Efectividad del programa de musicoterapia, en el envejecimiento activo y saludable en la tercera edad - Anexo de Cochayoc, Tarma ­ 2022 / Effectiveness of the Music Therapy Program in Active and Healthy Aging in the Elderly -Cochayoc Annex, Tarma ­2022

Objetivo: Determinar el efecto del programa de musicoterapia en el envejecimiento activo y saludable en la tercera edad ­anexo de Cochayoc, Tarma. Material y métodos: Cuasi experimental, prospectivo, longitudinal, analítico, aplicativo; con pre -post test de un mismo grupo experimental; la población es de 60 personas de la tercera edad y la muestra fue seleccionada a través del muestreo no probabilístico intencional constituido por 30 personas de la tercera edad, la recolección de datos fue mediante una lista de cotejo y uso de 3 cuestionarios. La prueba de confiabilidad fue Alfa de Cronbach, con un 0.87 considerado como bueno. Resultados: Los resultados evidencian que, tras la aplicación del pre test, las personas de la tercera edad en un 90% (27) no logran el envejecimiento activo y saludable; posterior al desarrollo del programa de musicoterapia se evidencia en el post test que un 93.3% (28) logran el envejecimiento activo y saludable. Con la prueba de Wilcoxon obtuvo que el valor P = 0,000 es menor al nivel de significancia 0,05; con un 95% de confianza, la aplicación del programa de musicoterapia "Melodías para la vida" es efectiva en el envejecimiento activo y saludable en la población de la tercera edad del Anexo de Cochayoc. Conclusiones: Tras comparar los valores entre el antes y después de aplicar el programa "Melodías para la vida" se observó que mejora el envejecimiento activo y saludable en todas sus dimensiones: emocional y afrontamiento positivo, hábitos saludables, cognitivo y participación social en las personas de la tercera edad

Objective:Determine the effect of the music therapy program on active and healthy aging in the elderly -Cochayoc Annex, Tarma. Material and methods:Quasi-experimental, prospective, longitudinal, analytical, applicative; with two observations (pre -post test) of the sameexperimental group; The population is 60 elderly people, and the sample was selected through intentional non-probabilistic sampling consisting of 30 elderly people, data collection was through a checklist and use of 3 questionnaires. The reliability test was Cronbach's Alpha, with 0.87 considered good. Results:The results show that, after the application of the pre-test, 90% (27) of the elderly don't achieve active and healthy aging; after the development of the music therapy program, it is evident in thepost test that 93.3% (28) achieved active and healthy aging. With the Wilcoxon test, it was obtained that the P value = 0.000 is less than the 0.05 level of significance; with 95% confidence, the application of the music therapy program "Melodies for life" is effective in active and healthy aging in the elderly population of the Cochayoc Annex. Conclusions:After comparing the values between before and after applying the "Melodies for Life" program, it was observed that it improves active and healthy agingin all its dimensions: emotional and face positively, healthy habits, cognitive and social participation in elderly people

Effects of an integrative multimodal inpatient program on fatigue and work ability in patients with Post-COVID Syndrome-a prospective observational study.

Post-COVID syndrome (PCS) is characterized by a variety of non-specific symptoms. One of the leading symptoms is fatigue. So far, there is no evidence-based causal therapy established and treatment of PCS is primarily symptom-oriented. The Clinic for Internal and Integrative Medicine in Bamberg, Germany, offers a comprehensive multimodal integrative inpatient therapy for PCS patients. Within a prospective uncontrolled observational study, the results of N = 79 patients were analysed. Post-COVID fatigue patients were hospitalized for up to 14 days. The treatment consists of individual modules depending on the patient's needs. It includes a wide range of integrative non-pharmacological treatment modalities. Outcomes were assessed before and after the inpatient treatment as well as 6 months after discharge from the hospital. Results show that fatigue of post-COVID patients in this study (M = 76.30, SD = 10.18, N = 64) was initially significantly higher than in the subsample "women aged 60-92 years" of the general German population (M = 51.5, Schwarz et al. [Schwarz et al. in Onkologie 26:140-144, 2003]; T(63) = 19.50, p < .001). Fatigue was significantly and clinically relevant reduced directly after discharge (MT1 = 76.21, SD = 11.38, N = 42; MT2 = 66.57, SD = 15.55, N = 42), F(1, 41) = 19.80, p < .001, partial eta squared = .326, as well as six months after discharge (MT3 = 65.31, SD = 17.20, N = 42), F(1, 41), p < .001, partial eta squared = .371. Additionally, self-reported ability to work (NRS, 0-10) improved significantly from admission (MT1 = 2.54, SD = 2.23, N = 39) to discharge (MT2 = 4.26, SD = 2.60, N = 39), F(1, 38) = 26.37, p < .001, partial eta squared = .410), as well as to six months later (MT3 = 4.41, SD = 3.23, N = 39), F(1, 38) = 15.00, p < .001, partial eta squared = .283. The study showed that patients suffering from chronic post-COVID syndrome for several months can achieve a significant improvement in their leading fatigue symptoms and a significant improvement in the subjective assessment of their ability to work through a comprehensive two-week multimodal integrative inpatient program.

