The effects of a short-term meditation-based mindfulness protocol in patients receiving hemodialysis.

Mindfulness-based approaches that promote health, improve quality of life, and reduce the impact of comorbidities are key aspects in chronic diseases management. We aimed to verify the impact of a short-term meditation protocol on psychosocial and physiological parameters in chronic hemodialysis patients. We enrolled twenty-two patients, median age of 69.5 years old, into a 12-week meditation protocol that occurred during each hemodialysis session for 10-20 minutes, 3x/week, in a private tertiary hospital. We then evaluated clinical, psychological, and laboratorial parameters pre- and post-meditation. Patients exhibited a better control of serum phosphorus (-0.72 mg/dL; P = 0.002), a decrease in systolic blood pressure (-1.90 mmHg; P = 0.009), a 23% decrease in depressive symptoms (P = 0.014), and an increase of 7% in the self-compassion scale (P = 0.048) after meditation. To note, we observed an increase in 13% of the mindfulness score (P = 0.019). Our preliminary study describes the effects of a short-term meditation protocol in chronic hemodialysis setting. We observed a decrease in depressive symptoms and in blood pressure values, an improvement in self-compassion and serum phosphorous levels. In conjunction with the promising results of meditation in chronic kidney disease setting, this encouraging preliminary study supports the need for additional clinical trials.

Mindfulness-Based Versus Story Reading Intervention in Public Elementary Schools: Effects on Executive Functions and Emotional Health.

INTRODUCTION: In this study we compared the effects of a mindfulness-based intervention (MBI) with a story reading intervention (SI) on the executive functions and psychological profile of children in two different public schools in São Paulo, Brazil. METHODS: In this controlled clinical trial, 207 children aged 8 to 9 years old responded to the Five-Digit Test (FDT), stress levels, depression, anxiety, positive and negative affect, at baseline (T0) and 8 weeks later (T1). From T0 to T1, school 1 participated in MBI classes and school 2 in IS classes. RESULTS: In school 1 (MBI), children improved their scores on all tests except reading (errors) and counting (errors) compared with school 2. No differences were observed between groups in terms of emotional health. CONCLUSION: It is feasible to implement MBI or SI in Brazilian public schools. Students in the MBI group presented broader effects in executive functions, while students in the SI group showed a trend toward reduced negative affect and depression symptoms.

Microstates in complex and dynamical environments: Unraveling situational awareness in critical helicopter landing maneuvers.

Understanding decision-making in complex and dynamic environments is relevant for designing strategies targeting safety improvements and error rate reductions. However, studies evaluating brain dynamics in realistic situations are scarce in the literature. Given the evidence that specific microstates may be associated with perception and attention, in this work we explored for the first time the application of the microstate model in an ecological, dynamic and complex scenario. More specifically, we evaluated elite helicopter pilots during engine-failure missions in the vicinity of the so called "dead man's curve," which establishes the operational limits for a safe landing after the execution of a recovery maneuver (autorotation). Pilots from the Brazilian Air Force flew a AS-350 helicopter in a certified aerodrome and physiological sensor data were synchronized with the aircraft's flight test instrumentation. We assessed these neural correlates during maneuver execution, by comparing their modulations and source reconstructed activity with baseline epochs before and after flights. We show that the topographies of our microstate templates with 4, 5, and 6 classes resemble the literature, and that a distinct modulation characterizes decision-making intervals. Moreover, the source reconstruction result points to a differential activity in the medial prefrontal cortex, which is associated to emotional regulation circuits in the brain. Our results suggest that microstates are promising neural correlates to evaluate realistic situations, even in a challenging and intrinsically noisy environment. Furthermore, it strengthens their usage and expands their application for studying cognition under more realistic conditions.

The Integration of Meditation and Positive Psychology Practices to Relieve Stress in Women Workers (Flourish): Effects in Two Pilot Studies.

