title stringlengths 1 1.19k | keywords stringlengths 0 668 | concept stringlengths 0 909 | paragraph stringlengths 0 61.8k | PMID stringlengths 10 11 |
|---|---|---|---|---|
ACKNOWLEDGMENTS | We would like to thank our families for their constant support and encouragement during this study. Their love and sacrifices have been invaluable to our success. We are deeply grateful for their contributions to our personal and professional growth. Thank you, from the bottom of our hearts. No funding was received for this study. | PMC10315777 | ||
DATA AVAILABILITY STATEMENT | The datasets utilized in this study can be accessed upon reasonable request to the corresponding author. | PMC10315777 | ||
REFERENCES | PMC10315777 | |||
Background | Women’s health care seeking delays remains an unresolved major public health problem in developing and underdeveloped countries. This study aimed to evaluate a health-promoting neighborhood intervention to improve health care seeking behavior (HCSB) among reproductive age Iranian women using Health Promotion Model (HPM). | PMC10091519 | ||
Method | This randomized controlled trial was conducted on 160 women of reproductive age in two groups: experimental and control. Data were collected by self-administered questionnaire based on HPM constructs and a medical symptom checklist. A health-promoting neighborhood intervention was performed in seven sessions for the experimental group. HCSB and HPM constructs were measured before and 3 months after intervention in the two groups. p < 0.05 was considered significant level. | PMC10091519 | ||
Results | bleeding, fatigue, chest pain, mental disorder, headache, vaginal itching | BLEEDING, SPOTTING BETWEEN PERIODS | The average mean age of participants was 30.45 ± 7.80 years. After intervention, the mean score of self-efficacy, interpersonal influences, commitment to plan and HCSB was increased significantly in women in the experimental group, while negative constructs such as perceived barriers, negative activity-related affect, and immediate competing demands and preferences significantly decreased (p < 0.05). In addition, the mean score of referring for symptoms such as excessive sweating, persistent fatigue or weakness, headache, bleeding or spotting between periods, vaginal itching and irritation, unusual vaginal discharge, flashing, chest pain, rapid heartbeats, aching muscles or joints, urinary problems and some mental disorder was increased significantly in experimental group compared to control group (p < 0.05). | PMC10091519 |
Conclusions | The results of study show that an intervention based on the HPM have a positive impact on HCSB and its associated factors and can help improve women’s health behaviors and health outcomes. | PMC10091519 | ||
Keywords | PMC10091519 | |||
Background | Gender differences often effect on taking preventive health measures, access to health care centers, taking medicines and adherence to treatment or followHealth care seeking behavior (HCSB) referred to activities that are performed with the aim of maintaining and promoting health, preventing illness or to deal with any deviation from good health [There are few studies that have specifically examined the HCSB and related factors in reproductive age women, and most of them lacked theoretical framework interventions. However, a theoretical model can help the health educators in various ways, including gathering information in the stage of needs assessment, program development and create tailored content to improve the desired behavior, as well as program evaluation. A theory or model helps to identify the characteristics of the individual and the living environment that somehow affect her/his behaviors and thus increase the effectiveness of health education programs [ | PMC10091519 | ||
Theoretical framework | A review of the existing literature on HCSB shows that most of previous studies have no theoretical framework and only a few studies used some constructs of theories and models. For example, the role of individual factors (such as educational level, monthly income, household size) has been discussed in some studies [ | PMC10091519 | ||
Methods | PMC10091519 | |||
Study design and participants | chronic disease | CHRONIC DISEASE | This randomized controlled trial was conducted on 160 women of reproductive age in Qom, Iran. Participants were selected by cluster sampling. Briefly, two municipal districts were randomly selected from eight ones, and then two health centers were randomly selected from each district so that four health centers were included in the study. Finally, 40 women of reproductive age were randomly selected from each four health centers according to inclusion criteria and randomly allocated to one control (n = 80) group and one intervention (n = 80) group. Inclusion criteria were being married, having Iranian nationality, and the age of 15–49 years (all participants were above 16 years of age) and exclusion criteria were being pregnant and having a diagnosed chronic disease or condition that need to ongoing medical therapies or long-term medical care setting.Sample size was calculated considering the confidence level of 95%, Z | PMC10091519 |
Data collection instruments | PMC10091519 | |||
1. HPM constructs questionnaire on HCSB | To develop the HPM questionnaire, first, a qualitative study was conducted with 22 women of reproductive age and health stuff. Questionnaire items are extracted from qualitative data and also related literature. Ten women of reproductive-aged, participated in the pilot study and examined the initial scale for simplicity, clarity and readability (face validity) and then the questionnaire was modified to their opinions. Content validity rate (CVR) and content validity index (CVI) also were assessed by the expert panel with the participation of 10 people. Based on the experts’ opinions, CVI and CVR were considered acceptable with 0.94 and 0.96 respectively. | PMC10091519 | ||
1–1. Individual characteristics | DISEASES | this section includes age, education level, occupation, number of family members and health insurance coverage, and the way (s) of gaining health information about women’s diseases and health issues. | PMC10091519 | |
1–2. Perceived benefits | the most important benefits of HCSB, from the perspective of women of reproductive age, include 8 items (such as | PMC10091519 | ||
1–3. Perceived barriers | this scale includes 15 items regarding individual barriers, social barriers and barriers associated with the treatment process (such as | PMC10091519 | ||
1–4. Self-efficacy | this section was aimed to measure women’s judgment about their abilities to do HCSB using a 7-point scale (such as | PMC10091519 | ||
1–5. Activity-related emotions | the emotions associated with HCSB were divided into two parts: positive emotions (3 items such as | PMC10091519 | ||
1–6. Interpersonal influences | according to HPM, this construct was divided into three subsections: (a) Social support (8 items such as | PMC10091519 | ||
1–7. Situational influences | to measure situational influences, 10 items were developed to investigate the location and situation in which the woman feels comfortable doing HCSB (such as | PMC10091519 | ||
1–8. Immediate competitive preferences and demands | Twelve items were used to measure this construct to investigate the most important preferences (such as | PMC10091519 | ||
1–9. Commitment to plan of action | This scale consists of 7 items (such as | PMC10091519 | ||
1–10. HCSB | six four-choice items were developed that addressed referral times, referral location, and treatment follow-up rate. The items were scored as 1(= never) to 4 (= always). | PMC10091519 | ||