AIP-based Professional Intervention Program for Adversity for trauma and stress reduction in groups: a pilot study in Ethiopia.

Introduction: Drawing from the principles of EMDR (Eye Movement Desensitization and Reprocessing) therapy and the AIP model, the Professional Intervention Program for Adversity (PIPA) was developed with the objective of amalgamating low-intensity group exercises into a unified framework, as a comprehensive intervention for group therapy. The PIPA Program integrates various aspects of EMDR therapy-such as stabilization, resourcing, desensitization, reprocessing, and forming beliefs about the self and future-into a cohesive program. The program's structure includes self-regulation exercises, the Pillars of Life, the Flash Technique, and the Quadrants exercise. Methods: The PIPA Program was administered to more than 220 individuals with a high probability of traumatization by the two-year civil war in Ethiopia (2020-2022). Results: The results of this study show a statistically significant improvement in PTSD symptoms on PCL-5 scores (from M = 38.58 to M = 20.59) after completing the entire PIPA Program and statistically significant lower SUDS scores within the program segments of the Flash Technique and the Quadrants exercises. Discussion: Future studies should explore the long-term effects of the PIPA Program and its broader application across different therapeutic contexts. The findings suggest that the PIPA Program is a promising group-based intervention for trauma treatment that is safe and effective, especially in non-clinical settings and for culturally diverse populations.

Combined Effect of Early Nutrition Therapy and Rehabilitation for Patients with Chronic Obstructive Pulmonary Disease Exacerbation: A Prospective Randomized Controlled Trial.

The effectiveness of rehabilitation programs (RP) for chronic obstructive pulmonary disease (COPD) exacerbation remains controversial. However, few studies have investigated the combined effects of exercise and nutritional therapy. This study aimed to determine the effects of combined nutritional therapy on the physical function and nutritional status of patients with COPD exacerbation who underwent early RP. A randomized controlled trial was conducted in patients hospitalized for COPD exacerbations. Patients were assigned to receive a regular diet in addition to RP (control group) or RP and nutrition therapy (intervention group). Physical function, including quadricep strength and body composition, was assessed. The intervention group was administered protein-rich oral nutritional supplements. A total of 38 patients with negligible baseline differences were included in the analysis. The intervention group showed a notably greater change in quadriceps strength. Lean body mass and skeletal muscle indices markedly decreased in the control group but were maintained in the intervention group. Logistic regression analysis identified nutritional therapy as a significant factor associated with increased muscle strength. No serious adverse events were observed in either group. Therefore, nutritional therapy combined with RP is safe and effective for improving exercise function while maintaining body composition in patients with COPD exacerbation.

A streamlined multidisciplinary metabolic clinic in psychiatric recovery service: a pilot study.

Background: The metabolic syndrome (MetS) is a collection of risk factors for cardiovascular disease and type-2 diabetes, that includes central obesity, hypertension, hyperglycaemia and dyslipidaemia. An audit indicated inadequate MetS screening in an Australian psychiatric recovery service. Objectives: We aimed to improve MetS screening, identification and intervention by offering streamlined lifestyle education, clinical reviews and discharge planning. This pilot program prioritized holistic, culturally-sensitive, patient-centric, and trauma-informed approaches to enhance metabolic health outcomes. Methods: A Metabolic Clinic was piloted in two psychiatric rehabilitation cottages (n=35), which involved disciplines of dietetics, exercise physiology, diversional therapy, occupational therapy, peer workforce, social work, clinical psychology, pharmacy, nursing and medical. Another cottage (n=15) was assigned as the comparison and received standard care. A 12-week, 3-times-per-week lifestyle and behavioral program, called MetFit, was devised and offered to those identified at screening for the treatment cottages. Outcome measures were feasibility measures, the five metabolic parameters (waist circumference, blood pressure, fasting serum triglycerides, high-density lipoprotein, and glucose), functional measures, and a meal questionnaire. Results: The treatment cottages had qualitative advantages in screening and identifying MetS. Of four enrolled consumers in MetFit, an improvement of triglycerides (p=0.08), squats (p=0.02), and push-ups (p=0.07) was observed. Major challenges of enrolment included an overall lack of acknowledgment of its importance, poor motivation of consumers and resources limitation. Conclusions: The one-stop provision of groups, peer support and inpatient pathway with multidisciplinary team-integration was generally accepted by consumers and the MDT and has iteratively demonstrated the urgent need for consumer-centered physical care and a cultural shift to foster collaboration within a psychiatric service.

