intervention response

  • 文章类型: Journal Article
    生活方式干预可以预防2型糖尿病(T2DM)。然而,尽管体重减轻,但有些人没有预期的改善。缺乏在早期阶段鉴定此类个体的生物标志物。胰岛素样生长因子1(IGF-1)和胰岛素样生长因子结合蛋白1(IGFBP-1)显示可预测糖尿病前期的T2DM发病。我们评估了这些标志物是否也能预测生活方式干预的成功,从而可能指导个性化策略。我们分析了IGF-1,IGFBP-1和胰岛素样生长因子结合蛋白2(IGFBP-2)的空腹血清水平与代谢和人体测量参数变化的关系。包括肝内脂质(IHL)和内脏脂肪组织(VAT)体积,通过磁共振成像(MRI)测量,在345名糖尿病前期风险较高的参与者中(54%为女性;年龄36-80岁)。参与者参加了三项随机饮食干预试验,并在基线和干预后一年进行了评估。使用IBMSPSSStatistics(28版)进行统计分析,并且显著性设定为p<0.05。在为期一年的干预中,观察到总体显著改善.通过基线IGF-1和IGFBP-1百分位数对个体进行分层显示出显着差异:与较低水平相比,较高的IGF-1水平与更有利的变化相关。特别是在增值税和国际人道主义法方面。较低的基线IGFBP-1水平与较大的改善相关,特别是在IHL和2h葡萄糖中。更高的生物活性IGF-1水平可能预测糖尿病前期生活方式干预后更好的代谢结果。可能作为个性化干预的生物标志物。
    Lifestyle interventions can prevent type 2 diabetes (T2DM). However, some individuals do not experience anticipated improvements despite weight loss. Biomarkers to identify such individuals at early stages are lacking. Insulin-like growth factor 1 (IGF- 1) and Insulin-like growth factor binding protein 1(IGFBP-1) were shown to predict T2DM onset in prediabetes. We assessed whether these markers also predict the success of lifestyle interventions, thereby possibly guiding personalized strategies. We analyzed the fasting serum levels of IGF-1, IGFBP-1, and Insulin-like growth factor binding protein 2 (IGFBP-2) in relation to changes in metabolic and anthropometric parameters, including intrahepatic lipids (IHLs) and visceral adipose tissue (VAT) volume, measured by magnetic resonance imaging (MRI), in 345 participants with a high risk for prediabetes (54% female; aged 36-80 years). Participants were enrolled in three randomized dietary intervention trials and assessed both at baseline and one year post-intervention. Statistical analyses were performed using IBM SPSS Statistics (version 28), and significance was set at p < 0.05. Within the 1-year intervention, overall significant improvements were observed. Stratifying individuals by baseline IGF-1 and IGFBP-1 percentiles revealed significant differences: higher IGF-1 levels were associated with more favorable changes compared to lower levels, especially in VAT and IHL. Lower baseline IGFBP-1 levels were associated with greater improvements, especially in IHL and 2 h glucose. Higher bioactive IGF-1 levels might predict better metabolic outcomes following lifestyle interventions in prediabetes, potentially serving as biomarkers for personalized interventions.
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  • 文章类型: Journal Article
    We address defining and identifying students with dyslexia within the context of multi-tier systems of support (MTSS). We review proposed definitions of dyslexia, evidence for proposed definitional attributes, and emphasize the role of instructional response in identifying students with dyslexia. We identify dyslexia as individuals with specific deficits in reading and spelling single words combined with inadequate response to evidence-based instruction. We propose a hybrid identification process in which assessment is utilized within school-wide MTSS allowing for integration of routinely collected progress monitoring data as well integrating with more formal diagnostic measures. This proposed \"hybrid\" method demonstrates strong evidence for valid decision-making and directly informs instruction. We close proposing a revised definition of dyslexia that incorporates these elements.
