Non-pharmacological Interventions Research Articles

The Effectiveness of Alkaline Water Consumption and Walking Exercise on the Quality of Life of Diabetes Mellitus Patients at the Pratama Yakri Clinic

ABSTRACT In 2022, the International Diabetes Federation (IDF) recorded that 537 million adults (aged 20-79 years) or 1 in 10 people live with diabetes worldwide. Diabetes also causes 6.7 million deaths or 1 every 5 seconds. China is the country with the largest number of diabetes sufferers in the world, 140.87 million people. Furthermore, India is recorded as having 74.19 million people with diabetes, Pakistan 32.96 million, and the United States 32.22 million. Indonesia is in fifth position with the number of diabetes sufferers of 19.47 million. A person suffering from Diabetes Mellitus will have a disrupted quality of life. Apart from walking, non-pharmacological treatment that can be done by type 2 diabetes mellitus sufferers is by consuming alkaline water with a PH > 8. To determine the effectiveness of consuming alkaline water and walking exercise on the quality of life of diabetes mellitus patients. Quasi experiment with a posttest group design. The sample in this study was all 40 diabetes mellitus patients at the Pratama Yakri Clinic in Jakarta in December 2023. The sampling technique uses total sampling. The majority of respondents in the intervention group had good quality of life (70.0%), in the majority group their quality of life was very poor (75.0%). Alkaline water consumption and walking exercise are effective in improving the quality of life of diabetes mellitus patients (p value 0.000). Consuming alkaline water and walking exercise are effective in improving the quality of life of diabetes mellitus patients. It is hoped that diabetes mellitus sufferers will carry out activities such as walking and consuming alkaline water to improve their quality of life. Keywords: Walking Exercise, Alkaline Water, Diabetes Mellitus, Quality Life

Monitoring and reporting adverse events in pragmatic clinical trials testing nonpharmacological pain management interventions.

Monitoring and reporting adverse events in pragmatic clinical trials testing nonpharmacological pain management interventions.

A health-equity framework for tailoring digital non-pharmacological interventions in aging

A health-equity framework for tailoring digital non-pharmacological interventions in aging

Adapting to change: experiences and recommendations from the Pain Management Collaboratory on modifying statistical analysis plans.

Best practices for clinical trials stipulate that statistical analysis plans (SAPs) need to be finalized before initiation of any analysis. However, there is limited guidance about when changes to SAPs are acceptable and how these changes should be incorporated into the research plan with appropriate documentation. We conducted a survey of 12 pragmatic clinical trials (PCTs) in the Pain Management Collaboratory that evaluated nonpharmacological interventions for pain to assess the following SAP information: (1) location of statistical analysis details, (2) types of statistical analyses planned, (3) sponsor requirements, (4) templates used for development, (5) publication plan, (6) changes since trial launch, (7) process of documenting changes, and (8) process of updating the trial registry. All 12 PCTs provided details of their SAPs for the primary outcomes in the institutional review board-approved trial protocol; 8 included plans for secondary outcomes, and 6 included plans for tertiary/exploratory outcomes. Most PCTs made SAP changes after trial initiation, many as a result of COVID-19-related issues. Eleven of the PCTs were actively recruiting participants. Changes were made to sample size, study design, study arms, and analytical methods, all before the data lock/unblinding. In all cases, justification for the changes was documented in the trial protocol or SAP, signed off by the trial biostatistician and principal investigator, and reviewed/approved by an institutional review board, data and safety monitoring board, or sponsor. We recommend that SAP changes can be acceptable up to the time of data lock/unblinding. To maintain full transparency and necessary rigor, clear documentation of such changes should include details, rationale, date(s) such changes were implemented, and evidence of approval by relevant oversight bodies.

The Italian guideline on diagnosis and treatment of dementia and mild cognitive impairment.

