The multisensory mind: a systematic review of multisensory integration processing in Anorexia and Bulimia Nervosa.

Individuals with Anorexia Nervosa and Bulimia Nervosa present alterations in the way they experience their bodies. Body experience results from a multisensory integration process in which information from different sensory domains and spatial reference frames is combined into a coherent percept. Given the critical role of the body in the onset and maintenance of both Anorexia Nervosa and Bulimia Nervosa, we conducted a systematic review to examine multisensory integration abilities of individuals affected by these two conditions and investigate whether they exhibit impairments in crossmodal integration. We searched for studies evaluating crossmodal integration in individuals with a current diagnosis of Anorexia Nervosa and Bulimia Nervosa as compared to healthy individuals from both behavioral and neurobiological perspectives. A search of PubMed, PsycINFO, and Web of Sciences databases was performed to extract relevant articles. Of the 2348 studies retrieved, 911 were unique articles. After the screening, 13 articles were included. Studies revealed multisensory integration abnormalities in patients affected by Anorexia Nervosa; only one included individuals with Bulimia Nervosa and observed less severe impairments compared to healthy controls. Overall, results seemed to support the presence of multisensory deficits in Anorexia Nervosa, especially when integrating interoceptive and exteroceptive information. We proposed the Predictive Coding framework for understanding our findings and suggested future lines of investigation.

Diagnoses of Anorexia Nervosa and Bulimia Nervosa have increased dramatically in recent years, taking on the characteristics of a mental health emergency. More research is therefore needed to better understand these conditions, especially given their complex and multifaceted nature. Patients affected by these conditions report significant alterations in body-self experience. Body experience results from a cross-modal integration process in which information from different sensory modalities and spatial frames is combined. Therefore, we systematically reviewed studies that focused on multisensory integration in patients affected by Anorexia Nervosa and Bulimia Nervosa, as it may play a key role in the onset and maintenance of these pathologies. Studies in this review found multisensory integration difficulties in patients with Anorexia Nervosa, but not enough studies were retrieved to draw conclusions regarding Bulimia Nervosa. We discussed findings trying to link behavioral, neuropsychological, and neuroscientific evidence in light of the predictive coding framework to provide a different perspective on patients' distorted body experiences. This may lead to new insights to refine our understanding of these complex and poorly understood disorders.

A Self-Help Virtual Therapeutic Experience Intervention for Overcoming Psychological Distress Related to the COVID-19 Pandemic: Results From the European Multicentric COVID Feel Good Trial.

OBJECTIVE: The general objective of the current study was to investigate the efficacy of a novel self-help virtual therapeutic experience (specifically, the COVID Feel Good intervention) in lowering the psychological burden experienced during the COVID-19 lockdowns in four European countries. METHODS: We focused on participants recruited from June 2020 to May 2021 in the context of a European multicenter project including four university/academic sites. The total number of participants in the longitudinal studies was 107 (study 1, N = 40; study 2, N = 29; study 3, N = 38). The randomized controlled trial (study 4) included 31 participants in total, 16 in the intervention group and 15 in the control group. Primary outcome measures were depression, anxiety, stress symptoms, perceived stress level, and perceived hopelessness. The secondary outcome was experienced social connectedness. RESULTS: Using separate linear mixed-effects models, the most consistent result across countries was a reduction in perceived stress after the participation in the COVID Feel Good intervention. By pooling the results of the models using a random-effects meta-analysis, we found that after the COVID Feel Good intervention, participants reported a decrease in perceived general distress (mean standardized effect size for general distress in the treatment groups compared with the control conditions was -0.52 [ p = .008, 95% confidence interval = -0.89 to -0.14]) and an increase in the perceived social connection (mean standardized effect size for social connection using COVID Feel Good compared with the control conditions was 0.50 [ p ≤ .001, 95% confidence interval = 0.25 to 0.76]). CONCLUSIONS: Findings of this study indicate that a virtual self-help intervention is effective in reducing psychological distress. These results contribute to the growing literature supporting the use of digital psychological therapies to relieve psychological distress among the general population during the COVID-19 pandemic.Trial Registration : ISRCTN63887521.

From Virtual Reality to Regenerative Virtual Therapy: Some Insights from a Systematic Review Exploring Inner Body Perception in Anorexia and Bulimia Nervosa.

