Pablo Valdés-Badilla

Background: Slow gait, weak handgrip strength, and impaired balance are common functional deficits in aging populations that predict adverse health outcomes. Accurate, scalable prediction tools are needed for community-based screening in low-resource settings. Objectives: To benchmark nine machine learning (ML) classifiers for predicting the presence of ≥1 functional deficit using cardiometabolic and anthropometric predictors; to assess calibration, generalization, and clinical utility; to quantify the incremental value of these predictors over age and sex; and to characterize the stability of SHAP-based feature importance. Methods: We analyzed cross-sectional data from the Mexican Health and Aging Study 2012 (MHAS 2012) biomarker sub-study (N = 1961; mean age 61.9 ± 10.5 years; 59.8% women). The outcome was ≥1 of slow gait (<0.8 m/s), weak handgrip (EWGSOP2 sex-specific cut-points), or inability to sustain a 10-s one-leg stance (prevalence 78.7%). Twenty cardiometabolic and anthropometric predictors were used, excluding the functional measures used in outcome construction. Performance was estimated with nested, repeated stratified 10-fold cross-validation (5 × 10 outer folds; inner 5-fold hyperparameter tuning), with all preprocessing confined to training folds. Results: Logistic Regression (LR) achieved the highest discrimination (AUC-ROC 0.751, 95% CI 0.724–0.779), with good calibration (scaled Brier 0.125; calibration slope 0.96) and a small overfit gap (0.011); no classifier outperformed it (ET: AUC 0.745). An age–sex model alone reached AUC 0.734; all other predictors added ΔAUC = +0.018 (95% CI 0.004–0.031), almost entirely through anthropometry, whereas blood biomarkers and blood pressure added no measurable discrimination. SHAP identified age, sex, height, body weight, and BMI × Age as the most influential features; BMI ranked 12th of 20 (bootstrap 95% rank interval 8–20). Conclusions: Cardiometabolic and anthropometric predictors identify middle-aged and older Mexican people with ≥1 functional deficit with moderate accuracy (AUC ≈ 0.75), but most of the signal is carried by age, sex, and simple anthropometry. This reproducible, circularity- and leakage-free framework supports risk stratification rather than diagnosis, and requires external and temporal validation before clinical implementation.

Background: Osteopenia is highly prevalent after menopause and increases the risk of osteoporosis, falls, and fragility fractures. Whole-body vibration has been proposed as a low-impact exercise strategy, but its clinical effectiveness remains uncertain. This systematic review with meta-analysis aims to analyze the effects of whole-body vibration on bone mineral density and balance in postmenopausal women with osteopenia. Methods: Five electronic databases were searched following PRISMA guidelines. Randomized controlled trials including postmenopausal women diagnosed with osteopenia by dual-energy X-ray absorptiometry were included. Methodological quality, risk of bias, and certainty of evidence were assessed using TESTEX, RoB 2, and GRADE, respectively. Effect sizes were calculated using Hedges’ g with 95% confidence intervals. Results: Five randomized controlled trials involving 248 women were included. Interventions lasted from 8 weeks to 12 months. Whole-body vibration did not produce significant improvements in bone mineral density at the tibia, radius, or lumbar spine, nor did it significantly improve balance compared with control conditions. The certainty of evidence was low for bone mineral density and very low for balance, mainly due to risk of bias, small sample sizes, and imprecision. Conclusions: Current evidence does not provide sufficient support for clinically meaningful improvements in BMD or balance following WBV in postmenopausal women with osteopenia. Nevertheless, conclusions remain uncertain because they are based on only five randomized controlled trials and very few studies per pooled outcome. Therefore, WBV cannot currently be recommended as a stand-alone intervention for improving BMD or balance, but neither can a potentially beneficial effect be definitively excluded. Larger, adequately powered, and methodologically rigorous trials are required before firm clinical recommendations can be established.

