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Background Major depressive disorder (MDD) and generalized anxiety disorder (GAD) are highly prevalent among university students and predict impaired college performance and later life role functioning. Yet most students do not receive treatment, especially in low-middle-income countries (LMICs). We aim to evaluate the effects of expanding treatment using scalable and inexpensive Internet-delivered transdiagnostic cognitive behavioral therapy (iCBT) among college students with symptoms of MDD and/or GAD in two LMICs in Latin America (Colombia and Mexico) and to investigate the feasibility of creating a precision treatment rule (PTR) to predict for whom iCBT is most effective. Methods We will first carry out a multi-site randomized pragmatic clinical trial ( N = 1500) of students seeking treatment at student mental health clinics in participating universities or responding to an email offering services. Students on wait lists for clinic services will be randomized to unguided iCBT (33%), guided iCBT (33%), and treatment as usual (TAU) (33%). iCBT will be provided immediately whereas TAU will be whenever a clinic appointment is available. Short-term aggregate effects will be assessed at 90 days and longer-term effects 12 months after randomization. We will use ensemble machine learning to predict heterogeneity of treatment effects of unguided versus guided iCBT versus TAU and develop a precision treatment rule (PTR) to optimize individual student outcome. We will then conduct a second and third trial with separate samples ( n = 500 per arm), but with unequal allocation across two arms: 25% will be assigned to the treatment determined to yield optimal outcomes based on the PTR developed in the first trial (PTR for optimal short-term outcomes for Trial 2 and 12-month outcomes for Trial 3), whereas the remaining 75% will be assigned with equal allocation across all three treatment arms. Discussion By collecting comprehensive baseline characteristics to evaluate heterogeneity of treatment effects, we will provide valuable and innovative information to optimize treatment effects and guide university mental health treatment planning. Such an effort could have enormous public-health implications for the region by increasing the reach of treatment, decreasing unmet need and clinic wait times, and serving as a model of evidence-based intervention planning and implementation. Trial status IRB Approval of Protocol Version 1.0; June 3, 2020. Recruitment began on March 1, 2021. Recruitment is tentatively scheduled to be completed on May 30, 2024. Trial registration ClinicalTrials.gov NCT04780542 . First submission date: February 28, 2021.

Background Heterogeneity of treatment effects (HTEs) can occur because of either differential treatment compliance or differential treatment effectiveness. This distinction is important, as it has action implications, but it is unclear how to distinguish these two possibilities statistically in precision treatment analysis given that compliance is not observed until after randomization. We review available statistical methods and illustrate a recommended method in secondary analysis in a trial focused on HTE. Methods The trial randomized n = 880 anxious and/or depressed university students to guided internet‐delivered cognitive behavioral therapy (i‐CBT) or treatment‐as‐usual (TAU) and evaluated joint remission. Previously reported analyses documented superiority of i‐CBT but significant HTE. In the reanalysis reported here, we used baseline (i.e., pre‐randomization) covariates to predict compliance among participants randomized to guided i‐CBT, generated a cross‐validated within‐person expected compliance score based on this model in both intervention groups, and then used this expected composite score as a predictor in an expanded HTE analysis. Results The significant intervention effect was limited to participants with high expected compliance. Residual HTE was nonsignificant. Conclusions Future psychotherapy HTE trials should routinely develop and include expected compliance composite scores to distinguish the effects of differential treatment compliance from the effects of differential treatment effectiveness.

: Eating behavior disorders (EBDs) are a public health concern among undergraduate students. Evidence suggests that certain health-related academic environments may be associated with heightened psychological vulnerability. Hence, we aimed to evaluate the association between nursing education and the risk of EBDs and to assess whether self-esteem and anxiety mediate this relationship. : A cross-sectional analytical study was conducted between July and August 2023 among 433 undergraduate students from two public universities in Hidalgo, Mexico. The sample included 209 nursing students and 224 peers from non-health-related programs. Self-esteem, anxiety, and EBD risk were assessed using the Rosenberg Self-Esteem Scale, Hamilton Anxiety Rating Scale, and Eating Attitudes Test-26, respectively. Logistic regression and counterfactual mediation analyses were performed, adjusting for age, sex, family income, and year of study. : Nursing students showed higher odds of low self-esteem (aOR = 1.64; 95% CI: 1.06-2.53), anxiety (aOR = 2.06; 95% CI: 1.25-3.37), and EBDs risk (aOR = 2.37; 95% CI: 1.37-4.09) compared with non-health peers. Mediation analyses revealed significant indirect effects through self-esteem (aOR = 1.20; 95% CI: 1.03-1.38) and anxiety (aOR = 1.14; 95% CI: 1.01-1.29). : Nursing education was independently associated with a higher risk of EBDs, with statistical mediation analyses indicating that differences in self-esteem and anxiety may help characterize this association. Self-esteem exerted a slightly stronger indirect effect, suggesting that negative self-evaluation may represent a more proximal psychological process rather than a causal determinant.