Meditation and positive psychology have been reported as promising approaches to deal with stress. This exploratory pilot study aims to evaluate the efficacy of meditation and positive psychology-based intervention on stress. Two experiments are reported; in the first one, 29 healthcare professionals were included (intervention = 14; control = 15), and the second one included 57 women managers (intervention = 27; control = 30). All participants were evaluated before and after eight weeks for levels of stress, anxiety, depression, and psychiatric symptoms. In Experiment 1, intervention group participants showed a reduction in stress levels and anxiety symptoms, and in Experiment 2, participants in the intervention group showed a decrease in stress, psychiatric symptoms, and sleep quality, when compared to the control group. A multi-component intervention based on positive psychology and meditation practices was effective at reducing stress as well as improving related stress parameters such as anxiety, psychiatric symptoms, and sleep quality.

An Intervention to Increase Situational Awareness and the Culture of Mutual Care (Foco) and Its Effects During COVID-19 Pandemic: A Randomized Controlled Trial and Qualitative Analysis.

Situational awareness is especially important to decision-making in health care. Comprehending the situation is crucial for anticipating any change in the environment and delivering optimal care. The objective of this study was to evaluate the effects of a training to increase situational awareness and mutual care designed for health care workers (FoCo) in a randomized controlled trial with additional qualitative analysis. We also investigated the perception of the training for the COVID-19 pandemic moment, in May 2020, almost 6 months after we finished the data collection at the Emergency Care Unit, which became a COVID-19 treatment reference for the care of a population depending on the public health system, in Sao Paulo, Brazil. We conclude that FoCo training can be an important instrument for health care professionals both in times of pandemic and "normal times," to increase situational awareness, the culture of mutual care and decrease the possibility of occupational injuries and illnesses.

Effects of Yoga Respiratory Practice (Bhastrika pranayama) on Anxiety, Affect, and Brain Functional Connectivity and Activity: A Randomized Controlled Trial.

Pranayama refers to a set of yoga breathing exercises. Recent evidence suggests that the practice of pranayama has positive effects on measures of clinical stress and anxiety. This study explored the impact of a Bhastrika pranayama training program on emotion processing, anxiety, and affect. We used a randomized controlled trial design with thirty healthy young adults assessed at baseline and after 4 weeks of pranayama practices. Two functional magnetic resonance imaging (MRI) protocols were used both at baseline and post-intervention: an emotion task as well as a resting-state acquisition. Our results suggest that pranayama significantly decreased states of anxiety and negative affect. The practice of pranayama also modulated the activity of brain regions involved in emotional processing, particularly the amygdala, anterior cingulate, anterior insula, and prefrontal cortex. Resting-state functional MRI (fMRI) showed significantly reduced functional connectivity involving the anterior insula and lateral portions of the prefrontal cortex. Correlation analysis revealed that changes in connectivity between the ventrolateral prefrontal cortex and the right anterior insula were associated with changes in anxiety. Although it should be noted that these analyses were preliminary and exploratory, it provides the first evidence that 4 weeks of B. pranayama significantly reduce the levels of anxiety and negative affect, and that these changes are associated with the modulation of activity and connectivity in brain areas involved in emotion processing, attention, and awareness. The study was registered at https://www.ensaiosclinicos.gov.br/rg/RBR-2gv5c2/(RBR-2gv5c2).

Greater Anteroposterior Default Mode Network Functional Connectivity in Long-Term Elderly Yoga Practitioners.

Large-scale brain networks exhibit changes in functional connectivity during the aging process. Recent literature data suggests that Yoga and other contemplative practices may revert, at least in part, some of the aging effects in brain functional connectivity, including the Default Mode Network (DMN). The aim of this cross-sectional investigation was to compare resting-state functional connectivity of the medial prefrontal cortex (MPFC) and posterior cingulate cortex-precuneus (PCC-Precuneus) in long-term elderly Yoga practitioners and healthy paired Yoga-naïve controls. Two paired groups: yoga (Y-20 women, Hatha Yoga practitioners; practicing a minimum of twice a week with a frequency of at least 8 years) and a control group (C-20 women, Yoga-naïve, matched by age, years of formal education, and physical activity) were evaluated for: Mini Mental State Examination (MMSE), Beck Depression Inventory (BDI), Instrumental Activities of Daily Living (IADL), and open-eyes resting-state functional magnetic resonance imaging (fMRI)-seed to voxel connectivity analysis (CONN toolbox 17.f) with pre-processing-realignment and unwarping, slice-timing correction, segmentation, normalization, outlier detection, and spatial filtering. The analysis included a priori regions of interest (ROI) of DMN main nodes-MPFC and PCC-Precuneus. There was no difference between groups in terms of: age, years of formal education, MMSE, BDI and IADL. The Yoga group had a higher correlation between MPFC and the right angular gyrus (AGr), compared to the controls. Elderly women with at least 8 years of yoga practice presented greater intra-network anteroposterior brain functional connectivity of the DMN. This finding may contribute to the understanding of the influences of practicing Yoga for a healthier cognitive aging process.

