Revisión sistemática de la efectividad de la meditación en el bienestar psicológico en estudiantes de ciencias de la salud

La meditación es una herramienta eficaz para promover el bienestar psicológico y manejar el estrés y los trastornos psicológicos asociados con situaciones académicas, clínicas y asistenciales altamente demandantes en contextos académicos sanitarios. Este artículo evalúa el impacto de intervenciones basadas en la meditación, en el bienestar psicológico de estudiantes de ciencias de la salud. Se buscaron ensayos clínicos controlados en la Biblioteca virtual de Salud (BVS), Biblioteca Cochrane, Trip Database, Sage Pub, Springer Link, Wiley Online Library, Medline (vía PubMed), Europe PMC, ScienceDirect, APA PsycInfo y ERIC. Se identificaron 651 estudios. Se incluyeron 13 estudios que cumplieron con los criterios de elegibilidad. Se encontró que la práctica de meditación no clínica, predominantemente mediante intervenciones basadas en la atención plena (mindfulness), realizadas en contextos académicos tiene un efecto positivo en el bienestar psicológico y en la competencia socioemocional del estudiantado. Los beneficios a largo plazo dependen de que los estudiantes practiquen la meditación regularmente. Estos hallazgos tienen implicaciones para la educación sanitaria. Sugieren integrar la meditación como un enfoque preventivo para mejorar el bienestar psicológico del estudiantado.

A meditação é uma ferramenta eficaz para promover o bem-estar psicológico, administrar o estresse e os transtornos psicológicos associados a situações acadêmicas, clínicas e assistenciais altamente demandantes em contextos acadêmicos sanitários. Este artigo avalia o impacto de intervenções baseadas na meditação para o bem-estar psicológico de estudantes de Ciências da Saúde. Foram buscados ensaios clínicos controlados na Biblioteca Virtual de Saúde (BVS), Biblioteca Cochrane, Trip Database, Sage Pub, Springer Link, Wiley Online Library, Medline (via PubMed), Europe PMC, Science Direct, APA PsycInfo e ERIC. Foram identificados 651 estudos. Foram incluídos 13 estudos que cumpriram os critérios de elegibilidade. Foi encontrado que a prática da meditação não clínica, predominantemente por meio de intervenções baseadas na atenção plena (mindfulness), realizadas em contextos acadêmicos, tem um efeito positivo no bem-estar psicológico e na competência socioemocional dos estudantes. Os benefícios a longo prazo dependem de que os estudantes pratiquem a meditação regularmente. Essas descobertas têm implicações para a educação sanitária. Sugerimos integrar a meditação como uma abordagem preventiva para melhorar o bem-estar psicológico dos estudantes.

Meditation is an effective tool to promote psychological well-being and manage stress and psychological distress associated with highly demanding academic, clinical and healthcare situations in academic health contexts. This paper evaluates the impact of meditation-based interventions on the psychological well-being of health occupations students. Controlled clinical trials were searched in the Biblioteca virtual de Salud (BVS), Cochrane Library, Trip Database, Sage Pub, Springer Link, Wiley Online Library, Medline (via PubMed), Europe PMC, ScienceDirect, APA PsycInfo, and ERIC. 651 studies were identified. Thirteen studies that met the inclusion criteria were included. It was found that non-clinical meditation practice, mainly through mindfulness-based interventions, carried out in academic contexts has a positive effect on the psychological well-being and socio-emotional competence of the student body. Long-term benefits depend on students practicing meditation regularly. These findings have implications for health education. They suggest integrating meditation as a preventive approach to improve the psychological well-being of students.

Healthy Change Intervention: A Cluster RCT in Preschooler Mothers in Mexico and the United States.