Background: Home education encompasses heterogeneous educational arrangements, and its relationship with psychosocial well-being remains unclear. Objective: This study maps empirical evidence on emotional, behavioral, mental health, social, interpersonal, and family-related outcomes and experiences among home education children and adolescents. Methods: This scoping review followed Joanna Briggs Institute guidance and PRISMA-ScR. Eight databases were searched from inception to 9 September 2026 without language or publication-date restrictions. Peer-reviewed original empirical publications involving home education children and adolescents aged 5–18 years were eligible. Mixed-age studies were retained when this age group constituted the primary home education population or when relevant age-disaggregated findings were available; inseparable findings were classified as mixed-age evidence. Two reviewers independently screened records and charted data. Findings were synthesized descriptively and narratively. Results: Of 4427 records, 23 publications were included and mapped across four psychosocial domains. Comparative findings were heterogeneous, with favorable, null, mixed, and less favorable patterns across outcomes and populations. Qualitative studies described perceived benefits and challenges related to family relationships, individualized support, previous school experiences, and social opportunities. Several publications used overlapping or potentially overlapping samples. Conclusions: Comparative evidence did not show a consistent association between home education and either better or poorer psychosocial well-being. The available literature was heterogeneous in design, population, educational context, measurement approach, and informant, supporting a context-sensitive interpretation rather than universal conclusions of benefit, equivalence, or harm.

Existe escasa información respecto a la relación entre los parámetros antropométricos y la funcionalidad motriz en sujetos activos e inactivos. En ese sentido, la presente investigación pretende determinar la relación entre las características antropométricas y la puntuación de funcionalidad motriz en sujetos chilenos con distintos niveles de actividad física. La muestra incluyó 63 sujetos (20 mujeres), distribuidos en tres grupos: grupo físicamente activo (GFA, n=21), grupo deportista (GD, n=21) y grupo físicamente inactivo (GFI, n=21). Las variables estudiadas correspondieron a la composición corporal, perímetro de cintura (PC), índice de masa corporal (IMC), índice cintura-cadera (ICC) y funcionalidad motriz a través del Functional Movement Screen (FMS). Se aplicó Anova una vía, el test de Pearson y un modelo de regresión lineal múltiple, considerando un p <0,05. Los resultados indican correlaciones moderadas e inversas entre la puntuación FMS y la sumatoria de pliegues cutáneos, Zadiposidad, masa adiposa (kg) e IMC en el GFI (-0,52 ≤ r ≤ -0,62), y con la sumatoria de pliegues cutáneos, masa adiposa (kg y %) en el GFA(-0,54 ≤ r ≤ -0,60). Los cambios en la puntuación del FMS se explican principalmente por la suma de pliegues cutáneos, la Zadiposidad, la masa grasa (kg), el porcentaje de masa grasa y el PC. En conclusión, las características antropométricas y la funcionalidad motriz se encuentran asociadas en sujetos chilenos físicamente activos (GFA) e inactivos, mostrando una relación inversa entre el puntaje del FMS con los parámetros de la composición corporal relacionados con la adiposidad.

Background/Objectives: Multiple sclerosis (MS) frequently limits participation in daily occupations and is associated with disabling fatigue. However, the effects of occupational therapy (OT) remain uncertain because available trials have evaluated heterogeneous interventions and outcomes. This systematic review synthesized evidence from randomized controlled trials (RCTs) on occupational performance and physical and cognitive fatigue in adults with MS. Materials and Methods: Seven bibliographic databases were searched from inception to 10 August 2026: MEDLINE via PubMed, Scopus, the Cochrane Central Register of Controlled Trials (CENTRAL) via the Cochrane Library, Web of Science Core Collection, APA PsycINFO via EBSCOhost, CINAHL Complete via EBSCOhost, and ProQuest Central. Two independent reviewers performed study selection, data extraction, and risk-of-bias assessment using RoB 2. Certainty of evidence was evaluated using GRADE. Given the clinical and methodological heterogeneity, findings were synthesized narratively following the Synthesis Without Meta-Analysis guideline. The protocol was registered in PROSPERO (CRD420251115448). Results: Seven RCTs involving 488 randomized participants were included. Findings for occupational performance were inconsistent: one small waitlist-controlled trial reported large short-term benefits from occupational performance coaching, whereas an active-comparator trial found improvements in both groups without clear superiority. Other findings showed no comparative benefit or provided only indirect evidence. Fatigue findings were similarly inconsistent: one 20-participant pilot trial favored a sleep-targeted OT intervention, two trials found no comparative benefit, and one large trial transiently favored usual-care OT. The certainty of evidence was very low for both outcomes. Conclusions: The available evidence does not consistently establish that OT interventions improve occupational performance or reduce physical and cognitive fatigue in adults with MS. Larger, adequately powered RCTs using clearly defined OT interventions, standardized outcomes, and longer follow-up periods are required.

