Effects of mindfulness on body image, affect, and smoking in women

Recent research has shown that body image stimuli increase negative affect and smoking urges among female smokers. Mindfulness (paying attention to present-moment experience with an attitude of nonjudgmental acceptance) may be a useful technique to minimize the influence of body image issues on negative affect, smoking urges, and smoking behavior. The present study investigated whether mindfulness can influence the way female college smokers respond to a body image challenge. The study used a 2 x 2 factorial design with body image challenge (trying on a bathing suit vs. observing a purse) crossed with instructions (mindfulness vs. silence). Female smokers (n = 64) were randomly assigned to one of 4 conditions: Purse + Control (n = 16), Body Image + Control (n = 15), Purse + Mindfulness (n = 15), and Body Image + Mindfulness (n = 18). Participants had a mean age of 20.03 (±1.77) and were 87.5% Caucasian. There were significant interactions indicating that self-reported state mindfulness increased for those who listened to mindfulness instructions versus silence. In addition, participants receiving the mindfulness intervention did not show significant increases in weight dissatisfaction and negative affect associated with trying on a bathing suit, versus participants in the silent condition. Experimental groups did not differ in self-reported urges to smoke or likelihood of accepting the experimenter’s offer to smoke directly after the session. However, among participants who tried on a bathing suit, those who received mindfulness instructions reported that they planned to wait longer to smoke. Furthermore, mindfulness moderated the relationship between negative affect and smoking urges, such that among participants who received the mindfulness instructions, negative affect was not related to smoking urges. The results provide preliminary support for the use of mindfulness-based treatments for female smokers in coping with body image concerns

Crisis intervention for people with severe mental illnesses

Background A particularly difficult challenge for community treatment of people with serious mental illnesses is the delivery of an acceptable level of care during the acute phases of severe mental illness. Crisis-intervention models of care were developed as a possible solution. Objectives To review the effects of crisis-intervention models for anyone with serious mental illness experiencing an acute episode compared to the standard care they would normally receive. If possible, to compare the effects of mobile crisis teams visiting patients' homes with crisis units based in home-like residential houses. Search methods We searched the Cochrane Schizophrenia Group’s Study-Based Register of Trials. There is no language, time, document type, or publication status limitations for inclusion of records in the register. This search was undertaken in 1998 and then updated 2003, 2006, 2010 and September 29, 2014. Selection criteria We included all randomised controlled trials of crisis-intervention models versus standard care for people with severe mental illnesses that met our inclusion criteria. Data collection and analysis We independently extracted data from these trials and we estimated risk ratios (RR) or mean differences (MD), with 95% confidence intervals (CI). We assessed risk of bias for included studies and used GRADE to create a 'Summary of findings' table. Main results The update search September 2014 found no further new studies for inclusion, the number of studies included in this review remains eight with a total of 1144 participants. Our main outcomes of interest are hospital use, global state, mental state, quality of life, participant satisfaction and family burden. With the exception of mental state, it was not possible to pool data for these outcomes. Crisis intervention may reduce repeat admissions to hospital (excluding index admissions) at six months (1 RCT, n = 369, RR 0.75 CI 0.50 to 1.13, high quality evidence), but does appear to reduce family burden (at six months: 1 RCT, n = 120, RR 0.34 CI 0.20 to 0.59, low quality evidence), improve mental state (Brief Psychiatric Rating Scale (BPRS) three months: 2 RCTs, n = 248, MD -4.03 CI -8.18 to 0.12, low quality evidence), and improve global state (Global Assessment Scale (GAS) 20 months; 1 RCT, n = 142, MD 5.70, -0.26 to 11.66, moderate quality evidence). Participants in the crisis-intervention group were more satisfied with their care 20 months after crisis (Client Satisfaction Questionnaire (CSQ-8): 1 RCT, n = 137, MD 5.40 CI 3.91 to 6.89, moderate quality evidence). However, quality of life scores at six months were similar between treatment groups (Manchester Short Assessment of quality of life (MANSA); 1 RCT, n = 226, MD -1.50 CI -5.15 to 2.15, low quality evidence). Favourable results for crisis intervention were also found for leaving the study early and family satisfaction. No differences in death rates were found. Some studies suggested crisis intervention to be more cost-effective than hospital care but all numerical data were either skewed or unusable. We identified no data on staff satisfaction, carer input, complications with medication or number of relapses. Authors' conclusions Care based on crisis-intervention principles, with or without an ongoing homecare package, appears to be a viable and acceptable way of treating people with serious mental illnesses. However only eight small studies with unclear blinding, reporting and attrition bias could be included and evidence for the main outcomes of interest is low to moderate quality. If this approach is to be widely implemented it would seem that more evaluative studies are still neede