OBJECTIVE: To assess effects of Healthy Change intervention on maternal perception of her child's body weight (MPCW), maternal feeding style, and obesogenic home environment. METHODS: A randomized control trial was conducted, consisting of two arms: the intervention group received the Healthy Change program, and the control group received the Hygiene and Accident Prevention program. A total of 356 mother-preschool child dyads participated, 182 in the intervention group and 174 in the control group, residing in Mexico and the United States. Data were collected at baseline and after the program through self-administered questionnaires completed by mothers and child anthropometric measurements. RESULTS: Although no significant between-group difference in pre- and post-intervention change of MPCW was found, sub-analyses revealed that a higher proportion of mothers in the intervention group accurately perceived their child's body weight at the study endpoint using categorical (67% vs. 57.1%, p < 0.005) and visual scales (48.9% vs. 41.8%, p < 0.015). Additionally, more mothers of overweight children in the intervention group accurately perceived their children's overweight and obese status compared to those in the control group (29.8% vs. 10.3%, X2 = 4.26, df = 1, p < 0.039). The intervention group also displayed a higher proportion of mothers with authoritative feeding style (26.4% vs. 16.5%, p < 0.036) and significantly higher family nutrition and physical activity scores (29.1 vs. 28.0, p < 0.000) at the study endpoint. CONCLUSIONS FOR PRACTICE: Healthy Change Intervention led to improved accuracy of MPCW, a shift toward maternal authoritative feeding styles, and positive changes in obesogenic home environments.

The potential of a hygiene-based message, preferred learning modalities, and *iLubricarte, Liberarte, Lavarte+!" or L 3 + for the prevention of HIV/STI in Peru.

Background: Hygiene-based practices of lubrication, genital cleansing, postcoital urination, and rectal douching are common behaviors among populations at higher risk of human immunodeficiency virus (HIV)/sexually transmitted infections (STI). Yet, the role these behaviors have on HIV/STI risk has not been well elucidated, especially among transgender women (TW) and gay, bisexual, and other men who have sex with men (GBMSM). Additionally, advances in biomedical strategies have heralded a new era of HIV/AIDS prevention that may be accompanied by behavioral changes that lead to decreases in condom usage and subsequent changes to STI sequelae. Nevertheless, many people at higher risk are not benefiting equally from these options, strengthening the need for more sustainable, evidence-based methods. Objectives: This study explored the knowledge, attitudes, and behaviors of hygiene-based practices, proven preventative methods, and preferred learning methods among Peruvian TW and GBMSM. Methods: 30 interviews and 50 questionnaires were conducted with TW (N=35), GBMSM (N=35), healthcare providers (N=5), and key community informants (N=5). Results: Most participants perceived hygiene-based practices to be common behaviors and a significant aspect of sexual wellbeing. Educational materials utilizing social media and hosting in-person events were also viewed favorably, with value to enhancing HIV/STI knowledge. Conclusions: Several barriers to autonomy surfaced in the data, including systemic disparities to adequate HIV/STI services, top vs. bottom social dynamics, and PrEP accessibility issues. Continued work is needed to address the barriers to the acceptability, feasibility, and potential efficacy of hygiene-based practices, biomedical/barrier strategies, and L 3 +.

Cognitive and motor improvement by tummy time practice in preemies from low-income settings: a randomized clinical trial.

Introduction: Early intervention and parental education for preemies are limited in some low-income countries. Thus, this study aimed to assess whether daily tummy time (TT) associated with usual care (UC) enhances motor and cognitive development in preemies from low-income countries. The main and secondary aim was to assess prone head elevation (PHE) and motor and cognitive functions, respectively. Methods: Thirty-one preemies with a mean gestational age at birth of 33.3 ± 1.6 weeks and weighing <2,500 g were included and 18 completed all assessments. Parents from the TT group were asked to perform TT with their preemies for at least 20 min during daily activities and playtime. Motor and cognitive functions were assessed by a blinded examiner using the motor and cognitive composite scores of Bayley-III after two and four months of corrected age. PHE was given by the angle from the tragus of the ear to the supporting surface of the infant; measurements were obtained using the Kinovea® software at baseline, after two, three, and four months of corrected age. Results: The Bayley-III motor composite score of the TT group was higher than the UC group after two and four months of corrected age. The PHE angle increased over time but did not differ between groups. Discussion: Nevertheless, TT expanded the perspective of preemies to explore their bodies and environment, favoring the stimuli for motor and cognitive patterns. The loss of participants (31%) was one of the limitations of the study, illustrating the challenge of providing continued early interventions to preemies from low-income countries. In this sense, TT practice is a home intervention that may improve motor and cognitive function of preemies immediately after hospital discharge.

Exploration of barriers to treatment for patients with eating disorders in Chile.