Approximately 2 million people in Italy are currently living with dementia or mild cognitive impairment (MCI), and 4 million are involved as family members or caregivers. Considering the significant impact of dementia, the Italian Ministry of Health entrusted the Italian National Institute of Health (Istituto Superiore di Sanità) with the development of a guideline within the Italian National Guideline System (Sistema Nazionale Linee Guida, SNLG) on the diagnosis and treatment of dementia and MCI. The main objective was to provide evidence-based recommendations aimed at reducing the variability and ensuring the appropriateness of clinical practices throughout the whole care process from identification and diagnosis to the end of life for people with dementia (PwD) or MCI and their families/caregivers. The GRADE-ADOLOPMENT approach was used to adopt, adapt and update the guideline developed by the National Institute for Health and Care Excellence in 2018 (NG97). The methodology was based on the Methodological Handbook produced by the SNLG. A multidisciplinary panel of 29 experts and four representatives of family members/caregivers discussed and approved 47 review questions. Of these, 34 questions were adopted from the NG97, and 13 were new questions, including 10 questions referring to MCI. Systematic literature reviews were performed for each question, and a team of methodological and clinical experts qualitatively assessed and summarised results from included studies based on the GRADE approach. To facilitate the implementation and dissemination of the contents of this guideline, a care pathway and a leaflet dedicated to PwD or MCI and their families/caregivers were also developed. The literature review for this guideline included studies published up to November 2023. More than 1000 peer-reviewed publications were included, covering the following areas: (i) identification, diagnosis and post-diagnostic support; (ii) care models and care coordination; (iii) pharmacological interventions for cognitive symptoms; (iv) non-pharmacological interventions for cognitive symptoms; (v) non-cognitive symptoms, intercurrent illnesses and palliative care. The multidisciplinary panel discussed and approved 167 clinical practice recommendations and 39 research recommendations. Italy's first National Guideline on dementia and MCI addresses diagnosis, treatment and care within the National Healthcare System. It includes recommendations on pharmacological and non-pharmacological approaches, and emphasises tailored interventions, comprehensive cognitive assessment, staff training and palliative care. The guideline also underlines the need to involve PwD in decision-making and supporting caregivers throughout the entire course of the disease. Structured strategies for the dissemination and implementation of the guideline will be defined within the Italian Fund for Alzheimer and other Dementias 2024-2026. An interactive care pathway and a leaflet dedicated to PwD and their carers are already available. The guideline will be updated starting January 2027, but early updates may be planned in case of breakthrough advancements.

Effect of GLP-1 receptor agonists on weight and cardiovascular outcomes: A review.

Diet and lifestyle modifications remain the foundation of obesity treatment, but they have historically proven insufficient for significant, long-term weight loss. As a result, there is a high demand for new pharmacologic treatments to promote weight loss and prevent life-threatening diseases associated with obesity. Researchers are particularly interested in 1 type of drug, glucagon-like peptide 1 receptor agonists (GLP-1 RAs), because of its promising potential in addressing the limitations of non-pharmacologic treatments. In addition to their role in weight loss, these drugs have shown promising early evidence of cardiovascular benefits in obese patients, further enhancing their clinical relevance. Semaglutide and liraglutide, which were initially approved for the treatment of type 2 diabetes, have since been approved by the Food and Drug Administration as weight loss medications due to their effectiveness in promoting significant and sustained weight loss. In this narrative review, we will explore the mechanism of GLP-1 RAs, their effects on weight loss, cardiovascular risk factors and outcomes, common adverse effects, and strategies for managing these effects.