Mobile-Delivered Mindfulness Intervention on Anxiety Level Among College Athletes: Randomized Controlled Trial.

BACKGROUND: College athletes are a group often affected by anxiety. Few interventional studies have been conducted to address the anxiety issues in this population. OBJECTIVE: We conducted a mobile-delivered mindfulness intervention among college athletes to study its feasibility and efficacy in lowering their anxiety level and improving their mindfulness (measured by the Five Facet Mindfulness Questionnaire [FFMQ]). METHODS: In April 2019, we recruited 290 college athletes from a public university in Shanghai, China, and 288 of them were randomized into an intervention group and a control group (closed trial), with the former (n=150) receiving a therapist-guided, smartphone-delivered mindfulness-based intervention and the latter receiving mental health promotion messages (n=138). We offered in-person instructions during the orientation session for the intervention group in a classroom, with the therapist interacting with the participants on the smartphone platform later during the intervention. We used generalized linear modeling and the intent-to-treat approach to compare the 2 groups' outcomes in dispositional anxiety, precompetition anxiety, and anxiety during competition, plus the 5 dimensions of mindfulness (measured by the FFMQ). RESULTS: Our intent-to-treat analysis and generalized linear modeling found no significant difference in dispositional anxiety, precompetition anxiety, or anxiety during competition. Only the "observation" facet of mindfulness measures had a notable difference between the changes experienced by the 2 groups, whereby the intervention group had a net gain of .214 yet fell short of reaching statistical significance (P=.09). Participants who specialized in group sports had a higher level of anxiety (ß=.19; SE=.08), a lower level of "nonjudgemental inner experience" in FFMQ (ß=-.07; SE=.03), and a lower level of "nonreactivity" (ß=-.138; SE=.052) than those specializing in individual sports. CONCLUSIONS: No significant reduction in anxiety was detected in this study. Based on the participant feedback, the time availability for mindfulness practice and session attendance for these student athletes in an elite college could have compromised the intervention's effectiveness. Future interventions among this population could explore a more student-friendly time schedule (eg, avoid final exam time) or attempt to improve cognitive and scholastic outcomes. TRIAL REGISTRATION: Chinese Clinical Trial Registry ChiCTR1900024449; https://www.chictr.org.cn/showproj.html?proj=40865.

Promoting the Wellness of Older Adults through Integrated Health-Promoting Programs and Supportive Peers: A Quasi-Experimental Study in Semi-Urban Communities of Northeastern Thailand.

INTRODUCTION/OBJECTIVES: Thailand has approached an aged society in which the proportion of older adults rose from 5% in 1995 to 20.7% in 2022 and is projected to increase to 27.2% in 2030. Older adults face health risks and challenges, requiring supportive care. This research aimed to promote the wellness of older adults through Integrated Health-Promoting Programs and Supportive Peers (IHPP-SP) in semi-urban communities. METHODS: A one-group pretest-posttest quasi-experimental study was conducted among 229 older adults from 22 communities. The interventions covered analyzing community situations and determinants, designing and developing IHPP-SP, enhancing the capabilities of supportive peers, and establishing a support system. Mean and proportion differences were analyzed using the paired t-test and McNemar test. RESULTS: After implementing IHPP-SP, the mean score significantly increased for happiness (P = .004), Activities of Daily Living: ADLs (P = .034), and family support (P < .001), but did not differ regarding depression (P = .413). The proportion of healthy behaviors significantly increased for tobacco use (P = .035), dietary intake (P = .018), and physical activity (P < .001), but not for alcohol consumption (P = .377). CONCLUSIONS: The IHPP-SP provided potential benefits to promote the wellness of older adults.

Low-intensity mindfulness and cognitive-behavioral therapy for social anxiety: a pilot randomized controlled trial.