Despite advances in our understanding of the behavioral and molecular factors that underlie the onset and maintenance of Eating Disorders (EDs), it is still necessary to optimize treatment strategies and establish their efficacy. In this context, over the past 25 years, Virtual Reality (VR) has provided creative treatments for a variety of ED symptoms, including body dissatisfaction, craving, and negative emotions. Recently, different researchers suggested that EDs may reflect a broader impairment in multisensory body integration, and a particular VR technique-VR body swapping-has been used to repair it, but with limited clinical results. In this paper, we use the results of a systematic review employing PRISMA guidelines that explore inner body perception in EDs (21 studies included), with the ultimate goal to analyze the features of multisensory impairment associated with this clinical condition and provide possible solutions. Deficits in interoception, proprioception, and vestibular signals were observed across Anorexia and Bulimia Nervosa, suggesting that: (a) alteration of inner body perception might be a crucial feature of EDs, even if further research is needed and; (b) VR, to be effective with these patients, has to simulate/modify both the external and the internal body. Following this outcome, we introduce a new therapeutic approach-Regenerative Virtual Therapy-that integrates VR with different technologies and clinical strategies to regenerate a faulty bodily experience by stimulating the multisensory brain mechanisms and promoting self-regenerative processes within the brain itself.

Mitigating negative emotions through virtual reality and embodiment.

Oncological treatments are responsible for many of the physical changes (aesthetic and functional) associated with cancer. Because of this, cancer patients are at high risk of developing mental health problems. The aim of this study is to propose an innovative Virtual Reality (VR) training that uses a somatic technique (i.e., embodiment) to create a bridge with the bodily dimension of cancer. After undergoing a psycho-educational procedure, a combination of exposure, out-of-body experience, and body swapping will gradually train the patient to cope with cancer-related difficulties, increasing stress tolerance, and patient empowerment. The most engaging step of this advanced form of Stress Inoculation Training is the body swapping experience, which will guide the patient in embodying a resilient cancer patient who is facing similar difficulties. Through the VR ability to simulate the human brain functioning, and the potential of embodiment to hook to the somatic dimension of illness, we expect that once the concepts endured through the patient's experience of resilience are triggered, the patient will be more prone to implement functional coping strategies in real life, reaching empowerment and adjusting to the post-treatment difficulties. When the scenarios are built and the training tested, our intervention could be used to support patients with different oncological diseases and who are treated in different cancer hospitals, as well as patients with other non-oncological problems (e.g., social anxiety). Future research should focus on using our paradigm for other clinical populations, and supporting cancer patients in coping with different distressing situations.

Psychological variables associated with quality of life in patients with head and neck cancer: the role of body image distress.

OBJECTIVE: The aim of this cross-sectional study was to explore the relationship between quality of life (QoL) and body image distress in patients with head and neck cancer (HNC), considering relevant psychological variables (i.e., coping strategies, social anxiety symptoms, self-esteem, intolerance of uncertainty, pain, and distress). We also aimed to explore gender differences in patients with HNC in terms of relevant psychological variables in HNC. METHODS: Fifty-one HNC patients (37 males and 14 females) completed self-report questionnaires to assess body image distress, physical and mental QoL, and relevant psychological variables in HNC (coping strategies, social anxiety symptoms, self-esteem, intolerance of uncertainty, pain, and distress) before undergoing treatment. Pearson's correlations and four-step hierarchical regressions were performed to assess the relationship between body image distress, QoL, and the abovementioned psychological variables, while one-way analyses of variance and one-way analysis of covariance were employed to assess gender differences. RESULTS: Physical QoL was associated with body image distress above and beyond disease duration, distress, coping strategies, pain, mental QoL, and self-esteem, while mental QoL was associated with pain above and beyond distress, coping strategies, physical QoL, self-esteem, and body image distress. Concerning gender differences, females scored higher than males on most of the explored psychological variables, except for physical QoL and intolerance of uncertainty, and showed lower mental QoL and self-esteem than males. CONCLUSION: Body image distress and pain emerged as negatively associated with QoL, and almost all the explored psychological variables differed among genders. Psychological interventions targeting body image distress and pain should be promoted in patients with HNC to increase their QoL, while keeping gender differences in mind.

Development of a text message-based intervention for follow-up colposcopy among predominately underserved Black and Hispanic/Latinx women.

PURPOSE: Underserved Black and Hispanic/Latinx women show low rates of follow-up care after an abnormal Pap test, despite the fact that cervical cancer is one of the few preventable cancers if detected early. However, extant literature falls short on efficacious interventions to increase follow-up for this population. A concurrent mixed methods study was completed to evaluate the acceptability of a text message-based intervention and identify perceived barriers and facilitators to follow-up after an abnormal Pap test among underserved predominantly Black and Hispanic/Latinx women. METHODS: Patients who completed follow-up for an abnormal Pap test were recruited to complete a cross-sectional survey, qualitative interview assessing barriers and facilitators to follow-up, and text message content evaluation (N = 28). Descriptive statistics were performed to describe background variables and to evaluate the acceptability of text messages. A directed content analysis was completed for the qualitative interviews. RESULTS: Participants expressed interest in a text message-based intervention to increase abnormal Pap test follow-up. In the qualitative interviews, low knowledge about cervical risk and negative affect toward colposcopy/test results were identified as barriers to follow-up. Facilitators of follow-up included feeling relieved after the colposcopy and adequate social support. Participants rated the text messages as understandable, personally relevant, and culturally appropriate. CONCLUSION: The findings suggest that underserved Black and Hispanic/Latinx women experience cognitive and emotional barriers that undermine their ability to obtain follow-up care and a text message-based intervention may help women overcome these barriers. Future research should develop and evaluate text message-based interventions to enhance follow-up after an abnormal Pap test.

