Reducing Stress Through Music and Meditation: A Low-Barrier Mental Health Intervention for Unhoused Women in Shelter Settings

Reducing Stress Through Music and Meditation: A Low-Barrier Mental Health Intervention for Unhoused Women in Shelter Settings Seven nursing students from Seattle Pacific University partnered with a women’s day center in downtown Seattle to support unhoused women experiencing chronic stress and systemic inequalities. The center serves as a safe and welcoming space where women can access essential services including hot meals, hygiene facilities, healthcare connections, and case management, all while fostering a sense of dignity, community, and personal agency. Many clients faced significant trauma and housing insecurity, which contributed to ongoing stress and health challenges, conditions often compounded by social determinants of health and limited access to mental health resources (King County, 2025; Mar et al., 2021). As part of our clinical experience, we sought to understand these challenges more deeply and explore how nursing students could support client wellness in a meaningful and sustainable way. This paper will describe the context of our partnership, the needs we identified through engagement with clients and staff, and the nursing-based intervention we implemented in response. Background In King County, over 40,000 individuals are currently experiencing homelessness, and 15% of those identify as Black/African American (King County Regional Homelessness Authority, 2024). Among these individuals, 34% of adults suffer from mental illness, highlighting the urgent need for accessible mental health support within this population. A local Pacific Northwest homeless shelter serves as a critical daytime drop-in center for women navigating the challenges of homelessness. These women are often impacted by the cumulative effects of social determinants of health (SDOH), including limited access to stable housing, employment, transportation, and healthcare. These ongoing barriers increase the risk of chronic stress, depression, anxiety, and other mental health conditions (The Seattle Times, 2024). A study by Ket La Mar et al. (2021) emphasizes that both barriers and facilitators related to accessing mental healthcare play a crucial role in either hindering or supporting mental health recovery among homeless women with serious mental illness. Compounding the issue, many women experiencing homelessness remain hidden, often avoiding shelters or staying in unstable situations as a means of self-protection, an observation supported by existing literature on the invisibility and vulnerability of this population (Milaney et al., 2020). In response, our community health initiative is grounded in the belief, supported by participant feedback and aligned with trauma-informed care approaches, that small, consistent acts of care, such as music-guided meditation, may contribute to improved mental well-being. These low-barrier interventions offer a calming space for healing, especially when participants are encouraged to continue them independently within the shelter setting (YWCA Seattle King Snohomish, 2025). Activities with Rationale Our project involved facilitating a 30-minute weekly music and meditation coping group for clients at a women’s shelter. Each session began with calming music to establish a welcoming, grounded environment, followed by a brief guided meditation focused on breathwork, mindfulness, or body awareness. Designed to be low-barrier, non-invasive, and trauma-informed, the group aimed to empower clients to participate in safe and supportive ways. These activities were chosen based on responses to our first surveys, which showed that the most commonly favored coping mechanisms were meditation and music. This approach ensured that the intervention reflected client-identified needs and aligned with their preferences. We implemented a weekly 30-minute coping group centered on music and meditation, informed by the preferences clients expressed during our initial assessment period. This low-barrier, trauma-informed intervention began with calming music and transitioned into brief guided meditation practices focused on breathwork and grounding. Both components were selected for their accessibility and potential to promote relaxation without requiring verbal disclosure. Research supports the use of music and meditation as therapies for individuals dealing with stress from trauma and mental health issues. Studies show that music-based interventions can reduce anxiety, depression, and stress while fostering emotional expression and resilience, especially when verbal processing may be retraumatizing (Zhao et al., 2024; Jamil et al., 2023; Maiti, 2017). Meditation practices have similarly demonstrated effectiveness in improving emotional regulation and coping abilities among populations experiencing high psychosocial stress. These evidence-based strategies were essential in guiding the structure of