Impaired brain dopamine transporter in chemobrain patients submitted to brain SPECT imaging using the technetium-99m labeled tracer TRODAT-1.

PURPOSE: "Chemobrain" is a medical secondary effect of cancer chemotherapy treatment characterized by a general decline in cognition affecting visual and verbal memory, attention, complex problem-solving skills, and motor function. Dopamine (DA) central nervous system neurotransmitters serve an important role in cognition, and changes in DA could potentially explain impaired cognition associated with chemotherapy. Therefore, our objective was to assess in vivo dopaminergic dysfunction in the central nervous system (CNS) of a group of female breast cancer survivors with cognitive impairment following chemotherapy. METHODS: Twenty-eight women reporting chemobrain were recruited for this study and compared to 22 healthy reference women. Striatal dopamine transporter (DAT) binding ratio was determined by 99mTc-TRODAT-1 (a highly selective radiotracer for DAT in the dorsal striatum) single-photon emission computed tomography and a quantitative evaluation was obtained by DatQUANT™ software (GE Healthcare). The DAT binding ratio (BRDAT) in the patient and control groups was compared using the Student's t test, a multivariate analysis of variance (MANOVA) was used to compare age, years of schooling and BRDAT. The relationship between continuous variables, such as cognitive impairment and BRDAT was assessed using Pearson correlation test. RESULTS: There was a difference in BRDAT between the chemobrain patients and control group. Patients had statistically significant (p < 0.05) lower concentrations of the radiopharmaceutical in the striatum. CONCLUSIONS: We identified a significant dopaminergic decrease in all regions of the dorsal striatum within the patients reporting cognitive dysfunction after chemotherapy. Therefore, our results indicate a possible role of dopamine transporter in the physiopathology of chemobrain, even out of the acute phase of symptoms.

Self-compassion is associated with less stress and depression and greater attention and brain response to affective stimuli in women managers.

BACKGROUND: Women have been assuming more responsibilities and higher positions in major companies, which exposes them to high levels of stress. Higher perceived work stress is related to higher emotional reactivity. Difficulties with emotional regulation can lead to anxiety and mood disorders, which are more prevalent in women than men. Indeed, women leaders are more likely to experience emotional fatigue than men due to excessive empathy. Our aim was to evaluate the associations between self-compassion (SC) scores to depression symptoms, perceived stress and mindfulness, as well as with brain responses to high-arousal unpleasant and pleasant pictures from the International Affective Picture System (IAPS), as measured through functional Magnetic Resonance Imaging (fMRI) in women managers. METHODS: Forty-six participants were selected for the study. All participants filled the Self Compassion Scale (SCS), Beck Depression Inventory (BDI), Mindful Awareness Attention Scale (MAAS) and the Perceived Stress Scale (PSS). After that they were scanned during an fMRI affective response paradigm. Correlation analysis were performed among these variables. RESULTS: Our data suggest that women with higher SC scores respond to affective stimuli with higher activation of the precuneus (a brain region related to self-referential processing), lower levels of stress and depression and show greater attention in everyday activities. CONCLUSION: SC may be an important characteristic for women leaders because of its association with higher sensitivity to emotional stimuli and mindfulness. These skills may allow them to be more aware of others while being less susceptible for stress and depression symptoms.

Posterior cingulate cortex/precuneus blood oxygen-level dependent signal changes during the repetition of an attention task in meditators and nonmeditators.