Yoga for Adults with Intellectual and Developmental Disabilities: A Pilot Study

Intellectual and developmental disabilities (IDD) include diagnoses such as autism spectrum disorder (ASD), Down syndrome (DS), and fragile X syndrome (FXS). Generally, individuals with IDD have an increased risk of experiencing poor functional fitness compared to adults without IDD, which can lead to an increased rate of health deterioration and reduced ability to complete activities of daily living. Functional fitness might be positively impacted by yoga, which is an ancient mind-body practice that that synchronously uses controlled breath practices, mindfulness, and physical postures. Yoga has generally been demonstrated to be effective for improving functional fitness for adults, both with and without disability. Little research, however, has been done regarding yoga for individuals with IDD. This single-arm pilot study measured pre and post test functional fitness after a yoga intervention delivered for 60-minutes twice a week for six weeks in a special population recreation center for people with IDD. Eligible individuals completed a battery of functional fitness physical performance measures. A team of yoga teachers and a yoga therapist developed a standardized intervention protocol to promote improving muscular strength and balance. Each yoga session included a standardized progression of postures, breath work, and guided meditation, and affirmations called “mantras” (e.g. I am strong, I am loved). Multiple modifications were offered for engaging in postures including participating from a chair. Each session ended with a four-minute relaxation pose. Pre- and posttest scores were compared using a Wilcoxon Signed Rank test and were further examined with a percent change calculation (Time 1-Time 2/Time 1 * 100). Nine participants assented and completed pre and post-testing. There was a significant improvement in three of the six functional fitness measures. This intervention study indicates positive outcomes to promote functional fitness among individuals with IDD. The preliminary significant results indicate that a yoga intervention may have the potential to enhance functional fitness in people with IDD

Dynamic Transmission of Staphylococcus Aureus in the Intensive Care Unit

Staphylococcus aureus is an important bacterial pathogen. This study utilized known staphylococcal epidemiology to track S. aureus between patients, surfaces, staff hands and air in a ten-bed intensive care unit (ICU). Methods: Patients, air and surfaces were screened for total colony counts and S. aureus using dipslides, settle plates and an MAS-100 slit-sampler once a month for 10 months. Data were modelled against proposed standards for air and surfaces, and ICU-acquired staphylococcal infection. Whole-cell genomic typing (WGS) demonstrated possible transmission pathways between reservoirs. Results: Frequently touched sites were more likely to be contaminated (>12 cfu/cm2; p = 0.08). Overall, 235 of 500 (47%) sites failed the surface standard (≤2.5 cfu/cm2); 20 of 40 (50%) passive air samples failed the “Index of Microbial Air” standard (2 cfu/9 cm plate/h), and 15/40 (37.5%) air samples failed the air standard

Coastal cliff ground motions and response to extreme storm waves

Coastal cliff erosion from storm waves is observed worldwide, but the processes are notoriously difficult to measure during extreme storm wave conditions when most erosion normally occurs, limiting our understanding of cliff processes. Over January–February 2014, during the largest Atlantic storms in at least 60 years with deepwater significant wave heights of 6–8 m, cliff-top ground motions showed vertical ground displacements in excess of 50–100 µm; an order of magnitude larger than observations made previously. Repeat terrestrial laser scanner surveys over a 2 week period encompassing the extreme storms gave a cliff face volume loss of 2 orders of magnitude larger than the long-term erosion rate. The results imply that erosion of coastal cliffs exposed to extreme storm waves is highly episodic and that long-term rates of cliff erosion will depend on the frequency and severity of extreme storm wave impacts

The Roles of Want to Commitment and Have to Commitment in Explaining Physical Activity Behavior

Background: Several theories and models have been proposed to explain decisions in changing and adopting behavior but few address the intricacies of behavioral maintenance. The current study assesses the utility of the Investment Model, which identifies satisfaction, investments, and involvement alternatives as predictors of commitment and continued behavior, in predicting physical activity behavior. Methods: Participants (N = 267) completed questionnaires about physical activity and commitment. Structural equation modeling assessed relationships among 2 types of exercise commitment (want to or enthusiastic commitment, have to or obligatory commitment), 3 commitment determinants (satisfaction, investments, and alternatives), and physical activity (minutes of physical activity, stage of behavior change). Results: Want to commitment, but not have to commitment, was related to stage of exercise behavior change and time spent in physical activity. Satisfaction and investments were positively related to want to commitment; whereas, satisfaction, investments, and alternatives were positively related to have to commitment. The model explained 68% and 23% of the variance in time spent in physical activity and stage of behavior change, respectively. Conclusions: This study provides support for the application of the Investment Model to physical activity and suggests that want to commitment may be important for explaining and predicting sustained physical activity behavior

Antimicrobial resistance point-of-care testing for gonorrhoea treatment regimens: cost-effectiveness and impact on ceftriaxone use of five hypothetical strategies compared with standard care in England sexual health clinics.