BACKGROUND: Eating disorders (EDs) are associated with high morbidity and mortality, affecting predominantly young people and women. A delay in starting treatment is associated with chronic and more severe clinical courses; however, evidence on barriers and facilitators of access to care in Latin America is scarce. We aimed to identify barriers and facilitators of ED treatment in Chile from the perspective of patients, relatives, and health professionals. METHODS: Qualitative approach through semi-structured interviews with patients, their relatives, and health professionals. Participants were recruited from two ED centers in Santiago, Chile (one public and one private). Analysis was mainly based on Grounded Theory, using MAXQDA software. RESULTS: 40 interviews were conducted (n = 22 patients, 10 relatives, and 8 health professionals). The mean age of patients was 21.8 years, while the mean duration of untreated ED was 91.4 months (median 70 months). Five categories emerged with intersections between them: patient (P), family and social environment (FSE), health professionals (HP), healthcare system (HCS), and social and cultural context (SCC). Relevant barriers appeared within these categories and their intersections, highlighting a lack of professional knowledge or expertise, cultural ignorance or misinformation regarding EDs, and patient's ego-syntonic behaviors. The main facilitators were patients' and relatives' psychoeducation, recognition of symptoms by family members, and parents taking the initiative to seek treatment. CONCLUSIONS: This study provides information regarding access to treatment for patients living with EDs in Chile. A practical public health approach should consider the multi-causality of delay in treatment and promoting early interventions. Eating disorders (EDs) may severely affect the daily functioning of people enduring them. A delay in starting treatment is associated with a disease that is more difficult to treat. To our knowledge, there are no published studies carried out in Latin America exploring factors influencing treatment initiation in EDs patients. This study aimed to identify facilitators of and barriers to treating patients with EDs in Chile. We interviewed patients (n = 22), their relatives (n = 10), and health professionals (n = 8) from a private and a public center in Santiago, Chile. Our analysis showed that the main barriers to starting treatment were the lack of professional knowledge in ED, the monetary cost of illness, and cultural misinformation. Facilitators were related to the role of the family in recognizing and addressing the disease while being educated in EDs by professionals. This study helps to provide data about treatment access in developing countries. While facilitators and barriers were similar to others reported in the literature, the untreated ED's duration was longer. It is essential to address these barriers to provide access to treatment more efficiently and prevent severe and enduring forms of disease.

Unstressing the Reticulum: Nutritional Strategies for Modulating Endoplasmic Reticulum Stress in Obesity.

The progression of obesity involves several molecular mechanisms that are closely associated with the pathophysiological response of the disease. Endoplasmic reticulum (ER) stress is one such factor. Lipotoxicity disrupts endoplasmic reticulum homeostasis in the context of obesity. Furthermore, it induces ER stress by activating several signaling pathways via inflammatory responses and oxidative stress. ER performs crucial functions in protein synthesis and lipid metabolism; thus, triggers such as lipotoxicity can promote the accumulation of misfolded proteins in the organelle. The accumulation of these proteins can lead to metabolic disorders and chronic inflammation, resulting in cell death. Thus, alternatives, such as flavonoids, amino acids, and polyphenols that are associated with antioxidant and anti-inflammatory responses have been proposed to attenuate this response by modulating ER stress via the administration of nutrients and bioactive compounds. Decreasing inflammation and oxidative stress can reduce the expression of several ER stress markers and improve clinical outcomes through the management of obesity, including the control of body weight, visceral fat, and lipid accumulation. This review explores the metabolic changes resulting from ER stress and discusses the role of nutritional interventions in modulating the ER stress pathway in obesity.

Assessing a Couples-Based, Digital HIV Serostatus-Neutral Intervention (Para Ti, Para Mí, Para Nosotros) for Adult Cisgender Sexual Minority Male Couples in Lima, Peru: Protocol for a 6-Month Pilot Randomized Controlled Trial.