Effectiveness of Virtual Yoga for Chronic Low Back Pain

Chronic low back pain (CLBP) is a common condition with substantial impact on patients, in the form of physical and emotional suffering; health care costs; productivity; and health care professional burden. Although clinical guidelines recommend use of nonpharmacologic treatments first, such as yoga, there is a gap between guidelines and implementation in clinical practice. To compare the effects of virtual yoga classes vs a wait-list control on CLBP intensity, back-related function, sleep quality, and pain medication use. Single-blinded, 24-week, 2-arm, randomized clinical trial conducted from May 3, 2022, through May 23, 2023, comparing live streamed yoga classes (the yoga now group) with a wait-list control (the yoga later group, in which participants were offered the virtual intervention after the study but without assessments) among adults with CLBP. Adults 18 to 64 years of age with CLBP were recruited from the Cleveland Clinic Employee Health Plan, a large health system self-insured health plan. Inclusion criteria included a mean LBP intensity score of at least 4 on an 11-point numerical rating scale (scores ranged from 0 to 10, with higher scores indicating worse pain) and daily back pain interference about half or more of the days. Twelve consecutive weekly, 60-minute, virtual, live streamed hatha yoga group classes. Coprimary outcomes were mean pain intensity in the previous week on the 11-point numerical rating scale and back-related function as assessed using the 23-point modified Roland Morris Disability Questionnaire ([RMDQ], with higher scores reflecting poorer function) at 12 weeks. Secondary and exploratory outcomes included these measures at 24 weeks, pain medication use, and PROMIS sleep quality assessed using the Sleep Disturbance Short Form 8a, item 1 (scores ranged from 0 to 4, with higher scores reflecting better sleep quality). Analyses followed the intention-to-treat principle. Among 140 participants enrolled (yoga now = 71; yoga later = 69), the mean (SD) age was 47.8 (11.7) years and most were female (113 [80.7%]) and college-educated (103 [73.5%]). Mean (SD) baseline pain intensity (5.7 [1.5]) and RMDQ ([12.1 [4.4]) scores reflected moderate back pain and impairment. At week 12, yoga now compared with yoga later had greater reductions in mean pain intensity (-1.5 [95% CI, -2.2 to -0.7] points; P < .001) and mean RMDQ (-2.8 [95% CI, -4.3 to -1.3] points; P < .001) scores. At 24 weeks, the improvements in pain (mean change, -2.3 [95% CI, -3.1 to -1.6] points; P < .001) and RMDQ (mean change, -4.6 [95% CI, -6.1 to -3.1] points; P < .001) scores were sustained. At 12 weeks, yoga now participants reported 21.4 (95% CI, 5.2-37.6) absolute percentage points less use of any analgesic medication during the past week than yoga later participants and at 24 weeks, 21.2 absolute percentage points (95% CI, 5.2%-37.3%). Improvements in sleep quality were greater for participants in yoga now than among participants in yoga later at 12 weeks (mean change, 0.4 [95% CI, 0.1-0.7] points; P = .008) and 24 weeks (mean change, 0.4 [95% CI, 0.1-0.7] points; P = .005). Results of this randomized clinical trial of 140 adults with CLBP who were members of a large health system self-insured health plan suggest that virtual yoga classes may be a feasible, safe, and effective treatment option. ClinicalTrials.gov Identifier: NCT05319691.

Impact of the COVID-19 pandemic on participants in pragmatic clinical trials for chronic pain: implications for trial outcomes and beyond.

The COVID-19 pandemic had profound effects on society, including those living with chronic pain. This study sought to examine pandemic impacts on individuals enrolled in pragmatic clinical trials focused on nonpharmacological treatments for chronic pain. We evaluated responses to a questionnaire on COVID-19 impacts that had been administered to participants (n=2024) during study enrollment in 3 pragmatic clinical trials for chronic pain treatment. All trials were part of the National Institutes of Health (NIH)-Department of Veterans Affairs (VA)-Department of Defense (DOD) Pain Management Collaboratory. COVID-19-related impacts on access to health care, mental health, finances, ability to meet basic needs, and social support were assessed. Pandemic impacts were found in all domains assessed, including access to health care, mental and emotional health, ability to meet basic needs, finances, and social support. Impacts varied by demographic and clinical characteristics. The participants most negatively impacted by the pandemic were younger, Black or Latino, female, more educated, and unemployed and had screened positive for depression. No impact differences were found with regard to alcohol use disorder screenings or a prior history of COVID-19. Higher levels of pain were associated with worse pandemic impacts, and negative impacts declined over time. Negative impacts of the pandemic on individuals living with chronic pain cut across aspects of life that are also central to effective pain management, including access to health care, social support, and mental and emotional health, with differential impacts found across key demographic and clinical factors. These findings should yield consideration of pandemic impacts in clinical practice and as moderating effects of treatment outcomes in clinical trials conducted during the pandemic.