BackgroundWidespread ceftriaxone antimicrobial resistance (AMR) threatens Neisseria gonorrhoeae (NG) treatment, with few alternatives available. AMR point-of-care tests (AMR POCT) may enable alternative treatments, including abandoned regimens, sparing ceftriaxone use. We assessed cost-effectiveness of five hypothetical AMR POCT strategies: A-C included a second antibiotic alongside ceftriaxone; and D and E consisted of a single antibiotic alternative, compared with standard care (SC: ceftriaxone and azithromycin).AimAssess costs and effectiveness of AMR POCT strategies that optimise NG treatment and reduce ceftriaxone use.MethodsThe five AMR POCT treatment strategies were compared using a decision tree model simulating 38,870 NG-diagnosed England sexual health clinic (SHC) attendees; A micro-costing approach, representing cost to the SHC (for 2015/16), was employed. Primary outcomes were: total costs; percentage of patients given optimal treatment (regimens curing NG, without AMR); percentage of patients given non-ceftriaxone optimal treatment; cost-effectiveness (cost per optimal treatment gained).ResultsAll strategies cost more than SC. Strategy B (azithromycin and ciprofloxacin (azithromycin preferred); dual therapy) avoided most suboptimal treatments (n = 48) but cost most to implement (GBP 4,093,844 (EUR 5,474,656)). Strategy D (azithromycin AMR POCT; monotherapy) was most cost-effective for both cost per optimal treatments gained (GBP 414.67 (EUR 554.53)) and per ceftriaxone-sparing treatment (GBP 11.29 (EUR 15.09)) but with treatment failures (n = 34) and suboptimal treatments (n = 706).ConclusionsAMR POCT may enable improved antibiotic stewardship, but require net health system investment. A small reduction in test cost would enable monotherapy AMR POCT strategies to be cost-saving

The prism model: advancing a theory of practice for arts and humanities in medical education

Introduction: The arts and humanities have transformative potential for medical education. Realizing this potential requires an understanding of what arts and humanities teaching is and what it aims to do. A 2016 review of exclusively quantitative studies mapped three discursive positions (art as intrinsic to, additive to or curative for medicine) and three epistemic functions (art for mastering skills, perspective taking, and personal growth and activism). A more inclusive sample might offer new insights into the position and function of arts and humanities teaching in medical education. Methods: Informed by this 2016 framework, we conducted discursive and conceptual analyses of 769 citations from a database created in a recent scoping review. We also analyzed the 15 stakeholder interviews from this review for recurring themes. These three analyses were iteratively compared and combined to produce a model representing the complex relationship among discursive functions and learning domains. Results: The literature largely positioned arts and humanities as additive to medicine and focused on the functions of mastering skills and perspective taking. Stakeholders emphasized the intrinsic value of arts and humanities and advocated their utility for social critique and change. We offer a refined theory of practice—the Prism Model of four functions (mastering skills, perspective taking, personal insight and social advocacy)—to support more strategic use of arts and humanities in medical education across all learning domains. Discussion: The Prism Model encourages greater pedagogical flexibility and critical reflection in arts and humanities teaching, offering a foundation for achieving its transformative potential

How are the arts and humanities used in medical education? Results of a scoping review

Purpose Although focused reviews have characterized subsets of the literature on the arts and humanities in medical education, a large-scale overview of the field is needed to inform efforts to strengthen these approaches in medicine. Method The authors conducted a scoping review in 2019 to identify how the arts and humanities are used to educate physicians and interprofessional learners across the medical education continuum in Canada and the United States. A search strategy involving 7 databases identified 21,985 citations. Five reviewers independently screened the titles and abstracts. Full-text screening followed (n = 4,649). Of these, 769 records met the inclusion criteria. The authors performed descriptive and statistical analyses and conducted semistructured interviews with 15 stakeholders. Results The literature is dominated by conceptual works (n = 294) that critically engaged with arts and humanities approaches or generally called for their use in medical education, followed by program descriptions (n = 255). The literary arts (n = 197) were most common. Less than a third of records explicitly engaged theory as a strong component (n = 230). Of descriptive and empirical records (n = 424), more than half concerned undergraduate medical education (n = 245). There were gaps in the literature on interprofessional education, program evaluation, and learner assessment. Programming was most often taught by medical faculty who published their initiatives (n = 236). Absent were voices of contributing artists, docents, and other arts and humanities practitioners from outside medicine. Stakeholders confirmed that these findings resonated with their experiences. Conclusions This literature is characterized by brief, episodic installments, privileging a biomedical orientation and largely lacking a theoretical frame to weave the installments into a larger story that accumulates over time and across subfields. These findings should inform efforts to promote, integrate, and study uses of the arts and humanities in medical education