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  • 文章类型: Journal Article
    背景:先前的研究表明,简短的认知行为预防失眠计划可以降低高危青少年患失眠的风险71%。这项研究旨在评估高危青少年亚组对失眠预防的不同反应。
    方法:将有失眠家族史和阈下失眠症状的青少年随机分配到为期4周的失眠预防计划或非活动对照组。在基线时进行评估,1周,干预后6个月和12个月。基线睡眠,白天,和情绪概况通过使用潜在类别分析(LCA)来确定不同的亚组。分析是根据意向治疗方法进行的。
    结果:LCA确定了三个亚组:(a)仅失眠症状,(b)失眠症状,白天嗜睡和轻度焦虑,和(c)失眠症状伴有白天嗜睡,轻度焦虑,和抑郁症。与对照组相比,第3亚组接受干预的青少年在12个月随访期间失眠障碍的发生率显着降低(风险比[HR]=0.37;95%置信区间[CI]:0.13-0.99;p=.049),第2亚组(HR=0.14;95%CI:0.02-1.08;p=.059)。此外,在第2和第3亚组中接受干预的青少年日间过度嗜睡的风险降低(第2亚组:调整后OR[AdjOR]=0.45,95%CI:0.23-0.87;第3亚组:调整后OR=0.32,95%CI:0.13-0.76)和可能的焦虑(第2亚组:调整后OR=0.47,95%CI:0.27-0.82;第3亚组:随访-
    结论:有失眠风险的青少年可以根据其心理状况分为不同的亚组,这与对失眠预防计划的不同反应有关。这些发现表明,需要进一步对有风险的青少年进行表型分析和分组,以制定个性化的失眠预防方法。
    BACKGROUND: Previous study has shown that a brief cognitive-behavioral prevention insomnia program could reduce 71% risk of developing insomnia among at-risk adolescents. This study aimed to evaluate the differential response to insomnia prevention in subgroups of at-risk adolescents.
    METHODS: Adolescents with a family history of insomnia and subthreshold insomnia symptoms were randomly assigned to a 4-week insomnia prevention program or nonactive control group. Assessments were conducted at baseline, 1 week, and 6- and 12-month after the intervention. Baseline sleep, daytime, and mood profiles were used to determine different subgroups by using latent class analysis (LCA). Analyses were conducted based on the intention-to-treat approach.
    RESULTS: LCA identified three subgroups: (a) insomnia symptoms only, (b) insomnia symptoms with daytime sleepiness and mild anxiety, and (c) insomnia symptoms with daytime sleepiness, mild anxiety, and depression. The incidence rate of insomnia disorder over the 12-month follow-up was significantly reduced for adolescents receiving intervention in subgroup 3 compared with the controls (hazard ratio [HR] = 0.37; 95% confidence interval [CI]: 0.13-0.99; p = .049) and marginally for subgroup 2 (HR = 0.14; 95% CI: 0.02-1.08; p = .059). In addition, adolescents who received intervention in subgroups 2 and 3 had a reduced risk of excessive daytime sleepiness (subgroup 2: adjusted OR [AdjOR] = 0.45, 95% CI: 0.23-0.87; subgroup 3: AdjOR = 0.32, 95% CI: 0.13-0.76) and possible anxiety (subgroup 2: AdjOR = 0.47, 95% CI: 0.27-0.82; subgroup 3: AdjOR = 0.33, 95% CI: 0.14-0.78) compared with the controls over the 12-month follow-up.
    CONCLUSIONS: Adolescents at risk for insomnia can be classified into different subgroups according to their psychological profiles, which were associated with differential responses to the insomnia prevention program. These findings indicate the need for further phenotyping and subgrouping at-risk adolescents to develop personalized insomnia prevention.