The efficacy of cognitive stimulation, cognitive training, and cognitive rehabilitation for people living with dementia: a systematic review and meta-analysis.

Cognition-oriented treatments (COTs) are a group of non-pharmacological treatments aimed at maintaining or improving cognitive functioning. Specific recommendations on the use of these interventions in people living with dementia (PLwD) are included in the Italian Guideline on the Diagnosis and Treatment of Dementia and Mild Cognitive Impairment, developed by the Italian National Institute of Health. This systematic review and meta-analysis, based on the GRADE methodology, is part of the guideline. Considered outcomes included the cognitive functions, quality of life, and functional abilities of PLwD, taking into account disease severity, modality and system of delivery, and form of the intervention. The effectiveness of these interventions on caregivers' outcomes was also assessed. Both group and individual cognitive stimulation were reported as effective in supporting cognitive functions in PLwD at any degree of severity. Individual cognitive training and group cognitive training were reported as effective in improving global cognitive functions in people with mild dementia. Cognitive rehabilitation appeared to be effective only in improving the functional abilities of people with mild dementia. Cognitive rehabilitation appeared to be the most effective in improving caregivers' outcomes, with results suggesting a reduction in care burden. The observed differences in the effectiveness of these interventions in people with different disease severity can be explained by the intrinsic characteristics of each intervention. Despite the large number of available studies, a high clinical, statistical, and methodological heterogeneity was observed. More methodologically rigorous studies are needed to clarify the effectiveness of each protocol and modality of intervention.

Attitudes and Beliefs Regarding Pain and Discrimination Among Black Adults with Sickle Cell Disease: A Mixed Methods Evaluation of an Adapted Chronic Pain Intervention.

This study sought to adapt a chronic pain group curriculum for adults with sickle cell disease (SCD). Given the association of experiences of racism and discrimination with health outcomes, this study also explored how such experiences for patients with SCD impact their interactions with clinicians and health-care systems. This mixed methods study recruited patients (aged ≥18 years) in a sickle cell treatment program; all self-identified as Black or African American. Key informant interviews evaluated a chronic pain program curriculum and rated the curriculum sessions' importance for SCD pain management. A survey containing six validated instruments then measured experiences of pain and discrimination, level of emotional expressivity, and trust in physicians and health insurers. Of the 19 adult patients approached, 12 (63%) completed the interview and survey. Interview data analysis resulted in five themes comprising pain, treatment, mental/emotional, health-care clinicians, and differences in SCD versus other chronic conditions. Each curriculum session was rated as "very important" or "important" by participants. Most described at least one experience of racism or discrimination in the medical setting and identified clinicians' lack of knowledge as a barrier to appropriate SCD care. Participants identified the importance of non-pharmacological treatments for SCD pain and appropriately managing pain caused by comorbid chronic conditions. Conversely, survey responses reported moderate levels of pain, infrequent discriminatory experiences in the medical setting, and moderate trust in medical professionals, whereas most reported experiences of discrimination in general settings. Many participants reported they either accepted it or did nothing in response to discriminatory experiences. Study findings emphasize the need to address experiences of racism and stigma in addition to experiences of emotional and physical pain among patients with SCD in the context of pain management. Findings from this study will inform the development of a SCD pain group curriculum for adult patients.

Nonpharmacological interventions for managing postoperative pain and anxiety in children: A randomized controlled trial.