BACKGROUND: HIV disproportionately affects sexual minority men (SMM; eg, gay, bisexual, and other men who have sex with men) in Lima, Peru; epidemiological data estimate that 32% to 39% of new HIV infections occur among adult cisgender SMM within primary partnerships (ie, male couples). Most HIV prevention-care research in Lima, Peru, has focused on SMM as individuals and not couples. To help address this critical gap in prevention care, we developed Para Ti, Para Mí, Para Nosotros (P3): a couples-based, digital HIV serostatus-neutral intervention (DHI) for adult cisgender SMM couples in Lima, Peru. The P3 DHI is designed to facilitate couples with skill-building, communication, decision-making, and working together to form and adhere to a detailed prevention care plan that aligns with their explicit sexual agreement. The P3 DHI is theoretically informed, self-guided, directed, sequential, and fully automated. OBJECTIVE: This pilot randomized controlled trial (RCT) aims to examine the preliminary effects of P3 on couples' formation and adherence to a detailed prevention care plan containing evidence-based strategies that also aligns with their explicit sexual agreement over time. In addition, the feasibility of enrollment and retention and couples' acceptability of P3 will be assessed. METHODS: The research implements a prospective, 6-month pilot RCT with a 3-month delayed control condition. After baseline, 60 enrolled SMM couples will be randomized to 1 of 2 conditions. Couples randomized to the unmatched, delayed control condition will receive access to the P3 DHI to use during the last 3 months of the trial after the 3-month assessment. Couples randomized to the immediate intervention condition will immediately receive access to the P3 DHI for 6 months. Study assessments will occur at baseline and months 3 and 6. Descriptive, comparative, qualitative, and longitudinal analyses using generalized linear mixed-effect, multilevel, and actor-partner interdependence models will be conducted to address the specific aims. RESULTS: The 6-month pilot RCT is ongoing. Recruitment, enrollment, and data collection began in January 2023 and ended in April 2024. A total of 74 adult cisgender SMM couples met all inclusion criteria, provided consent, and were enrolled in the pilot RCT. Retention was 92% (68/74) at month 6. Data are currently being analyzed to address the 3 specific aims regarding feasibility, acceptability, and preliminary efficacy. CONCLUSIONS: Findings from this research will reveal whether couples deemed the P3 DHI to be acceptable. Findings will also highlight the preliminary efficacy of the P3 DHI on couples managing their vulnerability to HIV and other sexually transmitted infections (STIs) over time via alignment of their prevention-care plan and sexual agreement. Trial findings will help shape the future direction of the P3 DHI while addressing the existing gap in prevention and care services for couples in the local context. TRIAL REGISTRATION: ClinicalTrials.gov NCT05873855; https://clinicaltrials.gov/study/NCT05873855. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID): DERR1-10.2196/63106.

Assessing Patient Satisfaction With Metacognitive Training (MCT) for Psychosis: A Systematic Review of Randomized Clinical Trials.

OBJECTIVES: Metacognitive training (MCT) for psychosis is a group intervention that combines cognitive-behavioural therapy and psychoeducation. It has proven efficacy in reducing psychotic symptoms and correcting cognitive biases implicated in the development and maintenance of psychotic symptoms. However, other outcomes, such as patient satisfaction with the intervention, have not been well studied despite their importance for adherence and overall success. A systematic review of randomized clinical trials was conducted to assess satisfaction with MCT among adults with psychotic spectrum disorders. METHODS: The search was conducted in Ovid Embase, Ovid MEDLINE, PsycINFO and Cochrane Central Register of Controlled Trials (CENTRAL). PRISMA guidelines and the Cochrane Risk of Bias Tool were followed, and certainty of evidence was ascertained using the Grading of Recommendations Assessment, Development and Evaluation framework. The study is registered with PROSPERO (CRD42023418097). RESULTS: Patient satisfaction was considered the primary outcome in 3 of the 10 studies reviewed. Four studies compared MCT with other psychosocial interventions (a newspaper discussion group, cognitive remediation and supportive therapy), two of which found significantly higher satisfaction with MCT. A high percentage of all patients found MCT comprehensible and considered it an important part of their treatment; they would recommend the training to others and found the group setting advantageous. Most participants expressed high subjective satisfaction or acceptance of MCT. CONCLUSIONS: The authors found evidence that MCT may be associated with high levels of satisfaction in clinical trials whose main objective is to assess patient satisfaction, but more research is needed to consolidate the findings, especially for the extended version of MCT.

Evaluation and Future Challenges in a Self-Guided Web-Based Intervention With and Without Chat Support for Depression and Anxiety Symptoms During the COVID-19 Pandemic: Randomized Controlled Trial.

