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Duration of untreated psychosis (DUP) is defined as the time between the onset of psychotic symptoms and the initiation of appropriate treatment. DUP has been the subject of intensive research to understand how it is associated with a poorer prognosis in patients with first-episode psychosis (FEP). Involuntary treatment is often necessary in the context of FEP.
Objectives
To characterize the relationship between the duration of untreated psychosis (DUP) and the type of hospitalization (voluntary versus involuntary) in patients admitted for FEP.
Methods
We conducted a retrospective observational study, collecting data from patients admitted between January 2019 and December 2022, in the psychiatric unit at our hospital in Bragança, Portugal. We used the information recorded in the clinical records and statistical analysis of the data was performed using the SPSS program.
Results
Over the 4-year study period, 81 patients with first-episode psychotic symptoms at admission were selected. The average age was 46.98 years, with a slight male predominance. 46.9% (n=38) were admitted involuntarily, and 53.1% (n=43) were admitted voluntarily. The average DUP was 73 days. DUP was 95.92 days for patients admitted involuntarily and 54.72 days for voluntary admission. This difference was not statistically significant.
Conclusions
There was a longer DUP in patients admitted involuntarily, although this association was not statistically significant. However, it is important to emphasize that involuntary hospitalization is frequently linked to more severe cases and poorer prognosis. Therefore, recognizing psychotic symptoms as early as possible is essential to facilitate prompt identification and effective treatment for patients experiencing their first episode of psychosis, ultimately leading to an improved prognosis.
Attention-deficit/hyperactivity disorder (ADHD) is one of the most prevalent neurodevelopment disorders in the world. Clinical guidelines for ADHD recommend multimodal treatment approaches, with current evidence suggesting that medication, including methylphenidate and various amphetamine formulations, in conjunction with psychosocial treatment are most effective in the short-term and long term. Over the last decade, an increasing number of studies investigating non-pharmacological treatments have been published, such as cognitive therapy, Neurofeedback (NF), Transcranial direct current stimulation with the aim of treating ADHD patients.
Objectives
We comprehensively reviewed literature searching for studies on the effectiveness and specificity of NF for the treatment of ADHD. The aim of this review is to understand if there is scientific evidence in using of electroencephalogram (EEG)-Neurofeedback for treating patients with ADHD.
Methods
We did a non systemathic review using pubmed and google schoolar databases in order to analyze the influence and effects of therapy in patients diagnosed with ADHD and under treatment based on EEG Neurofeedback. We analyzed 18 systhematic reviews and metha-analysis and 2 case control studies.
Results
Accourding to the systhematic reviews results showed positive and significant effects in the visual memory, attention and visual recognition (spatial working memory). EEG also showed improvement in upper alpha activity in a resting state (open-eyed) measured from the occipital area, which similarly indicated improvement in the cognitive domain (attention). Compared to non-active control treatments, NF appears to have more durable treatment effects, for at least 6 months following treatment.
Conclusions
In conclusion, it is possible to affirm that a neuromodulating effect of the therapy positively influences cognitive processes, mood, and anxiety levels in patients with ADHD and is associated with significant long-term reduction in symptoms. Though limitations exist regarding conclusions about the specific effects of NF, the review documents improvements in school, social, and family environments. However, future efforts should focus on implementing standard neurofeedback protocols, ensuring learning, and optimizing clinically relevant transfer and more studies are needed for a properly powered comparison of follow-up effects between NF and active treatments and to further control for non-specific effects.
Suicide is a leading cause of death in the United States, particularly among adolescents. In recent years, suicidal ideation, attempts, and fatalities have increased. Systems maps can effectively represent complex issues such as suicide, thus providing decision-support tools for policymakers to identify and evaluate interventions. While network science has served to examine systems maps in fields such as obesity, there is limited research at the intersection of suicidology and network science. In this paper, we apply network science to a large causal map of adverse childhood experiences (ACEs) and suicide to address this gap. The National Center for Injury Prevention and Control (NCIPC) within the Centers for Disease Control and Prevention recently created a causal map that encapsulates ACEs and adolescent suicide in 361 concept nodes and 946 directed relationships. In this study, we examine this map and three similar models through three related questions: (Q1) how do existing network-based models of suicide differ in terms of node- and network-level characteristics? (Q2) Using the NCIPC model as a unifying framework, how do current suicide intervention strategies align with prevailing theories of suicide? (Q3) How can the use of network science on the NCIPC model guide suicide interventions?