Redes de servicios médicos y tratamiento de cáncer de cérvix en Posadas, Avellaneda y Ciudad Autónoma de Buenos Aires / Health service networks and cervical cancer treatment in Posadas, Avellaneda and Ciudad Autónoma de Buenos Aires

INTRODUCCIÓN: El estudio de la atención integral pluridisciplinar de la salud es relevante para tratamientos como el de cáncer de cuello de útero (CCU) avanzado, debido a la complejidad de su abordaje. El objetivo de este trabajo fue evaluar el funcionamiento del conjunto de servicios médicos para el tratamiento del CCU según pautas del modelo de redes integradas de la Organización Panamericana de la Salud. MÉTODOS: Sobre una muestra de tres redes de servicios en Posadas, Avellaneda y Ciudad de Buenos Aires, se entrevistó a profesionales y pacientes, y se revisaron sus historias clínicas. Se efectuó un análisis del contenido y del discurso para interpretar el funcionamiento de las redes y sus determinaciones. RESULTADOS: Se verificó una escasa correspondencia con el modelo de referencia. Se destacan los problemas de comunicación entre los servicios y con las pacientes, que distorsionan el curso del tratamiento, así como una pobre intervención de las direcciones de hospitales y ministerios de salud sobre el desempeño de las redes. DISCUSIÓN: Los déficits del trabajo cooperativo entre servicios afectan la integración de las acciones de cuidado. La insuficiente comunicación con las pacientes dificulta la comprensión y su autonomía decisional. La baja intervención de la autoridad institucional y sanitaria complica el desarrollo del trabajo en red de los servicios

Accesibilidad al trasplante de células progenitoras hematopoyéticas en Argentina según entidades financiadoras de salud, 2000-2010 / Accessibility to hematopoietic stem cell transplantation in Argentina depending on health financing institution, 2000-2010

INTRODUCCION: Por su alto costo económico, la accesibilidad al transplante de células progenitoras hematopoyéticas (CPH) depende sustancialmente del ente financiador.OBJETIVO: Medir las diferencias en el grado de uso del transplante de CPH entre poblaciones de diferente situación social y diversos entes financiadores.METODOS: La muestra estuvo integrada por la Administración de Programas Especiales (APE) del Sistema Nacional de Obras Sociales, el Ente para el Financiamiento de Transplante de Organos (EFTO) de la Provincia de Buenos Aires y la Dirección de Asistencia Directa por Situaciones Especiales (DADSE) del Ministerio de Desarrollo Social de la Nación. El diseño fue equivalente al de caso-control. Se compararon las tasas de uso entre entidades y con la población con seguro ajena a la APE, asó como al interior de la DADSE según provincia e internamente en la APE según obra social. Los datos se procesaron con Excel. La significación estadística se obtuvo con el programa Epi-Info, módulo StatCalc.RESULTADOS: Las diferencias entre DADSE, EFTO y APE no fueron estadísticamente significativas. Sin embargo, en el desagregado de los datos internos de cada entidad, se comprobó que en la DADSE la tasa de uso provincial más alta era 24 veces superior a la menor (OR=24,3) y que en la APE la obra social con tasa más alta superaba por 15 veces a la menor (OR=15,4). Por su parte, la población con seguro de salud ajena a APE mostró tasas de uso más altas que las entidades de la muestra (OR=3,6).CONCLUSIONES: No existen diferencias en el uso del transplante de CPH entre las poblaciones con y sin trabajo formal (APE y DADSE respectivamente), lo que sugiere que el Estado compensa el déficit socio-laboral. Por otra parte, las profundas diferencias al interior de la DADSE y la APE, así como el mayor uso en la población con seguro ajeno a la APE, exponen una inequidad horizontal y la alertan sobe la necesidad de evitar barreras de acceso vinculadas a los financiadores.

