Activated Charcoal (Detox)

OBJECTIVE: The internet has become an important element in people's lives. The increasing use of smartphones and other electronic devices has promoted an increase in digital interactions, resulting in significant problems in the field of mental health. However, one of the implications of excessive internet use is impaired sleep quality, especially among users who use the internet before bed. METHODS: We searched the PubMed, Web of Science and PsycINFO databases to identify articles that addressed the association between excessive internet use and sleep quality. Studies in which participants had a previous diagnosis of insomnia or used psychoactive substances were excluded. RESULTS: The initial search resulted in a total of 3269 articles, 25 of which met the inclusion criteria. The results suggested an association between excessive internet use and sleep quality. CONCLUSION: Excessive internet use significantly compromises sleep quality, directly affecting users' mental and physical health. This study highlights the importance of strategies that promote digital education to raise awareness about the risks of excessive use of screens. Systematic review registration: PROSPERO, CRD 42024610542.

BACKGROUND: Digital connectivity is essential in modern work environments, enhancing productivity and communication. However, its rapid expansion post-COVID-19 raises concerns about burnout, digital fatigue, and work-related stress. OBJECTIVE: This PRISMA-based systematic review examines the benefits and challenges of digital work, assessing its impact on occupational health and proposing mitigation strategies. METHODS: A systematic search of PubMed, Google Scholar, Scopus, and Cochrane Library identified 40 peer-reviewed studies published since 2020, focusing on digital connectivity, remote work, and employee well-being. Studies on purely technological aspects were excluded. RESULTS: While digital tools improve efficiency and flexibility, they also increase workload, cognitive overload, and stress. Prolonged screen exposure contributes to mental exhaustion and sleep disturbances. Limited digital infrastructure further exacerbates productivity barriers. CONCLUSIONS: Digital connectivity offers both opportunities and risks. Organizations should implement structured policies such as offline hours, digital detox initiatives, and mental health support to sustain productivity and well-being. Future research should explore sector-specific interventions and long-term impacts of digital work practices.

The impact of social media has been significant on various aspects of life, particularly mental health. Growing concerns about the adverse effects of social media use have prompted the exploration of experimental interventions, defined as digital detox interventions. However, it remains unclear whether digital detox interventions are effective for mental health outcomes. The aim of this study was to provide comprehensive insights into the effects of digital detox interventions on various mental health outcomes, including depression, life satisfaction, stress, and mental well-being. Following the PRISMA guidelines, systematic searches were carried out in online databases, including PubMed and ScienceDirect, within the publication range of 2013 and 2023. A total of 2578 titles and abstracts were screened, and 10 studies were included in the analysis. A risk of bias assessment was conducted using RoB 2.0 and the Newcastle-Ottawa scale, while statistical analysis was conducted using RevMan 5.4.1. Our data indicated a significant effect of digital detox in mitigating depression with the standardized mean difference (SMD: -0.29; 95%CI: -0.51, -0.07, p=0.01). No statistically significant effects were discerned in terms of life satisfaction (SMD: 0.20; 95%CI: -0.12, 0.52, p=0.23), stress (SMD: -0.31; 95%CI: -0.83, 0.21, p=0.24), and overall mental well-being (SMD: 0.04; 95%CI: -0.54, 0.62, p=0.90). These data underscore the nuanced and selective influence of digital detox on distinct facets of mental health. In conclusion, digital detox interventions significantly reduce depressive symptoms, suggesting that intentional reduction or cessation of digital engagement may help alleviate contributing factors. However, no statistically significant effects were observed in mental well-being, life satisfaction, and stress. This discrepancy may be due to the complex nature of these constructs, involving various factors beyond the scope of digital detox interventions. © 2024 The Author(s).

OBJECTIVE: To determine the association between genetic factors and molar-incisor hypomineralisation (MIH) and/or hypomineralised second primary molars by means of a systematic review. DESIGN: A search was performed in Medline-PubMed, Scopus, Embase and Web of Science databases; manual search and search in gray literature were also performed. Selection of articles was performed independently by two researchers. A third examiner was involved in cases of disagreement. Data extraction was performed using an Excel® spreadsheet and independent analysis was performed for each outcome. RESULTS: Sixteen studies were included. There was an association between MIH and genetic variants related to amelogenesis, immune response, xenobiotic detoxification and other genes. Moreover, interactions between amelogenesis and immune response genes, and SNPs in the aquaporin gene and vitamin D receptors were associated with MIH. Greater agreement of MIH was found in pairs of monozygotic twins than dizygotic twins. The heritability of MIH was 20 %. Hypomineralised second primary molars was associated with SNPs in the hypoxia-related HIF-1 gene and methylation in genes related to amelogenesis. CONCLUSION: With very low or low certainty of evidence, an association was observed between MIH and SNPs in genes associated with amelogenesis, immune response, xenobiotic detox and ion transport. Interactions between genes related to amelogenesis and immune response as well as aquaporin genes were associated to MIH. With very low certainty of evidence, hypomineralised second primary molars was associated to a hypoxia-related gene and to methylation in genes related to amelogenesis. Moreover, higher agreement of MIH in pairs of monozygotic twins than dizygotic twins was observed.