BACKGROUND: The COVID-19 pandemic has had an impact on mental health worldwide. Low- and middle-income countries were largely affected by it. Mexico was one of the most affected countries. Extended periods of lockdowns, isolation, and social distancing, among other factors, highlighted the need to introduce web-based psychological interventions to the Mexican population. In this context, Mental Health COVID-19 emerged as a self-guided web-based intervention (SGWI) aimed at adults to improve mental health during the COVID-19 pandemic. OBJECTIVE: This study aims to assess the efficacy of 2 modalities of a self-guided intervention (with and without chat support) in reducing depression symptoms, generalized anxiety, community posttraumatic stress, widespread fear, anxiety, sleep quality, physiological and affective coping, and suicide ideation. In addition, it aimed to compare the moderating role of coping strategies, acceptance, and satisfaction in participants' symptom reduction. We hypothesize that the self-guided, chat-supported modality will show higher efficacy than the modality without chat support in achieving clinical change and better performance as a moderator of depression symptoms, generalized anxiety, community posttraumatic stress, widespread fear, anxiety, sleep quality, physiological and affective coping, and suicide ideation, as well as an increase in participants' satisfaction and acceptability. METHODS: A randomized controlled trial was conducted. Data were collected from May 2020 to June 2022. We performed intrasubject measures at 4 evaluation periods: pretest, posttest, and follow-up measurements at 3 and 6 months. Differences between intervention groups were assessed through the Mann-Whitney U test for continuous variables and the chi-square test for categorical variables. Changes due to intervention were analyzed using Wilcoxon W test. Moderated regression analysis was performed to test the hypothesized moderating role of coping strategies, usability, and opinion about treatment on clinical change. RESULTS: A total of 36 participants completed the intervention; of these, 5 (14%) were part of the SGWI group, and 31 (86%) were on the SGWI plus chat support (SGWI+C) group, which included a chat service with therapists. The perceived high complexity of the system for the SGWI group had a moderating effect associated with a lack of efficacy of the intervention regarding depression, but not when controlled for sociodemographic variables. A perception of lower helpfulness of the intervention was associated with poorer outcomes. Coping strategies did not show moderating effects. CONCLUSIONS: Enhancing the utility of web-based interventions for reducing clinical symptoms by incorporating a support chat to boost treatment adherence seemed to improve the perception of the intervention's usefulness. Web-based interventions face several challenges, such as eliminating complexities in platform use and increasing the users' perceived utility of the intervention, among other issues identified in the study. TRIAL REGISTRATION: ClinicalTrials.gov NCT04468893; https://clinicaltrials.gov/study/NCT04468893?tab=results. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID): RR2-10.2196/23117.

A pilot study of a new app based on self-compassion for the prevention and promotion of mental health among Brazilian college students.

Introduction: Epidemiological data suggest substantial issues on the mental health of university students worldwide. Self-compassion is associated with lower rates of psychological distress and better positive mental health. Thus, we have developed a app-based intervention based on self-compassion principles targeting the prevention and promotion of mental health in college students. The current pilot study assessed adherence to intervention, preliminary mental health benefits, and satisfaction and acceptability with the app among Brazilian college students. Methods: The study employed a pre-experimental single-group design along with pre-test and post-test assessments (n = 23). A mixed methods approach was utilized to comprehensively assess the outcomes of the intervention. Results: The overall adherence rate for the intervention was 37.87%, with 26.26% of participants successfully completing all modules. Among the 21 outcomes assessed, 15 exhibited statistically significant results. Notably, there was a substantial increase in self-compassion, demonstrating a large effect size (d = 1.15), and a moderate effect size reduction in stress (d = 0.62) and anxiety (d = 0.52). All satisfaction indicators for the intervention received scores above 7. The intervention was well-received by participants who completed it, although a potential barrier identified was the volume of text within the app and the need to adopt a more playful and concise format for the intervention. Discussion: Despite a notable participant dropout, the adherence to intervention aligns with patterns observed in other online interventions conducted in real-world settings. The observed mental health benefits, high satisfaction levels, and positive acceptance underscore the rationale for pursuing a subsequent randomized clinical trial.

Effects of mindfulness-based stress reduction training on the negative emotions and social functioning of patients with laryngeal cancer.