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  • 文章类型: Journal Article
    对利用当代数据密集型人类的研究,高通量\'omic\'测定技术,比如基因组学,转录组学,蛋白质组学和代谢组学,毫不含糊地揭示了人类在分子水平上的差异很大。这些差异,每个人不同的行为和环境暴露,影响个人对饮食和药物等健康干预措施的反应。关于根据个人细微差别的基因组为个人量身定制健康干预措施的最佳方法的问题,生理,行为,等。简介促使目前对“精密”医学的重视。这篇综述的目的是描述N-of-1(或个性化)多变量临床试验的设计和执行如何推进该领域。这些试验从整个人的角度关注个人对健康干预的反应,利用新兴的健康监测技术,并可用于解决精准医学时代最相关的问题。这包括如何验证可以指示干预的适当活动的生物标志物以及如何识别对个体的可能有益的干预。我们还认为,多元N-of-1和聚合N-of-1试验是在精准医学时代推进生物医学和转化科学的理想工具,因为从它们获得的见解不仅可以阐明如何治疗或预防疾病一般,但也提供深入了解如何提供实时护理的个人谁是寻求关注他们的健康问题摆在首位。
    Studies on humans that exploit contemporary data-intensive, high-throughput \'omic\' assay technologies, such as genomics, transcriptomics, proteomics and metabolomics, have unequivocally revealed that humans differ greatly at the molecular level. These differences, which are compounded by each individual\'s distinct behavioral and environmental exposures, impact individual responses to health interventions such as diet and drugs. Questions about the best way to tailor health interventions to individuals based on their nuanced genomic, physiologic, behavioral, etc. profiles have motivated the current emphasis on \'precision\' medicine. This review\'s purpose is to describe how the design and execution of N-of-1 (or personalized) multivariate clinical trials can advance the field. Such trials focus on individual responses to health interventions from a whole-person perspective, leverage emerging health monitoring technologies, and can be used to address the most relevant questions in the precision medicine era. This includes how to validate biomarkers that may indicate appropriate activity of an intervention as well as how to identify likely beneficial interventions for an individual. We also argue that multivariate N-of-1 and aggregated N-of-1 trials are ideal vehicles for advancing biomedical and translational science in the precision medicine era since the insights gained from them can not only shed light on how to treat or prevent diseases generally, but also provide insight into how to provide real-time care to the very individuals who are seeking attention for their health concerns in the first place.
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  • 文章类型: Journal Article
    现在有大量证据表明,平均而言,有效治疗阅读障碍的干预措施类型。一般不清楚,然而,什么预测了给定干预后个体水平变化的幅度。我们研究了理论上基于阅读计算模型的干预收益的新预测因子,并关注阅读系统功能组织中的个体差异。具体来说,我们估计了在语音加权干预前后,阅读障碍儿童(n=1183-4年级学生)在口头单词阅读任务中对两种信息来源--打印-语音对应关系和语义可成像性的依赖程度.我们表明,更多地依赖印刷语言规律性而较少依赖可想象性的儿童干预前的干预效果更好。并行,在干预过程中,对打印-言语对应关系的依赖增加,对可成像性的依赖减少的儿童,干预效果更好.重要的是,这两个因素与特定的阅读任务结果有不同的关系,更加依赖与伪词命名相关的印刷语音对应关系,而(较少)依赖与单词阅读和理解有关的可想象性。我们讨论了这些发现对阅读习得和教育实践的理论模型的意义。
    There is now considerable evidence regarding the types of interventions that are effective at remediating reading disabilities on average. It is generally unclear, however, what predicts the magnitude of individual-level change following a given intervention. We examine new predictors of intervention gains that are theoretically grounded in computational models of reading and focus on individual differences in the functional organization of the reading system. Specifically, we estimate the extent to which children with reading disabilities (n=118 3rd-4th graders) rely on two sources of information during an oral word reading task - print-speech correspondences and semantic imageability - before and after a phonologically-weighted intervention. We show that children who relied more on print-speech regularities and less on imageability pre-intervention had better intervention gains. In parallel, children who over the course of the intervention exhibited greater increases in their reliance on print-speech correspondences and greater decreases in their reliance on imageability had better intervention outcomes. Importantly, these two factors were differentially related to specific reading task outcomes, with greater reliance on print-speech correspondences associated with pseudoword naming, while (lesser) reliance on imageability related to word reading and comprehension. We discuss the implications of these findings for theoretical models of reading acquisition and educational practice.