BACKGROUND: Esophageal carcinoma is the third most common gastrointestinal malignancy worldwide and is largely unresponsive to therapy. African-Americans have an increased risk for esophageal squamous cell carcinoma (ESCC), the subtype that shows marked variation in geographic frequency. The molecular architecture of African-American ESCC is still poorly understood. It is unclear why African-American ESCC is more aggressive and the survival rate in these patients is worse than those of other ethnic groups. METHODS: To begin to define genetic alterations that occur in African-American ESCC we conducted microarray expression profiling in pairs of esophageal squamous cell tumors and matched control tissues. RESULTS: We found significant dysregulation of genes encoding drug-metabolizing enzymes and stress response components of the NRF2- mediated oxidative damage pathway, potentially representing key genes in African-American esophageal squamous carcinogenesis. Loss of activity of drug metabolizing enzymes would confer increased sensitivity of esophageal cells to xenobiotics, such as alcohol and tobacco smoke, and may account for the high incidence and aggressiveness of ESCC in this ethnic group. To determine whether certain genes are uniquely altered in African-American ESCC we performed a meta-analysis of ESCC expression profiles in our African-American samples and those of several Asian samples. Down-regulation of TP53 pathway components represented the most common feature in ESCC of all ethnic groups. Importantly, this analysis revealed a potential distinctive molecular underpinning of African-American ESCC, that is, a widespread and prominent involvement of the NRF2 pathway. CONCLUSION: Taken together, these findings highlight the remarkable interplay of genetic and environmental factors in the pathogenesis of African-American ESCC.

Although completion of detoxification (detox) and a successful transition from detox to substance use disorder (SUD) treatment and/or mutual-help groups are associated with better SUD outcomes, many patients do not complete detox or do not receive SUD care following detox. The purpose of this structured evidence review, summarizing data extraction on a yield of 26 articles, is to identify patient, program, and system factors associated with the outcomes of completion of alcohol detox and successful transitions from alcohol detox to SUD treatment and mutual-help group participation. The review found wide variability among studies in the rates at which patients complete a detox episode (45 to 95%) and enter SUD treatment or mutual-help groups after detox (14 to 92%). Within program factors, behavioral practices that contribute to both detox completion and transitioning to SUD care after detox entail involving the patient's family and utilizing motivational-based approaches. Such practices should be targeted at younger patients, who are less likely to complete detox. Although more studies using a randomized controlled trial design are needed, the evidence suggests that barriers to detox completion and transition to SUD care can be overcome to improve patient outcomes. Published by Elsevier Inc.

INTRODUCTION: Dependence on opioids is a multifactorial condition involving genetic and psychosocial factors. There are three stages to treating opioid dependence. Stabilisation is usually by opioid substitution treatments, and aims to ensure that the drug use becomes independent of mental state (such as craving and mood) and independent of circumstances (such as finance and physical location). The next stage is to withdraw (detox) from opioids. The final stage is relapse prevention. This treatment process contributes to recovery of the individual, which also includes improved overall health and wellbeing, as well as engagement in society. METHODS AND OUTCOMES: We conducted a systematic review and aimed to answer the following clinical questions: What are the effects of drug treatments for stabilisation (maintenance) in people with opioid dependence? What are the effects of drug treatments for withdrawal in people with opioid dependence? What are the effects of drug treatments for relapse prevention in people with opioid dependence? We searched: Medline, Embase, The Cochrane Library, and other important databases up to March 2011 (Clinical Evidence reviews are updated periodically; please check our website for the most up-to-date version of this review). We included harms alerts from relevant organisations such as the US Food and Drug Administration (FDA) and the UK Medicines and Healthcare products Regulatory Agency (MHRA). RESULTS: We found 26 systematic reviews, RCTs, or observational studies that met our inclusion criteria. We performed a GRADE evaluation of the quality of evidence for interventions. CONCLUSIONS: In this systematic review, we present information relating to the effectiveness and safety of the following interventions: buprenorphine; clonidine; lofexidine; methadone; naltrexone; and ultra-rapid withdrawal regimens.

INTRODUCTION: Dependence on opioids is a multifactorial condition involving genetic and psychosocial factors. There are three approaches to treating opioid dependence. Stabilisation is usually by opioid substitution treatments, and aims to ensure that the drug use becomes independent of mental state (such as craving and mood) and independent of circumstances (such as finance and physical location). The next stage is to withdraw (detox) from opioids. The final aim is relapse prevention. METHODS AND OUTCOMES: We conducted a systematic review and aimed to answer the following clinical questions: What are the effects of drug treatments for stabilisation (maintenance) in people with opioid dependence? What are the effects of drug treatments for withdrawal in people with opioid dependence? What are the effects of drug treatments for relapse prevention in people with opioid dependence? We searched: Medline, Embase, The Cochrane Library, and other important databases up to May 2008 (Clinical Evidence reviews are updated periodically; please check our website for the most up-to-date version of this review). We included harms alerts from relevant organisations such as the US Food and Drug Administration (FDA) and the UK Medicines and Healthcare products Regulatory Agency (MHRA). RESULTS: We found 23 systematic reviews, RCTs, or observational studies that met our inclusion criteria. We performed a GRADE evaluation of the quality of evidence for interventions. CONCLUSIONS: In this systematic review, we present information relating to the effectiveness and safety of the following interventions: buprenorphine; clonidine; lofexidine; methadone; naltrexone; and ultra-rapid withdrawal regimes.

INTRODUCTION: Dependence on opioids is a multifactorial condition involving genetic and psychosocial factors. There are three approaches to treating opioid dependence. Stabilisation is usually by opioid substitution treatments, and aims to ensure that the drug use becomes independent of mental state, such as craving and mood, and independent of circumstances, such as finance, and physical location. The next stage is to withdraw (detox) from opioids. The final aim is relapse prevention. METHODS AND OUTCOMES: We conducted a systematic review and aimed to answer the following clinical questions: What are the effects of drug treatments for stabilisation (maintenance) in people with opioid dependence? What are the effects of drug treatments for withdrawal in people with opioid dependence? What are the effects of drug treatments for relapse prevention in people with opioid dependence? We searched: Medline, Embase, The Cochrane Library and other important databases up to June 2006 (Clinical Evidence reviews are updated periodically, please check our website for the most up-to-date version of this review). We included harms alerts from relevant organisations such as the US Food and Drug Administration (FDA) and the UK Medicines and Healthcare products Regulatory Agency (MHRA). RESULTS: We found 21 systematic reviews, RCTs, or observational studies that met our inclusion criteria. We performed a GRADE evaluation of the quality of evidence for interventions. CONCLUSIONS: In this systematic review we present information relating to the effectiveness and safety of the following interventions: buprenorphine, clonidine, lofexidine, methadone, naltrexone, and ultra-rapid withdrawal.