Of all the known pillared layered clays (PILC), Al-PILC is the most studied. In spite of that, its use on a commercial scale is not yet possible due to the large amount of water required for its synthesis. The aim of the present work was to take advantage of the beneficial effects of ultrasound radiation for reducing intercalation time, and to optimize the synthesis parameters in order to find a viable industrial means of preparing Al-PILC.
A comprehensive study of the effect of ultrasonic radiation on the parameters which have a direct effect on the amount of water used in the synthesis was conducted, specifically on the effects of: (1) mmol of Al/g of clay ratio (R) by decreasing the volume of A1 solution and keeping the amount of clay constant, (2) the concentration of clay in the initial suspension (or not suspending the clay at all), and (3) the concentration of the A1 precursor solution. The use of ultrasonic radiation produced the expected reduction in exchange time which was attributed to a decrease of the clay-particle size. This decrease of particle size gave rise to an improvement in the diffusion of the A1 precursor towards the core of the clay grain leading to solids with increased surface areas, basal spacing and X-ray diffraction peak definition. By optimizing the synthesis parameters directly involved in the consumption of water, it was possible to decrease the amount used by >60%.
Mirror exposure therapies (MET) have been proposed to reduce symptomatology in patients with Anorexia Nervosa. However, most MET protocols or related studies do not specify the patients’ distance to the mirror, or when they do so, such a distance may differ significantly (from 0,5 to 3 meters). Such modifications of mirror positioning could imply variations in patients’ fixation patterns on different body parts (i.e., attentional bias between weight-related and non-weight related body parts), since previous studies shown that dissociated neural systems (either in left or right cerebral hemispheres) are involved in the attentional patterns and scanning strategies depending on the distance (i.e., in near and far space). Furthermore, as the body-related attentional bias (AB) has been shown to be a part of the maintenance mechanism of AN symptomatology, any modification of attentional patterns due to mirror’s distance variations may influence the efficacy of MET.
Objectives
This study aims to use Virtual Reality (VR) and Eye-Tracking (ET) technologies to precisely analyse the effect of the distance to the mirror on the attentional patterns.
Methods
137 female college students were immersed in a VR environment in which they could look in the mirror at their respective avatars created from the measurements and photos of their real bodies. The mirror was positioned at 3.30m in front of the participants in “group 1” (n1 = 54), and at 1.54m in front of the participants in “group 2” (n2 = 83). Eye-Tracking feature and OGAMA software (Freie Universität, Berlin, Germany) were used to record and process the visual attentional pattern of each participant, during a 30-second free viewing task at her avatar. Complete Fixation Time (CFT) was assessed as the fixation time difference between weight- and non-weight- related body parts, defined from the weight scale of the PASTAS questionnaire. Independent Sample t-Test was conducted to analyse CFT mean difference between both groups.
Results
Independent Samples t-Test shows statistically significant CFT mean difference (F (1, 135) = 1.571, p < 0.001, 95% IC [1717; 5581]) between both groups. While fixation pattern of the group positioned further to the mirror (group 1) was more focused on weight-related body parts (CFT mean = 2282ms, SD = 809), the fixation pattern of the group positioned closer to the mirror (group 2) was more focused on non-weight-related body parts (CFT mean = -1367ms, SD = 587).
Conclusions
This study shows new opportunities to use VR and ET technologies to precisely analyse the variations of fixation patterns as a function of mirror position in MET. Such information may contribute to adapt and develop new MET’s protocols for AN patients, optimizing the distance to the mirror. It also underscores the importance of specifying the distance to the mirror in MET-related studies to improve replicability.
