vagal reactivity are linked to MIL, shedding light on the physiology underlying MIL and its health associations.

Online Mindfulness-Based Cognitive Behavioral Therapy Intervention for Youth With Major Depressive Disorders: Randomized Controlled Trial.

BACKGROUND: Approximately 70% of mental health disorders appear prior to 25 years of age and can become chronic when ineffectively treated. Individuals between 18 and 25 years old are significantly more likely to experience mental health disorders, substance dependencies, and suicidality. Treatment progress, capitalizing on the tendencies of youth to communicate online, can strategically address depressive disorders. OBJECTIVE: We performed a randomized controlled trial (RCT) that compared online mindfulness-based cognitive behavioral therapy (CBT-M) combined with standard psychiatric care to standard psychiatric care alone in youth (18-30 years old) diagnosed with major depressive disorder. METHODS: Forty-five participants were randomly assigned to CBT-M and standard care (n=22) or to standard psychiatric care alone (n=23). All participants were provided standard psychiatric care (ie, 1 session per month), while participants in the experimental group received an additional intervention consisting of the CBT-M online software program. Interaction with online workbooks was combined with navigation coaching delivered by phone and secure text messaging. RESULTS: In a two-level linear mixed-effects model intention-to-treat analysis, significant between-group differences were found for the Beck Depression Inventory-II score (difference -8.54, P=.01), Quick Inventory of Depressive Symptoms score (difference -4.94, P=.001), Beck Anxiety Inventory score (difference -11.29, P<.001), and Brief Pain Inventory score (difference -1.99, P=.03), while marginal differences were found for the Five Facet Mindfulness Questionnaire-Nonjudging subscale (difference -2.68, P=.05). CONCLUSIONS: These results confirm that youth depression can be effectively treated with online CBT-M that can be delivered with less geographic restriction. TRIAL REGISTRATION: Clinical Trials.gov NCT03406052; https://www.clinicaltrials.gov/ct2/show/NCT03406052.

Philosophical Theories of Truth and Nursing: Exploring the Tensions.

In this paper, the authors explore three philosophical theories of truth and offer a critique of this foundational area of scholarship for nursing. A brief summary of key ideas related to the three substantial philosophical theories of truth-that is, correspondence, pragmatism, and coherence-serves to highlight various convictions and commitments that facilitate or discourage the growth of nursing knowledge in particular ways. The authors conclude that the coherence theory of truth offers a more inclusive view of truth and best captures and supports the diversity that exists within nursing knowledge and the regulative ideal to which nursing aspires.

Wearable Technology and Physical Activity Behavior Change in Adults With Chronic Cardiometabolic Disease: A Systematic Review and Meta-Analysis.

OBJECTIVE: To evaluate the effectiveness of wearable device interventions (eg, Fitbit) to improve physical activity (PA) outcomes (eg, steps/day, moderate to vigorous physical activity [MVPA]) in populations diagnosed with cardiometabolic chronic disease. DATA SOURCE: Based on Preferred Reporting Items for Systematic Reviews and Meta-Analyses, an electronic search of 5 databases (Medline, PsychINFO, Scopus, Web of Science, and PubMed) was conducted. STUDY INCLUSION AND EXCLUSION CRITERIA: Randomized controlled trials (RCTs) published between January 2000 and May 2018 that used a wearable device for the full intervention in adults (18+) diagnosed with a cardiometabolic chronic disease were included. Excluded trials included studies that used devices at pre-post only, devices that administered medication, and interventions with no prospective control group comparison. DATA EXTRACTION: Thirty-five studies examining 4528 participants met the inclusion criteria. Study quality and RCT risk of bias were assessed using the Cochrane Collaboration Tool. DATA SYNTHESIS: Meta-analyses to compute PA (eg, steps/day) and selected physical dispersion and summary effects were conducted using the raw unstandardized pooled mean difference (MD). Sensitivity analyses were examined. RESULTS: Statistically significant increases in PA steps/day (MD = 2592 steps/day; 95% confidence interval [CI]: 1689-3496) and MVPA min/wk (MD = 36.31 min/wk; 95% CI: 18.33-54.29) were found for the intervention condition. CONCLUSION: Wearable devices positively impact physical health in clinical populations with cardiometabolic diseases. Future research using the most current technologies (eg, Fitbit) will serve to amplify these findings.

The influence of work patterns on indicators of cardiometabolic risk in female hospital employees.

OBJECTIVE: This study explored the associations between work patterns and indicators of cardiometabolic risk in female hospital employees. BACKGROUND: Aspects of work environments potentially influence the health of employees; however, we have a poor understanding of how different hospital work patterns contribute to cardiovascular risk in female employees. METHODS: We conducted a cross-sectional study of 466 female employees from 2 hospitals in Ontario. Data were collected through self-report, physical examination, and use of hospital administrative work data. RESULTS: In the adjusted analyses, full-time work status, extended shift length, and working 35 or more paid overtime hours per year were significantly associated with metabolic syndrome. CONCLUSIONS: Different work patterns increase cardiometabolic risk in female employees, suggesting a need to better monitor the health of the workforce and implement healthy workplace policy.

Public health reform and health promotion in Canada.