Hospitalizations and surgical procedures are unpleasant for both children and their parents. Therefore, postoperative pain assessments and management are less commonly performed in younger children than in adults. To evaluate the effects of nonpharmacological interventions on postoperative pain and anxiety in children. In this randomized controlled trial, 160 children were randomly allocated to experimental (n=80) and control (n=80) groups. The children in the experimental group received age-appropriate distraction interventions for 3 postoperative days along with usual care. Children in the control group received standard care only. Each patient's pain was assessed using the EVENDOL pain scale, while their anxiety was measured using the modified Yale Preoperative Anxiety Scale. The data were analyzed using SPSS 23.0. Descriptive statistics (frequency, percentage, mean, and standard deviation) and repeated-measures analysis of variance were used to analyze the data. The children in the experimental group showed significantly decreased pain, anxiety, and physiological parameters (heart rate, respiratory rate, and oxygen saturation) compared to those in the control group. Significant intergroup differences were noted in the mean and standard deviation values of the pain, anxiety, and physiological parameters. The distraction interventions provided by nurses reduced the pain and anxiety levels and improved the postoperative recovery of pediatric surgical patients.

A clinical algorithm for diagnosis and treatment of insomnia in adults: an updated review.

Difficulty falling asleep and/or maintaining sleep are common complaints in patients visiting medical clinics. Insomnia can occur alone or in combination with other medical or psychiatric disorders. Diagnosis and management of insomnia at times are perplexing. This updated study review aimed at a clinical algorithm for diagnosis and treatment of insomnia in adults. We developed an easy-to-apply algorithm to diagnose and manage insomnia that can be used by general practitioners and non-sleep specialists. To this end, our team reviewed the previous studies to determine the prevalence, evaluation, and treatment of insomnia. We used the results to develop a clinical algorithm for diagnosing and managing insomnia.Insomnia occurs in a short (less than 3months duration) or chronic form (≥3months duration). Insomnia management includes both pharmacological and non-pharmacological interventions. There is ample research evidence for the impact of a variety of non-pharmacological treatments, but both types of treatments can be used for each patient. If there are any contradictions in the diagnosis process, therapists should use objective instruments, such as polysomnography, but they should not be in a hurry to use these instruments.

Evidence-Based Review on Symptomatic Management of Huntington's Disease.

Huntington's disease (HD) is a neurodegenerative disorder characterized by motor, behavioral, and cognitive impairments and significant impacts on patient quality of life. This evidence-based review, conducted by the Korean Huntington Disease Society task force, systematically examines current pharmacological and nonpharmacological interventions for symptomatic management of HD. Following PRISMA guidelines, databases were searched for studies up to August 2022 that focused on 23 symptoms across four domains: motor, neuropsychological, cognition, and others. This review provides a comprehensive and systematic approach to the management of HD, highlighting the need for more high-quality clinical trials to develop robust evidence-based guidelines.

Effectiveness of Non-Pharmacological Interventions for Spasticity Management in Multiple Sclerosis: A Systematic Review.

This systematic review aims to determine the effectiveness of non-pharmacological interventions for the management of spasticity in people with multiple sclerosis (pwMS). A comprehensive literature search in health science databases (MEDLINE, Embase, CENTRAL, CINHAL) was performed to identify randomized controlled trials (RCTs) (up to April 2024). Manual searching in journals and screening of the reference lists of identified studies were conducted. Two authors independently selected the studies, assessed the methodological quality, and summarized the evidence. A meta-analysis was not feasible due to the methodological, clinical, and statistical diversity of the included studies. Overall, 32 RCTs (n=1,481 participants) investigated various types of non-pharmacological interventions including: physical activity, transcranial magnetic stimulation (intermittent theta burst stimulation [iTBS], repetitive transcranial magnetic stimulation [rTMS]), electromagnetic therapy, transcutaneous electrical nerve stimulation, vibration therapy, shock wave therapy, self-management educational programs, and acupuncture. All studies scored 'low' on the methodological quality assessment, implying a high risk of bias. The findings suggest 'moderate to low certainty' evidence for physical activity programs used in isolation or combination with other interventions (pharmacological or non-pharmacological), and for iTBS/rTMS with or without adjuvant exercise therapy in improving spasticity in adults with MS. There is 'very low certainty' evidence supporting the use of other modalities for treating spasticity in this population. Despite a wide range of non-pharmacological interventions used for the management of spasticity in pwMS, there is a lack of conclusive evidence for many. More robust trials with larger sample sizes and longer-term follow-ups are needed to build evidence for these interventions.