Background: Mental health problems are common among university students. This systematic review and meta-analysis examined the effects of mental health interventions on depressive symptoms, anxiety, and sleep quality in this population. Methods: Randomized controlled trials published through 30 July 2026 were identified in MEDLINE/PubMed, Scopus, the Cochrane Library, Web of Science Core Collection, EBSCOhost, CINAHL, and ProQuest. Risk of bias and certainty of evidence were assessed using Cochrane Risk of Bias 2 and GRADE, respectively. Random-effects meta-analyses used mean differences (MDs) for outcomes reported on the same scale and Hedges’ g for sleep outcomes that used non-equivalent PSQI scores. Between-study variance was estimated using restricted maximum likelihood, with modified Hartung Knapp Sidik Jonkman inference. The protocol was registered in PROSPERO (CRD420261344616). Results: Nine studies met the eligibility criteria, and seven contributed to at least one meta-analysis. Interventions reduced PHQ-9 scores on average (MD = 2.21 points, 95% CI 0.89 to 3.54; p = 0.006; I² = 81.0%), although the 95% prediction interval included no effect (−1.20 to 5.63). The pooled effects on GAD-7 scores (MD = 1.99, 95% CI −0.48 to 4.46; p = 0.089; I² = 92.0%) and sleep quality (Hedges’ g = 1.30, 95% CI −3.08 to 5.68; p = 0.330; I² = 99.1%) were not statistically conclusive. All prediction intervals included the null. Conclusions: Mental health interventions may reduce depressive symptoms among university students on average, but substantial heterogeneity limits the generalizability of this finding. Evidence for effects on anxiety and sleep quality remains inconclusive. More rigorous and clinically comparable trials are required.

Objective: To compare the effects of multicomponent training (MCT) and elastic-band training (EBT) on global cognition and executive function in older women. Methods: This single-blind, parallel-group randomized controlled trial was conducted over 16 weeks and included two supervised 60-min sessions per week. Twenty-six older women were randomly assigned to either the MCT group ( n = 13) or the EBT group ( n = 13). Cognitive outcomes included global cognition assessed with the Montreal Cognitive Assessment (MoCA), processing speed and visual attention assessed with the Trail Making Test Part A (TMT-A), and executive function assessed with the Trail Making Test Part B (TMT-B). Linear mixed-effects models were used to evaluate group, time, and group × time effects while adjusting for age and education. TMT-B was predefined as the primary executive function outcome. Results: A significant group × time interaction was observed for TMT-B performance ( p = 0.019). However, neither the within-group nor between-group post hoc comparisons remained significant after false discovery rate (FDR) correction, and the interaction did not remain significant when FDR correction was conservatively applied across all model-level interactions. No significant group × time interactions were observed for MoCA ( p = 0.289) or TMT-A ( p = 0.214). Conclusion: Although the primary model suggested different temporal trajectories in TMT-B performance, the nonsignificant adjusted post hoc comparisons and the conservative sensitivity analysis preclude any conclusion that MCT was superior to EBT. Neither intervention produced significant changes in global cognitive performance or processing speed and visual attention. Therefore, the TMT-B finding should be considered exploratory and requires confirmation in larger, adequately powered randomized controlled trials.

Introduction: Dual-task training is proposed as a rehabilitative strategy to mitigate motor and cognitive impairments in patients with Parkinson’s disease (PD). This systematic review and meta-analysis sought to consolidate existing information regarding the impact of dual-task therapies on health-related quality of life (HRQoL) and cognitive performance in middle-aged and older persons diagnosed with PD. Methods: A systematic review of randomized controlled trials (RCTs) published to May 2026 was performed utilizing PubMed, EBSCOhost, Scopus, and Web of Science. The chosen studies adhered to the PICOS framework. The Methodological quality and certainty of evidence were assessed using the Cochrane Risk of Bias 2 tool and GRADE framework, respectively. The review protocol is recorded in PROSPERO under the number CRD420251159680. Results: Out of 3,037 identified records, 10 RCTs met the eligibility criteria and were included in the systematic review, of which 9 contributed data to the meta-analysis. The meta-analysis showed a statistically significant but modest effect on HRQoL measured with the Parkinson’s Disease Questionnaire-39 (SMD = 0.35; 95% CI: 0.03–0.67; p = 0.03). No significant between-group effects were observed for TMT-A (MD = 0.99; 95% CI: -3.38 to 5.37; p = 0.66), TMT-B (SMD = 0.02; 95% CI: -0.24 to 0.29; p = 0.86), or MoCA (SMD = 0.19; 95% CI: -0.26 to 0.64; p = 0.41). Conclusion: Dual-task interventions may produce a modest improvement in HRQoL in people with Parkinson’s disease, whereas the current evidence does not demonstrate significant benefits for the cognitive outcomes assessed. These findings should be interpreted cautiously given the limited number of studies, methodological limitations, and clinical heterogeneity across interventions. Systematic review registration: https://www.crd.york.ac.uk/PROSPERO/view/CRD420251159680 , identifier CRD420251159680.