BACKGROUND AND PURPOSE: Among several cognitive advantages, meditation is thought to enhance practitioners' capacity for sustained attention. In the present study, we explored this question by testing meditation practitioners (meditators) and nonpractitioners (nonmeditators) on a task that requires sustained attention, the Stroop Word-Color Task (SWCT), while using functional MRI. PARTICIPANTS AND METHODS: Participants were all right-handed and included 23 regular meditators as well as 17 nonmeditators. Participants viewed color words (i.e. 'red,' 'blue,' or 'green') presented one at a time on the screen that were written in either the same color (congruent condition) or a different color (incongruent condition) and were asked to indicate the color of the print. Participants also viewed noncolor words written in unrelated colors (neutral condition). Both groups completed the same two acquisition runs. RESULTS: Although both meditators and nonmeditators gave faster responses on run 2 than run 1 for both the neutral and incongruent trials, nonmeditators showed decreased activation and meditators showed increased activation in precuneus/posterior cingulate cortex. These regions were previously shown to be activated in the SWCT and belong to default mode network as well as to cognitive control network. CONCLUSION: Attention to repetitive stimuli during two equal runs of SWCT is mediated by the precuneus/posterior cingulate cortex, and mental training through meditation may influence the activity of these regions during such tasks.

Cognition and brain function in elderly Tai Chi practitioners: A case-control study.

OBJECTIVE: To compare cognition and brain function in elderly Tai Chi and Water Aerobics practitioners. METHODS: Eight Tai Chi (TC) and 8 Water Aerobics (WA) practitioners matched by gender, education and age underwent neuropsychological and fMRI scan during attention (Stroop Word Color Task) and working memory (N Back) tasks. RESULTS: Groups were similar for demographic and cognitive variables. Besides anxiety (smaller in TC group), there were no differences between groups in neuropsychological variables. During the Stroop Word Color Task, TC group had smaller brain activation in the right intracalcarine cortex, lateral occipital cortex, and occipital pole, than WA. During N back, TC group presented smaller brain activation in the right frontal pole and superior frontal gyrus. CONCLUSION: Despite the small number of participants in this preliminary study, both groups had similar cognitive performance, however the Tai Chi group required less brain activation to perform the attention and memory tasks, therefore they may have a more efficient cognitive performance than Water Aerobics group.

A Stress Reduction Program Adapted for the Work Environment: A Randomized Controlled Trial With a Follow-Up.

Objective: The aim of this study was to evaluate an in situ stress reduction program, named PROGRESS, developed to meet the specific needs of workers in a business context and to research its impact upon non-severe psychiatric symptoms, stress, anxiety, depression, processing speed/attention and mindfulness. Methods: Participants with stress complaints were randomized into two groups: the main intervention group: group 1-G1, (n = 22); and the control group: group 2-G2, (n = 22). The protocol was divided into three distinct phases for the purpose of the study. Both groups were evaluated at time 1 (T1), before the first 8-week intervention, which only G1 received. The second evaluation was made on both groups at time 2 (T2), immediately after this first program; in order to test the program's replicability and investigate possible follow-up effects, an identical second 8-week program was offered to G2 during time 3 (T3), while G1 was simply instructed to maintain the practice they had learned without further instruction between T2 and T3. A Confirmatory factor analysis (CFA) was conducted to investigate the construct validity of PROGRESS. Results: Repeated measures MANOVA test, comparing G1 and G2, showed the effect of the intervention from T1 to T2 (p = 0.021) and from T2 to T3 (p = 0.031). Univariate analysis showed that participants from G1 improved levels of non-severe psychiatric symptoms, anxiety, depression, stress, processing speed/attention and mindfulness when compared with G2, from T1 to T2 (p < 0.05). After the participants in G2 received the intervention (T2 to T3), this group also showed improvement in the same variables (p < 0.05). At the end of their follow-up period (T2-T3) - during which they received no further support or instruction - G1 maintained the improvements gained during T1-T2. The two main components were stress (stress in the last 24-h, in the last week and last month) and mental health (non-severe psychiatric symptoms, depression, anxiety and mindfulness). Conclusion: PROGRESS, an in situ mindfulness program adapted to fit within the reality of business time constraints, was effective at replicating in more than one group the reduction of stress, depression, anxiety, non-severe psychiatric symptoms, processing speed and also the improvement of attention skills, showing sustained improvement even after 8-weeks follow-up. Clinicaltrails.gov identifier: NCT02660307. https://clinicaltrials.gov/ct2/show/NCT02660307?term=Progress&rank=6.

