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IntroductionSubstance Use Disorder (SUD) is a chronic condition that impacts various facets of an individual’s life, and society as a whole. The Mindfulness-Based Relapse Prevention (MBRP) protocol is an innovative intervention that can help to prevent relapse, particularly when used as a post-treatment approach. However, although there is significant evidence of its effectiveness in studies from high-income countries (HICs), there is a dearth of studies examining its feasibility and efficacy in low- and middle-income countries (LMICs). Thus, this study investigates the feasibility of MBRP as an adjunct to outpatient treatment for SUD in a socially vulnerable Brazilian population.MethodsThe study employed a mixed-methods design in eight Psychosocial Care Centers for Alcohol and Drugs (CAPS-ad) in the city of São Paulo, and involved 140 participants, 24 healthcare professionals and 7 CAPS-ad managers. In total, 17 MBRP intervention groups were conducted. The study assessed qualitative indicators of acceptability, demand, implementation, adaptation, integration, and limited efficacy testing through group interviews, in-depth interviews and field diary records. It also included limited efficacy testing of the protocol using a quantitative pre-post pilot study to investigate consumption behavior, using the Timeline Followback (TLFB) assessment method; depression, using the Center for Epidemiologic Studies Depression (CES-D) scale; anxiety, using the state trait anxiety index (STAXI-2); craving, using the Penn Alcohol Craving Scale (PACS); readiness to change, using the Readiness-to-Change Ruler (RCR); and severity of dependence, using the Severity of Dependence Scale (SDS). The qualitative data were triangulated with the quantitative data to comprehensively evaluate the feasibility of the intervention.ResultsThe sample comprised socially vulnerable participants with a high dropout rate, primarily due to social factors. Despite facing challenges in respect of regular engagement and initial cultural misperceptions of meditation, the intervention showed positive acceptance and mental health benefits, including impacts on consumption behavior.DiscussionThe study emphasizes the importance of adapting the format of the protocol to better suit vulnerable populations, and to ensure its effective integration into the public healthcare system. Future research should explore protocol modifications, assess its effectiveness in different contexts, and conduct cost-benefit analyses for broader implementation.

Abstract Background To develop prevention programs or early interventions to reduce alcohol consumption and related problems among college students, it is essential to understand their motivations for drinking and the spontaneous (effective and non-effective) strategies they employ to control, considering the social and cultural contexts influence. This study aimed to explore these factors and the student’s application of selfcare in different situations and environments, as well as to identify their reasons for not drinking. Methods The students were invited to participate using a snowball sampling, up to the theoretical saturation point. Qualitative individual semi-structured interviews were carried out and the interviews contents were analyzed using the NVivo software. The participants were 23 college students between 18 and 24 years old, with diverse patterns of alcohol use (low-risk to suggestive of dependence). Results Data analysis highlighted three main themes: (a) Contexts (such as bars, “open bar” parties and others) and consumption patterns; (b) Protective Strategies (such as stop-drinking intervals, eating before or during drinking, returning home in the company of a friend); (c) Motivations to control drinking (such as sense of responsibility, bad previous experiences, family and religious issues). Protective strategies and motivation to control drinking were perceived to be less prominent in specific contexts that favor high alcohol consumption, as open bar parties. Conclusions Motivations and protective strategies varied according to the drinkers’ profile, social situations and settings in which they consumed alcohol. The results highlight the need for preventive interventions planned for specific drinking patterns and contexts.

Abstract Background There is a workforce shortage in the children’s hospice sector, but there has been little research on the specific challenges of working in this setting and on how these challenges might be alleviated. To identify appropriate interventions to improve staff wellbeing, the drivers of wellbeing in children’s hospices need to be known and measured. This paper reports on the development of two measures, one for work-related rewards and one for work-related stressors, for use in children’s hospice care teams. Methods A mixed-methods, four-stage study; the first three phases focused on the development of the scales, and the last stage focused on the validation of the scales. Participants of all stages were children’s hospice care team staff members in the UK. Stage 1: survey assessing the relevance and comprehensiveness of the original scale items (N = 60); Stages 2 (focus groups; N = 16) and 3 (cognitive interviews; N = 14) to assess content validity; Stage 4: UK-wide survey (N = 414) to validate the final version of the new, children’s hospice-specific scales using Rasch Analysis (RA) and Confirmatory Factor Analysis (CFA). Results Due to poor fitting indices shown in the results from the RA, five items (out of 36) were removed from the new rewards scale used in the UK-wide survey and 20 (out of 62) were removed from the new stressors scale. CFA also supported the removal of the items and showed a one-factor structure for the rewards scale and a three-factor structure for the stressors scale were adequate—the sub-scales for the stressors scale related to caring for an ill or dying child (“Child” sub-scale), working with parents and families (“Parent” sub-scale), and stressors related to organisational factors, such as team conflict and workload (“Organisation” sub-scale). Conclusions Both of the new scales showed good psychometric properties and can be useful in clinical settings and research to assess the perceived intensity of the work-related rewards and stressors for children’s hospice staff.