Previous research has shown that virtual reality (VR)-based exposure therapy is effective in the treatment of anxiety disorders. However, more information regarding the specific features of this intervention for the treatment of fear of flying (FoF) is needed. The primary aim of this systematic review was to update and analyse the existing data on the efficacy of VR exposure treatment (VRET) in FoF, providing information on the optimal methodological conditions for its administration. The Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) method was employed to select the articles. PsycInfo, Medline and Web of Science were chosen as databases with a wide range of publications related to health and psychology. Thirty-three eligible articles were included in this review. Results showed that participants’ anxiety decreased after being systematically exposed to flight-related VR environments. VRET is at least as effective as other evidence-based treatments, such as cognitive behavioural therapy (CBT) or in vivo exposure therapy (IVET), and therefore is a highly recommended alternative when IVET is difficult to administer, and an excellent complement to enhance CBT efficacy. Regarding sensory cues, the addition of motion feedback synchronised with visual and auditory cues during the exposure to VR environments might improve the efficacy of VRET for FoF, but more research supporting this statement is still needed.
Substance misuse increases the risk of developing psychosis in vulnerable people. However, patients with substance use disorders’ attributes and their effect on first-episode psychosis (FEP) are still unclear.
Objectives
To describe and compare inpatient admissions for FEP with substance misuse and its impact on clinical outcomes.
Methods
We conducted an observational and retrospective study, analyzing sociodemographic determinants and clinical data regarding the patients hospitalized for FEP, between January 2019 and June 2022, in the psychiatric unit at our hospital in Bragança, Portugal. We used logistic regression to estimate the effect of social determinants and other clinical data regarding the patients hospitalized for FEP with substance abuse.
Results
We included 78 patients in this study. Of these patients, 30% (n=23) reported substance (drugs or alcohol) misuse prior to hospital admission. Regarding only the patients with substance misuse, 96% were male and the median age was 31 years. Cannabis was the most often reported substance of abuse (83%). Most of these patients were unmarried (OR:10.794; 95%CI:2.855-40.805;P=0.001), lived in a rural setting (OR:0.263; 95%CI:0.094-0.731;P=0.009) and had no previous psychiatric history (OR:1.022; 95%CI:0.386-2.709;P=0.964).Regarding hospital admission, 70% were involuntary admitted (OR:4;95%CI:1.408-11.366;P=0.007) and the median time of hospitalization was 17 days. At the time of discharge, 48% of these set of patients still didn’t have insight into their mental illness (OR:1.737;95%CI:0.646-4.679;P=0.272). During the evaluation period of this study, 13% of the patients were readmitted to the hospital (OR:1.029;95%CI:0.241-4.383;P=0.970) and 35% missed outpatient appointments (OR:3.133;95%CI:1.003-9.791;P=0.044). The diagnoses at the time of discharge were: substance-induced psychosis (52%), schizophrenia (22%), affective psychosis (17%), and acute and transient psychotic disorder (9%).
Conclusions
This analysis indicates substance misuse predates and is prevalent in FEP. Many of these patients fail to recognize and accept that they are suffering from a mental illness and drop out of outpatient psychiatric care. Further, substance-induced psychoses are associated with a significant risk for transition to schizophrenia particularly following cannabis-induced psychosis. Thus, it is crucial to optimize adherence to the therapeutic regimen and outpatient follow-up.
The treatment with long-acting injectable antipsychotics (LAIAs) is more and more frequent and it shows advantages regarding adherence, effectiveness and tolerance.
Objectives
To describe and compare the profile of patients under treatment with LAIAs in a psychiatric hospital in Portugal.
Methods
An observational and retrospective study was carried out with the collection of data referring to patients hospitalized with a first psychotic episode between 01/01/2019 and 30/06/2022 in a psychiatric hospital in Portugal and the respective evaluation of sociodemographic and clinical data through the information recorded in the clinical files.
Results
During the 42 months of the study, we selected 78 patients who presented psychotic symptoms on admission. Patients with a history of previous psychotic episodes and prescription of antipsychotic therapy prior to hospitalization were excluded.
Of 78 patients hospitalized with a first psychotic episode, 34 - which corresponds to approximately 44% - were discharged with LAIAs.