2. Medical symptom checklist | DISEASE | the medical symptom checklist contains the most common signs or symptoms of disease in females. This instrument was administered to measure the mean of referring to the health care system after observing signs or symptoms during the three months. The scores were ranged between − 1(= not performing HCSB) to 1 (= performing HCSB). | PMC10091519 | |
Local intervention program to improve HCSB | PMC10091519 | |||
a. Development of educational materials | illness, ill | DISEASE, MINOR | analysis of pre-test results revealed that many of our participants did not have information about the warning signs or symptoms of illness and the appropriate time to visit a doctor. The rate of self-treatment was high, and they only referred to the doctor if they were severely ill or felt ill for a long time; or they referred to the doctor only when vital organs were also involved. They had little information about how to manage some of the minor signs of illness at home. According to the need assessment of participants, we used several educational resources to improve their HCSB:
A booklet in Farsi, titled “Educational posters to increase knowledge and sensitivity to the intervention program installed in neighborhood health care centers and schools;Educational pamphlets (for three groups of women of reproductive age, health staff and husbands):Internet-based women’s health education channel containing educational text content, videos and images (also available to other family members);Two native educational apps, one for the early diagnosis of the disease according to reported symptoms, and the other for locating health centers, laboratories and pharmacies across the city; The selection of educational resources was carried out according to the participants’ initial need assessment and also assessment of access to them. The resources were offered to experimental group at certain intervals until the completion of the intervention. The educational programs for experimental group were held at the health centers, and the participants of the two groups were not in contact with each other. Therefore, women from control group did not exposed to educational resources and they only received routine education from health staff. | PMC10091519 |
b. Educational strategies | intervention was performed according to the protocol of HPM. According to this protocol, some intervention strategies are specific to one construct, and others are applicable to modifying several constructs. It may be therefore possible to use a strategy to change a construct in one session and to reinforce another construct in other sessions. Table
Example of strategies used in intervention based on HPM constructs | PMC10091519 | ||
c. Implementation of the intervention | seven sessions (6 sessions for women of reproductive age and 1 session for health care staff) were held in the experimental group. The interval between sessions was one week. During the implementation of the program, the quality of the components of the program and its implementation was reviewed using the process evaluation checklist, and if necessary, changes were made to increase the likelihood of success. In addition, the assessment, which measured the change in HCSB and HPM constructs, was performed using a researcher-made questionnaire both at pre-test and 3 months after intervention in the two groups. The response rate in both stages was 100%. | PMC10091519 | ||
Data analysis | To analyze the results from educational intervention, parametric statistical tests were performed after the normal distribution of data was investigated by the Komomolorov-Smirnov test. Before intervention, demographic characteristics were investigated by chi-squared test, and the HPM constructs and medical symptoms in the two groups was investigated by independent | PMC10091519 | ||
Results | illness | The average age of participants was 30.45 ± 7.80 years. Before the intervention program, there was no significant difference in demographic characteristics, HPM constructs, and referral rate to health care staff after observing the symptoms of illness in the two groups. Table
Demographic characteristics of reproductive age Iranian womenAge categories(18–49 years)
Comparison of mean and standard deviation of HCSB and PHM constructs before and after the intervention in the experimental groupMean values were significantly different from those of the control group (independent-samples t test): Mean values were significantly different from those before the intervention (paired-samples t test):
Comparison of mean and standard deviation of referring to the health care system after observing symptoms of illness before and after the intervention in the experimental groupMean values were significantly different from those of the control group (independent-samples t test): Mean values were significantly different from those before the intervention (paired-samples t test): | PMC10091519 | |
Discussion | ’ behaviors | EVENTS, HEART DISEASES, DISORDERS | According to the results of this study, the mean score of perceived benefits of HCSB significantly increased in the experimental as compared to that before intervention, while this increase was not statistically significant in comparison to control group. Fair et al. [After the intervention, perceived barriers in the women in experimental group significantly decreased as compared to control group. There is some evidence that community health programs, in local communities or small religious organizations, have helped increase the reception of health services by reducing perceived barriers [The results of study indicated that the educational intervention program was able to increase the positive feelings and reduce the negative feelings in the experimental group. The findings of Low et al. suggest that creating a positive emotion in the patient due to receiving support from health care providers creates a sense of security, which ultimately enables the patient to easily accept recommendations regarding treatment options [An appropriate strategy for enhancing the positive emotions and reducing the negative ones in patients is to communicate with those who have already been treated using the same therapeutic process and who are satisfied with their HCSB [The findings of this study showed that educational intervention increased the mean score of the interpersonal influences construct in women in experimental group compared to control group. A large number of studies have shown the association between interpersonal influences and their direct impact on health and receiving health care [The mean score of situational influences in experimental group was significantly different from the pre-intervention stage, but this increase was not statistically significant in comparison with control group. It may be due to the role of some social factors which should be considered in addition to environmental factors. Ensor et al. stated even with the presence of health services and appropriate geographical access, people may not use them, because the health services are not in accordance with their culture and needs [After intervention, the mean scores of behavioral preferences and competitive demands significantly decreased in the women in experimental group compared to control group. Jayapalan et al. suggest that education and information in health centers and in the community should be increased to reduce the use of alternative treatments. The public health sector should offer affordable and high quality services. Health planners and managers should be aware of the concerns that patients have on healthcare issues such as access to medicines and confidentiality, that make them evade referring to the health care system and instead seek out alternative treatments [The results of study showed educational intervention, by increasing the women’s