More than 25 years have passed since the release of the Ottawa Charter for Health Promotion. This document represented a substantial contribution to public health in its emphasis on the economic, legal, political and cultural factors that influence health. With public health renewal underway across Canada, and despite overwhelming support in the public health community for the Ottawa Charter, how much its principles will be included in the renewal process remains unclear. In this paper, we present the historical understanding of health promotion in Canada, namely highlighting the contributions from the Lalonde Report, Alma Ata Declaration, the Ottawa Charter for Health Promotion and the more recent population health movement. We discuss public health renewal, using the province of British Columbia in Canada as an example. We identify the potential threats to health promotion in public health renewal as it unfolds.

Physical activity status of academic professors during their early career transition: an application of the theory of planned behavior.

Life-transitions (e.g. parenthood) have been linked to physical inactivity, yet the topic requires further exploration. In this study, we evaluated changes in the physical activity (PA) of adults during their early career transition using retrospective analysis and the theory of planned behavior. Recruitment from January to March 2010 yielded a random sample of 267 assistant professors, ages 25-44, employed within the last five years. Repeated measures analysis of variance (RM ANOVA) concluded that PA declined across the transition (d = 0.36-0.43) and was further attenuated by marriage, work hours, and parenthood status. Discriminant function analysis (DFA) identified specific behavioral and control correlates about PA enjoyment, limited time, inconsistent schedule, work demands, and job pressures to distinguish between those who remained active from those who did not across the transition. PA interventions administered prior to career transitions may be needed to prevent physical inactivity.

Motor skill interventions to improve fundamental movement skills of preschoolers with developmental delay.

Preschoolers with developmental delay (DD) are at risk for poor fundamental movement skills (FMS), but a paucity of early FMS interventions exist. The purpose of this review was to critically appraise the existing interventions to establish direction for future trials targeting preschoolers with DD. A total of 11 studies met the inclusion criteria. Major findings were summarized based on common subtopics of overall intervention effect, locomotor skill outcomes, object-control outcomes, and gender differences. Trials ranged from 8 to 24 weeks and offered 540-1700 min of instruction. The majority of trials (n = 9) significantly improved FMS of preschoolers with DD, with a large intervention effect (η(2) = 0.57-0.85). This review supports the utility of interventions to improve FMS of preschoolers with DD. Future researchers are encouraged to include more robust designs, a theoretical framework, and involvement of parents and teachers in the delivery of the intervention.

Supporting the students most in need: academic self-efficacy and perceived teacher support in relation to within-year academic growth.

Academic self-efficacy and perceived teacher support in relation to academic skill growth across one academic year were examined in the study. Participants included 193 5th-grade students. Teachers collected curriculum-based measures (CBM) of reading and math on three occasions as part of routine academic benchmarks, and researchers collected student-reported measures of academic self-efficacy and perceived teacher support in the spring of the same academic year. Results indicated that academic self-efficacy was positively related to fall reading and math CBM scores and that perceived teacher support was unrelated to fall scores or growth across the academic year. Academic self-efficacy and perceived teacher support interacted in relation to math CBM growth such that low levels of perceived teacher support were related to greater growth, particularly for students with high academic self-efficacy. Follow-up analyses indicated that students with the lowest fall CBM scores and smallest growth rates reported higher levels of perceived teacher support, suggesting that teachers support the students most in need.

Occupation correlates of adults' participation in leisure-time physical activity: a systematic review.

CONTEXT: The rapid changes to the labor force (e.g., advances in technology, overtime hours) have increased obesogenic behaviors (e.g., lack of physical activity, sedentariness on the job). PURPOSE: The purpose of this review was to unite and appraise the existing research examining occupation correlates of adults' participation in leisure-time physical activity (LTPA) to establish direction for future research targeting habitual inactivity. EVIDENCE ACQUISITION: Eligible studies were searched from January 2009 to July 2010 in English peer-reviewed journals. A total of 62 studies passed the inclusion criteria. Major findings were summarized based on common subtopics of occupation category/status, occupational physical activity (OPA), work hours, psychological work demands, and LTPA. EVIDENCE SYNTHESIS: Included articles were published between 1984 and 2010, with sample sizes ranging from 158 to 203,120. Occupation factors correlated with LTPA, but the magnitude of the effect was difficult to determine because of heterogeneous measures. Occupation category/status was directly associated with LTPA, with white-collar/professionals showing the highest LTPA compared to blue-collar workers. When OPA was measured, a positive association with LTPA was found. Work hours appeared to have a negative threshold effect on LTPA. Some preliminary evidence found psychosocial work demands (e.g., job strain) to be negatively correlated with LTPA levels. CONCLUSIONS: Convincing evidence supports the premise that those employed in occupations demanding long work hours and low OPA are at risk of inactivity. Existing research has focused heavily on cross-sectional data and study-created self-report measures. Longitudinal evaluations using robust research measures (e.g., accelerometry, National occupation classification tool) are a priority for future research.

DFT prediction and experimental observation of substrate-induced catalyst decomposition in ruthenium-catalyzed olefin metathesis.

Ruthenacyclobutane decomposition, involving competitive beta-hydride transfer to Ru and reductive olefin elimination during ruthenium-catalyzed olefin metathesis, is predicted by density functional theory calculations and experimentally confirmed by propene and butene formation during degenerate Ru-methylidene-catalyzed metathesis of ethylene. The results provide new focus on the nature of ruthenium metathesis catalyst decomposition under catalytic conditions.