Effects of a 7-Day Meditation Retreat on the Brain Function of Meditators and Non-Meditators During an Attention Task.

Meditation as a cognitive enhancement technique is of growing interest in the field of health and research on brain function. The Stroop Word-Color Task (SWCT) has been adapted for neuroimaging studies as an interesting paradigm for the understanding of cognitive control mechanisms. Performance in the SWCT requires both attention and impulse control, which is trained in meditation practices. We presented SWCT inside the MRI equipment to measure the performance of meditators compared with non-meditators before and after a meditation retreat. The aim of this study was to evaluate the effects of a 7-day Zen intensive meditation training (a retreat) on meditators and non-meditators in this task on performance level and neural mechanisms. Nineteen meditators and 14 non-meditators were scanned before and after a 7-day Zen meditation retreat. No significant differences were found between meditators and non-meditators in the number of the correct responses and response time (RT) during SWCT before and after the retreat. Probably, due to meditators training in attention, their brain activity in the contrast incongruent > neutral during the SWCT in the anterior cingulate, ventromedial prefrontal cortex/anterior cingulate, caudate/putamen/pallidum/temporal lobe (center), insula/putamen/temporal lobe (right) and posterior cingulate before the retreat, were reduced compared with non-meditators. After the meditation retreat, non-meditators had reduced activation in these regions, becoming similar to meditators before the retreat. This result could be interpreted as an increase in the brain efficiency of non-meditators (less brain activation in attention-related regions and same behavioral response) promoted by their intensive training in meditation in only 7 days. On the other hand, meditators showed an increase in brain activation in these regions after the same training. Intensive meditation training (retreat) presented distinct effects on the attention-related regions in meditators and non-meditators probably due to differences in expertise, attention processing as well as neuroplasticity.

The effects of mindfulness and relaxation training for insomnia (MRTI) on postmenopausal women: a pilot study.

OBJECTIVE: The aim of the study was to evaluate the effects of mindfulness and relaxation training for insomnia on insomnia and quality of life in postmenopausal women. METHODS: Thirty postmenopausal women aged 50 to 65 years, who were not using hormone therapy, and had a diagnosis of insomnia and an apnea-hypopnea index of less than 15, were randomly assigned to two groups: a mindfulness intervention group and a control group. They were assessed before the intervention, and 8 weeks after its completion using questionnaires assessing sleep quality (Pittsburgh Sleep Quality Index), insomnia (Insomnia Severity Index), quality of life in menopause (Menopause-Specific Quality of Life), menopausal symptoms (Kupperman Menopausal Index), and level of attention (Mindfulness Awareness Attention Scale). They were also assessed through ambulatory polysomnography. This is a pilot study and is limited by its small sample size. RESULTS: The results of the questionnaires showed significant differences in the group that received mindfulness training compared with the control group, namely, improvements in sleep quality, a reduction in the severity of insomnia, a better quality of life, improved attention levels, and a reduction in menopausal and vasomotor symptoms. Polysomnography results showed no differences between the groups. CONCLUSIONS: Eight weeks mindfulness meditation training improved sleep quality, quality of life, attention levels, and reduced vasomotor symptoms in postmenopausal women with insomnia.

Greater Cortical Thickness in Elderly Female Yoga Practitioners-A Cross-Sectional Study.

Yoga, a mind-body activity that requires attentional engagement, has been associated with positive changes in brain structure and function, especially in areas related to awareness, attention, executive functions and memory. Normal aging, on the other hand, has also been associated with structural and functional brain changes, but these generally involve decreased cognitive functions. The aim of this cross-sectional study was to compare brain cortical thickness (CT) in elderly yoga practitioners and a group of age-matched healthy non-practitioners. We tested 21 older women who had practiced hatha yoga for at least 8 years and 21 women naive to yoga, meditation or any mind-body interventions who were matched to the first group in age, years of formal education and physical activity level. A T1-weighted MPRAGE sequence was acquired for each participant. Yoga practitioners showed significantly greater CT in a left prefrontal lobe cluster, which included portions of the lateral middle frontal gyrus, anterior superior frontal gyrus and dorsal superior frontal gyrus. We found greater CT in the left prefrontal cortex of healthy elderly women who trained yoga for a minimum of 8 years compared with women in the control group.