ability to manage daily life priorities and increasing control over unforeseen events, reduced the score of immediate competing demands and thus helped improve their decisions in challenging situations. Blanc observed that empowering women had a profound effect on the use of health services and could improve women’s reproductive health [Finally, after intervention, the mean score of HCSB in experimental group increased compared to control group, indicating that the designed intervention was appropriate for the behavior. In fact, the HCSB is improved when a person decides to seek health care services in the formal health service resources immediately after observing illness symptoms and interpreting them appropriately. But this behavior is not a mere decision-making process, but rather, in order to achieve this purpose, in addition to behavioral characteristics, other factors that can entail family members’ behaviors, and norms and expectations of the community as well as the characteristics and behaviors of the health service provider should also be taken into account [In the present study, there was a significant difference between the mean scores of referring to the health care system after observing some medical symptoms related to mental disorders, urogenital problems, heart diseases, or some non-specific symptoms before and after the intervention in the experimental group. There is evidence, show that using health intervention strategies such as consultation and education, sharing key messages and mass media campaigns causes a significant increase in appropriate seeking medical care [ | PMC10091519 |
Strengths and limitations | One of the strengths of the present study was the use of women’s participation throughout all stages of the intervention (including developing the questionnaire; choosing the appropriate educational strategies and materials that tailored to suit the needs and preferences of them through the needs assessment; implementation; and evaluation). Another strength of this study is the use of a researcher-made questionnaire with a theoretical framework based on HPM which is a comprehensive model for health-related behaviors.One limitation of the study is the use of a self-report tool and therefore the respondents’ responses may have been subject to their personal interpretations. To mitigate this problem, the tool has been continuously reviewed by a panel of experts in order to develop a comprehensive questionnaire. In addition, participants in this study were selected from women of reproductive age in urban areas, and it is therefore recommended to replicate the study among women in the rural or other cultural settings after modification of educational interventions to suit illiterate women. | PMC10091519 | ||
Acknowledgements | The authors thank all reproductive age women participated in this study, as well as health managers and relevant health staff in the four selected health centers. | PMC10091519 | ||
Author Contribution | TR proposed the study. TR, TF were involved in the design the study with supervision of MAM. TR and TF collected the data and HF performed the statistical analysis. TR and MAM prepared the first draft of the manuscript and the authors read, revised and approved the final manuscript. | PMC10091519 | ||
Funding | No funding was received for the study. | PMC10091519 | ||
Data Availability | The data sets used and/or analyzed during the current study are not publicly available due to confidentiality of data and subsequent research, but are available from the corresponding author on reasonable request. | PMC10091519 | ||
Declarations | PMC10091519 | |||
Ethics approval and consent to participate | The protocol of study was approved ethics committee of Shahid Sadoughi Yazd University of Medical Sciences (IR.SSU.SPH.REC.1394.89 and IRCT number: IRCT2016021126519N1 2016-06-04). A written informed consent was obtained from all participants. In the case of illiterate women, it was completed by their husbands. All participants were above 16 years of age and none of the participants refused to take part in the study. The study was performed in accordance with the Declaration of Helsinki. | PMC10091519 | ||
Consent for publication | Not applicable: individual information has not been published. | PMC10091519 | ||
Competing interests | The authors declare that they have no competing interests. | PMC10091519 | ||
Abbreviations | Health Care Seeking BehaviorHealth Promotion ModelContent validity ratecontent validity index | PMC10091519 | ||
References | PMC10091519 | |||
Significance | inflammation, infection, Foralumab) reduced lung inflammation, autoimmunity, coronavirus disease 2019 | CORONAVIRUS DISEASE 2019, INFLAMMATORY RESPONSES, INFLAMMATION, DISEASE, SEVERE ACUTE RESPIRATORY SYNDROME, COVID-19 INFECTION, INFILTRATES, MULTIPLE SCLEROSIS (MS), INFECTION, MULTIPLE SCLEROSIS, CORONAVIRUS, AUTOIMMUNITY, DISEASES, COMPLICATIONS, INFLUENZA | Edited by Lawrence Steinman, Stanford University, Stanford, CA; received November 28, 2022; accepted January 30, 2023Activated T cells play an important role in the complications following COVID-19 infection. Anti-CD3 monoclonal antibody (mAb) binds to the T cell receptor and dampens inflammation by modulating T cell function. We show here that nasal administration of a fully human anti-CD3 Mab (Foralumab) modulates T cell inflammatory responses in COVID-19 by suppressing effector features in multiple T cell subsets, an effect also seen in subjects with multiple sclerosis. Immunomodulation by nasal anti-CD3 mAb represents a novel avenue for treatment of inflammatory human diseases.T cells are present in early stages of the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection and play a major role in disease outcome and long-lasting immunity. Nasal administration of a fully human anti-CD3 monoclonal antibody (Foralumab) reduced lung inflammation as well as serum IL-6 and C-reactive protein in moderate cases of COVID-19. Using serum proteomics and RNA-sequencing, we investigated the immune changes in patients treated with nasal Foralumab. In a randomized trial, mild to moderate COVID-19 outpatients received nasal Foralumab (100 μg/d) given for 10 consecutive days and were compared to patients that did not receive Foralumab. We found that naïve-like T cells were increased in Foralumab-treated subjects and NGK7The coronavirus disease 2019 (COVID-19) pandemic represents the greatest global public health crises since the pandemic influenza outbreak of 1918 (T cell responses are crucial for SARS-CoV-2 immunity. CD4We and others have shown the modulation of T cell function by the oral or nasal administration of anti-CD3 monoclonal antibody in animal models of autoimmunity and inflammation including multiple sclerosis (MS) (We previously conducted a pilot trial administering nasal Foralumab in subjects with mild to moderate COVID-19 and found a reduction in serum IL-6 and C-reactive protein and more rapid clearance of lung infiltrates in treated individuals ( | PMC10243127 |
Results | PMC10243127 | |||