BACKGROUND: Cognitive-behavioral therapy (CBT) effectively improves the clinical symptoms of social anxiety disorder. However, there are non-responders who cannot decrease their cost/probability bias significantly; hence, their social anxiety symptoms remain unaddressed. Mindfulness training and cognitive-behavioral approaches promote a reduction in cost/probability bias and social anxiety symptoms. This study examines the effectiveness of a four-session program of mindfulness and CBT (M-CBT) in a non-clinical sample of individuals with high social anxiety. METHODS: Participants were 50 Japanese undergraduate students (37 women and 13 men) randomly allocated to an intervention group (n = 27) and a control group (n = 23). The intervention group underwent a four-session M-CBT program, while the control group did not receive any treatment. RESULTS: A group × time analysis of covariances showed significant interactions in the negative cognition generated when paying attention to others in probability bias, fear of negative evaluation by others, dispositional mindfulness, depressive symptoms, and subjective happiness. M-CBT also produced significant pre-post improvements in the above outcomes with moderate to high effect sizes (ds = .51-1.55). Conversely, there were no interactions in social anxiety symptoms and self-focused attention. CONCLUSIONS: These results indicate that M-CBT was effective for the negative cognition generated when paying attention to others in probability bias, fear of negative evaluation by others, dispositional mindfulness, depressive symptoms, and subjective happiness. The combination of mindfulness training with cognitive restructuring is proposed as potentially helpful for individuals with probability bias, leading to negative cognition from paying attention to others. TRIAL REGISTRATION: University Hospital Medical Information Network (UMIN CTR) UMIN000036763. Registered May 16, 2019.

Adapting an Adolescent and Young Adult Program Housed in a Quaternary Cancer Centre to a Regional Cancer Centre: Creating Equitable Access to Developmentally Tailored Support.

Adolescents and young adults (AYAs) with cancer, representing those between 15 and 39 years of age, face distinctive challenges balancing their life stage with the physical, emotional, and social impacts of a cancer diagnosis. These challenges include fertility concerns, disruptions to educational and occupational pursuits, issues related to body image and sexual health, and the need for age-appropriate psychosocial support within their communities. The Princess Margaret Cancer Centre (PM), a quaternary care center, established a specialized AYA program in 2014, offering holistic and developmentally tailored psychosocial support and currently, efforts are underway to expand this to other regions in the province to address the need for equitable access. The establishment process involves securing funding, conducting an environmental scan, identifying service gaps, developing clinical pathways, and implementing AYA supportive care. An accessible AYA program should also consider social determinants of health, social location, intersectionality, and an interdisciplinary health approach in understanding health inequities in AYA oncology care. This paper describes the processes implemented and challenges faced in creating a community-based AYA program beyond major resource-rich cities and efforts to address intersectionality.

Make me more comfortable: effects of a hypnosis session on pain perception in chronic pain patients.

Introduction: Approximately one-quarter of Canadians experience chronic pain, a debilitating condition often necessitating opioid use, which raises concerns regarding dependency and overdose risks. As an alternative, we developed the HYlaDO program (Hypnose de la Douleur, hypnosis of Pain in French), a novel self-hypnosis approach for chronic pain management. The development of this program followed the ORBIT model, a comprehensive framework for designing interventions encompassing several phases ranging from design to efficacy assessment. Methods: In the present work, we conducted a preliminary evaluation of the HYlaDO program with 21 participants (18 of the 21 patients were included in the analysis). The primary objective was to determine one session of the program's effectiveness in altering pain, anxiety and relaxation via pre-post analysis. The secondary goal was to examine the long-term effects across the same measures, in addition to the overall quality of life. Results: The results highlight the benefits of our approach, while participants reported short-term significant pain reduction, decreased anxiety, and increased relaxation. Additionally, preliminary trends suggest improvements in physical activity and quality of life metrics. Discussion: These positive outcomes highlight HYlaDO's potential as an alternative to opioid therapy for chronic pain. Encouraged by these results, we aim to extend our research to a broader and more diverse cohort, paving the way for comprehensive randomized controlled trials. This expansion will further validate HYlaDO's efficacy and its role in transforming chronic pain management.

Evaluation of the Tinnitus Teleconsulting System's Back-Referral Program for National Health Insurance Patients with Diabetes Mellitus in Primary Care.

BACKGROUND: One of the techniques available through Social Security healthcare organizations to assist the government in the implementation of social distancing without restricting patients access to particular health treatments is primary healthcare Tinnitus Teleconsulting. The purpose of this research is to gather data on how well the City of South Jakarta's primary medical care Audiology Teleconsulting strategy was implemented during the COVID-19 pandemic. METHOD: This study uses a qualitative research method and was conducted during November 2022-Mei 2023 at the City of South Jakarta Primary Health Care, the social security agency of health's South Jakarta Branch, and the social security agency of health's Primary Health Care Guarantee Division at the Head Office. Data collection techniques were through Focus Group Discussions, in-depth interviews with key informants, and document review. RESULTS: The results showed that most of the informants already knew the process and output of FKTP Tinnitus Teleconsulting performance; only a few FKTPs did not understand the process and output of policy performance, so even though they acknowledged that they had implemented it, there were no documents recorded in the logbook or electronically recorded patient medical data through the social security agency's health care application. CONCLUSION: The findings of this study can be used by FKTP and other district or city social security agencies of health to improve the performance achievement of FKTP Tinnitus Teleconsulting implementation.