Wearable inertial sensors have become tools for objectively assessing mobility in older people. This study analyzed whether wearable inertial sensors could detect exercise-induced mobility changes and compared the effects of multicomponent training (MCT) and elastic band training (EBT) on mobility and physical function in older women. Forty-two participants were randomly allocated to either the MCT (n = 21) or EBT (n = 21) group, where 38 (EBT: n = 19; MCT: n = 19) completed the 16-week intervention. Outcomes included instrumented Timed Up-and-Go (iTUG) assessed with a wearable inertial sensor, the Senior Fitness Test, maximal isometric handgrip strength, conventional TUG, anthropometric measurements, health-related quality of life, and blood biomarkers. Data were analyzed using age-adjusted linear mixed-effects models. The iTUG showed shorter completion time (p < 0.001), reduced middle-turn duration (p = 0.004), and increased cadence (p = 0.007). Significant time effects were also observed for chair stand (p = 0.011), arm curl (p < 0.001), and conventional TUG (p = 0.009). No significant group × time interactions were detected. After adjustment for multiple comparisons, no significant changes were observed in anthropometric measures, health-related quality of life, or blood biomarkers. Wearable inertial sensors detected training-related mobility changes, and both exercise programs improved physical function and mobility without between-group differences.

Background: Although previous studies have reported the benefits of combining physical activity with supplementation on body composition and physical performance in older people with sarcopenia, previous meta-analysis often included heterogeneous interventions, combining multiple types of supplements. Therefore, this systematic review and meta-analysis aimed to analyze the available body of published peer-reviewed randomized controlled trials (RCTs) studies on the effects of strength training (ST) combined with supplementation (S) (ST + S) using whey protein (WP) and beta-hidroxi-beta-metilbutirato (HMB) on body composition, physical performance, and biomarkers in older people with sarcopenia. Methods: Using 6 databases PubMed, Medline, Cumulative Index to Nursing and Allied Health Literature Complete, Scopus, Cochrane Library, and Web of Science a thorough literature search was carried out to March 2025. The Grading of Recommendations Assessment, Development, and Evaluation, Tool for the assEssment of Study qualiTy and reporting in EXercise, Rob 2, and Preferred Reporting Items for Systematic reviews and Meta-Analyses tools were used to evaluate the methodological quality and certainty of evidence. Hedge g effect sizes were computed. Potential sources of heterogeneity, such as subgroup analyses (type of supplements or training vs supplementation), were chosen using a fixed- or random-effects model. The protocol (code CRD42025643858) was registered in International Prospective Register of Systematic Reviews. Results: Of 2322 records, 7 RCTs with 472 participants were included. These 7 studies showed a high methodological quality ≥10 points in Tool for the assEssment of Study qualiTy and reporting in EXercise. Four overall meta-analysis showed significant increases ( P  < .05) in fat-free mass (effect sizes [ES] = 0.39), maximal isometric handgrip strength (MIHS, ES = 1.38), chair stand test (ES = 0.33), and 6-minute walk test (ES = 0.33). In the subgroup meta-analysis, the ST + S subgroup showed a significant increase ( P < .01) in MIHS compared to supplementation alone. Similarly, WP combined with ST was associated with a significant improvement in MIHS (ES = 0.49), whereas no significant improvement was observed with HMB combined with ST. In contrast, in fat mass and knee extension strength, no significant differences were reported between ST + S and ST or S. Conclusion: ST combined with WP or HMB supplementation may contribute to improvements in fat-free mass and selected physical performance outcomes in older people with sarcopenia. However, the limited number of RCTs, relatively small sample sizes, moderate-to-high risk of bias, and inconsistent subgroup findings indicate that the current evidence should be interpreted cautiously and considered promising rather than definitive.