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The present study evaluated the association of food addiction (FA), the change of the BMI/age z-score and the consumption of ultra-processed foods in overweight students undergoing a 16-month, multicomponent intervention in the school environment. FA was investigated using the Yale Food Addiction Scale for Children, and the dietary assessment was estimated using the semi-quantitative FFQ in overweight 9-11-year-old students (BMI/age z-score ≥ 1) of both sexes at their baseline and after the intervention (n 120). Among the schoolchildren, 33·4 % had FA in at least one of the two assessments. The analysis of mixed-effects models to assess the effect of the intervention and the change of the BMI/age z-score between evaluations showed that the occurrence of FA influenced the maintenance of weight (time#FA, ß = 0·30, 95 % CI 0·05, 0·54, P = 0·016). Weight loss was observed only in individuals who did not present FA (BMI/age z-score = -0·3). When evaluating the effect of the intervention and the dietary variables, we verified a reduction in the consumption of sugary milk-based drinks -71·13 kJ (-17 kcal), P = 0·04 only in non-FA students at the end of the study. FA has been identified as an underlying factor with therapeutic relevance, and an enhanced understanding of FA can open new paths for the prevention and management of obesity.
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Stigma toward mental disorders is one of today's most pressing global issues. The Covid-19 pandemic has exacerbated the barriers to social inclusion faced by individuals with mental disorders. Concurrently, stigma reduction interventions, especially those aimed at university students, have been more difficult to implement given social distancing and campus closures. As a result, alternative delivery for programs contributing to stigma reduction is required, such as online implementation. This paper reports the results of a controlled study focused on an online multi-component program on reducing stigma toward mental illness that included project-based learning, clinical simulations with standardized patients and E-Contact with real patients. A total of 40 undergraduate students from the Universidad del Desarrollo in Santiago, Chile, participated in the study. They were randomly divided between an intervention and control group. The intervention group participated in the online multi-component program, while the control group participated in an online educational program on cardiovascular health. We assessed the impact of the program by using the validated Spanish-language versions of the Attribution Questionnaire AQ-27 and the Questionnaire on Student Attitudes toward Schizophrenia with both groups, before and after the intervention. In addition, an ad hoc Likert scale ranging from 0 to 5 was used with the intervention group in order to assess the learning strategies implemented. Following the intervention, the participants belonging to the intervention group displayed significantly lower levels of stereotypes, perception of dangerousness, and global score toward people with schizophrenia (p < 0.001). In addition, participants presented lower levels of dangerousness-fear, avoidance, coercion, lack of solidarity, and global score (p < 0.001). The control group displayed no statistically significant differences in the level of stigma before and after the evaluation, for all of the items assessed. Finally, the overall assessment of each of the components of the program was highly positive. In conclusion, the study shows that online programs can contribute to reducing stigma toward mental disorders. The program assessed in this study had a positive impact on all the dimensions of stigma and all of the components of the program itself were positively evaluated by the participants.
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BACKGROUND: Delirium is a complex neuropsychiatric syndrome that is common among elderly inpatients. It has been associated with increased mortality, longer hospital stays, cognitive and functional decline and increased institutionalisation rates. Multicomponent interventions, a series of non-pharmacological strategies frequently handled by nursing staff, might be useful for prevention. OBJECTIVES: To assess the efficacy of multicomponent interventions in preventing incident delirium in the elderly. METHODS: A systematic review of randomised trials was undertaken. Two independent reviewers performed iterative literature searches in seven databases without language restrictions. Grey literature repositories were considered as well. The quality of included trials was assessed by using the criteria established by the Cochrane Collaboration. When possible, data were synthesised into a meta-analysis. Heterogeneity was assessed using the χ2 and I2 tests. FINDINGS: A total of 21,788 citations were screened, and seven studies of diverse quality were included in the review, comprising 1,691 participants. Multicomponent interventions significantly reduced incident delirium (relative risk [RR] 0.73, 95% confidence interval [CI] 0.63-0.85, P<0.001) and accidental falls during the hospitalisation (RR 0.39, 95% CI 0.21, 0.72, P=0.003), without evidence of differential effectiveness according to ward type or dementia rates. Non-significant reductions in delirium duration, hospital stay and mortality were found as well. INTERPRETATION: Multicomponent interventions are effective in preventing incident delirium among elderly inpatients. Effects seemed to be stable among different settings. Due to the limited amount of data, potential benefits in survival need to be confirmed in further studies. Future research should be aimed at contrasting different multicomponent programmes to select the most useful interventions.
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Delírio/prevenção & controle , Prevenção Primária/métodos , Acidentes por Quedas/prevenção & controle , Fatores Etários , Distribuição de Qui-Quadrado , Terapia Combinada , Delírio/diagnóstico , Delírio/mortalidade , Delírio/psicologia , Humanos , Incidência , Pacientes Internados , Razão de Chances , Fatores de Risco , Resultado do TratamentoRESUMO
Introducción: el delirium es un síndrome neuropsiquiátrico común entre adultos mayores. Se asocia a mayor mortalidad, deterioro cognitivo y aumentos en costos en salud. Las intervenciones multicomponentes parecen ser eficaces en prevenir el delirium. Objetivo: evaluar la evidencia disponible respecto del uso de intervenciones multicomponentes para prevenir delirium entre adultos mayores hospitalizados. Metodología: se realizó una revisión de la literatura en cinco bases de datos, en búsqueda de revisiones sistemáticas que informaran la utilidad de las intervenciones multicomponentes para reducir el delirium incidente. Las revisiones fueron evaluadas en cuanto a su calidad sobre la base de los criterios de la Colaboración Cochrane. Resultados: se detectaron tres revisiones sistemáticas. La estrategia de búsqueda fue adecuada en todas, aunque dos de ellas incluyeron ensayos no aleatorizados en el análisis. Los programas evaluados fueron heterogéneos, por lo que no se realizó metaanálisis en ninguna de ellas. Sin embargo, fueron descritos resultados benéficos en todas ellas. Discusión: existe evidencia de moderada calidad que sugiere que las intervenciones multicomponentes son eficaces para reducir el delirium incidente. Es necesario realizar nuevas revisiones sistemáticas restringidas a ensayos aleatorizados para obtener una respuesta definitiva sobre su utilidad.
Introduction. Delirium is a common neuropsychiatric syndrome arising among elderly inpatients. It has been associated with increased mortality, cognitive decline and increased healthcare costs. Multicomponent interventions might be useful in preventing incident delirium. Objectives. To assess the available evidence regarding multicomponent interventions in preventing incident delirium among elderly inpatients. Methods. A literature review was conducted in 5 databases in search for systematic reviews evaluating multicomponent interventions in preventing incident delirium. Included reviews were assessed by using the criteria recommended by the Cochrane Collaboration. Results. Three systematic reviews were found. All described adequate searching methods, but two considered non-randomized designs for analyses. Important heterogeneity was seen among studies, precluding meta-analyses. However, beneficial effects were described regarding incident delirium prevention. Discussion. Moderate-quality evidence suggests that multicomponent interventions are useful in preventing delirium. New systematic reviews should restrict their methods to randomized trials in order to allow a definitive conclusion to be made.