OBJECTIVE: To explore the influence of mindfulness-based stress reduction (MBSR) training on the negative emotions and social functioning of patients with laryngeal cancer post-operation. METHODS: Sixty-five patients with laryngeal cancer admitted to our hospital from January 2017 to December 2019 were selected and divided into an observation group of 33 cases and a control group of 32 cases according to the patient's wishes. The control group received routine intervention, while the observation group received mindfulness decompression training in addition to the control group. Both groups were evaluated after 8 weeks of intervention. The research tools included the self-rating anxiety scale (SAS), self-rating depression scale (SDS), Pittsburgh Sleep Quality Index (PSQI), Social Disability Screening Schedule (SDSS), Social Support Rating Scale (SSRS), and European Organization for Research and Treatment of Cancer Quality of Life Questionnaire (QLQ-C30), all of the scores of them were used to verify the foregoing scale. The effects of MBSR were evaluated by the differences between the post- and pre-intervention scores in each scale. T-test was used for mean comparison and Pearson test was used for rate comparison χ2 inspection. LITERATURE REVIEW: Patients will have negative emotions during the surgical treatment of laryngeal malignancies (Literature 1), which will affect their mental health (literature 2, 3, 4, 5, 6, 7). Mindfulness decompression training (literature 10, 11) can reduce the depression and anxiety of patients with malignant tumors (literature 14, 15). According to the inclusion criteria and exclusion criteria (literature 16 and 17), two groups of patients were selected in this study, and the scores were obtained using research tools including SAS (literature 19), SDS (literature 20), PSQI (literature 21), SDSS (literature 22) and QLQ-C30 (literature 24 and 25). The effect of MBSR was evaluated by the difference before and after the intervention scores in each scale. RESULTS: After the intervention, the scores of the SAS and SDS in the two groups were lower than before (P < 0.05), the PSQI score of the two groups was lower than before (P < 0.05), the SDSS score of the two groups was lower than before (P < 0.05), and the scores of the QLQ-C30 in the two groups were higher than before intervention (P < 0.05). CONCLUSION: Mindfulness-based stress reduction training can reduce the negative emotions of patients with laryngeal cancer and improve their quality of sleep, social functioning, and quality of life. It is worthy of clinical application.

Effects of video-guided active breaks with curricular content on mental health and classroom climate in chilean schoolchildren aged 6 to 10: study protocol for a multicentre randomized controlled trial.

Background: The incidence of mental health issues in children is increasing worldwide. In Chile, a recent surge in reports of deteriorating mental health among school populations and an increase in complaints related to poor school climate have been observed. Physical activity, specifically active breaks in the classroom, has shown positive effects on children's health. However, evidence regarding its impact on mental health and school climate in children is limited. Objective: This work outlines the design, measurements, intervention program, and potential efficacy of the "Active Classes + School Climate and Mental Health" project. This project will assess a 12-week program of active breaks through guided videos with curricular content in the school classroom, and its effects on mental health and school climate as its primary indicators. Additionally, it will measure physical activity, physical fitness, motor competence, and academic performance in students aged 6-10 years in the Biobío province, Chile, as secondary indicators. Methodology: A multicenter randomized controlled trial involving 823 students from 1st to 4th grade (6-10 years old), six schools (three intervention and three control) will be conducted in the Biobío region, Chile. Participants belonging to the intervention group will implement video-guided active breaks through the "Active Classes" web platform, featuring curricular content, lasting 5-10 min and of moderate to vigorous intensity physical activity, twice a day, Monday to Friday, over a span of 12 weeks. Expected Results/Discussion: To our knowledge, this will be the first study in Chile to evaluate the effects of incorporating video-guided active breaks with curricular content on mental health variables and school climate in schoolchildren. Thus, this study contributes to the scarce evidence on the effects of video-guided active breaks on mental health variables and school climate in schoolchildren worldwide. Additionally, it will provide crucial information about active teaching methodologies that have the potential to positively contribute to the wellbeing of students, thus addressing the problems of mental health and climate in Chilean schools. ClinicalTrials.gov ID NCT06423404.

Nutritional Interventions in Older Persons with Type 2 Diabetes and Frailty: A Scoping Systematic Review.

In the elderly, the coexistence of type 2 diabetes mellitus (T2DM) and frailty is frequent. Much has been described about pharmacological management and glycemic control goals. However, there is a knowledge gap in terms of the objectives and characteristics of interventions, especially nutritional ones, for this population. A scoping review was performed to document the objectives, characteristics, and results of nutritional interventions in older people with T2DM and frailty. The five-stage framework of Arksey and O'Malley was used, as was the PRISMA extension for scoping reviews. The results stand out for three trends, as follows: (1) experimental studies with multicomponent intervention physical exercise programs and nutritional programs based on educational processes or behavioral intervention; (2) observational studies with an association of the kind of diet assessed by scales and their relation to stages of frailty; (3) a review that updates recommendations on pharmacological and non-pharmacological, diet, exercise, management, as well as glucose control goals for diabetes in frail older persons. Finally, the evidence shows that management of T2DM in older adults with frailty requires goals and interventions tailored to their functional capacity and health condition. The exercise, diet, and education programs reviewed have demonstrated their effectiveness in improving physical performance, reducing the risk of frailty or progression to more advanced stages, and achieving better glycemic control.