our intervention to ensure it was both meaningful and safe for participants. To evaluate the impact of our intervention and inform sustainable improvements, we distributed pre- and post-session surveys assessing participants\u27 emotional states. This data collection process facilitates the measurement of perceived stress levels and emotional well-being over time. By offering a consistent space for relaxation and self-regulation, the intervention supports our SMART goal: reducing perceived stress and enhancing coping, with at least 65% of participants reporting a positive emotional effect after each session. Outcomes Over an 8-week community health rotation, we implemented and evaluated a low-barrier music and meditation group to reduce stress and support emotional well-being among unhoused women. Two days were dedicated to assessment through surveys, with another two focused on rapport-building through informal activities. Initial surveys revealed higher stress levels in the mornings and a strong interest in music and meditation for relaxation, clarity, and connection, confirming the intervention met participants\u27 needs. Eight women participated in two 30-minute sessions over two weeks, featuring calming music and guided mindfulness exercises centered on breathwork and deep relaxation. Pre-session surveys showed that 87% of participants reported feeling stressed, and 75% had prior exposure to similar practices. Participants were motivated by connection and curiosity, with relaxation and mental clarity as secondary goals. Post-session evaluations indicated that 60% experienced significant stress reduction, with meditation rated as the most helpful component, followed by music. Others reported neutral or minimal change. Participants also valued the quiet and communal atmosphere. One woman shared, “I feel more connected with myself and my energy. I needed that.” Seven participants desired to continue the group, indicating a strong interest in making it a regular wellness service. Although a few declined participation due to fatigue or personal preferences, and occasional space limitations posed minor challenges, the intervention met our SMART goal of reducing perceived stress and promoting emotional well-being. Conclusion We successfully partnered with a women’s day center to support the mental health of women experiencing homelessness through a trauma-informed wellness program using music and meditation. Guided by client feedback, we created a low-barrier space for stress relief and emotional regulation. Despite initial rapport challenges, intentional relationship-building fostered meaningful connections. While attendance and emotional readiness varied, participation and positive feedback affirmed the program’s impact. By centering client-identified needs, we delivered an intervention that strengthened coping skills, offered tools for continued well-being, and provided deliverables to promote sustained resource access and community engagement, emphasizing the value of accessible, sustainable, and evidence-informed mental health interventions tailored to the complex needs of underserved communities. References Jamil, A., Gutlapalli, S. D., Ali, M., Oble, M. J. P., Sonia, S. N., George, S., Shahi, S. R., Ali, Z., Abaza, A., & Mohammed, L. (2023). Meditation and its mental and physical health benefits in 2023. Cureus, 15(6), e40650. https://assets.cureus.com/uploads/review_article/pdf/156473/20240724-319105-6zhq57.pdf King County (2025). About homelessness and its impact in King County. https://kingcounty.gov/en/dept/dph/health-safety/health-centers-programs-services/health-services-for-the-homeless/healthcare-for-the-homeless/about-us#:~:text=About%20homelessness%20and%20its%20impact,family%20to%20avoid%20the%20streets King County Regional Homelessness Authority (2024). Point in time count. https://kcrha.org/community-data/king-county-point-in-time-count/ Maiti, R. (2017). Meditation, A Highly Powerful Tool to Enhance the Productivity and Happiness of Life in Modern World. International Journal of Bio-Resource & Stress Management, 8(2), 360–368. https://research.ebsco.com/c/4cjrct/viewer/pdf/qbwvme7dvn?route=details Mar, K. L., Mizock, L., Veazey, C., & Nelson, A. (2021). Mental health care barriers and facilitators experienced by homeless women with serious mental illness. Journal of Social Distress and the Homeless, 32(1), 59–68. https://doi.org/10.1080/10530789.2021.1967646 Milaney, K., Williams, N., Lockerbie, S. L., Dutton, D. J., & Hyshka, E. (2020). Recognizing and responding to women experiencing homelessness with gendered and trauma-informed care. BMC Public Health, 20(1). https://doi.org/10.1186/s12889-020-8353-1 Zhao, N., Lund, H. N., & Jespersen, K. V. (2024). A systematic review and meta-analysis of music interventions to improve sleep in adults with mental health problems. European psychiatry: the journal of the Association of European Psychiatrists, 67(1), e62. https://doi.org/10.1192/j.eurpsy.2024.177