RNA Sequencing Identifies T Effector Subset Changes in Foralumab-Treated Subjects. | inflammation, hypercytokinemia | CORONAVIRUS, BLOOD, PATHOGENESIS, INFLAMMATION | To investigate the transcriptomic changes in immune cells following nasal Foralumab treatment in SARS-CoV-2-infected patients, we Fluorescence-activated cell sorting (FACS)sorted CD3Compositional Analysis Shows Reduction of Effector T Cell Subsets in Foralumab-Treated subjects. Study design. Subjects were treated with 100 µg of nasal Foralumab given daily for 10 consecutive days. Blood was collected on day -2 and day 10. For bulk RNA-seq, CD3We then compared CD3We next investigated the effect of nasal Foralumab on gene expression in T cells, B cells, and monocytes by comparing pre- treatment (day-2) vs. follow-up (day 10) in Foralumab-treated vs. untreated subjects. IPA of the differentially expressed genes (DEGs) before and after treatment showed downregulation of inflammatory pathways such as hypercytokinemia and interferon signaling pathway in both groups. We also identified a coronavirus pathogenesis pathway that were downregulated in the Foralumab group but not in untreated controls (We thus analyzed the effect of nasal Foralumab on gene expression in B cells by comparing pre-treatment vs. day 10 in Foralumab-treated vs. untreated subjects Our bulk RNA-seq analysis suggested that nasal administration of Foralumab led to the downregulation of genes related to inflammation and coronavirus pathogenesis and that its immunomodulatory effects were mostly pronounced in CD3+ T cells, although we could find some evidence for changes indirectly affecting both monocytes and B cells.We also performed droplet-based 10x CellRanger sequencing in FACS sorted cells from healthy controls, untreated COVID-19 subjects, and Foralumab-treated COVID-19 subjects (We next compared gene expression of total CD3Because anti-CD3 activates T cells, we next investigated the cell state score of predefined gene sets associated to T cell exhaustion and activation in COVID-19 ( | PMC10243127 |
Discussion | SARS-CoV-2 infection, hyperactive T, COVID-19 infection | SARS-COV-2 INFECTION, INFLAMMATORY RESPONSES, DISEASE, COVID-19 INFECTION, PATHOGENESIS | T cells play an important role in subjects with COVID-19 infection as COVID-19 patients develop hyperactive T cell responses that contribute to disease pathogenesis (We found that In addition to treatment of COVID-19 subjects with nasal Foralumab, we have treated healthy volunteers (We chose a dose of 100 μg for 10 d in COVID-19 patients based on results in healthy volunteers and dose-response curves in animals given nasal anti-CD3. What is remarkable in our findings is that identical gene changes were observed in healthy subjects given 50 μg × 5 d, COVID-19 subjects given 100 μg × 10 d, as well as in MS subjects given 50 μg in an every-other-day regimen at 2-wk intervals. We believe this adds to the robustness of our findings and demonstrates that the dose used (50 to 100 μg) is in the appropriate range to induce immune effects of nasal Foralumab. In addition, identical gene expression changes were observed in animals treated with nasal anti-CD3 at a dose of 1 μg for 5 d. Formal clinical trials will be needed to establish an optimal dosing regimen.We propose a mechanism of action whereby nasal Foralumab in humans involves the induction of a quiescence program in T cells through the upregulation of We also found that the Rhoa/ROCK1 pathway, known to be negatively regulated by GTPases was downregulated in Foralumab-treated subjects. Several important immunomodulatory roles of the Rhoa/ROCK1 signaling pathway and its respective genes in T cell function have been shown including the role of Cofilin in T cell hyporesponsiveness (BDNF levels were increased in the overall COVID-19 cohort at baseline and several subjects in the subsequent non-treatment cohort had high baseline values. It has been shown that COVID-19 may be associated with increased BDNF perhaps related to an immune response to modulate the disease (In summary, we found that nasal Foralumab modulates T cell inflammatory responses that occurs in SARS-CoV-2 infection by suppressing effector features in multiple CD3Although our cohort it is limited by its size and is not powered to present a biomarker associated with clinical outcomes in COVID-19, the major finding in our study is the identification of a unique mechanism associated with nasal Foralumab in humans that will help advance use of Foralumab as an adjunct therapy for COVID-19 and guide long-term use of this therapy in autoimmune conditions. | PMC10243127 |
Material and Methods | PMC10243127 | |||
Study Design and Subject Groups. | Patients with mild to moderate COVID-19 were recruited and treated at the Santa Casa de Misericordia de Santos in São Paulo State, Brazil, as previously described ( | PMC10243127 | ||
PBMC Isolation. | Human peripheral blood mononuclear cells (PBMC) isolation was performed within 4 h after blood collection according with standard protocol ( | PMC10243127 | ||
Flow Cytometry and Cell Sorting. | PBMCs were thawed at 37C into complete RPMI media with 5% human AB serum (Gemini Bioproducts) in the presence of benzonase [20 mL/10mL], washed with PBS and resuspended in Fcr Block human TruStain FcX™ (1:20) and stained for viability (eFluor 506 viability dye, Invitrogen, 1:1,000). 3 × 10 | PMC10243127 | ||
Single-Cell 5’mRNA Sequencing and Bulk Smart-seq2 RNA-Seq. | Immune cells from participants that received Foralumab and untreated controls without the use of dexamethasone ( | PMC10243127 | ||
Sequencing Analysis. | Venn diagram visualizations were created using Integrated web-based visualization tool (DiVenn) used for Bulk-RNA-seq visualization ( | PMC10243127 | ||
Olink Proteomics and Multiplex. | INFLAMMATION | Inflammation panel comprising of 96 protein biomarkers (Olink Proteomics) was used on serum samples of patients at baseline (day-2) and day 10. Data from the analyzed protein biomarkers was presented in normalized protein expression (NPX) values, Olink Proteomics’s arbitrary unit on log2 scale. Cytokine/Chemokine/Growth Factor Panel (EPX450-12171-901) in serum samples in patients treated with Foralumab, untreated control, and healthy controls. Assay was performed by The Cytokine Core, LLC according to the manufacturer’s instructions. Markers were BDNF, EGF, Eotaxin, FGF-2, GM-CSF, GRO-α*, HGF, IFN-α, IFN-γ, IL-1RA, IL-1α, IL-1B, IL-2, IL-4, IL-5, IL-6, IL-7, IL-8, IL-9, IL-10, IL-12(p70), IL-13, IL-15, IL-17A, IL-18, IL-21, IL-22, IL-23, IL-27, IL-31, IP-10, LIF,MCP-1, MIP-1α, MIP-1β, NGF-β, RANTES, PDGF-BB, PIGF-1, SCF, SDF-1α, TNF-α, TNF-β, VEGF-A, VEGF. | PMC10243127 | |
Statistical Analysis. | Results are shown as the mean values (±SEM) or median (±IQR) and considered statistically significant when comparisons between groups, using Student’s | PMC10243127 | ||
Supplementary Material | Dedivitis | NEUROLOGIC DISEASES, APPENDIX | Appendix 01 (PDF)Click here for additional data file.Dataset S01 (XLSX)Click here for additional data file.Dataset S02 (XLSX)Click here for additional data file.Dataset S03 (XLSX)Click here for additional data file.Dataset S04 (XLSX)Click here for additional data file.Dataset S05 (XLSX)Click here for additional data file.Dataset S06 (XLSX)Click here for additional data file.Dataset S07 (XLSX)Click here for additional data file.Dataset S08 (XLSX)Click here for additional data file.We honor all patients that voluntarily participated in this study. Special thanks to the clinical team involved in sample collection: Joāo Neto, Fernanda Santos, Bianca Gobbo, Giovana S. de Paula, Thais M. Santana, Raquel da Mata, Marcelle G. Spinola, Rodrigo Morrone and Gerson D. Keppeke. We also thank Rogerio Dedivitis for supporting this work. We thank Tiziana LifeScience and Brigham and Women’s regulatory team that supported sample importation Jules Jacob, Vaseem Palejwala, William Clementi, Taylor Saraceno, Jessica Hunter, Corey Staiti, Jacob Reynolds and Laura Cox. We thank Kunwar Shailubhai for all his support with this trial. We thank BWH flow cytometry and sequencing core facility members Adam Chicoine, Junning case, Kevin Wei and Zhu zhu for their great assistance. We acknowledge Brigham and Women’s Hospital clinical team Tarun Singhal, Jon Zurawski, Fermish Saleh, Belinda J Kaskow, Katherine Hanus, Zhenhua Li, Johnna F. Varghese, Shrishti Saxena that participated in phase I trial. We thank Christian Barro and Danielle Leserve for their work in animal studies that supported the data present in this work and Wesley Brandāo for his help with validation assays. Lastly, we thank Francisco Quintana and Vijay Kuchroo for their scientific inputs. T.G.M. was supported by Susan Furbacher Conroy Fellowship. This work was supported by Ann Romney Center for Neurologic Diseases. | PMC10243127 |