Patients receiving LAIAs had an average age of 39 years. The average number of days of hospitalization was 28 days; 41% were female (n=14) and 59 were male (n=20); 35% (n=12) consumed psychoactive substances previously on admission to hospital; 62% (n=21) were discharged under the compulsive treatment regimen. Regarding the diagnosis at discharge, based on the international classification of disease-11 (ICD-11), the most common were schizophrenia, psychotic disorder induced by psychoactive substances and acute and transient psychotic disorder.
From the statistical analysis carried out, no correlation was observed between the rate of readmissions and the administration of LAIAs, nor was there any correlation between the rate of readmissions and compulsive outpatient treatment.
Conclusions
Despite what is described in the literature, in the sample under study, the LAIAs were not superior in the variables studied, namely in reducing the readmission rate. Possible explanations for the results obtained may be justified by the size of the sample under study and the follow-up time of the cases.
The current COVID-19 pandemic has aggravated pre-existing oxygen supply gaps all over the world. In fact, oxygen shortages occurred in affluent areas with highly developed healthcare systems. The state-of-affairs created much suffering and resulted in potentially preventable deaths. Meanwhile, several international activities have been initiated to improve oxygen availability in the long-term by creating new networks of oxygen plants and supply channels. However, disasters such as the current pandemic may require rapid, autarkic oxygen production. Therefore, we determined whether oxygen resilience could conceivably be improved through self-made oxygen generators using material that is easily available even in remote areas. The team comprised engineers and physicians with hands-on experience in low- and middle-income countries. We constructed and tested self-made setups for water hydrolysis and membrane-based oxygen purification. We must conclude, however, that the massive amounts of oxygen patients with COVID-19 require cannot be reasonably met with such simple measures, which would require high efforts and hold potential risks.
The prevalence of the optic canal anatomical variants across the sphenoid sinus varies widely among different ethnic groups. This study aimed to analyse the anatomical variants of the optic canal and their relationship to sphenoid sinus pneumatisation in a Hispanic population.
Method
A review of 320 sphenoid sinuses by high-resolution computed tomography was performed. DeLano's classification of the optic canal, presence of dehiscence, septa insertion, sphenoid sinus pneumatisation and presence of Onodi cells were established.
Results
Dehiscence of the optic canal was observed in 4.7 per cent (n = 15) of the analysed sinuses. Type 4 and 3 optic canals were significantly more frequent among postsellar sphenoid sinuses than other patterns of sphenoid sinus pneumatisation (p = 0.002 and p = 0.018). A type 4 optic canal has a higher tendency to present inserted septum than other optic canal types (p = 0.014).
Conclusion
This study described the optic canal variants in a Hispanic population, which complements existing literature addressing other ethnicities.
The appearance on the skin of herpes virus lesions, concomitantly with the coronavirus disease 2019 (COVID-19) pandemic, leads us to suspect an underlying infection with severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2). Diagnostic reverse transcriptase polymerase chain reaction tests and immunoglobulin M (IgM) and IgG seroconversion studies have therefore been carried out. We present three cases of herpes virus infections in immunocompetent patients: one of the infections was herpes simplex 1 in a 40-year-old woman, and the other two were herpes varicella-zoster infections in a 62-year-old man and a 25-year-old woman. The patients were in the care of the southern health district of Seville of the SAS (Andalusian Health Service) during the Spanish state of alarm over the COVID-19 pandemic. The SARS-CoV-2 infection was confirmed in only one of the three cases. In this study, we briefly review the etiopathogenic role of the COVID-19 pandemic situation, whereby immunodeficiencies are generated that favour the appearance of other viral infections, such as herpes virus infections.