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  • 文章类型: Journal Article
    当前针对儿童外部化问题的基于证据的预防计划显示出适度的总体影响大小,并且对于相当大比例的参与青年来说在很大程度上是无效的。然而,我们对与特定节目反应相关的青年和家庭特征的理解相当有限。当前的研究使用儿童和家庭风险状况作为对早期Risers进行问题预防性干预的反应轨迹的预测因子。由学校随机分配了240名表现出学校攻击性的幼儿园年龄青年的样本,以早期Risers干预或对照条件。使用一些儿童和家庭风险变量,潜在的概况分析产生了一个由五个独特的风险概况组成的解决方案。三个低风险和混合风险与干预措施的反应有限相关。一个高风险特征是适应不良的育儿和儿童外部化的增加,表明相对于控制条件,在3年的时间内,外部化行为的轨迹显着改善。另一个高风险特征是纪律不一致,父母的痛苦很高,和升高的儿童内化和外化症状似乎有积极的发展趋势被干预相对于控制条件中断,可能与相对于控制条件的医源性效应一致。研究结果支持继续努力使用更广泛的风险概况来检查异质性,以应对预防性干预措施,使用复制,将对干预剪裁产生影响。
    Current evidence-based prevention programming targeting child externalizing problems demonstrates modest overall effect sizes and is largely ineffective for a sizable proportion of youth who participate. However, our understanding of the youth and family characteristics associated with response to specific programming is quite limited. The current study used child and family risk profiles as predictors of response trajectories to the Early Risers conduct problem preventive intervention. A sample of 240 kindergarten-aged youth displaying elevated school-based aggression were randomized by school to either the Early Risers intervention or a control condition. Using a number of child and family risk variables, a latent profile analysis produced a solution consisting of five unique risk profiles. Three low and mixed risk profiles were associated with a limited response to the intervention. One high-risk profile characterized by maladaptive parenting and elevated child externalizing demonstrated notably improved trajectories of externalizing behavior over a 3-year period relative to the control condition. Another high-risk profile characterized by inconsistent discipline, high parental distress, and elevated child internalizing and externalizing symptoms seemed to have positive developmental trends disrupted by the intervention relative to the control condition, potentially consistent with an iatrogenic effect relative to the control condition. The study results support continued efforts to use broader risk profiles to examine heterogeneity in response to preventive interventions and, with replication, will have implications for intervention tailoring.
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  • 文章类型: Journal Article
    背景:这项研究试图为非大学就读的新兴成年人提供信息,一个有风险的人,和研究不足的人口,通过确定简短的酒精干预后的反应模式。这项研究是对一项随机对照干预试验数据的重新分析,针对非学生新兴成年饮酒者的个性化反馈酒精干预。目标:该研究的目的是(1)通过识别以大量饮酒(即高峰使用,在一个典型的星期内暴饮暴食的次数,暴饮暴食天数的比例,峰值估计血液酒精浓度[eBAC])在酒精干预后,和(2)区分与干预反应相关的因素的亚组(即关于同龄人饮酒多少的感知规范,酒精使用的严重程度,心理健康症状,并准备改变)。方法:参与者是从社区招募的81名(64.2%的男性)非学生重度饮酒者,年龄在18-25岁之间(平均年龄=22.04)。结果:研究结果揭示了两个对干预表现出不同反应的潜在亚组(即干预“反应者”和“无反应者”)。Further,响应者报告了更高的干预前描述性规范认知和酒精使用严重程度.结论/重要性:当前的调查有助于了解短期酒精干预在非学生新兴成年人中对谁起作用,并可以为未来的研究提供信息,以促进对干预工作无反应的人的行为改变。
    Background: This study sought to inform research with noncollege-attending emerging adults, an at-risk, and understudied population, by identifying patterns of response following a brief alcohol intervention. This study was a reanalysis of data from a randomized controlled intervention trial testing a brief, personalized feedback alcohol intervention targeting nonstudent emerging adult drinkers. Objectives: The study aims were to (1) model intervention response by identifying subgroups characterized by changes in heavy drinking (i.e. peak use, number of binges during a typical week, proportion of binge days, peak estimated blood alcohol concentration [eBAC]) following the alcohol intervention, and (2) distinguish subgroups on factors related to intervention response (i.e. perceived norms regarding how much peers drink, alcohol use severity, mental health symptoms, and readiness to change). Methods: Participants were 81 (64.2% men) nonstudent heavy drinkers between ages 18-25 years (average age = 22.04) recruited from the community. Results: Findings revealed two latent subgroups that exhibited differential response to the intervention (i.e. intervention \"responders\" and \"nonresponders\"). Further, responders reported higher pre-intervention descriptive normative perceptions and alcohol use severity. Conclusions/Importance: The current investigation contributed to knowledge regarding for whom brief alcohol interventions work in the short term within nonstudent emerging adults and could inform future research to facilitate behavior change in those unresponsive to intervention efforts.