Author contributions | V.K. | T.G.M., K.T.F.M., D.M., S.I., R.M.R., and H.L.W. designed research; T.G.M., L.M., A.P., and K.T.F.M. performed research; C.D.G., T.B.L., C.M.B.-A., T.C., and H.L.W. contributed new reagents/analytic tools; T.G.M., C.D.G., T.B.L., B.C.H., and V.K. analyzed data; and T.G.M., V.K., and H.L.W. wrote the paper. | PMC10243127 | |
Competing interests | The authors have organizational affiliations and stock ownership to disclose: H.L.W. is chair of the Scientific Advisory Board of Tiziana and received consulting fees and stock options from the company. T.C. is a member of the scientific advisory board and serves as a consultant to Tiziana Life Sciences. CMB-A serves as a consultant to Tiziana Life Sciences. T.G.M. and K.T.F.M. received consultation fees from Tiziana LifeScience to monitor the clinical trials in which samples were used in this present work. In addition to providing Foralumab, Tiziana Life Sciences also provided financial assistance to the trial and immunological studies but did not participate in statistical analysis or data interpretation.Preprint server: This article is a PNAS Direct Submission. | PMC10243127 | ||
Data, Materials, and Software Availability | RNA-seq and single cell raw data files can be found in NCBI platform | PMC10243127 | ||
Supporting Information | PMC10243127 | |||
Background | balance dysfunction, PD, Parkinson's disease, stroke | STROKE, PARKINSON'S DISEASE, NEURODEGENERATIVE DISEASE | Parkinson's disease (PD) is the second most common neurodegenerative disease. Patients often present with balance dysfunction. Several studies have applied visual feedback training to stroke patients and demonstrated significant improvement. However, the application of visual feedback balance training in PD patients has not been reported. | PMC10782303 |
Objective | PD | To observe the effects of visual feedback balance training combined with conventional rehabilitation training on the balance function of patients with early PD. | PMC10782303 | |
Methods | PD, BBS | Fifty patients with early PD were randomly divided into control group and observation group. The control group received conventional rehabilitation training, including body position transfer, weight shifting, movement in all directions and gait training. The observation group were added with visual feedback balance training on the basis of the training above. All patients were trained 5 times per week for 4 weeks. Berg Balance Scale (BBS), Time Up-and-Go test (TUG) and Pro-Kin balance training instrument were used to evaluate the balance function of patients before and after treatment, and the balance function were compared between the two groups. | PMC10782303 | |
Results | BBS | The BBS and TUG scores of the observation group and the control group were improved significantly (P<0.01), and the BBS and TUG scores of the observation group were improved more obviously than control group (P<0.01). The length and area of eye open and closed condition in the observation group and the control group were significantly reduced compared with those before training (P<0.01), and the degree of reduction in the observation group was more obvious (P<0.01). The length and area of the observation group and the control group before and after training when eye open were smaller than those when eye closed (P<0.01). | PMC10782303 | |
Conclusion | PD | The conventional rehabilitation therapy can improve the balance function of PD patients, but the combination of visual feedback balance training and conventional rehabilitation therapy can improve the balance function more significantly. | PMC10782303 | |
Introduction | death, neurodegenerative disease, Parkinson's disease, PD, white matter lesions | EVENTS, PARKINSON'S DISEASE, NEURODEGENERATIVE DISEASE | Parkinson's disease (PD) is a chronic progressive neurodegenerative disease in the elderly, which is characterized by prominent death of dopaminergic neurons in the substantia nigra pars compacta and wide spread presence of alpha synuclein, an intracellular proteinFalls are frequent and recurrent events in individuals with PD, with 45-68% of people with PD falling annually and two-thirds of them experiencing more than onceNon-pharmacological treatment, such as exercise and physical therapy, demonstrates many benefits for individuals with PD including improvements in stability and balance, gait and independenceThe Pro-kin system is designed for balance training, which provides visual feedback of center of gravity in real time, making it possible to adjust balance according to system feedback.The Pro-kin training system has been reported for the balance function treatment of individuals with white matter lesions | PMC10782303 |
Materials and methods | tremor, BBS, rigidity, PD, bradykinesia | BLIND | Patients who were diagnosed with PD by a doctor from June 2020 to October 2021 were recruited from the Sino-French Department of Neurological Rehabilitation of Gansu Provincial Hospital. Patients should have no less than two of the four classic motor symptoms of PD, including resting tremor, rigidity, bradykinesia and asymmetric onsetFifty patients were recruited into this study and randomly divided into two groups: the control group and the intervention group. Randomization was performed by a doctor who was not involved in the study. All participants signed informed consents.The study was a single blind randomized controlled trial in which the evaluator was unaware of the treatment. Pretest and post-test designs were used to evaluate the effectiveness of the training. Participants were randomly assigned to the control group or the observation group by a physician who was not involved in the study. An opaque sealed envelope was selected from 50 sealed envelopes containing group assignment.All subjects were assessed by the Berg Balance Scale (BBS), the Time Up-and-Go Test (TUG) and the built-in assessment procedures of the Pro-Kin balance training system before the training. span style=“font-family: ‘Times New Roman’; color:#0070c0; background-color:#ffffff”>The specific evaluation methods are as follows: First, subjects were asked to complete 14 items in turn according to the BBS scale, including sitting independently, standing with eyes closed, standing on one leg, walking up and down stairs, turning around for a week and so on14. Each item is rated from 0 to 4 points according to the degree of completion. The higher the score is, the better the completion is. The scores of all items are added up to obtain the total score of the BBS test. Then, the subjects were asked to conduct TUG test15. The subjects were asked to stand up from the chair, walk 3 meters to the indicating line, then turn around and sit on the chair. The therapist recorded the time spent. The average time of three tests were the result of TUG test. Finally, the built-in evaluation program of Pro-kin Visual Feedback Balance Training System (PK254, Tec nobody, Italy) was used for testing balance function. Turn on the computer and click the “Static stability Test” option on the screen. Therapist asked the subject to stand on the test table with their eyes looking straight ahead and tell the subject to hold as still as possible for 30 seconds. Then, therapist asked the subject to close eyes and hold as still as possible for 30 seconds. The system automatically recorded the movement of the center of gravity and depicted the curve of change. The total length of the trajectory