Background: Hand hygiene (HH) is the most important measure for preventing healthcare-associated infections. The objective is to gain insight into the evolution of the degree of compliance with recommendations (DCR) on HH and its associated factors in the surgical areas of a tertiary-care hospital. Methods: This observational, cross-sectional study, was repeated over time, with direct observation of the DCR on HH during the daily activity of healthcare workers in surgical areas: general surgery, urology, vascular surgery, traumatology, neurosurgery, thoracic surgery, heart surgery, pediatric surgery, otorhinolaryngology, gynecology and obstetrics, ophthalmology. Over 14 years (from 2005 to 2018), 15,946 HH opportunities were registered, together with different additional variables (age, sex, professional position, surgical area ). The 2 test was used to study the association and the crude, and adjusted odds ratios were used to quantify its magnitude. Results: The DCR on HH in surgical areas was 49.7% (95% CI, 48.9%–50.5%), and in the group of nonsurgical areas it was 53.4% (95% CI, 53.1%–54.1%). The area with the highest degree of compliance was urology (56.7%; 95% CI, 53.9%–59.6%), and the area with the lowest degree of compliance was traumatology (43.3%; 95% CI, 40.4%–46.2%). Some associated factors were the indications after an activity has been performed (58.6%; aOR, 2.7; 95% CI, 2.5–2.9) and the availability of pocket-size alcohol-based disinfectant (63.8%; aOR, 2.4; 95% CI, 2.2–2.5). Conclusions: The DCR on HH in surgical areas is lower than in other hospital areas, and there is still some margin for improvement. We have identified some modifiable factors that have an independent association with HH compliance in surgical areas. Focusing on them will increase compliance with HH with the ultimate goal of reducing healthcare-associated infections.
Background:Pseudomonas aeruginosa, is the third etiologic agent of healthcare associated infections, and the most frequent pathogen in ventilator-associated pneumonia (VAP). In critical care units is associated with high mortality, long hospital stay, and high healthcare-associated costs. We evaluated the effectiveness of filter placement in the water taps in critical care units to prevent the occurrence of healthcare-associated infections (HAIa) by Pseudomonas aeruginosa. Methods: This experimental study was both cross-over and open-label in nature. We included patients admitted for >24 hours in critical care units over 24 months. The study was divided into 4 periods of 6 months each. We divided the study into 2 groups: patients in units with filters and patients in units without filters. We compared the incidence density of P. aeruginosa HAIs (number of cases divided by the number of person days) according the ECDC definition of case criteria between the groups. The 2 test was used, and the magnitude of the association was calculated as a rate ratio with a 95% confidence interval, adjusted using a Poisson regression model. Results: Overall, 1,132 patients were included in the study: 595 in units with water tap filters and 537 in units without water tap filters. HAI incidence among patients in units with water tap filters was 5.3 per 1,000 person days stay; without water tap filters, HAI incidence was 4.7 per 1,000 person days stay (HR, 0.94; 95% CI, 0.47–1.90). Conclusions: The preliminary results of this study indicate a a lower incidence of P. aeruginosa HAIs in units with filters placed in water taps than in units without filters.
To characterize associations between exposures within and outside the medical workplace with healthcare personnel (HCP) SARS-CoV-2 infection, including the effect of various forms of respiratory protection.
Design:
Case–control study.
Setting:
We collected data from international participants via an online survey.
Participants:
In total, 1,130 HCP (244 cases with laboratory-confirmed COVID-19, and 886 controls healthy throughout the pandemic) from 67 countries not meeting prespecified exclusion (ie, healthy but not working, missing workplace exposure data, COVID symptoms without lab confirmation) were included in this study.
Methods:
Respondents were queried regarding workplace exposures, respiratory protection, and extra-occupational activities. Odds ratios for HCP infection were calculated using multivariable logistic regression and sensitivity analyses controlling for confounders and known biases.
Results:
HCP infection was associated with non–aerosol-generating contact with COVID-19 patients (adjusted OR, 1.4; 95% CI, 1.04–1.9; P = .03) and extra-occupational exposures including gatherings of ≥10 people, patronizing restaurants or bars, and public transportation (adjusted OR range, 3.1–16.2). Respirator use during aerosol-generating procedures (AGPs) was associated with lower odds of HCP infection (adjusted OR, 0.4; 95% CI, 0.2–0.8, P = .005), as was exposure to intensive care and dedicated COVID units, negative pressure rooms, and personal protective equipment (PPE) observers (adjusted OR range, 0.4–0.7).
Conclusions:
COVID-19 transmission to HCP was associated with medical exposures currently considered lower-risk and multiple extra-occupational exposures, and exposures associated with proper use of appropriate PPE were protective. Closer scrutiny of infection control measures surrounding healthcare activities and medical settings considered lower risk, and continued awareness of the risks of public congregation, may reduce the incidence of HCP infection.