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  • 文章类型: Journal Article
    Families with disruptive child behavior are typically referred to services based on children\'s behavior alone, rather than on underlying mechanisms of disruptive behavior. Yet, the presence of the precise mechanisms targeted by services might be essential for intervention success. We integrated person- and variable-centered approaches to test whether families with combined disruptive child behavior and harsh/inconsistent parenting indeed benefit most from a behavioral parenting intervention in indicated prevention context, compared to families with disruptive child behavior but less harsh/inconsistent parenting, and families with less severe disruptive behavior.
    Families (N = 387) of children aged 4 to 8 years (disruptive behavior >75th percentile) participated in a randomized trial of the Incredible Years parenting intervention (Trial NTR3594, www.trialregister.nl). We identified different response trajectories and tested whether families with combined child and parenting difficulties had a higher probability of responding well, compared to families with only child difficulties or less severe difficulties.
    Most intervention group families (82%) showed a nonresponse trajectory. A minority (18%) showed a response trajectory with strong reductions in disruptive behavior (Cohen\'s d =1.45). As expected, families with both child and parenting difficulties were most likely to respond: 20% more than families with only child difficulties, and 40% more than families with less severe difficulties.
    Incredible Years, as an indicated prevention program, benefits mainly families in which the mechanisms targeted by the intervention (ie, harsh/inconsistent parenting) is actually present, rather than all families. Careful matching of children to services based on assessments of both child and parenting behavior seems critical for intervention success.
    ORCHIDS: Study on Children\'s Genetic Susceptibility to Their Environment; https://www.trialregister.nl; 3594.
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  • 文章类型: Journal Article
    This study applied latent class analysis to a family-centered prevention trial in early childhood to identify subgroups of families with differential responsiveness to the Family Check-Up (FCU) intervention. The sample included 731 families with 2-year-olds randomized to the FCU or control condition and followed through age 5 with yearly follow-up assessments. A two-step mixture model was used to examine whether specific constellations of family characteristics at age 2 (baseline) were related to intervention response across ages 3, 4, and 5. The first step empirically identified latent classes of families based on several family risk and adjustment variables selected on the basis of previous research. The second step modeled the effect of the FCU on longitudinal change in children\'s problem behavior in each of the empirically derived latent classes. Results suggested a five-class solution, where a significant intervention effect of moderate to large size was observed in one of the five classes-the class characterized by child neglect, legal problems, and parental mental health issues. Pairwise comparisons revealed that the intervention effect was significantly greater in this class of families than in two other classes that were generally less at risk for the development of child disruptive behavior problems, albeit still low-income. Thus, findings suggest that (a) the FCU is most successful in reducing child problem behavior in more highly distressed, low-income families, and (b) the FCU may have little impact for relatively low-risk, low-income families. Future directions include the development of a brief screening process that can triage low-income families into groups that should be targeted for intervention, redirected to other services, monitored prospectively, or left alone.
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