PURPOSE OF RESEARCH: Application of psychedelics including ketamine may be important adjuncts in the treatment of alcohol and opioid use disorders. Most patients with alcohol or opioid use disorder (AUD/OUD) may present to the emergency department (ED) seeking care both for substance use and associated complaints. Understanding safety and preliminary efficacy of ketamine and other psychedelics to improve the care and potentially facilitate linkage to long term care for AUD/OUD in the ED is of high importance. Here, we describe our experience conducting rigorous double blind placebo controlled trials to evaluate safety of ketamine in the ED for AUD/OUD and the challenges in conducting this research among this important population. PRINCIPAL RESULTS: We conducted two studies to evaluate the safety of a single dose ketamine infusion for individuals seeking detox with AUD and those seeking psychiatric care who had OUD. Studies were conducted at an urban community and academic ED with variable pharmacy capabilities. Over the study period study 1 (AUD) screened N = 180 individuals for the study of which N = 3 were preliminarily eligible. None were able to pass full eligibility criteria resulting in no enrollments. Study 2 (OUD) screened N = 234 ED visits were screen of which N = 8 were eligible and N = 4 consented. All four participants were successfully randomized and treated with ketamine or placebo. We were unable to conduct follow up in any of the participants. MAJOR CONCLUSIONS: Enrollment of ED patients with AUD/OUD for ketamine trials in the ED is difficult and fraught with multiple challenges. Even with enrollment in the ED, follow up can be a significant challenge. This reinforces the need to consider innovative strategies to conduct ketamine and other psychedelic related trials among ED patients with AUD/OUD.

BACKGROUND: Excessive screen time is associated with psychological distress and physiological dysregulation. We evaluated a 2-week digital detox in medical students, focusing on key outcomes: cortisol, C-reactive protein (CRP), interleukin-6 (IL-6), heart-rate variability (HRV), and psychometrics (Perceived Stress Scale [PSS], Generalized Anxiety Disorder-7 [GAD-7]). METHODS: In a randomized three-group trial at two medical colleges, participants were allocated 1:1:1 to (i) detox + alternative activities, (ii) screen-time reduction only, or (iii) control. Randomization used stratified block procedures (campus × academic year × gender). We employed a convergent parallel mixed-methods approach, collecting qualitative feedback alongside quantitative measures, and integrating at interpretation. Compliance was tracked via device-level analytics and daily logs. Pre- and post-assessments included HRV, morning cortisol, CRP, IL-6, blood pressure, pulse, and PSS/GAD-7. "Alternative activities" were brief, low-cost options (mindfulness/breathing, brisk walking, journaling, in-person peer time), with ≥ 2 modalities per participant. RESULTS: The detox + activities group showed the largest improvements across biomarkers, HRV, and psychometric scores; the reduction-only group showed moderate improvements, while the control group exhibited no significant change. Beyond statistical significance, practical significance was observed: psychometric scores shifted across standard clinical categories (e.g., PSS high to moderate; GAD-7 moderate to mild), HRV increases indicated greater overall heart-rate variability and improved autonomic balance, and modest blood-pressure changes reflected favorable autonomic balance. Qualitative themes (e.g., mental reset, regaining academic control, reconnecting offline) converged with these changes. CONCLUSION: A structured, low-cost 2-week digital detox, particularly when paired with alternative activities, was associated with psychological well-being and key physiological markers in medical students. Limitations include the short intervention duration, two-site sample, reliance on self-report/app analytics for compliance, and absence of blinding

OBJECTIVE: To confirm the possibility of correcting protein-energy malnutrition in patients suffering from esophageal and gastric cancer using a new type of domestic enteral nutrition with a metabolic focus, such as DETOX, and to analyze the effect of correction of disorders on the course of the postoperative period. MATERIAL AND METHODS: A total of 70 patients suffering from esophageal and gastric cancer were selected for participation in the study using the open randomization method and divided into two groups of 35 people. Patients of the first group took domestic enteral nutrition LEOVIT ONCO, patients of the second group took imported enteral nutrition. Anthropometric indicators, laboratory and questionnaire data were assessed: during the initial consultation, before admission to the hospital - 14 days before hospitalization, immediately upon hospitalization, before surgery, in the first three days after surgery, before discharge. Data collection and processing was carried out by the staff of the Department of Faculty Surgery No. 2 named after G.I. Lukomsky based on the University Clinical Hospital No. 4 of Sechenov University. Statistical analysis was performed using the StatTech v. 4.6.3 program (developer - StatTech LLC, Russia). RESULTS: Domestic detoxifying enteral nutrition ensures normalization of body weight, an increase in the level of total protein, albumin and transferrin in the blood of patients before discharge by 15.3%, 16.4% and 74%, respectively, compared with the initial level, while imported nutrition contributed to a less pronounced increase in these indicators - by 11.8%, 9.6% and 48%, respectively. Despite the fact that both groups managed to achieve the desired level of total protein, albumin, in the LEOVIT ONCO group we needed less effort in terms of parenteral nutrition, enzymatic correction of profuse diarrhea, manifested with a significant decrease in the BCC, additional infusions of albumin and amino acids, especially in patients with a BMI <18. Unlike patients taking imported enteral nutrition, in patients on the background of LEOVIT ONCO therapeutic nutrition, immune-inflammatory markers (NLR, MLR, PLR) normalized, diarrhea of t