Telehealth program for symptomatic COVID-19 patients in Mindanao, Philippines: a whole-of-system, pragmatic interventional study on patient monitoring from isolation facilities to community reintegration.

The COVID-19 pandemic is impacting individuals and society's physical and mental health. Despite the lack of any definite and effective therapeutic regimen, public health measures such as quarantine and isolation have been instituted to contain this pandemic. However, these mitigating measures have also raised issues regarding isolated patients' mental and psychological well-being. Several stakeholders were engaged in this approach, including the university, the local health office, the tertiary hospital, and the local communities. This intervention addresses concerns regarding the health status of isolated individuals due to COVID-19 infection, making the program available to anyone who agrees to participate. This was done through telehealth services delivered via phone calls and SMS. The university provided technical support and telehealth manpower through medical students. The local health unit manages the isolation facilities, while the referral hospital offers specialty care for isolated patients through teleconsultation. Finally, the local community is the one that reintegrates discharged patients into their communities. Three hundred forty-four (344) participants were provided seven sessions on telehealth education and tracking of their COVID-19 prescribed practices and mental health. The mean age of the patients was 37 years; half were females, and 15% had comorbidities. Regarding their mental health status, the level of depression dropped from 6% to 1% (p<0.0001), the level of anxiety dropped from 12% to 2% (p<0.0001), and the level of stress dropped from 3% to 0% (p<0.0001) from the first day of admission to 2 weeks after discharge. Moreover, a general trend of statistically significant increase in various practices was noted: wearing face masks, physical distancing, disinfecting frequently held objects, hand hygiene, and self-monitoring for COVID-19 symptoms. Those with progressing symptoms of COVID-19 were referred immediately to the referral hospital. There were also no reports of complications of co-morbidities during their stay in the isolation facilities or social isolation upon community reintegration. The study concludes that telehealth services have the potential to address many challenges in providing continuous healthcare services to isolated patients until they are reintegrated into their community. Furthermore, a whole-of-society approach is necessary to provide holistic care to patients affected by the pandemic.

The Effects of Hyperbaric Oxygen Treatment on Verbal Scores in Children With Autism Spectrum Disorder: A Retrospective Trial.

Introduction Autism spectrum disorder (ASD) is a neurodevelopmental condition that affects millions worldwide. Suggested pathophysiology includes cerebral hypoperfusion, inflammation, mitochondrial and immune dysregulation, and oxidative stress. Debate exists concerning the benefit of hyperbaric oxygen therapy (HBOT) in treating ASD and its impacts on verbal behavior. The present study directly assesses the impacts of HBOT treatments on verbal behavior using a novel and unique manner.  Materials and methods A two-group quasi-experimental trial using a pretest and a posttest was designed to retrospectively assess (n = 65) any association between HBOT and change in verbal scores in children (n = 65) with ASD. All children completed two verbal tests six months apart, either the Verbal Behavior Milestones Assessment and Placement Program (VBMAPP) or the Assessment of Basic Language and Learning Skills (ABLLS), based on their developmental age. The control cohort received applied behavior analysis (ABA) without HBOT. The experimental cohort received ABA and a minimum of 40 HBOT treatments, breathing 100% oxygen at 2.0 atmosphere absolute (ATA) for 60 minutes. Results Sixty-five children were included, of which 32 received HBOT (mean (M) = 5.1, standard deviation (SD) = 2.93), with an age range of two to 17 years. More than 63% of the subjects had an autism severity level of three. The 23 children administered VBMAPP who received HBOT showed substantial mean differences with high effect sizes (ESs) (-0.743 to -1.65) and a total score (TS) ES equal to -1.23 as measured by Cohen's d. There was a statistically significant improvement (p < 0.05) in all VBMAPP milestone domains and TS. TS change from baseline versus those in the non-HBOT (Control-ABA) group (n=12) was 46.41 ± 20.14 vs 14.42 ± 6.99; p < 0.0001, ES = -1.23. The 30 children administered the ABLLS showed substantial mean difference (TS) change from baseline 268.89 ± 182.05 vs 190.81 ± 135.26 and exhibited small to medium (-.114 to -.773) ESs with a TS ES = -0.487. Due to the high within-group variability (low statistical power) within the ABLLS cohort, there was a non-significant mean difference between the control (ABA) and experimental (ABA + HBO2) groups' difference scores (p > 0.2024), despite the medium (TS) ES. Conclusions The child cohorts administered the VBMAPP and the ABLLS demonstrated substantial improvements between the non-HBOT (control-ABA) and HBOT (experimental-ABA + HBO2) groups as measured by the significant mean differences and small to large ESs. Simply put, the children in the experimental cohort acquired more verbal skills than their counterparts in the control group.