For the management of Spodoptera frugiperda, botanical extracts have been used to reduce the environmental impacts of synthetic chemical pesticides. In the present investigation, the insecticidal activity of the acetonic and methanolic extracts of Heterotheca inuloides (Asteraceae) and of the main compound 7-hydroxy-3,4-dihydrocadalene on this pest as well as its ecotoxicological effect on Poecilia reticulata were evaluated. A greater insecticidal response was obtained from the acetonic extracts than from the methanolic extracts, with LC50 values of 730.4 ppm and 711.7 ppm for samples 1 and 2, respectively. Similarly, there was a lethal effect on 50% of the P. reticulata population at low concentrations in the acetonic extract compared to the methanolic extract. The sesquiterpene 7-hydroxy-3,4-dihydrocadalene has greater insecticidal activity by presenting an LC50 of 44.36 ppm; however, it is classified as moderately toxic for guppy fish.

Chronic diseases such as type 2 diabetes mellitus (T2DM), arterial hypertension (HTN), and obesity are significant global health challenges, contributing to millions of premature deaths. In Mexico, these pose major challenges due to limited access to healthcare and inadequate primary care quality. Complementary medicine presents itself as an adjuvant in this context, offering minimally invasive techniques to enhance physical, mental, and spiritual well-being. However, effective treatment adherence is crucial for positive outcomes, influenced by self-efficacy, resulting in persistently low adherence rates—a pressing public health concern. This observational study aimed to explore how perceptions of complementary medicine and treatment adherence predict self-efficacy among individuals with chronic diseases in Mexico. Data were collected from 113 participants with chronic conditions, including T2DM, HTN, and obesity. Participants completed surveys assessing perception of complementary medicine, treatment adherence, and self-efficacy. Statistical analyses, including correlations and regression, were conducted to examine the relationships between variables. The study revealed significant correlations between the perception of complementary medicine, treatment adherence, and self-efficacy. Treatment adherence was positively associated with self-efficacy, while perception of holistic medicine was negatively correlated with self-efficacy. Perception of complementary medicine and adherence to treatment were found to predict 41.9% (p = 0.001) self-efficacy. These findings underscore the potential of complementary therapies in enhancing self-efficacy levels, and highlight the importance of holistic healthcare approaches in managing chronic conditions. Further research is needed to better understand these relationships and their implications for healthcare outcomes in Mexico and beyond.

Currently, the deployment of tracking devices is one of the most frequently used approaches to study movement ecology of birds. Recent miniaturization of light‐level geolocators enabled studying small bird species whose migratory patterns were widely unknown. However, geolocators may reduce vital rates in tagged birds and may bias obtained movement data. There is a need for a thorough assessment of the potential tag effects on small birds, as previous meta‐analyses did not evaluate unpublished data and impact of multiple life‐history traits, focused mainly on large species and the number of published studies tagging small birds has increased substantially. We quantitatively reviewed 549 records extracted from 74 published and 48 unpublished studies on over 7,800 tagged and 17,800 control individuals to examine the effects of geolocator tagging on small bird species (body mass <100 g). We calculated the effect of tagging on apparent survival, condition, phenology and breeding performance and identified the most important predictors of the magnitude of effect sizes. Even though the effects were not statistically significant in phylogenetically controlled models, we found a weak negative impact of geolocators on apparent survival. The negative effect on apparent survival was stronger with increasing relative load of the device and with geolocators attached using elastic harnesses. Moreover, tagging effects were stronger in smaller species. In conclusion, we found a weak effect on apparent survival of tagged birds and managed to pinpoint key aspects and drivers of tagging effects. We provide recommendations for establishing matched control group for proper effect size assessment in future studies and outline various aspects of tagging that need further investigation. Finally, our results encourage further use of geolocators on small bird species but the ethical aspects and scientific benefits should always be considered. Tagging slightly reduces only apparent survival of treated birds. The authors found stronger tagging effects when relatively heavier tags were used and no differences between published and unpublished studies. Finally, they call for the control group establishment in all future studies and provide guidelines for the selection of control individuals.

For the management of Spodoptera frugiperda, botanical extracts have been used to reduce the environmental impacts of synthetic chemical pesticides. In the present investigation, the insecticidal activity of the acetonic and methanolic extracts of Heterotheca inuloides (Asteraceae) and of the main compound 7-hydroxy-3,4-dihydrocadalene on this pest as well as its ecotoxicological effect on Poecilia reticulata were evaluated. A greater insecticidal response was obtained from the acetonic extracts than from the methanolic extracts, with LC[sub.50] values of 730.4 ppm and 711.7 ppm for samples 1 and 2, respectively. Similarly, there was a lethal effect on 50% of the P. reticulata population at low concentrations in the acetonic extract compared to the methanolic extract. The sesquiterpene 7-hydroxy-3,4-dihydrocadalene has greater insecticidal activity by presenting an LC[sub.50] of 44.36 ppm; however, it is classified as moderately toxic for guppy fish.