This study compared the efficacy of three 7-day detox strategies on young women's body image and wellbeing. The three strategies were: (a) Insta/TikTok break, (b) daily time-cap (30 minutes max), and (c) Insta/TikTok cleanse (removing appearance-focused content from feeds). A sample of 175 women aged 17-35 (M = 22.71) was randomized into one of the three detox conditions or social media use as usual. Participants completed assessments of self-objectification, appearance satisfaction, body appreciation, media pressure, and wellbeing at baseline, day 3 (check-in) and day 7 (posttest). Significant interactions showed that appearance satisfaction improved for all three detox groups from baseline to posttest, but no changes occurred for the control group. Appearance satisfaction also increased from day 3 to posttest in the Insta/TikTok cleanse group. Wellbeing improved from baseline to posttest for the daily time-cap group. Increases in wellbeing also occurred from day 3 to day 7 for the Insta/TikTok break and daily time-cap groups. No further interactions were found. Findings shed light on the varying effects of three 7-day social media detox strategies for promoting appearance satisfaction and overall wellbeing. Cleansing Instagram and TikTok feeds of appearance-focused content emerged as a particularly promising approach for improving appearance satisfaction.

Patients with human papillomavirus type 16 (HPV16) infection and low-grade cervical dysplasia [low-grade squamous intraepithelial lesion (LSIL)/CIN1] or atypical squamous cells [atypical squamous cells of undetermined significance (ASC-US)/atypical squamous cells- cannot exclude high-grade squamous intraepithelial lesion (ASC-H)] require active surveillance for disease progression. A safe and effective immunotherapy to clear HPV16 is an unmet medical need. The safety run-in cohort of a randomized double-blind, placebo-controlled phase II trial of PVX2 [vaccination twice with HPV16-targeting pNGVL4a-Sig/E7(detox)/HSP70 plasmid and once with the HPV16 L2E7E6 fusion protein "TA-CIN"] as immunotherapy for patients with HPV16+ ASC-US, ASC-H, or LSIL/CIN1 (NCT03911076) was recently completed. The primary objective of this cohort was to determine the safety and tolerability of PVX2 vaccination. Subjects were confirmed to have HPV16 infection and LSIL/CIN1, ASC-US, or ASC-H. Adverse events were evaluated using Common Terminology Criteria for Adverse Events v5.0. HPV typing by HPV16 18/45 Aptima Assay was done at baseline, month 6, and month 12, with simultaneous cytology analysis. Cervical biopsies and endocervical curettage were performed at baseline and month 6. In the safety run-in cohort 12 eligible patients were enrolled. Each received three monthly immunizations. One was lost to follow-up after week 12. There were no serious adverse events. A total of five adverse events were noted by 4 patients; 4 were considered not vaccine-related, and one 'unlikely related' by the investigator. At month 6, 45% (5/11) of participants converted to HPV16-negative and 2 others developed CIN2+ and received a loop electrosurgical excision procedure. At month 12, 64% (7/11) were HPV16-negative, including those HPV16-negative at month 6. In conclusion, PVX2 immunotherapy was well tolerated and associated with viral regression, supporting further testing. PREVENTION RELEVANCE: This safety run-in study cohort suggests that PVX2 immunotherapy is well tolerated in the target population and is sufficiently safe to warrant further clinical testing in a randomized study. The combined vaccine

BACKGROUND: Patients with recurrent or metastatic head and neck squamous cell carcinoma (R/M HNSCC) have a poor prognosis. The phase III KESTREL study evaluated the efficacy of durvalumab [programmed death-ligand 1 (PD-L1) antibody] with or without tremelimumab [cytotoxic T-lymphocyte-associated antigen 4 (CTLA-4) antibody], versus the EXTREME regimen in patients with R/M HNSCC. PATIENTS AND METHODS: Patients with HNSCC who had not received prior systemic treatment for R/M disease were randomized (2 : 1 : 1) to receive durvalumab 1500 mg every 4 weeks (Q4W) plus tremelimumab 75 mg Q4W (up to four doses), durvalumab monotherapy 1500 mg Q4W, or the EXTREME regimen (platinum, 5-fluorouracil, and cetuximab) until disease progression. Durvalumab efficacy, with or without tremelimumab, versus the EXTREME regimen in patients with PD-L1-high tumors and in all randomized patients was assessed. Safety was also assessed. RESULTS: Durvalumab and durvalumab plus tremelimumab were not superior to EXTREME for overall survival (OS) in patients with PD-L1-high expression [median, 10.9 and 11.2 versus 10.9 months, respectively; hazard ratio (HR) = 0.96; 95% confidence interval (CI) 0.69-1.32; P = 0.787 and HR = 1.05; 95% CI 0.80-1.39, respectively]. Durvalumab and durvalumab plus tremelimumab prolonged duration of response versus EXTREME (49.3% and 48.1% versus 9.8% of patients remaining in response at 12 months), correlating with long-term OS for responding patients; however, median progression-free survival was longer with EXTREME (2.8 and 2.8 versus 5.4 months). Exploratory analyses suggested that subsequent immunotherapy use by 24.3% of patients in the EXTREME regimen arm contributed to the similar OS outcomes between arms. Grade 3/4 treatment-related adverse events (TRAEs) for durvalumab, durvalumab plus tremelimumab, and EXTREME were 8.9%, 19.1%, and 53.1%, respectively. CONCLUSIONS: In patients with PD-L1-high expression, OS was comparable between durvalumab and the EXTREME regimen. Durvalumab alone, and with tremelimumab, demonstrated durable responses and reduced TRAEs versus the EXTREME regimen in R/M HNSCC.