Odimet®: A Pioneering Tele-Health Tool to Empower Dietary Treatment and the Acute Management of Inborn Errors of Metabolism-An Assessment of Its Effectiveness during the COVID Pandemic.

Strict adherence to a diet is an essential pillar of long-term treatment for many inborn errors of metabolism (IEMs). Tools that educate patients about dietary management can positively condition adherence and prevent morbidity. We designed a free online dietary calculation program (Odimet®, version 2.1.) for IEMs patients in 2008, updated in 2022, that provides detailed information on the content of amino acids, protein, lipids, carbohydrates, vitamins and minerals in >3000 food products, including specific medical foods for IEM. We analyzed the statistics on visits to Odimet® to evaluate its usefulness for long-term dietary management during a 5-year period focusing on three periods: pre-pandemic (15 March 2018-14 March 2020); pandemic 1 (15 March 2020-14 March 2021); and pandemic 2 period (15 March 2021-15 March 2023), in 120 patients with the following distribution: 84 patients with phenylketonuria (PKU); 12 with maple syrup urine disease (MSUD); 11 with urea cycle disorders (UCDs); and 13 with classical galactosemia. The evolutionary levels of their specific metabolic markers were evaluated, showing that globally, both pediatric and adult patients maintain a good metabolic control, even during a pandemic (median levels of phenylalanine in pediatric PKU patients 213.4 µmol/L and 482.3 µmol/L in adults; of leucine in MSUD patients: 144.2 µmol/L; of glutamine in UCDs: 726.8 µmol/L; and of galactose 1-phosphate levels in galactosemia: 0.08 µmol/L). The proportion of patients using Odimet® ranges from 78-100%. An increase in the number of diets being calculated was observed during COVID-19 pandemic. Currently, 14,825 products have been introduced (3094 from the general database, and 11,731 added by users to their own profiles). In 2023 63 emergency dietary adjustments in the studied intoxication-type pathologies were calculated in Odimet®. Our results suggest that its regular use contributes to maintaining metabolic stability in IEMs patients, allowing them to adapt their menus to their lifestyle, and represents a powerful complementary tele-health tool which can be used to perform remote real-time dietary follow-up.

Mindful Eco-Wellness: Steps Toward Personal and Planetary Health.

Rising greenhouse gas levels heat the earth's surface and alter climate patterns, posing unprecedented threats to planetary ecology and human health. At the same time, obesity, diabetes, and cardiovascular disease have reached epidemic proportions across the globe, caused in part by decreases in physical activity and by over-consumption of carbon-intensive foods. Thus, interventions that support active transportation (walking or cycling rather than driving) and healthier food choices (eating plant-based rather than meat-based diets) would yield health and sustainability "co-benefits." Emerging research suggests that mindfulness-based practices might be effective means toward these ends. At the University of Wisconsin-Madison, we have developed a mindfulness-based group program, Mindful Eco-Wellness: Steps Toward Healthier Living. Loosely based on the Mindfulness-Based Stress Reduction course, our curriculum teaches mindfulness practices in tandem with sustainability principles, following weekly themes of Air, Water, Food, Energy, Transportation, Consumption, Nature Experience, and Ethics. For example, the "Air" class offers participants practice in guided breath meditations while they learn about the benefits of clean air. The theme of "Food" is presented through mindful eating, accompanied by educational videos highlighting the consequences of food production and consumption. "Transportation" includes walking/movement meditations and highlights the health benefits of physical activity and detriments of fossil-fueled transportation. Pedagogical lessons on energy, ecological sustainability, and the ethics of planetary health are intertwined with mindful nature experience and metta (loving-kindness) meditation. Curricular materials, including teaching videos, are freely available online. Pilot testing in community settings (n = 30) and in group medical visits (n = 34) has demonstrated feasibility; pilot data suggests potential effectiveness. Rigorous evaluation and testing are needed.

Implementation of family adoption program using five-pronged strategy of integrated holistic health team: A way forward.

