Smoking is currently one of the main public health problems. Smoking cessation is known to be difficult for most smokers because of nicotine dependence. Repetitive transcranial magnetic stimulation (rTMS) over the left dorsolateral prefrontal cortex (DLPFC) has been shown to be effective in the reduction of nicotine craving and cigarette consumption. Here, we evaluated the efficacy of accelerated intermittent theta burst stimulation (aiTBS; four sessions per day for 5 consecutive days) over the left DLPFC in smoking cessation, and we investigated whether the exposure to smoking-related cues compared to neutral cues during transcranial magnetic stimulation (TMS) impacts treatment outcome. A double-blind, randomized, controlled study was conducted in which 89 participants (60 males and 29 females; age 45.62 ± 13.42 years) were randomly divided into three groups: the first group received active aiTBS stimulation while watching neutral videos, the second group received active aiTBS stimulation while watching smoking-related videos and the last group received sham stimulation while watching smoking-related videos. Our results suggest that aiTBS is a tolerable treatment. All treatment groups equally reduced cigarette consumption, nicotine dependence, craving and perceived stress. The effect on nicotine dependence, general craving and perceived stress lasted for at least 1 week after the end of treatment. Active aiTBS over the left DLPFC, combined with smoking related cues, is as effective as active aiTBS combined with neutral cues as well as placebo aiTBS in smoking cessation. These findings extend the results of previous studies indicating that TMS therapy is associated with considerably large placebo effects and that these placebo effects may be further increased when using advanced placebo coil technology.Clinical Trial Registrationwww.clinicaltrials.gov, identifier NCT05271175.

The use of community treatment orders (CTOs) is available in more than 70 jurisdictions around the world. Although CTOs are used extensively, their effectiveness remains doubtful. We comment on the existing evidence and focus on components that influence the outcomes of CTOs internationally. It is essential to identify factors that affect the delivery of CTOs, and mixed methodologies may improve our understanding regarding their efficiency.

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IntroductionMany studies argue that exposure to, and use of, multiple languages in childhood has beneficial effects beyond the linguistic domain, including on executive functions (EFs), although recent evidence remains controversial. EFs encompass abilities necessary for regulating goal-directed behaviours in everyday life and, in children, EFs strongly predict later academic achievement and wellbeing. One theoretical framework distinguishes “hot” EFs, which have a reward or affective component, from “cool” EFs that do not. How exposure to more than one language in early childhood modulates hot and cool EFs in later childhood, alongside other environmental and cognitive factors, remains poorly understood.MethodsWe analysed data from the UK Millennium Cohort Study, a large-scale, nationally representative longitudinal cohort study, which provides information on perinatal and environmental factors (e.g., languages spoken in the home, maternal education) alongside cognitive measures assessed in English. At 3 years, we examined the effect of multiple language exposure on the Bracken school readiness assessment (knowledge of shapes, letters, etc.), and on naming vocabulary. At age 11, we examined the predictors of cool EF, measured with a spatial working memory task; hot EF, measured using a gambling task; and vocabulary, measured using a verbal reasoning task.ResultsData from 16,134 children were analysed. At age 3, a negative effect of multiple language exposure on school readiness and vocabulary was observed, but the difference was smaller with higher maternal education. At age 11, there was also a negative effect on vocabulary, but smaller than that observed at age 3. There were no direct effects of language exposure on either spatial working memory or gambling scores. For hot EF, the multiple language exposure effects were indirect, mediated by early cognition, and the most significant predictor of gambling strategy was sex. For cool EF, school readiness and vocabulary at age 3 were the strongest predictors.DiscussionOur findings, based on a UK population sample, highlight the importance of considering socioeconomic status and early-life abilities when interpreting the effects of language environments on hot and cool EFs.