Evaluating a multicomponent intervention for managing kidney outcomes among patients with moderate or advanced chronic kidney disease (CKD): protocol for the Strategies for Kidney Outcomes Prevention and Evaluation (SKOPE) randomized controlled trial

BackgroundChronic kidney disease (CKD) poses a global health challenge with high morbidity and mortality rates. Early detection and prompt intervention are critical in preventing progression to end-stage kidney disease (ESKD) and cardiovascular complications. Effective CKD management requires comprehensive care packages that integrate both pharmacological and non-pharmacological interventions within collaborative, team-based models, aiming to enhance patient outcomes and overall quality of life. The goal of the Strategies for Kidney Outcomes Prevention and Evaluation (SKOPE) study is to establish effective multicomponent intervention (MCI) strategies for evaluating and preventing kidney outcomes in patients with moderate to advanced CKD within primary care settings in Singapore.MethodsThis study is a 3-year randomized controlled trial among 896 participants aged between 40 and 80 years with moderate or advanced CKD in five government-subsidized polyclinics in Singapore. The components of the MCI are (1) nurses/service coordinators trained as health coaches for motivational conversation and CKD-specific lifestyle counseling on diet and exercise, using a hybrid follow-up approach of in-person, telephone, and secure video meetings; (2) training physicians in algorithm-based standardized management of CKD; (3) subsidy on SGLT2i medications for CKD; and (4) regular CKD case review meetings. The primary outcome is the estimated glomerular filtration rate (eGFR) total slope from randomization to final follow-up at 36 months.DiscussionIf shown to be effective, cost-effective, and acceptable, SKOPE should be considered for scaling country-wide and in similar regional healthcare systems.Trial registrationClinicalTrials.gov NCT05295368. Registered on March 25, 2022.

Recent Insights in the Treatment for Clinical High Risk for Psychosis and Recent Onset Psychosis

Objectives: This study aims to assess the effectiveness of early interventions in preventing psychosis transition, promoting remission, and reducing hospitalization rates in individuals at high risk for psychosis and those with recent onset psychosis (ROP).Methods: A systematic review and meta-analysis were conducted, comparing early intervention strategies such as cognitive-behavioral therapy and psychosocial support to no intervention. The study focused on outcomes related to psychosis transition, remission rates, and prevention of psychiatric hospitalization.Results: Although only a subset of clinical high risk (CHR) individuals transition to full psychosis, non-pharmacological treatments like cognitive-behavioral therapy are generally recommended as a first-line approach. In ROP patients, early pharmacological treatment reduces relapse rates, while psychosocial interventions aim to improve various functional outcomes. The meta-analysis results of this study did not show a significant reduction in psychosis transition rates with specialized interventions for CHR patients. For ROP patients, early interventions initially reduced hospitalization rates, but this effect was not sustained in mid-term follow-up results.Conclusion: While early interventions offer short-term benefits in reducing psychosis transition and hospitalization, additional research is needed to determine their long-term effectiveness in functional recovery and overall patient outcomes.