Abstract Background Provision of and access to paediatric end-of-life care is inequitable, but previous research on this area has focused on perspectives of health professionals in specific settings or children with specific conditions. This qualitative study aimed to explore regional perspectives of the successes, and challenges to the equitable coordination and delivery of end-of-life care for children in the UK. The study provides an overarching perspective on the challenges of delivering and coordinating end-of-life care for children in the UK, and the impact of these on health professionals and organisations. Previous research has not highlighted the successes in the sector, such as the formal and informal coordination of care between different services and sectors. Methods Semi-structured interviews with Chairs of the regional Palliative Care Networks across the UK. Chairs or co-Chairs (n = 19) of 15/16 Networks were interviewed between October-December 2021. Data were analysed using thematic analysis. Results Three main themes were identified: one standalone theme (“Communication during end-of-life care”); and two overarching themes (“Getting end-of-life services and staff in the right place”, with two themes: “Access to, and staffing of end-of-life care” and “Inconsistent and insufficient funding for end-of-life care services”; and “Linking up healthcare provision”, with three sub-themes: “Coordination successes”, “Role of the networks”, and “Coordination challenges”). Good end-of-life care was facilitated through collaborative and network approaches to service provision, and effective communication with families. The implementation of 24/7 advice lines and the formalisation of joint-working arrangements were highlighted as a way to address the current challenges in the specialism. Conclusions Findings demonstrate how informal and formal relationships between organisations and individuals, enabled early communication with families, and collaborative working with specialist services. Formalising these could increase knowledge and awareness of end of life care, improve staff confidence, and overall improve professionals’ experiences of delivering care, and families’ experiences of receiving it. There are considerable positives that come from collaborative working between different organisations and sectors, and care could be improved if these approaches are funded and formalised. There needs to be consistent funding for paediatric palliative care and there is a clear need for education and training to improve staff knowledge and confidence.

ABSTRACT The study was carried out with the objective of evaluating the effects of using phytase levels at different energy densities in the diet of broilers, from 28 to 35 days of age. The experimental diets contained increasing levels of apparent metabolizable energy corrected for nitrogen balance and different levels of phytase. Growth performance variables, nutrient digestibility, as well as variables related to bone integrity were examined. Diets containing 500 FTU/kg in combination with 3150kcal.kg-1 of AMEn resulted in better growth performance. Supplementation with 500 and 1000 FTU/kg in the diets provide better coefficients of apparent and ileal digestibility of calcium and phosphorus, but negatively influence the deposition of calcium, phosphorus, dry matter, and ash in the tibia, in addition to adversely affecting the breakage and area of these bones in broilers. Bone length and the levels of magnesium and zinc present in the tibias were not influenced by the energy and phytase levels of the diets. There is no interaction between the different energetic densities and the phytase doses in the variables analyzed in the studied period. Increasing the energy density of diets resulted in improved apparent and ileal digestibility for most nutrients.

Objectives To better understand the complexity and healthcare needs of children and young people in Wales with life-limiting or life threatening conditions to better plan and target healthcare services. Previous attempts to quantify complexity have required primary data collection; this is not feasible at scale, use of existing data is preferred. Methods Routinely collected healthcare and administrative data were linked: primary care data, hospital care data sets, cancer and congenital anomaly registries, paediatric intensive care audit data and death records. Children and young people with life-limiting conditions were identified using a previously developed diagnostic framework. Previous work on conceptualising medical complexity across eight domains was operationalised for the first time using the wide range of available data, with scores across five domains and a total complexity score. The relationship between the complexity score, healthcare use, stage of condition and category of condition was explored. Results Children and young people with life-limiting conditions showed the full range of medical complexity scores, from zero to five, with distributions varying across age groups with increasing complexity at greater ages. Distributions also varied across categories of condition, with congenital and oncology conditions, although among the most prevalent, exhibiting lower medical complexity. Nonetheless, all conditions showed a range of complexities – there were no conditions for which all individuals were either high or low complexity. Complexity scores were correlated with stage of condition and healthcare use and may be used to identify groups likely to have higher healthcare demand or greater risk of clinical instability. While life-limiting conditions were more prevalent in areas of higher deprivation, there was no association between deprivation and medical complexity. Conclusion Assessment of medical complexity from routinely-collected data can be useful in better understanding a population and in targeting and planning care, without requiring additional data collection. This can help to design resilient services that prepare for changing needs and aid targeting of limited resources.