Why do some Mexicans with psychosis risk symptoms seek mental health care and others do not?

Help-seeking barriers differ according to the sociocultural context and country-specific mental healthcare system. More research is needed in low-middle-income countries, where early psychosis programs are still scarce, and the mental health care gap is wide. This study aims to explore predisposing, enabling, and need factors associated with mental health service utilization in 481 Mexicans self-reporting psychosis risk symptoms, as well as differences between those who were currently mental health service users (MHSU) and those who were not (non-MHSU). Participants responded to self-reported measures through an online survey. The factors associated with an increased probability of using mental health services were having an occupation, having a medium/high socioeconomic status, an intention to seek help from a mental health professional, fewer help-seeking barriers, moderate/severe anxious symptoms, higher distress associated with psychosis risk symptoms and social functioning impairment. Findings provide relevant information for designing more effective strategies to improve help-seeking, early identification, and timely treatment delivery in Mexico. The need to generate strategies focused on reducing stigma, enhancing psychosis literacy in the community, and increasing the identification of emerging signs of psychosis in primary healthcare professionals is highlighted, mainly when co-occurring with other psychiatric symptoms.

Feuerstein Instrumental Enrichment Program for People With Schizophrenia After the First Episode of Psychosis: Protocol for an Open-Label Intervention Study.

BACKGROUND: Schizophrenia is a disorder associated with neurocognitive deficits that adversely affect daily functioning and impose an economic burden. Cognitive rehabilitation interventions, particularly during the early phases of illness, have been shown to improve cognition, functionality, and quality of life. The Feuerstein Instrumental Enrichment (FIE) program, based on the Mediated Learning Experience and the Structural Cognitive Modifiability theory, has been applied in various disorders, but its applicability in schizophrenia has not yet been clarified. OBJECTIVE: This study aims to investigate the effects of the FIE program on the functionality of patients with first-episode schizophrenia. METHODS: In total, 17 patients will be recruited for an open-label intervention consisting of twice-weekly sessions for 10 weeks. The primary outcome measure will be changes in the Goal Achievement Scale score. Maze task performance from the Measurement and Treatment Research to Improve Cognition in Schizophrenia (MATRICS) battery will serve as a secondary outcome measure. At the same time, changes in Positive and Negative Syndrome Scale scores and other MATRICS domains will be analyzed as exploratory outcomes. Assessments will be administered before and after the intervention, with a follow-up period of 6 months. RESULTS: This trial was preregistered in The Brazilian Registry of Clinical Trials (RBR-4gzhy4s). By February 2024, 11 participants were enrolled in the training. Recruitment is expected to be completed by May 2024. Data analysis will be conducted between May and September 2024. The results are expected to be published in January 2025. CONCLUSIONS: This study may establish a protocol for the FIE program that uses mediation techniques for individuals in the early stages of schizophrenia. The results will add to the knowledge about strategies to promote cognitive skills and functional impairment in daily life. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID): DERR1-10.2196/57031.

Vaccine Confidence and Coverage among Medical Students at a Federal University in Brazil.

BACKGROUND: Declining vaccination coverage (VC) and vaccine hesitancy among medical students are global challenges. These challenges reflect individual and logistical barriers to a sufficient adherence toward essential vaccines for healthcare professionals, as well as presenting a need for educational strategies during undergraduate training. METHODS: This is a prospective study for evaluating VC rates, sociodemographic associations, and the vaccine confidence among medical students at a federal university in Brazil. The data collection included questionnaires and individual analyses of the participants' vaccination records. RESULTS: A total of 237 medical students from all six years of an undergraduate program participated, of whom 124 (52.3%) had a vaccination record. Although the majority considered the vaccines to be "Completely Safe" (86.9%), the VC rates for complete vaccination schedules were relatively low, ranging from 87.9% (hepatitis B vaccine) to 3.2% (meningococcal B vaccine), including the vaccines from the National Immunization Program (NIP) and the private sector. Higher VC rates were found to occur among students in the final years of their undergraduate studies, in those from families with higher monthly incomes, and those from private secondary schools. CONCLUSIONS: Given the low VC rates among medical students, other factors in addition to vaccine confidence may be determinants, thus highlighting the importance of reviewing policies for the inclusion of priority groups in the NIP and in implementing educational interventions during undergraduate training.