generated by the center of gravity motion was called the trajectory length, and the area enclosed by the trajectory generated by the center of gravity motion was called the area of the moving ellipse. The smaller the value of these two parameters, the better the balance function. Each patient was tested twice.After the evaluation, all subjects received rehabilitation training. All participants were given conventional balance training, including body position transfer, weight shifting, movement in all directions, standing on one leg, touching objects, turning around and throwing a ball. The training was conducted 30 minutes per session, 5 times a week, for 4 weeks.The observation group was added with visual feedback balance training in addition to conventional balance training, for 20 minutes per session, 5 times a week for 4 weeks. The Pro-kin visual feedback balance training system was used. The subjects stood on the training board. The central axis of the feet was located on the A1 and A5 lines of the balance platform. The highest points of the bilateral arches were located on the A3 and A7 lines of the balance platform respectively. The Angle between the feet was 60 degrees. The training method was as follows: four fixed locks were placed under the training board, then the subjects stood on the board and looked at the computer screen. By clicking on the “stability limit” module on the computer, the subjects controlled the slight movement of the training table with their feet to control the cursor on the screen to a specified position. Next, the therapist removed the fixed lock under the training board and adjusted the resistance value to the system-recommended 5. Then the subject placed one foot on the training board and the other foot on the ground, keeping the upper body still. The subject looked at the computer screen and controlled the large amplitude movement of the balance board through the ankle joint according to the cursor indication on the screen, making the cursor on the screen reach the specified position. | PMC10782303 |
Statistics | SPSS 24.0 software were used to analyse the data. Descriptive statistics were used for all outcome variables. The means and standard deviations were reported, which were expressed as-x±s. independent t-test was used for between-group comparison, and paired t-test was used for within-group comparison. The quantitative data were compared by chi-square test. P <0.01 was considered statistically significant. | PMC10782303 | ||
Results | BBS | DISEASE | One case fell off in the observation group and one case fell off in the control group after training, which was due to unwillingness to continue the training. There were no difference between groups in terms of gender, age, duration of disease and the Hoehn and Yahr scale grades(Demographic data of the participantsThe BBS and TUG scores of the observation group and the control group were improved significantly after training (P<0.01). The BBS and TUG scores of the observation group were improved more obviously than those of the control group (P<0.01) (BBS and TUG scores before and after treatmentThe length and area of eye open and eye closed condition in the observation group and the control group were significantly reduced compared with those before training (P<0.01), and the degree of reduction in the observation group was more obvious (P<0.01) (Evaluation results from Pro-kin balance system | PMC10782303 |
Discussion | PD, motor abnormalities, motor dysfunction, Cerebellar lesions | CORTEX, CEREBELLAR LESIONS, DYSFUNCTION | There are many factors leading to abnormal balance function in PD patients. On one hand, the loss of dopamine substantia nigra neurons leads to the decrease in dopamine, which in turn leads to motor dysfunction. On the other hand, decreased activity of the cholinergic system as a result of cholinergic neurons in peduncu lopontine nucleus and basal forebrain leads to balance dysfunction. In addition, abnormal activity in the cerebral cortex, the brain stem network and the midbrain motor area substantia nigra may cause motor dysfunction. Cerebellar lesions can also cause motor abnormalities and balance disordersThe conventional rehabilitation treatment for PD patients has been reported, such as endurance trainingThis study shows that the combination of conventional rehabilitation training and visual feedback balance training can improve the balance ability of early PD patients more significantly. Conventional rehabilitation training focuses on the movement control, center of gravity shift and precision training | PMC10782303 |
Conclusion | PD | The conventional rehabilitation treatment can improve the balance function of PD patients. This study shows that the combination of visual feedback balance training and conventional rehabilitation treatment can improve the balance function of PD patients more significantly. | PMC10782303 | |
Acknowledgments | The authors thank all of the study participants. | PMC10782303 | ||
Conflict of interest | The authors have no conflicts of interest to disclose. | PMC10782303 | ||
Funding | CEREBROVASCULAR DISEASES | Lanzhou City Science and Technology Development-Guiding Plan Project (grant number: 2017-ZD-45); Research Foundation of Gansu Provincial Hospital (Key-Disciplines) (grant number: 2019-395); Gansu Province Natural Science Foundation Project (22JR5RA673); Gansu Provincial Key Laboratory of Cerebrovascular Diseases (20JR10RA431). | PMC10782303 | |
Background | The present study examined Afghan asylum seekers’ and refugees’ self-perceived problems, and their experiences of treatment with an adapted version of the brief transdiagnostic psychological intervention “Problem Management Plus” (aPM+). Specifically, the study explored which problems trouble them most and how these problems influence their daily functioning. Further, it examined how various standardized outcome measures correlate with these subjectively perceived problems. | PMC10625214 | ||
Method | This study is part of a larger RCT study (PIAAS study) in which 88 Afghan asylum seekers and refugees were randomly allocated either to aPM + in addition to treatment as usual (aPM+/TAU) or TAU alone. The presented study uses a multi-method approach consisting of two parts: First, we investigated participants’ self-identified problems and subjective functional impairment using quantitative and qualitative assessment in both the aPM+/TAU and TAU group (n = 88). Second, we conducted in-depth qualitative interviews with a subsample of the aPM+/TAU group (n = 24) to gain a deeper understanding of participants’ personal experiences with aPM + and to obtain suggestions for improvement. Spearman correlations were applied for quantitative data, and deductive and inductive approaches of thematic analysis were used for qualitative data. | PMC10625214 | ||
Results | SECONDARY | We identified six main themes of self-perceived problems (primary post-migration living difficulties, general mental health problems, interpersonal stressors, secondary post-migration living difficulties, mental health problems specifically associated with stress, and somatic problems) and their consequences, as well as subjective functional impairment. Standardized measures of general mental health, posttraumatic psychopathology, and quality of life did not correlate with the intensity of self-perceived problems. aPM + was mostly perceived positively, and few participants had recommendations for its improvement. | PMC10625214 | |
Conclusion | voice, trauma | The study aimed at giving a voice to Afghan trauma survivors to inform service providers and policy makers about their needs. Based on their expertise, future interventions can be tailored to their actual needs and optimized in terms of practical use. aPM + proved to be a positively perceived intervention that reduces subjective symptom burden and facilitates daily functioning. Culture-sensitive treatments within (mental) health services should increase service utilization and improve (mental) health in the long term. | PMC10625214 | |