Methane (CH4) is a greenhouse gas (GHG) produced and released by eructation to the atmosphere in large volumes by ruminants. Enteric CH4 contributes significantly to global GHG emissions arising from animal agriculture. It has been contended that tropical grasses produce higher emissions of enteric CH4 than temperate grasses, when they are fed to ruminants. A number of experiments have been performed in respiration chambers and head-boxes to assess the enteric CH4 mitigation potential of foliage and pods of tropical plants, as well as nitrates (NO3−) and vegetable oils in practical rations for cattle. On the basis of individual determinations of enteric CH4 carried out in respiration chambers, the average CH4 yield for cattle fed low-quality tropical grasses (>70% ration DM) was 17.0 g CH4/kg DM intake. Results showed that when foliage and ground pods of tropical trees and shrubs were incorporated in cattle rations, methane yield (g CH4/kg DM intake) was decreased by 10% to 25%, depending on plant species and level of intake of the ration. Incorporation of nitrates and vegetable oils in the ration decreased enteric CH4 yield by ∼6% to ∼20%, respectively. Condensed tannins, saponins and starch contained in foliages, pods and seeds of tropical trees and shrubs, as well as nitrates and vegetable oils, can be fed to cattle to mitigate enteric CH4 emissions under smallholder conditions. Strategies for enteric CH4 mitigation in cattle grazing low-quality tropical forages can effectively increase productivity while decreasing enteric CH4 emissions in absolute terms and per unit of product (e.g. meat, milk), thus reducing the contribution of ruminants to GHG emissions and therefore to climate change.
Cognitive strategies have received considerable attention in the field of pain management, together with more traditional approaches based on physical interventions and behavior modification. Distraction is a technique that lately has been often studied.
Distraction is based on an individual's limited attention capacity; it diminishes attention aimed to a painful stimulus with a subsequent pain reduction (Wismeijer & Vingerhoets, 2005).
Objective
To study the effect of VR as a distraction technique in an experimental pain task.
Method
37 healthy participants were induced pain through two consecutive immersions using the cold-pressor test. All participants went through two experimental conditions: VR and black screen. The order of conditions was counterbalanced and a design of repetitive measures was used.
A virtual environment “Surreal World” was developed based on distraction techniques designed to surprise participants. The effect of VR as a distraction technique was evaluated using objective measures of pain (threshold, tolerance, pain intensity and time estimation) and other cognitive measures (self-efficacy and catastrophic thinking in vivo).
Results
VR significantly decreased tolerance and pain intensity, influenced participants to underestimate the length of immersion. A higher self-efficacy in VR and a lower rumination and helplessness were registered in the pain experience. Thus, VR may help improve the efficacy of cognitive strategies.
Perspectives
The study shows the relevance of VR as an adjunctive method in the treatment of acute pain and allows studying its efficacy in patients with chronic pain.
Tobacco craving is an intense desire to smoke. Cue-induced craving is considered the main responsible for relapse after smoking cessation. Cue Exposure Treatment (CET) consists of controlled and repeated exposure to stimuli associated with substance use in order to reduce craving associated.
Objective
To analyze the pattern of craving response of smokers exposed to Virtual Reality environments.
Methods
Forty-six smokers were exposed randomly to complex virtual scenes of 6 minutes long duration with smoking related cues that reproduce typical situations where people use to smokes. Craving was assessed before each exposure and 6 times during navigation with a visual analogic scale. For this secondary analysis the evolution of craving response were explored for the environments that produced the most and the least craving responses.
Results
In the environment that produced the highest craving level, the pattern of response remains similar after the second assessment during the exposure, that is, after two minutes. For the environment that trigger the lowest levels, the responses gradually increased during the exposure and the highest level appeared in the last craving assessment, after 6 minutes.
Conclusions
This study has several implications. In the first place, virtual reality environments are able to elicit craving. In the second, we found that differents patterns of craving response exist in response to VR environments. Furthermore, the results obtained in the present study may be useful for cessation programs that include CET, in which is it necessary to know the pattern of desire during the exposure.