About 65.5 % of the Indians live in rural areas while availability of healthcare is biased towards urban setups. Medicine in undergraduates is taught in ivory towers of medical colleges, a paradigm shift in teaching bedside medicine from these ivory towers to community level is required. Hence a new competency-based medical education for undergraduate course was adopted with family adoption program as a vital component, which provides an opportunity for undergraduates to get sensitised to problems and social dynamics at grass root level. We propose an integrated holistic health team model to implement family adoption program so as to address needs of community and build consensus amongst graduate students from various health disciplines to work in integrated team approach and result in enhanced learning. A five pronged strategy is implemented by forming an integrated team comprising of students from medical, aental, ayurveda, and physiotherapy & nursing streams. The institutions that have undergraduate program for any two to five of these disciplines can adopt proposed approach. Expected outcomes of utilising this model is to create holistic health team thereby inculcating in budding graduates team spirit, mutual cooperation & respect for other disciplines of health sciences and thereby holistic healthcare to community.

Perspective: Leveraging Electronic Health Record Data Within Food Is Medicine Program Evaluation: Considerations and Potential Paths Forward.

Government, health care systems and payers, philanthropic entities, advocacy groups, nonprofit organizations, community groups, and for-profit companies are presently making the case for Food is Medicine (FIM) nutrition programs to become reimbursable within health care services. FIM researchers are working urgently to build evidence for FIM programs' cost-effectiveness by showing improvements in health outcomes and health care utilization. However, primary collection of this data is costly, difficult to implement, and burdensome to participants. Electronic health records (EHRs) offer a promising alternative to primary data collection because they provide already-collected information from existing clinical care. A few FIM studies have leveraged EHRs to demonstrate positive impacts on biomarkers or health care utilization, but many FIM studies run into insurmountable difficulties in their attempts to use EHRs. The authors of this commentary serve as evaluators and/or technical assistance providers with the United States Department of Agriculture's Gus Schumacher Nutrition Incentive Program National Training, Technical Assistance, Evaluation, and Information Center. They work closely with over 100 Gus Schumacher Nutrition Incentive Program Produce Prescription FIM projects, which, as of 2023, span 34 US states and territories. In this commentary, we describe recurring challenges related to using EHRs in FIM evaluation, particularly in relation to biomarkers and health care utilization. We also outline potential opportunities and reasonable expectations for what can be learned from EHR data and describe other (non-EHR) data sources to consider for evaluation of long-term health outcomes and health care utilization. Large integrated health systems may be best positioned to use their own data to examine outcomes of interest to the broader field.

Considerations for Correction of Micronutrient Deficiencies Through Supplementation in Pregnant Women and Children Under-5 in Latin America.

BACKGROUND: Micronutrient deficiencies in Latin America are a public health concern, nonetheless, lack of information still exists in many countries, so that the true magnitude of the problem remains uncertain. OBJECTIVE: To summarise experiences that can inform the development of policies and programs to address micronutrient deficiencies throung supplementation in pregnant women and chlidren under five years of age in Latin American. METHODS: Review of the most evidence on the effects of micronutrients supplementation, focusing on pregnant women and children under five years of age. RESULTS: Certain population groups, as women of reproductive age and children under 2 years of age, are at increased risk for deficiency due to their high micronutrient requirements. This is compounded by the limited access to micronutrient-rich foods for many people living in vulnerable situations. Micronutrient supplementation is an effective intervention to prevent and treat deficiency and to mitigate its adverse effects on health, nutrition, and pregnancy outcomes in micronutrient-deficient populations. The potential benefits of supplementation programs, however, are realized only when they reach those who have the potential to benefit, that is, with inadequate intakes of micronutrients from dietary sources, and when the quality of design and delivery of the programs aresufficient to reach that population timely, regularly, and effectively to enable and motivate consumption. CONCLUSIONS: Several resources and experiences exist that can help favor the development of programs that can realize this biological and programmatic potential. There is need for continuous efforts to augment coverage and achieve results that can translate into economic benefits for individuals, families, and nations.