BACKGROUND: People spend large parts of their everyday life using their smartphones. Despite various advantages of the smartphone for daily life, problematic forms of smartphone use exist that are related to negative psychological and physiological consequences. To reduce problematic smartphone use, existing interventions are oftentimes app-based and include components that help users to monitor and restrict their smartphone use by setting timers and blockers. These kinds of digital detox interventions, however, fail to exploit psychological resources, such as through promoting self-efficacious and goal-directed smartphone use. OBJECTIVE: The aim of this study is to evaluate the theory-based smartphone app "Not Less But Better" that was developed to make people aware of psychological processes while using the smartphone and to support them in using their smartphone in accordance with their goals and values. METHODS: In a randomized controlled trial, effects of a 20-day intervention app consisting of five 4-day training modules to foster a goal-directed smartphone use were evaluated. In the active control condition (treatment as usual), participants received a digital detox treatment and planned daily time-outs of at least 1 hour per day. Up to a 3-week follow-up, self-reported problematic smartphone use, objectively measured daily smartphone unlocks, time of smartphone use, self-efficacy, and planning towards goal-directed smartphone use were assessed repeatedly. Linear 2-level models tested intervention effects. Mediation models served to analyze self-efficacy and planning as potential mechanisms of the intervention. RESULTS: Out of 232 enrolled participants, 110 (47.4%; 55 participants in each condition) provided data at postintervention and 88 (37.9%; 44 participants in each condition) at 3-week follow-up. Both conditions manifested substantial reductions in problematic smartphone use and in the amount of time spent with the smartphone. The number of daily unlocks did not change over time. Further, modelling changes in self-efficacy as a mediator between the intervention and problematic smartphone use at follow-up fit well to the data and showed an indirect e

BACKGROUND: There is a large body of research indicating that substance use disorder treatment completion leads to higher rates of sustained recovery. However, not much is known about how age and opioid treatment programs (OTPs) OTPinteract to affect treatment completion. The purpose of this article is to better understand the pathway between age, OTP, and treatment completion. METHODS: Data from the US 2017 Treatment Episodes Data Set was analyzed. Seemingly unrelated bivariate probit regression was used to determine whether OTP access mediates the relationship between age and treatment completion. We used propensity score matching to simulate the effects of a randomized control trial and to attenuate the likelihood of a Type 1 error. RESULTS: Older adults have a higher likelihood than their younger counterparts of completing treatment regardless of OTP status in inpatient and outpatient settings. Those who received OTP in inpatient treatment had a 45% increased probability of completing treatment in detox settings and a 41% increased probability of completing treatment in inpatient settings. Older adults (age 50+) were more likely to receive OTP than their younger counterparts. There is a small but significant indirect effect of age on treatment completion in inpatient settings. CONCLUSIONS: Older adults are more likely to receive OTP in both inpatient and outpatient settings. However, age does not appear to affect the probability of treatment completion when individuals receive OTP, except in inpatient settings. Implications are discussed.

BACKGROUND: Evidence-based interventions for treating opioid use disorder (OUD) in youth are limited and little is known about specific and general mechanisms of OUD treatments and how they promote abstinence. METHODS: The present study used data from the NIDA-CTN-0010 trial to evaluate the mediating effects of psychosocial treatment-related variables (therapy dose and therapeutic alliance) on end-of-treatment opioid abstinence in a sample of youth with OUD (n = 152, 40% female, mean age = 19.7 years) randomized to receive either 12-weeks of treatment with Bup/Nal ("Bup-Nal") or up to 2 weeks of Bup/Nal detoxification ("Detox") with both treatment arms receiving weekly individual and group drug counseling ± family therapy. RESULTS: Participants in the Bup-Nal group attended more therapy sessions (16 vs 6 sessions), had increased therapeutic alliance at week-4, and had less opioid use by week-12 compared to those in the Detox group. In both treatment arms, youth who attended more therapy sessions were less likely to have a week-12 opioid positive urine. In a multiple mediator model, therapy dose mediated the association between treatment arm and opioid abstinence. CONCLUSIONS: These findings provide preliminary support for a "dose-response" effect of addiction-focused therapy on abstinence in youth OUD. Further, the results identified a mediating effect of therapy dose on the relationship between treatment assignment and opioid treatment outcomes, suggesting that extended Bup-Nal treatment may enhance abstinence, in part, through a mechanism of therapy facilitation, by increasing therapy dose during treatment.

OBJECTIVES: Junior doctors are exposed to occupational and traumatic stressors, some of which are inherent to medicine. This can result in burnout, mental ill-health and suicide. Within a crossover pilot study comparing personalised, trauma-informed yoga to group-format exercise, qualitative interviews were conducted to understand the experience of junior doctors and whether such interventions were perceived to help manage these stressors. METHODS: Twenty-one doctors, 76% female, were order-randomised to consecutive 8-week yoga and exercise programmes. Fifty-two interviews were recorded before and after each programme. RESULTS: Many participants reported being time poor, sleep-affected, frequently stressed and occasionally in physical pain/distress. Major stressor themes were workplace incivility, death/human suffering and shift work with minimal support. Both interventions were acceptable for different reasons. Personalised yoga offered a therapeutic alliance, time to check-in and reduced anxiety/rumination. Group exercise provided energy and social connection. One participant found yoga beneficial following an acute workplace trauma: 'It was really eye opening how much I felt my body just needed to detox … I wouldn't have gone to a group fitness the next day … I just wanted to relax and breathe …We still had a big debrief which was great … (but) I almost felt like … I dealt with it physically and emotionally before going into it (P20).' CONCLUSION: Junior doctors found both interventions useful for stress management adjunctive to other organisational programmes though for different and complementary reasons, possibly related to delivery mode. Personalised, trauma-informed yoga provided a confidential therapeutic alliance whereas group exercise offered social connection. © Author(s) (or their employer(s)) 2022. No commercial re-use. See rights and permissions. Published by BMJ.