Attention plays an important rol in pain perception. Focusing attention in pain intensifies the painful experience whereas distraction may decrease its subjective sensation (Eccleston & Crombez, 1999).The purpose of the two studies is to establish the efficacy of distraction by means of VR in the control and reduction of pain using the cold-pressor test. In both studies threshold, tolerance, perceived pain intensity and time estimation were measured.
Study 1
37 healthy participants were induced pain in two consecutive immersions using the cold-pressor test. The experiment was counterbalanced and all participants went through two experimental conditions: VR (stereoscopic screen) and black screen. A virtual environment “Surreal World” was designed based on distraction of attention techniques. Results showed that VR significantly increased threshold and tolerance, diminished pain intensity and perception of time.
Study 2
35 healthy participants underwent two consecutive immersions using cold pressor: VR (using the updated version of Surreal World and 3D laptops) and black screen. VR significantly increased the threshold and tolerance, whereas variations in the estimation of time were barely significant.
Differences in the results of the two studies could be accounted for by the immersive effect of the stereoscopic screen. Findings are discussed in relation to previous studies on VR and pain. Results support VR as an adjunctive method in pain treatment and allow proving its efficacy in patients with chronic pain.
Mindfulness is a form of meditation that cultivates present moment awareness in a non-judging way. It has a Buddhist origin but has been practiced in the last 40 years without relation to any religious belief. It has been proposed as a treatment for a variety of ailments.
Objectives
To carry out an overview of systematic reviews of the evidence on mindfulness as a therapeutic tool.
Aims
To summarize the existing evidence on the efficacy of mindfulness.
Methods
We searched for systematic reviews in the Cochrane Database of Systematic Reviews (Cochrane Library).
Results
We found nine Cochrane reviews (for fibromyalgia, aggressiveness in intellectually disabled people, mechanical neck disorders, reducing sedentariness at work, anxiety, somatoform disorders, and post-stroke fatigue), two Cochrane review protocols (stress reduction of patients with breast cancer, and substance use disorders), 50 non-Cochrane reviews (29 provisional abstracts and 21 structured abstracts from the Centre for Reviews and Dissemination) on the efficacy of mindfulness. The Cochrane reviews showed a lack of conclusive evidence for fibromyalgia, aggressiveness in intellectually disabled people, anxiety disorders, somatoform disorders and post-stroke fatigue. Mindfulness training induced a non-significant reduction in workplace sitting time. For chronic neck pain, mindfulness exercises minimally improved function but no global effect was perceived at short term.
Conclusions
According to the existing Cochrane reviews, there is a general lack of evidence mindfulness as an effective treatment. For chronic neck pain, mindfulness exercises minimally improved function. We have detected important areas where high quality clinical trials are needed.
Disclosure of interest
The authors have not supplied their declaration of competing interest.
Considering a potential exercise-drug interaction, we investigated whether exercise training could improve the efficacy of specific antiparasitic chemotherapy in a rodent model of Chagas disease. Wistar rats were randomized into five groups: sedentary and uninfected (CT); sedentary and infected (SI); sedentary, infected and treated (SIT); trained and infected (TI); trained, infected and treated (TIT). After 9-weeks running training, the animals were infected with T. cruzi and followed up for 4 weeks, receiving 100 mg kg−1 day−1 benznidazole. No evidence of myocarditis was observed in CT animals. TI animals exhibited reduced parasitemia, myocarditis, and reactive tissue damage compared to SI animals, in addition to increased IFN-γ, IL-4, IL-10, heart non-protein antioxidant (NPA) levels and glutathione-s transferase activity (P < 0.05). The CT, SIT and TIT groups presented similar reductions in parasitemia, cytokines (IFN-γ, TNF-α, IL-4, IL-10, IL-17 and MCP-1), inflammatory infiltrate, oxidative heart damage and antioxidant enzymes activity compared to SI and TI animals, as well as reduced heart microstructural remodeling (P < 0.05). By modulating heart inflammation and redox metabolism, exercise training exerts a protective effect against T. cruzi infection in rats. However, the antiparasitic and cardioprotective effects of benznidazole chemotherapy are more pronounced, determining similar endpoints in sedentary and trained T. cruzi-infected rats.