Alzheimer’s Disease, Obesity, and Type 2 Diabetes: Focus on Common Neuroglial Dysfunctions (Critical Review and New Data on Human Brain and Models)

Background/Objectives. Obesity, type 2 diabetes (T2D), and Alzheimer’s disease (AD) are pathologies that affect millions of people worldwide. They have no effective therapy and are difficult to prevent and control when they develop. It has been known for many years that these diseases have many pathogenic aspects in common. We highlight in this review that neuroglial cells (astroglia, oligodendroglia, and microglia) play a vital role in the origin, clinical–pathological development, and course of brain neurodegeneration. Moreover, we include the new results of a T2D-AD mouse model (APP+PS1 mice on a high-calorie diet) that we are investigating. Methods. Critical bibliographic revision and biochemical neuropathological study of neuroglia in a T2D-AD model. Results. T2D and AD are not only “connected” by producing complex pathologies in the same individual (obesity, T2D, and AD), but they also have many common pathogenic mechanisms. These include insulin resistance, hyperinsulinemia, hyperglycemia, oxidative stress, mitochondrial dysfunction, and inflammation (both peripheral and central—or neuroinflammation). Cognitive impairment and AD are the maximum exponents of brain neurodegeneration in these pathological processes. both due to the dysfunctions induced by metabolic changes in peripheral tissues and inadequate neurotoxic responses to changes in the brain. In this review, we first analyze the common pathogenic mechanisms of obesity, T2D, and AD (and/or cerebral vascular dementia) that induce transcendental changes and responses in neuroglia. The relationships between T2D and AD discussed mainly focus on neuroglial responses. Next, we present neuroglial changes within their neuropathological context in diverse scenarios: (a) aging involution and neurodegenerative disorders, (b) human obesity and diabetes and obesity/diabetes models, (c) human AD and in AD models, and (d) human AD-T2D and AD-T2D models. An important part of the data presented comes from our own studies on humans and experimental models over the past few years. In the T2D-AD section, we included the results of a T2D-AD mouse model (APP+PS1 mice on a high-calorie diet) that we investigated, which showed that neuroglial dysfunctions (astrocytosis and microgliosis) manifest before the appearance of amyloid neuropathology, and that the amyloid pathology is greater than that presented by mice fed a normal, non-high-caloric diet A broad review is finally included on pharmacological, cellular, genic, and non-pharmacological (especially diet and lifestyle) neuroglial-related treatments, as well as clinical trials in a comparative way between T2D and AD. These neuroglial treatments need to be included in the multimodal/integral treatments of T2D and AD to achieve greater therapeutic efficacy in many millions of patients. Conclusions. Neuroglial alterations (especially in astroglia and microglia, cornerstones of neuroinflammation) are markedly defining brain neurodegeneration in T2D and A, although there are some not significant differences between each of the studied pathologies. Neuroglial therapies are a very important and p. promising tool that are being developed to prevent and/or treat brain dysfunction in T2D-AD. The need for further research in two very different directions is evident: (a) characterization of the phenotypic changes of astrocytes and microglial cells in each region of the brain and in each phase of development of each isolated and associated pathology (single-cell studies are mandatory) to better understand the pathologies and define new therapeutic targets; (b) studying new therapeutic avenues to normalize the function of neuroglial cells (preventing neurotoxic responses and/or reversing them) in these pathologies, as well as the phenotypic characteristics in each moment of the course and place of the neurodegenerative process.

Design and development of an ai-driven communication model for stimulating memory recall in patients with Alzheimer’s and other neurodegenerative diseases

This study presents the development and evaluation of an AI-driven communication tool designed to stimulate memory recall in patients with Alzheimer’s disease and other neurodegenerative disorders. The tool integrates machine learning algorithms, including Random Forest and Long Short-Term Memory (LSTM) networks, with mass communication theories to deliver personalized and adaptive communication strategies. The AI models were trained and tested on patient interaction data, enabling the tool to dynamically adjust its prompts based on real-time cognitive states. Performance metrics such as accuracy, precision, and AUC-ROC were used to assess model efficacy, with the Random Forest model achieving the highest performance across all metrics. Clinical trials demonstrated significant improvements in memory recall and emotional engagement in patients using the AI tool compared to standard cognitive stimulation therapy. Caregivers also reported higher satisfaction with the tool's usability and impact on patient interaction quality. These findings highlight the potential of AI-driven, personalized communication tools to revolutionize Alzheimer's care, offering scalable, adaptive interventions that improve cognitive and emotional health. Academically, this work advances the integration of AI and health communication, emphasizing culturally sensitive and patient-centered approaches. In healthcare, it presents a promising non-pharmacological intervention that can be easily scaled for widespread use, potentially reducing caregiver burden and improving patient outcomes.