What can it mean for today's girls and boys to encounter History-or rather, Historiography-in Primary School? It can be the beginning of a journey, starting from the here and now, to walk in small steps through time and space, to listen to the sources, to tell, one after the other, as in a count, the questions that the traces of the past pose to us, and to discover that the path taken will be, as for Ulysses, a "return home": time and place of encounters with our humanity, a traveling companion. In the suitcase three key-words, like clothes to wear, skills to acquire and use: experience, research, discovery and plenty of space to gather the tools of the historian's work.

O presente trabalho apresenta uma revisão sobre o hipercrescimento dentário e má oclusão em coelhos da espécie Oryctolagus cuniculus, visto que as doenças odontológicas representam 60% dos atendimentos na clínica de roedores e lagomorfos e há uma expansão de atendimentos nesta especialidade. O crescimento constante dos dentes do coelho pode ser prejudicado por diferentes fatores como processo infeccioso ou inflamatório, doenças metabólicas, traumas, teratogenia ou, a causa mais comum, que está relacionado ao manejo alimentar, quando não há ingestão de fibras suficientes para realização do desgaste dentário ou de movimentos mastigatórios errôneos provenientes da má oclusão. O diagnóstico deve ocorrer com base na anamnese e história clínica, associado aos exames complementares, preferencialmente de imagem. O tratamento ocorre com base na clínica, sendo recomendado o desgaste dentário ou exodontia. Nesse sentido, o conhecimento sobre as principais causas e fatores determinantes, bem como a evolução clínica e as abordagens terapêuticas do hipercrescimento dentário é de suma importância na prevenção e prognóstico, e assim, bem-estar desses animais.

Abstract Global alcohol consumption and harmful use of alcohol is projected to increase in the coming decades, and most of the increase will occur in low- and middle-income countries (LMICs); which calls for cost-effective measures to reduce alcohol exposure in these countries. One such evidence based measure is screening and brief intervention (BI) for alcohol problems. Some of the characteristics of BI make them a particularly appealing choice of interventions in low-resource settings. However, despite evidence of effectiveness, implementation of BI in LMICs is rare. In this paper we discuss barriers to implementation of BI in LMICs, with examples from Latin America and India. Key barriers to implementation of BI in LMICs are the lack of financial and structural resources. Specialized services for alcohol use disorders are limited or non-existent. Hence primary care is often the only possible alternative to implement BI. However, health professionals in such settings generally lack training to deal with these disorders. In our review of BI research in these countries, we find some promising results, primarily in countries from Latin America, but so far there is limited research on effectiveness. Appropriate evaluation of efficacy and effectiveness of BI is undermined by lack of generalisability and methodological limitations. No systematic and scientific efforts to explore the implementation and evaluation of BI in primary and community platforms of care have been published in India. Innovative strategies need to be deployed to overcome supply side barriers related to specialist manpower shortages in LMICs. There is a growing evidence on the effectiveness of non-specialist health workers, including lay counsellors, in delivering frontline psychological interventions for a range of disorders including alcohol use disorders in LMICs. This paper is intended to stimulate discussion among researchers, practitioners and policy-makers in LMICs because increasing access to evidence based care for alcohol use disorders in LMICs would need a concerted effort from all these stakeholders.

Resumo Objetivo Este estudo teve por objetivo avaliar a prevalência de dependência de internet, seus principais preditores e a associação com problemas emocionais em estudantes de psicologia (n = 1.916) e psicólogos (n = 4.359). Método Os indivíduos preencheram um questionário sociodemográfico e outros instrumentos específicos. Observou-se que 9,3% dos estudantes e 4,0% dos psicólogos foram detectados com uso excessivo de internet. Resultados Todos os participantes com uso excessivo de internet apresentaram uma frequência significativamente maior de sintomas de depressão, ansiedade e estresse, e estes problemas foram preditores para a dependência de internet somente entre os psicólogos. Conclusão Compreender o padrão de dependência de internet pode ajudar no desenvolvimento de políticas públicas específicas para esses indivíduos.

This study aimed to investigate the effects of Mindfulness-Based Relapse Prevention (MBRP) in decision-making, inhibitory control and impulsivity compared to Treatment as Usual (TAU) for individuals with Substance Use Disorders (SUD's) in Brazil. A randomized clinical trial was conducted with participants from a therapeutic community (n = 122). Decision-making (Iowa Gambling Task), impulsivity dimensions (UPPS-P Scale), and inhibitory control (Stroop Color-Word Test) were assessed before and after the MBRP 8-week intervention. GLM Multivariate analysis was used to evaluate the effects of MBRP on different impulsivity measures. The results showed that MBRP+TAU improved the general decision-making score (p = 0,008) compared to TAU. However, no significant effects were found in impulsivity dimensions and inhibitory control in individuals with SUDs in the therapeutic community. This study found improvement in decision-making in the total IGT score; however, no effect for self-reported impulsivity and inhibitory control among middle-aged patients after an 8-weeks intervention of MBRP protocol in an inpatient setting. It adds information to the subject, with implications and possible directions to be followed by the next clinical trials with patients with SUDs in treatment. Trial registration: EnsaiosClinicos.gov.br: RBR-6c9njc.