Case Report: Disease progression of renal cell carcinoma containing a novel putative pathogenic KAT6A::NRG1 fusion on Ipilimumab- Nivolumab immunotherapy. A case study and review of the literature

Renal cell carcinoma still carries a poor prognosis despite therapeutic advancements. Detection of genetic mutations is vital in improving our understanding of this disease as well as potential role in targeted therapy. Here we present a case of a 49 year old man with an aggressive renal cell carcinoma bearing a novel pathogenic KAT6A::NRG1 fusion. We will explore the clinical presentation, histological and molecular diagnostics, treatment and disease progression. We will discuss the relevance of this unique fusion and comparisons with cancer cases with similar genetic mutations. Further research is warranted for such cases, in order to facilitate better targeted treatments

Evaluation design of a reactivation care program to prevent functional loss in hospitalised elderly: A cohort study including a randomised controlled trial

Background: Elderly persons admitted to the hospital are at risk for hospital related functional loss. This evaluation aims to compare the effects of different levels of (integrated) health intervention care programs on preventing hospital related functional loss among elderly patients by comparing a new intervention program to two usual care progra

Effect of dexamethasone on newborn survival at different administration-to-birth intervals: A secondary analysis of the who action (Antenatal corticosteroids for improving outcomes in preterm newborn)-I trial

Background: The WHO ACTION-I trial demonstrated that dexamethasone significantly reduced neonatal mortality when administered to women at risk of early preterm birth in low-resource countries. We conducted a secondary analysis to determine how these benefits can be optimised, by evaluating the effect of dexamethasone compared to placebo on newborn mortality and severe respiratory distress outcomes at different administration-to-birth intervals, and identifying the interval with the greatest benefits.Methods: The WHO ACTION-I trial was a multi-country, individually-randomised, parallel-group, double-blind, placebo-controlled trial. It was conducted in 29 hospitals across Bangladesh, India, Kenya, Nigeria, and Pakistan. Women with a viable singleton or multiple pregnancy who presented to participating hospitals at a gestational age of 26 weeks 0 days-33 weeks 6 days and who were at risk of imminent preterm birth were eligible. In this secondary analysis, 2638 women and their newborns treated with single course of dexamethasone or placebo were analysed. Multivariate logistic regression was used to assess the effect of dexamethasone versus placebo on neonatal death, stillbirth or neonatal death, and severe respiratory distress at 24 h and at 168 h, by administration-to-birth interval (from 0 through 28 days), adjusting for gestational age at first dose. We used relative risks to identify the administration-to-birth interval with the greatest benefits of dexamethasone compared to placebo on the newborn outcomes.Findings: Between 24 December 2017 and 21 November 2019, 2852 women and their 3070 babies were enrolled in the WHO ACTION-I trial; 1332 women (1464 babies) in the dexamethasone group and 1306 women (1440 babies) in the placebo group were included in this secondary analysis. Neonatal mortality risk was lower with increasing time between initiating dexamethasone and birth, achieving peak mortality reduction by days 13 and 14 and then diminishing as the interval approached 28 days, regardless of gestational age at administration. For other outcomes, the overall pattern of risk reduction extending into the second week was consistent with that of neonatal death.Interpretation: In women at risk of preterm birth prior to 34 weeks\u27 gestation, the neonatal benefits of antenatal dexamethasone appear to increase with longer administration-to-birth intervals than previously thought. This knowledge can support clinical assessment and estimation of the risks of adverse preterm newborn outcomes at the time of birth, and the potential benefits of antenatal dexamethasone treatment for a known administration-to-birth interval.Funding: Bill and Melinda Gates Foundation; World Health Organization

Hepatitis C Virus Induced a Novel Apoptosis-Like Death of Pancreatic Beta Cells through a Caspase 3-Dependent Pathway

Epidemiological and experimental studies have suggested that Hepatitis C virus (HCV) infection is associated with the development of type 2 diabetes. Pancreatic beta cell failure is central to the progression of type 2 diabetes. Using virus infection system, we investigate the influence of HCV infection on the fate of the insulinoma cell line, MIN6. Our experiments demonstrate that the HCV virion itself is indispensable and has a dose- and time-dependent cytopathic effect on the cells. HCV infection inhibits cell proliferation and induces death of MIN6 cells with apoptotic characteristics, including cell surface exposure of phosphatidylserine, decreased mitochondrial membrane potential, activation of caspase 3 and poly (ADP-ribose) polymerase, and DNA fragmentation in the nucleus. However, the fact that HCV-infected cells exhibit a dilated, low-density nucleus with intact plasma and nuclear membrane indicates that a novel apoptosis-like death occurs. HCV infection also causes endoplasmic reticulum (ER) stress. Further, HCV RNA replication was detected in MIN6 cells, although the infection efficiency is very low and no progeny virus particle generates. Taken together, our data suggest that HCV infection induces death of pancreatic beta cells through an ER stress-involved, caspase 3-dependent, special pathway

Does Hepatitis C Virus Infection Increase Risk for Stroke? A Population-Based Cohort Study