OBJECTIVES: The objective of our study was to evaluate medication-related safety, tolerability and preliminary effectiveness of short-term benzodiazepine tapers to manage atypical withdrawal syndromes among individuals with opioid use disorder (OUD) exposed to the toxic unregulated drug supply containing high levels of non-pharmaceutical fentanyl and benzodiazepines. METHODS: We present a case series of individuals with OUD accessing hospital-based withdrawal-management services (N = 18) who were prescribed a benzodiazepine taper alongside medications for OUD (MOUD) in Vancouver, Canada between October 2023 and July 2024 (NCT06639373).Data were collected through baseline questionnaires (i.e., sociodemographic characteristics) and chart reviews; descriptive statistics are reported. RESULTS: Among the 18 participants receiving benzodiazepine tapers, the median age of participants was 30.5 years (IQR 23.8, 44.3), 11 were male, and 8 were unstably housed. All participants received diazepam. The mean total diazepam dose per patient was 93.2 mg (SD 55.7 mg) and the mean duration of the tapers was 5.61 days (SD 3.11). The mean maximum and minimum daily diazepam doses administered were 30.3 mg (SD 13.7 mg) and 7.9 mg (SD 2.5 mg). No medication-related adverse events or tolerability issues were reported. Among participants who completed withdrawal-management (n = 11), the majority (n = 8) remained on therapeutic doses of MOUD continuously for 30-days following discharge. One-third of patients (n = 6) had a patient-initiated discharge event. CONCLUSIONS: Short-term benzodiazepine tapers may be a useful adjunct to MOUD in managing complex withdrawal syndromes due to an increasingly adulterated drug supply. Further research on screening, diagnosis, and withdrawal management for this challenging clinical scenario is needed. © 2026 The Authors.

BACKGROUND: Positive psychology helps individuals enhance their attention, self-awareness, and positive thinking. Recent research has explored the impact of mindfulness-one of the core techniques in positive psychology-on behavioral addictions such as smartphone overuse. However, the effects of positive psychology courses that integrate mindfulness meditation, particularly in promoting digital detoxification and reducing smartphone addiction, have not been sufficiently studied. OBJECTIVE: This study aimed to examine the effectiveness of a positive psychology course incorporating drawing-breathing meditation in promoting digital detoxification and reducing smartphone addiction among nursing students at Shandong Xiehe University, China. METHODS: A quasi-experimental design was employed, consisting of a pre-test, post-test, and control group. Two classes were allocated as experimental and control groups without individual randomization to an experimental group (n = 33) and a control group (n = 33). Participants completed the Five Facets of Mindfulness Questionnaire (FFMQ), the Smartphone Addiction Scale (SAS), and the Digital Detoxification Scale (DDS) at three intervals: before, during, and after the intervention. RESULTS: The findings demonstrated that the integrated positive psychology course significantly enhanced mindfulness and digital detoxification while reducing smartphone addiction in the experimental group. No significant changes were observed in the control group across any of the measured variables. CONCLUSION: A positive psychology course integrated with drawing and breathing meditation was associated with improvements in digital mindfulness indicators and a reduction in smartphone addiction within the study sample. These findings can inform the design of future interventions that combine mindfulness and positive psychology to address technology-related behavioral issues among university students.

BACKGROUND AND AIMS: Mindfulness-based relapse prevention (MBRP) has been shown to be beneficial to individuals with substance use disorder (SUD) in the West. The current pilot study aimed at testing the feasibility of MBRP in a Chinese population. DESIGN: This pilot study adopted a design of randomized controlled trial comparing MBRP with treatment-as-usual group (TAU). SETTING: Participants were recruited from residential detox centers, community addiction counseling centers and substance abuse clinics specialized addiction treatment clinics in Hong Kong. PARTICIPANTS: A total of 81 adults (85.2% male) with SUD (illicit drugs only) were recruited. INTERVENTIONS: The intervention group participants (n = 41) attended a 1-hour orientation session followed by 2-hour weekly MBRP sessions for 8 weeks, delivered by a qualified MBRP teacher. The TAU group participants (n = 40) continued their service received from their referral agency. (After completion of all study assessments they were offered the same 8-week MBRP course.) MEASUREMENTS: Feasibility was measured by attendance, course satisfaction and retention rate. Participants' change in substance use and other related outcomes were captured by self-reported drug use, urine drug tests and a list of psychometric scales at baseline, immediately after MBRP and 3- and 6-month follow-up. FINDINGS: The MBRP course satisfaction was high, and the attendance (57.4%) and retention rates (63.4%-85.4%) were comparable to previous trials. No statistically significant differences were observed between the MBRP and TAU groups for any outcomes, including craving, depression, anxiety, mindfulness and health-related quality of life; however, improvement trends were noticed in the MBRP group in self-efficacy in managing high-risk situations at post intervention, as well as in addiction severity and psychological flexibility at the 6-month follow-up. CONCLUSIONS: Mindfulness-based relapse prevention was shown to be feasible for substance use disorder treatment in a Chinese population. In this small study there was only limited evidence of abstinence efficacy, and no evidence of a benefit on other secondary outcomes. © 2026 The Autho

Diet and detox teas are commonly marketed as over-the-counter products that claim to support weight loss through detoxification and metabolic enhancement. Despite their widespread use, the evidence base supporting these claims remains unclear. This mini review summarizes and critically examines the existing literature on the safety and efficacy of diet and detox teas marketed for weight loss. A focused review of the literature identified 10 studies spanning experimental research, case reports, product analyses, and marketing assessments. Overall, the available evidence provides limited support for weight loss benefits. A small number of experimental studies suggested modest effects on body weight or metabolic outcomes, while the majority of evidence consisted of case reports and product analyses. Notably, multiple reports described serious adverse health outcomes associated with diet and detox tea consumption, including electrolyte disturbances, cardiovascular events, and liver injury in otherwise healthy individuals. In addition, analytical studies identified undeclared pharmaceutical ingredients, high levels of stimulants, and inconsistencies between labeled and actual product contents in teas marketed as natural. Altogether, current evidence suggests that diet and detox teas marketed for weight loss offer minimal demonstrated benefit and may pose meaningful health risks. The findings highlight important gaps in the evidence base and underscore the need for improved regulatory oversight, clearer labeling, and higher-quality research to better inform consumers and health professionals regarding the use of these products for weight management.