Supplementary Information | The online version contains supplementary material available at 10.1186/s12889-023-17076-7. | PMC10625214 | ||
Keywords | Open access funding provided by Austrian Science Fund (FWF). | PMC10625214 | ||
Background | PTSD | DISORDERS | Afghans represent one of the largest populations of refugees and asylum seekers worldwide. More than 8.2 million Afghan refugeesPrevious reviews have reported varying prevalence rates of mental health disorders in refugees [While studies have demonstrated the effectiveness of evidence-based treatments for PTSD in refugee populations [The current study is part of the PIAAS project (a brief transdiagnostic psychological intervention for Afghan asylum seekers and refugees in Austria), which aimed to investigate the effectiveness of an adapted version of PM+ (aPM+) for Afghan refugees living in Austria [ | PMC10625214 |
Method | posttraumatic stress disorder, PMLD | The PIAAS project aimed to investigate self-perceived problems and correlations of participants’ general mental health, complex posttraumatic stress disorder (c-PTSD), and quality of life with self-reported problem severity. Furthermore, a subsample of the main PIAAS project was asked to discuss their personal experiences with aPM + and provide suggestions for improvement. Within the scope of the project, an extra session was developed to practice strategies to cope with PMLD. The main study was designed as a prospective, single-center, assessor-masked, individually randomized, two-group superiority trial.The current study uses quantitative and qualitative data from the group receiving aPM + in addition to treatment as usual (aPM+/TAU) and the TAU group from the baseline (t0) and follow-up assessment (t1) as well as qualitative data from in-depth interviews. The study consists of two parts: First, we investigated participants’ self-identified problems and subjective functional impairment by conducting quantitative and qualitative assessments with the treatment and control group (n = 88) of the PIAAS project. Second, we conducted qualitative in-depth interviews with a subsample of the treatment group (n = 24) to investigate participants’ opinions about aPM+.If participants mentioned during the interviews or treatment sessions that they had been subjected to domestic violence, they were provided with information about Austrian “protection against violence” laws [ | PMC10625214 | |
Setting and data collection | The assessments, intervention, and in-depth interviews were mainly conducted in the Outpatient Unit Research, Teaching, and Practice of the Faculty of Psychology at the University of Vienna. Data were collected face-to-face, with trained clinical psychologists and Dari-speaking interpreters, in a confidential room to ensure privacy. Reading material was translated into Dari. The self-report measures, which were administered as a structured interview due to a high rate of illiteracy in the sample, were implemented one week before the first session of the intervention and one week after the final session. The psychologists carrying out the assessments were blinded to the group allocation at both time points. The in-depth interviews took place between 5.0 and 80.4 (MD = 52.9, IQR = 35.4) weeks after the final intervention session. All in-depth interviews were audio-recorded, transcribed using the transcription software f4transcript (Edu-version), and anonymized. Finally, an independent research assistant compared all transcripts with the audio recordings. Audio files were permanently deleted following data analysis. Demographic information was collected within the main study [ | PMC10625214 | ||
Problem Management Plus, adapted (aPM+) | sleeping difficulties, mood disorders | aPM + comprises six individual sessions that are delivered once a week and involve different cognitive and behavioral strategies. It aims to empower traumatized asylum seekers and refugees to cope with emotional (e.g. stress, mood disorders, sleeping difficulties) and practical problems (e.g. organizing help, structuring daily routines). The original PM + manual comprises four core therapeutic strategies: “Managing Stress”, “Managing Problems”, “Get Going, Keep Doing”, and “Strengthening Social Support” [ | PMC10625214 | |
Instruments and in-depth interviews | Several instruments were used for the structured face-to-face interviews with participants of the treatment and control group (n = 88). All instruments showed good reliability in terms of internal consistency in the current sample [for details, To investigate participants’ experiences with aPM+, a semi-structured interview guide was developed [ | PMC10625214 | ||
Data analysis | PMC10625214 | |||
Data analysis of PSYCHLOPS | Initially, the coders started with a deductive approach following Braun & Clarke (2006) [ | PMC10625214 | ||
Data analysis of PSYCHLOPS severity score and further outcome measures | To quantify the association between the overall severity of self-perceived problems and participants’ general mental health, posttraumatic psychopathology, and quality of life, we calculated the correlations between the scores on the respective questionnaires. As the data of the PSYCHLOPS were not normally distributed, we used Spearman correlation (Shapiro-Wilk test | PMC10625214 | ||
Data analysis of the in-depth interviews regarding participants’ experiences with aPM+ | Since the analysis addressed specific research questions, a deductive approach of thematic analysis [ | PMC10625214 | ||
Results | PMC10625214 | |||
Results of part 1 (PSYCHLOPS) | PMC10625214 | |||
Quantitative analysis of the PSYCHLOPS | The overall severity score on the PSYCHLOPS was not significantly associated with general mental health (GHQ: r | PMC10625214 | ||
Results of part 2 (in-depth interviews) | headache | For an overview of the results of part 2, see Table
Overview of all Themes and most often mentioned subordinated codes per topicSlow breathing (22)Social support (12)Inactivity cycle (8)Tree of resources (7)Physical exercises accompanying slow breathing (5)Problem management (4)Positive relationship with PM + trainer (17)Talking openly about problems (7)PM + trainer showed empathy (2)Generally helpful (7)All strategies were helpful (4)Generally good experiences (4)Positive affirmations (5)Drinking a glass of water (3)Supportive words (2)Handouts (3)Weekly appointments (2)Reminder per SMS (2)Feeling better (10)Feeling empowered (5)Being calmer/steadier (5)Being more positive (4)Ruminating less (4)Regulating oneself better (11)Taking time to solve problems (1)Engaging more with people (5)Coping better with conflicts/being more patient (5)Seeking social support (2)Establishing daily structure/activation (5)Being more autonomous (2)Stomach smaller (1)Sleeping better (1)Having less headache (1)Cannot recognize impact (5)Ruminating more (1) | PMC10625214 | |
Experience with aPM+ | anger, anxiety | COLD | When asked about their overall experience with aPM+, nearly all participants described their participation as positive and mentioned specific strategies they found particularly useful (Supplementary Table
Another positively mentioned strategy was strengthening
I have learned something else here! About social support/ About being in contact with others. Before, I always hid from others/ or when my friends called me, I told them ‘I don’t have time’ or just ‘I can’t’. Somehow, I just tried to hide and didn’t want to see anybody or to go out with them. However, since I have been here [Note: participated in aPM+], I’ve learned that I need to have contact with others. And now, if others call me/ or I call them and I visit them/ or they come to me, or we go out together. I have much more contact with others now. (P81, f, 56)