The effect of listening to the voice recording of relatives on chest pain, anxiety and depression in patients hospitalized in the coronary intensive care unit: A randomized controlled trial.

After acute myocardial infarction, the prevalence of anxiety and depression is quite high in patients because of severe chest pain, distance from relatives, unfamiliar environment and orientation problems. To assess the effect of listening to the voice recordings of relatives of patients with acute myocardial infarction who were treated in the coronary intensive care unit (ICU) on chest pain, anxiety and depression parameters of the patients. In the study, which was conducted as a randomized controlled trial, voice recordings of the family members of the patients were created and played to the patients through a music pillow. The study was carried out with 60 patients, 30 experimental and 30 control groups. Three tests were applied to the patients 15 min before, and 15 and 30 min after the application. The data of the study were collected using the Patient Introduction Form, Hospital Anxiety Depression Scale, Visual Analogue Scale and Patient Follow-up Form. It was found that there was a significant decrease in the anxiety level of the patients in the intervention group after listening to the audio recording (p < .001, 95% CI: -3.796; -0.070). However, there was no significant difference between the pain and depression scores of the control and intervention groups (p > .05). In the ICUs of patients with acute myocardial infarction, it may be recommended to play audio recordings of their relatives to reduce the severity of anxiety. In the intensive care setting, the use of voice recordings of relatives can be used as an effective, non-pharmacological intervention to reduce anxiety in patients with acute myocardial infarction. This approach may potentially improve overall recovery by reducing patient anxiety in the intensive care setting.

Mechanical acupuncture at HT7 attenuates alcohol self-administration in rats by modulating neuroinflammation and altering mPFC-habenula-VTA circuit activity.

Alcohol use disorder is a chronic disorder with significant limitations in pharmacological treatments, necessitating the exploration of non-pharmacological interventions. We used a model of alcohol self-administration (10% v/v) to analyze behavioral, neurochemical, and signaling mechanisms. Our findings demonstrate that stimulation of the HT7 acupuncture point significantly decreased the frequency of active lever presses in rats self-administering alcohol (p < 0.05). Alcohol self-administration increased microglial activity and sigma 1 receptor expression in the habenula (Hb), while HT7 stimulation mitigated these effects, decreasing microglial activity and sigma 1 receptor levels (p < 0.05). Additionally, alcohol self-administration reduced brain-derived neurotrophic factor (BDNF) expression in the medial prefrontal cortex (mPFC) and increased tyrosine hydroxylase (TH) levels in the ventral tegmental area (VTA) (p < 0.05). HT7 stimulation reversed these alterations by increasing BDNF expression in the mPFC and decreasing TH levels in the VTA (p < 0.05). Further investigation revealed that BDNF microinjection into the mPFC inhibited sigma 1 receptor activity in the Hb, while microglial inhibition in the Hb decreased TH expression in the VTA (p < 0.05). The administration of the microglial inhibitor MINO to the Hb also reduced alcohol self-administration (p < 0.05). These results suggest that HT7 stimulation regulates the mPFC-Hb-VTA circuit, leading to decreased alcohol-seeking behavior. Our study demonstrates that HT7 acupuncture can modulate the mPFC-Hb-VTA circuit, providing a potential non-pharmacological treatment for alcohol-seeking behavior by influencing microglial activity, sigma 1 receptor expression, and TH levels. These findings contribute to a deeper understanding of the neural mechanisms underlying acupuncture's therapeutic effects on alcohol use disorder.