Barriers and Benefits in Telemedicine Arising Between a High-Technology Hospital Service Provider and Remote Public Healthcare Units: A Qualitative Study in Brazil.

BACKGROUND: In Brazil, the Program for Institutional Development of the Unified Healthcare System (PROADI-SUS) has implemented a telemedicine service for urgent situations and emergencies. It is delivered by a high-technology (HT) hospital to 15 remote healthcare units (RUs) in 11 different Brazilian states. The aim of this study was to investigate possible barriers and benefits in telemedicine service among these units. MATERIALS AND METHODS: We performed a qualitative study on the perceptions of physicians involved in telemedicine service in their role as providers and consultants. An individual, semistructured recorded interview was conducted with 28 physicians (17 HT; 11 RU) encompassing telemedicine resources and interaction among HT and RU physicians. Data analysis was performed by Discourse of Collective Subject. RESULTS: We identified the following barriers in the telemedicine service: (1) lack of experience in the use of technology or the quality of the internet signal; (2) the multiplicity of different telemedicine platforms; (3) the quality of the image sent to the HT hospital; (4) the misunderstanding that telemedicine is a time-consuming technology instead of a resource that may help to save lives; (5) not feeling comfortable exposing doubts to other HT colleagues; (6) problems in the management of telemedicine use in the RUs; and (7) political and legal issues. However, important benefits in telemedicine service were also described. CONCLUSIONS: The structural barriers should be the target of hospital managers. Development of standard remote care protocols may increase the use of telemedicine and create new work routines. Given the relationship difficulties among the RU and HT doctors during telemedicine consultations, other meetings should be organized to allow more interpersonal interactions. These meetings may also have the goal of sharing outcome indicators of their joint activity in telemedicine to stimulate and make them aware of the benefits of their interaction.

Yoga and compassion meditation program improve quality of life and self-compassion in family caregivers of Alzheimer's disease patients: A randomized controlled trial.

AIM: To investigate the effects of the practice of yoga in combination with compassion meditation on the quality of life, attention, vitality and self-compassion of family caregivers of patients with Alzheimer's disease. METHODS: A total of 46 volunteers were randomly allocated to two groups, the yoga and compassion meditation program group (n = 25), and the control group (CG) that received no treatment (n = 21). The program lasted 8 weeks, and comprised three yoga and meditation practices per week, with each session lasting 1 h and 15 min. Quality of life, attention, vitality, and self-compassion scores were measured pre- and postintervention. RESULTS: The yoga and compassion meditation program group showed statistically significant improvements (P < 0.05) on quality of life, attention, vitality and self-compassion scores as compared with the control group, which showed no statistical significant differences at the postintervention time-point. CONCLUSIONS: The findings of the present study suggest that an 8-week yoga and compassion meditation program can improve the quality of life, vitality, attention, and self-compassion of family caregivers of Alzheimer's disease patients. Geriatr Gerontol Int 2017; 17: 85-91.

Mindfulness Meditation Improves Mood, Quality of Life, and Attention in Adults with Attention Deficit Hyperactivity Disorder.

OBJECTIVE: Adults with attention deficit hyperactivity disorder (ADHD) display affective problems and impaired attention. Mood in ADHD can be improved by mindful awareness practices (MAP), but results are mixed regarding the enhancement of attentional performance. Here we evaluated MAP-induced changes in quality of life (QoL), mood, and attention in adult ADHD patients and controls using more measures of attention than prior studies. METHODS: Twenty-one ADHD patients and 8 healthy controls underwent 8 weekly MAP sessions; 22 similar patients and 9 controls did not undergo the intervention. Mood and QoL were assessed using validated questionnaires, and attention was evaluated using the Attentional Network Test (ANT) and the Conners Continuous Performance Test (CPT II), before and after intervention. RESULTS: MAP enhanced sustained attention (ANT) and detectability (CPT II) and improved mood and QoL of patients and controls. CONCLUSION: MAP is a complementary intervention that improves affect and attention of adults with ADHD and controls.