In today's digitized societies, where constant connectivity is perceived as a social norm, many people voluntarily seek temporary digital disconnection to balance out benefits and harms. Given that any direct effectiveness of digital disconnection is limited, recent approaches emphasized its conditionality. Conducted in two culturally dissimilar countries (the United States and Indonesia), the present large-scale cross-sectional youth surveys (Ns = 1,922 and 2,107, respectively) explored whether different popular feature- and rules-based digital disconnection strategies (digital detox app use vs. reflective smartphone disengagement vs. digital solitude) may serve as an ambivalent moderator for relationships between habitual and compulsive smartphone checking, on one side, and digital stress experiences, on the other. For U.S. youth only, results indeed suggested that reflective smartphone disengagement might minimize detrimental side effects of firm checking habits, whereas it exacerbates links to digital stress for people who struggle with smartphone checking compulsiveness. © The Author(s) 2025.

Digital technology is embedded in daily life, and growing evidence suggests that evening and bedtime screen engagement may disrupt sleep in young adults. Associations appear stronger for bedtime exposure and problematic or addiction-like patterns of use than for total screen time alone. This review aims to synthesize current evidence on the relationship between smartphone and social media use and sleep outcomes in young adults, with particular attention to the timing of device use, problematic digital engagement, and psychological or behavioral factors that may influence sleep. A narrative literature review was conducted using a broad, non-systematic search of PubMed, Scopus, Web of Science, and Google Scholar. Observational, longitudinal, experimental, or interventional studies and higher-level syntheses were included when they contributed to conceptual understanding of the screen-sleep relationship. Evidence was organized thematically across domains, including overall associations, bedtime and in-bed use, problematic and addictive behaviors, bedtime procrastination, psychological mediators (rumination and fear of missing out), chronotype, objective exposure and sleep measures, content versus duration, and cross-cultural consistency. Across diverse populations and study designs, digital media use was consistently associated with poorer sleep outcomes, including reduced sleep quality, delayed sleep onset, shorter sleep duration, and daytime dysfunction. Bedtime and nighttime use showed stronger associations than general daily exposure, supporting sleep displacement and circadian disruption as key pathways. Problematic smartphone and social media use demonstrated particularly robust links with poor sleep and insomnia-related symptoms, and longitudinal evidence suggested bidirectional relationships between problematic phone use, impaired sleep, and depressive symptoms. Bedtime procrastination emerged as a central behavioral mediator, while rumination and fear of missing out contributed to cognitive-emotional arousal that sustains sleep disruption. Objective smartphone tracking and wearable sleep measures generally supported associations between nighttime phone act

IMPORTANCE: Amid an ongoing addiction crisis, private equity (PE) firms have acquired large numbers of residential substance use disorder (SUD) treatment facilities in the US. How PE ownership affects SUD care prices and facility characteristics is not well understood. OBJECTIVE: To evaluate prices and facility characteristics of residential substance use treatment facilities owned by PE firms compared with other for-profit facilities. DESIGN, SETTING, AND PARTICIPANTS: This cross-sectional study using a secret shopper framework was conducted from June 2024 to April 2025. PE-acquired residential SUD treatment facilities were matched to non-PE-acquired, for-profit control facilities by geographic proximity. Trained callers posed as individuals seeking residential SUD care for a family member with pending Medicaid insurance. EXPOSURES: Ownership by PE vs non-PE for-profit entities. MAIN OUTCOMES AND MEASURES: The primary outcome was daily rate. Secondary outcomes included bed availability and wait times, admission requirements, services, staffing, amenities, and facility-initiated contact. RESULTS: This study included 341 residential facilities with completed call data (127 PE-acquired, 214 geographically matched non-PE for-profit). Mean (SD) daily rates were 15.6% higher at PE facilities ($910.73 [$463.16]; median, $854.29 [IQR, $589.29-$1071.43]) compared with non-PE facilities ($779.87 [$501.92]; median, $750.56 [IQR, $480.64-$952.38]; Benjamini-Hochberg-adjusted P = .04). This significantly higher daily rate was also found after adjustment for geographic cluster-matched fixed effects (β = $127.73; 95% CI, $29.57-$225.87; adjusted P = .03). Compared with non-PE-acquired control facilities, PE-acquired facilities were less likely to offer detox services (74.8% vs 88.8%; adjusted P = .02) and private rooms (12.1% vs 25.7%; adjusted P = .02), and more likely to make postcall contact attempts (mean [SD], 0.68 [1.39] vs 0.18 [0.47]; adjusted P < .001). CONCLUSIONS AND RELEVANCE: In this national secret shopper study, PE-acquired residential SUD treatment facilities reported higher daily prices than geographically matched non-PE for-profit facilities. Price differenc

BACKGROUND: Medication overuse headache (MOH) causes substantial disability in suffering patients, significantly reducing the quality of life. It may lead to structural and functional brain changes detectable by neuroimaging. Successful and effective treatments can alleviate headache burden, reduce consumption of abused drugs and reverse the biological alterations. Therefore, improvement of therapeutic strategies and optimization of patient stratification to match the individuals who can benefit with certain approaches, is essential. This study investigates DNA methylation (DNAm) associated with response to MOH treatment. METHODS: This analysis was performed within the frame of Epimode project - prospective quantitative longitudinal observational study of genome-wide DNA methylation in neurological cohort. 18 MOH patients, in age range between 33 and 66 years, received treatment which included education on diagnosis, recommendation to stop overused drugs and eventually 5-day inpatient withdrawal program. The effectiveness of MOH therapy was evaluated based on (a) overuse outcome (remission or persistence of MOH diagnosis) and (b) mitigating effect (reversal from chronic to episodic headache attacks), both assessed after 5 months from the enrolment. Genome-wide DNA methylation assay was performed (Infinium Human MethylationEPIC BeadChip, Illumina) in whole blood samples collected at baseline and after 3, 5 and 9 months from enrolment. RESULTS: Performed DNAm differential analysis identified methylation signatures linked to MOH treatment and revealed genes involved in epigenetic regulation of response. Among the others, we found PTPRN2, RHOJ, PCDH-γs, CACNA family and SLC38A4 genes as associated with MOH overuse outcome; MUC4 and FKBP11 - as related to mitigating effect of the intervention; and FMOD or ZDHHC14 which resulted linked to both endpoints. We observed that differential methylation signal seemed to predominantly capture the changes associated to excessive use of acute medications. Pathway enrichment analysis demonstrated that the genes with differential methylation signal might be involved in pathways related to (i) metabolic detoxification and (ii) neur