Aim: To assess the risks, benefits, and resource implications of home‐blended food for children with gastrostomy tubes compared with a formula diet. Method: This prospective cohort study of children (aged 0–18 years) collected baseline data on gastrointestinal symptoms, nutritional intake, anthropometric outcomes, parent and child quality of life, and resource use. A propensity score‐weighted generalized linear mixed model was used to compare children receiving a home‐blended versus formula diet. Results: Baseline data were obtained for 180 children (2019–2021; 107 males, 73 females; mean age 9 years 7 months [SD 4 years 5 months]). Children receiving a home‐blended diet (n = 104) had similar diagnoses and age but more lived in areas of lower deprivation and parental education was higher compared to the parents of children receiving a formula diet (n = 76). Children receiving home‐blended diets had significantly better gastrointestinal scores than those receiving formula diets (B = 13.8, p < 0.001). The number of gut infections and tube blockages were similar between the two groups but with fewer stoma site infections in the group receiving home‐blended food. Children receiving a home‐blended diet had more fibre in their diet compared to children receiving a formula diet. Interpretation: Home‐blended diets should be seen as a safe option for children who are gastrostomy‐fed unless clinically contraindicated. Equality of access to home‐blended diets for children with gastrostomy should be assessed by local clinical teams. What this paper adds: Children with gastrostomy receiving a home‐blended diet had fewer gastrointestinal symptoms compared to children receiving a formula diet.Children with gastrostomy receiving a home‐blended diet had no more complications than children receiving a formula diet. What this paper adds: Children with gastrostomy receiving a home‐blended diet had fewer gastrointestinal symptoms compared to children receiving a formula diet.Children with gastrostomy receiving a home‐blended diet had no more complications than children receiving a formula diet. [ABSTRACT FROM AUTHOR]

Background: Although child mortality has decreased over the last few decades, around 4,500 infants and children die in the UK every year, many of whom require palliative care. There is, however, little evidence on paediatric end-of-life care services. The current National Institute for Health and Care Excellence (NICE) guidance provides recommendations about what should be offered, but these are based on low quality evidence. The ENHANCE study aims to identify and investigate the different models of existing end-of-life care provision for infants, children, and young people in the UK, including an assessment of the outcomes and experiences for children and parents, and the cost implications to families and healthcare providers. Methods: This mixed methods study will use three linked workstreams and a cross-cutting health economics theme to examine end-of-life care models in three exemplar clinical settings: infant, children and young adult cancer services (PTCs), paediatric intensive care units (PICUs), and neonatal units (NNUs). Workstream 1 (WS1) will survey current practice in each setting and will result in an outline of the different models of care used. WS2 is a qualitative comparison of the experiences of staff, parents and patients across the different models identified. WS3 is a quantitative assessment of the outcomes, resource use and costs across the different models identified. Discussion: Results from this study will contribute to an understanding of how end-of-life care can provide the greatest benefit for children at the end of their lives. It will also allow us to understand the likely benefits of additional funding in end-of-life care in terms of patient outcomes.

Abstract Background Homelessness is one of the most severe forms of social exclusion and is an important public health issue. It is characterized by processes of weakening of interpersonal bonds. The objective of this study was, therefore, to elucidate how interpersonal relationships change over the life cycle of homeless drug and alcohol users. Method We used a qualitative methodology. The participants were adults who had a history of homelessness and use of alcohol and other drugs. The interviews were semi structured and used a timeline instrument. All interview were audio recorded, transcribed, and submitted to thematic analysis. Results Twenty individuals participated in the study. Reports on social exclusion over time stood out in respect of four main themes and their respective subthemes: Theme 1 – Childhood: instability upbringing, abuse, violence, and an absent or not very present father figure; Theme 2 – Adolescence: school dropout and failure; acceptance of gender and sexual orientation; birth of first child, living with a partner or getting married: Theme 3 – Adulthood: estrangement or conflicting relationship with family; health problems; drug trafficking and prostitution; Theme 4 – Cross-cutting factors: death of relatives and substance use. Conclusion The results suggest that interpersonal relationships are permeated by successive breakups, conflicts and other events that start in childhood and can have a cumulative effect in later stages of life, and cross the subsequent phases. Substance abuse and dependence are mentioned as cross-cutting factors that intensify social exclusion in all stages of life.