INTRODUCTION: Because of its high cost, accessibility to hematopoietic stem cell (HSC) transplantation depends greatly on the financing institution.OBJECTIVE: To measure the difference in the degree of use of HSC transplantation, considering populations from different social situations and health financing institutions.METHODS: The sample was composed by the special programs administration (APE) of the national social security system, the financing institution for organ transplantations (EFTO) of Buenos Aires Province and the office of direct assistance for special situations (DADSE) of the National Social Development Ministry. The design was equivalent to the case-control method. The study compared the use rates between different financing institutions and with the population having other kind of insurance, as well as within DADSE by province and within APE by social health insurance plan. Data was processed using Excel. Statistical information was obtained through the Epi-Info software (StatCalc module).RESULTS: The differences between DADSE, EFTO and APE were statistically non-significant. However, data collected within each institution showed that in DADSE the highest usage rate for a province was 24 times higher than the lowest one (OR=24.3) and that in APE the highest usage rate for a social health insurance plan was 15 times than the lowest one (OR=15.4). Population with health insurance other than APE showed a usage rate higher than the sample (OR=3.6).CONCLUSIONS: There is no difference in the use rates of HSC transplantation between populations with and without formal work (APE and DADSE respectively), suggesting that the state compensated the socio-occupational deficit. However, the big differences within DADSE/APE and with populations having insurance of other kind show a situation of horizontal inequity and the need to eliminate access difficulties due to financing institutions.

Accesibilidad al trasplante de células progenitoras hematopoyéticas en Argentina según entidades financiadoras de salud, 2000-2010 / Accessibility to hematopoietic stem cell transplantation in Argentina depending on health financing institution, 2000-2010

INTRODUCCION: Por su alto costo económico, la accesibilidad al transplante de células progenitoras hematopoyéticas (CPH) depende sustancialmente del ente financiador.OBJETIVO: Medir las diferencias en el grado de uso del transplante de CPH entre poblaciones de diferente situación social y diversos entes financiadores.METODOS: La muestra estuvo integrada por la Administración de Programas Especiales (APE) del Sistema Nacional de Obras Sociales, el Ente para el Financiamiento de Transplante de Organos (EFTO) de la Provincia de Buenos Aires y la Dirección de Asistencia Directa por Situaciones Especiales (DADSE) del Ministerio de Desarrollo Social de la Nación. El diseño fue equivalente al de caso-control. Se compararon las tasas de uso entre entidades y con la población con seguro ajena a la APE, asó como al interior de la DADSE según provincia e internamente en la APE según obra social. Los datos se procesaron con Excel. La significación estadística se obtuvo con el programa Epi-Info, módulo StatCalc.RESULTADOS: Las diferencias entre DADSE, EFTO y APE no fueron estadísticamente significativas. Sin embargo, en el desagregado de los datos internos de cada entidad, se comprobó que en la DADSE la tasa de uso provincial más alta era 24 veces superior a la menor (OR=24,3) y que en la APE la obra social con tasa más alta superaba por 15 veces a la menor (OR=15,4). Por su parte, la población con seguro de salud ajena a APE mostró tasas de uso más altas que las entidades de la muestra (OR=3,6).CONCLUSIONES: No existen diferencias en el uso del transplante de CPH entre las poblaciones con y sin trabajo formal (APE y DADSE respectivamente), lo que sugiere que el Estado compensa el déficit socio-laboral. Por otra parte, las profundas diferencias al interior de la DADSE y la APE, así como el mayor uso en la población con seguro ajeno a la APE, exponen una inequidad horizontal y la alertan sobe la necesidad de evitar barreras de acceso vinculadas a los financiadores.

INTRODUCTION: Because of its high cost, accessibility to hematopoietic stem cell (HSC) transplantation depends greatly on the financing institution.OBJECTIVE: To measure the difference in the degree of use of HSC transplantation, considering populations from different social situations and health financing institutions.METHODS: The sample was composed by the special programs administration (APE) of the national social security system, the financing institution for organ transplantations (EFTO) of Buenos Aires Province and the office of direct assistance for special situations (DADSE) of the National Social Development Ministry. The design was equivalent to the case-control method. The study compared the use rates between different financing institutions and with the population having other kind of insurance, as well as within DADSE by province and within APE by social health insurance plan. Data was processed using Excel. Statistical information was obtained through the Epi-Info software (StatCalc module).RESULTS: The differences between DADSE, EFTO and APE were statistically non-significant. However, data collected within each institution showed that in DADSE the highest usage rate for a province was 24 times higher than the lowest one (OR=24.3) and that in APE the highest usage rate for a social health insurance plan was 15 times than the lowest one (OR=15.4). Population with health insurance other than APE showed a usage rate higher than the sample (OR=3.6).CONCLUSIONS: There is no difference in the use rates of HSC transplantation between populations with and without formal work (APE and DADSE respectively), suggesting that the state compensated the socio-occupational deficit. However, the big differences within DADSE/APE and with populations having insurance of other kind show a situation of horizontal inequity and the need to eliminate access difficulties due to financing institutions.