Endocrine-disrupting chemical (EDC) exposure from plastics and everyday products is widespread and linked to infertility. We conducted a 3-month uncontrolled feasibility pilot study among five idiopathically infertile couples to assess whether an intensive lifestyle intervention was associated with within-person changes in urinary EDC biomarkers and exploratory changes in reproductive parameters. The intervention was embedded in a film project ("The Plastic Detox") and integrated personalized education, product substitutions, at-home urine biomonitoring, sperm testing, and weekly coaching. Urine and semen samples were collected at baseline, 6 weeks, and 12 weeks. Linear mixed-effects models were used to estimate biomarker changes. BPA was designated a priori as the primary biomarker endpoint. Directional reductions were observed in urinary bisphenol A (BPA), mono-n-butyl phthalate (MBP), and monobenzyl phthalate (MBzP) over the intervention period. Within-person reductions in products containing ingredients of concern were associated with lower BPA levels. Descriptive upward trends of semen parameters were observed, with the majority of the subfertile men testing >40 million motile sperm/ejaculate after the intervention. Participants had increased environmental health literacy, were more motivated to reduce exposures, and reported improved wellness endpoints. Four couples achieved pregnancy and live birth during follow-up; given the uncontrolled design and small sample size, these outcomes are presented descriptively. Overall, this pilot study demonstrates feasibility and measurable biomarker change, supporting evaluation in larger, controlled trials.

BACKGROUND: In a world where the mind vibrates even when the phone does not, digital habits are quietly reshaping how we rest, focus, and feel. Phantom vibration syndrome (PVS), the false sensation of a phone vibrating, and problematic smartphone use (PSU) have become increasingly common among university students. These behaviors may reflect deeper psychological conditioning linked to anxiety, poor sleep, and stress, yet they remain underexplored from a public health perspective. METHODS: A cross-sectional online survey was conducted among 553 university students to examine the prevalence and correlates of PVS and PSU. Standardized scales measured sleep disturbance, anxiety symptoms, and academic stress. Descriptive and inferential analyses were performed using IBM SPSS Statistics version 29.0 (IBM Corp., Armonk, NY, USA). An open-ended question invited students to share strategies for managing smartphone use, and responses were analyzed thematically to identify recurring digital well-being themes. RESULTS: Phantom vibrations were reported by 41.4% of participants, with 22% experiencing them occasionally and 5.4% frequently. More than half (54.8%) reported fatigue and poor sleep. Higher PSU scores were significantly associated with anxiety (p<0.01) and sleep disturbance (p<0.05). Qualitative insights revealed three consistent coping patterns: digital detox routines, environmental changes, and structured daily activities that limited device use. CONCLUSIONS: The findings suggest that the modern student's constant connectivity has subtle but measurable effects on mental and physical well-being. By treating digital balance as an essential health behavior, similar to sleep hygiene or nutrition, universities can help protect students from the psychological fatigue of always being online. Addressing PVS and PSU through awareness and behavioral interventions should be considered a public health priority for the digital age.

BACKGROUND: Small intestinal bacterial overgrowth (SIBO) is a common, yet underdiagnosed, gut condition caused by gut dysbiosis. A previous study has shown the potential of herbal therapy, providing equivalent results to rifaximin. OBJECTIVES: The objective of this study was to assess how the use of an oral botanical regimen may modulate the gut microbiome, facial erythema, and intestinal permeability in those with SIBO. METHODS: This was an open-label prospective study of adults that had lactulose breath test-confirmed SIBO. Participants received a 10-week oral supplementation of a Biocidin liquid tincture and GI Detox+. If participants were found to be non-responsive to treatment after 10 weeks with a persistently positive lactulose breath test, a third oral supplement, Olivirex, was administered for an additional 4 weeks. Lactulose breath tests were administered at baseline, weeks 6, 10, and 14 to assess for SIBO status. A high-resolution photographic analysis system was utilized to analyze changes in facial erythema. Stool sample collections and venipuncture were performed to analyze the gut microbiome and intestinal permeability. RESULTS: A total of 33 subjects were screened with breath testing, and 19 subjects were found to have SIBO. Three of the subjects withdrew during the screening period prior to baseline, and sixteen subjects enrolled. Four subjects dropped out after baseline. Hydrogen-dominant SIBO was the most common subtype of SIBO, followed by methane and hydrogen sulfide. The botanical regimen was most effective for hydrogen- and hydrogen sulfide-dominant SIBO, leading to negative breath test results at week 10 in 42.8% and 66.7% of participants, respectively. Compared to baseline, supplementation with the botanical regimen led to positive shifts in short-chain fatty acid-producing bacteria such as A. muciniphila, F. prausnitzii, C. eutectus, and R. faecis by 31.4%, 35.4%, 24.8%, and 48.7% percent at week 10, respectively. The mean abundance of Firmicutes decreased by 20.2%, Bacteroides increased by 30%, and the F/B ratio decreased by 25.4% at week 10 compared to baseline. At week 10, there was a trending 116% increase in plasma LPS/IgG (p = 0.0