Diffuse pulmonary lymphangiomatosis as a differential diagnosis of anterior mediastinal mass.

Diffuse pulmonary lymphangiomatosis (DLP) is an extremely rare silent disease, characterized by proliferation and thickening of abnormal pulmonary, pleural, and mediastinal soft tissue lymphatic channels. Its clinical presentation is nonspecific symptoms such as cough, dyspnea, and hemoptysis. Tomographic findings for DLP include thickening of the interlobular septa and peribronchovascular interstitium and ground glass opacities. Nevertheless, the anterior mediastinal mass, associated with thickening of interlobular septa and peribronchovascular interstitial, ground glass opacities, pleural effusion, diffuse infiltration of the mediastinum and pleural thickening in a patient with lymphangiomas, DLP should be suspected as a differential diagnosis.

An internet-based self-help intervention for the reduction of consumption of ultra-processed products and increase of physical activity in Mexican university population: study protocol for a randomized controlled trial.

Introduction: The consumption of ultra-processed products has been associated with the etiology of various diseases, mainly metabolic diseases. On the other hand, physical activity acts as a protective factor that helps prevent the appearance of this type of disease. In addition to the physical effects, both the consumption of ultra-processed products (UPPs) and sedentary behaviors have been associated with a significant impact on people's mental health. These problems occur significantly in university students. Online internet interventions are an alternative that has the advantage of reaching a broader sample size and adapting to various problems. Methods: A randomized controlled clinical superiority trial with two independent groups will be developed with 176 participants. Participants in both groups will be evaluated in 5 steps: (1) pretest, (2) middle of the intervention, (3) post-test, (4) follow-up at 3 months, and (5) follow-up at 6 months. In the experimental group ("UNISALUD"), participants will receive an intervention composed of 11 sessions with interactive elements such as videos, audio, and infographics created through the user experience (UX) principles and based on the health action process approach (HAPA). The participants in the control group will be on the waiting list and will receive treatment 27 days after fulfilling the inclusion criteria. Thus, participants will not receive the treatment immediately. Discussion: The study is expected to establish the feasibility of a self-help internet-based intervention created based on the user experience methodology and the health action process model, leading to a significant decrease and increase in the consumption of UPPs, ultra-healthy products, and physical activity, respectively. Conclusion: Internet-based interventions are scarce in Latin America. Due to their potential, this study will provide data about consumption of UPPs, physical activity, and mental health of the Mexican population, which will influence the reduction of health-related complications through prevention strategies or measures.Clinical Trial Registration:ClinicalTrials.gov, NCT05834842.

Is cancer back?-psychological issues faced by survivors of breast cancer.

Breast cancer survival rates have shown notable improvements over the years thanks to advancements in detection, treatment modalities, and supportive care. However, survivors often encounter challenges when reintegrating into daily life and managing persistent physical and psychological concerns. This review article aims to delve into the multifaceted emotional complexities faced by survivors, encompassing a spectrum of issues from fear of recurrence to body image insecurities, thus emphasizing the imperative for comprehensive support. Articles were reviewed through searches of PubMed and through searches of the author's own file. We will examine not only the risk factors contributing to heightened psychological distress but also the periods of vulnerability and the most common unmet needs encountered by these individuals. Additionally, we will discuss various psychological interventions and strategies designed to promote resilience and enhance the quality of life post-diagnosis. Furthermore, we will underscore the pressing need for ongoing, specific research endeavors aimed at addressing the long-term psychological impacts of cancer recurrence on survivorship. By shedding light on these critical aspects, we aim not only to provide insight into the challenges faced by survivors but also to advocate for the importance of integrating comprehensive psychological support into survivorship care. Through this thorough exploration, we seek to empower both survivors and healthcare professionals alike, facilitating a deeper understanding of the complexities inherent in the breast cancer survivorship journey. Ultimately, our aim is to highlight the crucial aspects that must be considered by healthcare professionals in providing holistic care to breast cancer survivors.