Plain language titleCorrecting Vitamin and Mineral Deficiencies in Pregnant Women and Children in Latin AmericaPlain language summaryPrevious articles in this supplement have highlighted the importance of micronutrient (vitamin and mineral) deficiencies in Latin America, their causes and effects in different population groups, and some alternatives for their prevention and control. At certain stages of life, particularly during the first 1000 days (from pregnancy to 2 years of age), high nutrient requirements predispose to nutritional deficiencies. This is exacerbated by the limited access to healthy foods for populations living in vulnerable situations. Dietary supplements are therefore an effective strategy for preventing and treating deficiencies and mitigating their adverse effects on the nutrition and health of the population. In this article, we review the most recent estimates on the prevalence of nutrient deficiencies, with a focus on pregnant women and children under 2 years of age; the types of supplements available, and the international recommendations for supplementation during this period of life. There is strong evidence for several benefits of short-term supplementation. In pregnant women, vitamin and mineral levels are improved and a healthy pregnancy is achieved. In children, vitamin and mineral levels are also improved, and some (such as iron and zinc) improve growth and development. In the long term, there are economic benefits for individuals, families, and nations. Several recommendations from studies and supplementation programs are also discussed. Although nutritional supplementation can be cost-effective, benefits will only be achieved if the types and formulations of supplements meet the assessed nutritional needs of the population and if a program is properly designed and implemented. Similarly, programs that include supplements need to be monitored and evaluated to ensure that supplements are taken regularly and for long enough to achieve these benefits.

Mindfulness-based interventions to support wellbeing of adults in low socio-economic settings: a realist review.

BACKGROUND: Mindfulness as a modality involves training the innate human capacity for present-moment awareness with a view to cultivating a more harmonious and integrated life experience, especially in the face of hardship. Over the past four decades, the field of mindfulness has grown rapidly. Despite a substantial body of literature outlining the many benefits of mindfulness practice within a range of contexts and populations, the authors noticed that studies addressing the adaptation, application and value of mindfulness-based interventions (MBIs) for adults within socio-economically challenged setting were scant. To address this gap, we conducted a realist review of studies pertaining to MBIs within low socio-economic settings, to determine the extend and nature of research in this sector and culminating in a program theory which may be useful for the design of interventions going forward. METHODS: We selected realist review as the methodology as it is well suited to investigating the complex nature of social interventions. The value of realist review is that the exploration of the causal relationships between the mechanisms (M) within a specific context (C) towards particular outcomes (O) offers a deeper understanding of the intervention which may assist in more effective delivery going forward. The review follows the guidelines presented by the Realist and Meta-narrative Evidence Synthesis - Evolving Standards project. RESULTS: Of the 112 documents identified, 12 articles met the inclusion criteria. Of these 12 studies, 10 were conducted in the United States, with little representation across the rest of the globe. The interventions described in these articles were varied. We identified mechanisms that offered beneficial outcomes for participants across a range of contexts, with indications of how interventions might be adapted towards greater accessibility, acceptability, and feasibility within communities. CONCLUSION: By reviewing the various programs in their respective contexts, we developed a program theory for implementing socio-culturally adapted MBIs in low socio-economic settings. In the future, this program theory could be tested as a means to create a sense of wellbeing for people living in low socio-economic settings.

Improvements in nutrition knowledge among adults with physical disabilities: A program evaluation of the mindfulness, exercise, and nutrition to optimize resilience (MENTOR) program 2020-2021.

BACKGROUND: The Centers for Disease Control and Prevention (CDC) funds a quality improvement (QI) health promotion telewellness program for adults with physical disabilities. OBJECTIVE: The nutrition component of the parent program, Mindfulness, Exercise, and Nutrition to Optimize Resilience (MENTOR) program, from 2020 to 2021, was evaluated to assess changes in nutrition knowledge of people with physical disabilities. METHODS: This was a quasi-experimental program evaluation by pre-post survey of participating adults with physical disabilities. Participants attended weekly nutrition classes for eight weeks with optional one-on-one counseling with a Registered Dietitian. Participants completed pre-post General Nutrition Knowledge Questionnaire Revised (GNKQ-R) that were analyzed using paired t-tests. Participants were grouped into quartiles by pre-program GNKQ-R scores for additional comparisons. Program attendance and post-program feedback were also evaluated. RESULTS: A total of 286 participants completed the MENTOR program, and 31% (n = 89) completed pre-post questionnaires for data analysis. Mean pre-program GNKQ-R scores were 58.4 ± 15.1 and post scores were 64.4 ± 11.3, which demonstrated a statistically significant improvement in nutrition knowledge (p < .001). Ancillary analysis revealed that participants with the lowest quartile of pre-program nutrition knowledge had the greatest improvements in their post-GNKQ-R scores (Mean change 16.4 ± 13.9). Questionnaire data revealed participants' subjective knowledge changes and their feedback on the nutrition component of the program. CONCLUSIONS: The eight-week MENTOR program effectively improved nutrition knowledge among people with physical disabilities. This demonstrates the impact the program can have on individual knowledge levels. Additionally, these results support the implementation of the program to the broader population of people with disabilities.