Learning about the
Of course, if you stay home and sleep/ if you lie in bed/ you don’t get out and if you don’t have contact with others, it makes you sick, yes. That was very helpful/ I learned here that when you sit all day at home/ if you don’t leave the flat/ if you don’t do anything, you are probably getting sick/ So, now I go out/ I go for a walk in the park and things like that/ I do that a lot, yes. (P64, m, 59)
The newly developed sixth session was greatly appreciated by the participants. Those who chose to
Some participants mentioned that they use various strategies they have learned in aPM+:
Last time, I used this strategy/how do you call it/ the strategy to calm me down when I am angry, the one that helps me to control my anger. For example, I need to focus on the feeling that is right there and feel my body/ and if my fist is clenched, I need to consciously release it. I also learned that it helps me to leave the situation/ just to go to another place. That helped me a lot, especially in some discussions (laughing)/ and also drinking a glass of cold water and slowly breathing in and out. (P42, f, 37)
Many participants described the
I had the chance to talk with her about everything. Even about stuff I couldn’t talk about with others. I have many friends/ many friends, but I couldn’t talk with them about my personal problems. Here [note: aPM + training], I talked about everything that was in my heart. I took everything out of my heart. (P18, m, 25)
Some participants mentioned that the aPM + trainer suggested something or supported them in ways that were not explicitly described in the original manual but may have been applied intuitively, since all aPM + trainers were experienced clinical psychologists. Therefore, we developed the theme
After attending the final aPM + session, 15 participants indicated that they continued with the
Although most of the participants shared positive experiences, some reported challenges during their participation of aPM+. Several described difficulties with
Some participants had
P: Nothing helped against my anxiety/ I suffer from anxiety/ I was afraid, but it [note: aPM + training] was not helpful.
I: It didn’t help you to deal better with your anxiety?
P: No. (P86, m, 26)In view of the special situation in which participants were living, some saw themselves as faced with | PMC10625214 |
Reported effects of aPM+ | Participants perceived a positive impact after aPM + training in several domains: Nevertheless, the majority of participants reported positive experiences, particularly in terms of changes on the Furthermore, participants identified increased
Some situations are very stressful. For example, this month I have an appointment for my driver’s license. (…). It is difficult because I have to learn a lot before the test and before I go to the test on that day, I will do the breathing exercise that I learned in training. (P83, f, 25)One participant also acknowledged that: “Okay, I started from scratch. Where am I now? And then I noticed that life doesn’t go all that fast. The problem isn’t solved all at once. That is what I have learned.” (P36, m, 23).Some participants identified positive changes on the On the Only few participants also reported positive | PMC10625214 | ||
Recommendation of aPM+ and its strategies | SAID | Half of the participants recommended aPM+ to relatives or friends.
I have told my children that I am here for this training. Then I also contacted other people (…) I contacted my friends again. And they said, “What happened? We see you again. We hear you again.“ I told them that I was going to the University of Vienna for this training and they were happy. My children too, my friends too. And there was also a mother and daughter, I gave them the address and I said, “You could go there too, if you want.“ I think the two of them came too. (…) I was really excited, and I was happy about the training and I told everyone about it. (P81, f, 56)Slow breathing (“Managing Stress”) was recommended most frequently, while other strategies were scarcely mentioned (Supplementary Table | PMC10625214 | |
Participants’ suggestions for improving aPM+ | Although some participants seemed reticent about suggesting improvements, “Maybe you [the interviewer] know better after all / maybe learn something else that is more helpful (…) there is nothing on my mind. You are a therapist; you know better than I do.” (P31, m, 21), some suggestions were given. Several participants thought that
I think it would be better if there were more hands-on practice. (…) Some people don’t want to leave home, their own apartment, and feel inactive. They are always at home. That’s why I think it would be necessary to do more exercises. (…) You had the strategy “problem management” that helps you to get out of a problem when you look closely at it. I think for these people [future aPm + participants] you really need that kind of hands-on practice. That you do it together with them. Then they can get out of such problems. Solve their own problems.” (P81, f, 56).Furthermore, participants proposed | PMC10625214 | ||
Discussion | The present study investigated Afghan refugees´ subjective perspective of their mental health and problems. Further, it examined their experience of a standardized treatment program aPM+. Regarding our first aim, we identified six main themes about participants’ most and second-most troubling problems: | PMC10625214 | ||
Subjective functional impairment | PTSD |
When asked about their most troubling problems before training, approximately two thirds of the participants reported functional impairment concerning performance-oriented activities, language acquisition, and activities of daily living. This is in line with previous studies that likewise revealed functional impairment across psychological domains in individuals with PTSD symptomatology [
In line with previous research, two thirds of our sample reported an impaired ability to learn and to concentrate as one of their main subjectively perceived challenges [ | PMC10625214 | |
Subjective perception of PM+ | After the training, participants reported a positive experience with the aPM + training and that they noticed positive changes in several psychological domains (mental, knowledge, interpersonal, behavioral). For instance, they perceived increased positive feelings and improved attitudes (mental domain), and increased expertise regarding self-regulation (knowledge domain). Interpersonal contact became easier and participants felt more competent in structuring their daily life. These findings correspond to previous research, which likewise reported positive perceptions of the intervention and its strategies [
Participants perceived
Interestingly, participants rarely reported somatic symptoms. Research on somatic symptoms in refugee populations has yielded heterogeneous findings [Furthermore, participants perceived the therapeutic relationship as helpful. This is in line with previous research that found a positive therapeutic relationship to be a reliable predictor of positive treatment outcomes [Participants reported that they recommended the training to family and friends because they were able to feel positive effects of the training. Therefore, it is important to note that peers could also serve as facilitators of mental health service use, and future mental health interventions should consider this within their treatment designs [ | PMC10625214 |
Subsets and Splits
No community queries yet
The top public SQL queries from the community will appear here once available.