BACKGROUND: The relationship between hepatitis C virus infection and risk of stroke remains inconsistent. This study evaluates the risk of stroke in association with chronic hepatitis C infection in a longitudinal population-based cohort. METHODS: We identified 4,094 adults newly diagnosed with hepatitis C infection in 2002-2004 from the Taiwan National Health Insurance Research Database. Comparison group consisted of 16,376 adults without hepatitis C infection randomly selected from the same dataset, frequency matched by age and sex. Events of stroke from 2002-2008 were ascertained from medical claims (International Classification of Diseases, Ninth Revision, Clinical Modification, ICD-9-CM, codes 430-438). Multivariate adjusted hazard ratios (HRs) and 95% confidence intervals (CIs) were estimated for potential associated factors including HCV infection, age, sex, low-income status, urbanization, cessation of cigarette smoking, alcohol-related illness, obesity, history of chronic diseases and medication use. FINDINGS: During 96,752 person-years of follow-up, there were 1981 newly diagnosed stroke cases. The HRs of stroke associated with medical conditions such as hypertension, diabetes and heart disease were 1.48 (95% CI 1.33 to 1.65), 1.23 (95% CI 1.11 to 1.36) and 1.17 (95% CI 1.06 to 1.30), respectively, after adjustment for covariates. The cumulative risk of stroke for people with hepatitis C and without hepatitis C infections was 2.5% and 1.9%, respectively (p<0.0001). Compared with people without hepatitis C infection, the adjusted HR of stroke was 1.27 (95% CI 1.14 to 1.41) for people with hepatitis C infection. CONCLUSION: Chronic hepatitis C infection increases stroke risk and should be considered an important and independent risk factor

Chronic hepatitis c genotype-4 infection: role of insulin resistance in hepatocellular carcinoma

<p>Abstract</p> <p>Background</p> <p>Hepatitis C virus (HCV) is a major cause of chronic hepatitis and hepatocellular carcinoma (HCC) and different HCV genotypes show characteristic variations in their pathological properties. Insulin resistance (IR) occurs early in HCV infection and may synergize with viral hepatitis in HCC development. Egypt has the highest reported rates of HCV infection (predominantly genotype 4) in the world; this study investigated effects of HCV genotype-4 (HCV-4) on prevalence of insulin resistance in chronic hepatitis C (CHC) and HCC in Egyptian patients.</p> <p>Methods</p> <p>Fifty CHC patients, 50 HCC patients and 20 normal subjects were studied. IR was estimated using HOMA-IR index and HCV-4 load determined using real-time polymerase chain reaction. Hepatitis B virus was excluded by enzyme-linked immunosorbent assay. Standard laboratory and histopathological investigations were undertaken to characterize liver function and for grading and staging of CHC; HCC staging was undertaken using intraoperative samples.</p> <p>Results</p> <p>HCC patients showed higher IR frequency but without significant difference from CHC (52% vs 40%, p = 0.23). Multivariate logistic regression analysis showed HOMA-IR index and International Normalization Ratio independently associated with fibrosis in CHC; in HCC, HbA1c, cholesterol and bilirubin were independently associated with fibrosis. Fasting insulin and cholesterol levels were independently associated with obesity in both CHC and HCC groups. Moderate and high viral load was associated with high HOMA-IR in CHC and HCC (p < 0.001).</p> <p>Conclusions</p> <p>IR is induced by HCV-4 irrespective of severity of liver disease. IR starts early in infection and facilitates progression of hepatic fibrosis and HCC development.</p

Elevated Plasma IL-6 Associates with Increased Risk of Advanced Fibrosis and Cholangiocarcinoma in Individuals Infected by Opisthorchis viverrini

Opisthorchis viverrini is considered among the most important of the food-borne trematodes due to its strong association with advanced periductal fibrosis and bile duct cancer (cholangiocarcinoma). We investigated the relationship between plasma levels of Interleukin (IL)-6 and the risk of developing advanced fibrosis and bile duct cancer from chronic Opisthorchis infection. We show that IL-6 circulates in plasma at concentrations 58 times higher in individuals with advanced fibrosis than age, sex, and nearest-neighbor matched controls and 221 times higher in individuals with bile duct cancer than controls. We also observed a dose-response relationship between increasing levels of plasma IL-6 and increasing risk of advanced fibrosis and bile duct cancer; for example, in age and sex adjusted analyses, individuals with the highest quartiles of plasma IL-6 had a 19 times greater risk of developing advanced periductal fibrosis and a 150 times greater risk of developing of bile duct cancer than individuals with no detectable level of plasma IL-6. Finally, we show that a single plasma IL-6 measurement has excellent positive predictive value for the detection of both advanced bile duct fibrosis and bile duct cancer in regions with high O. viverrini transmission. These data support our hypothesis that common mechanisms drive bile duct fibrosis and bile duct tumorogenesis from chronic O. viverrini infection. Our study also adds a unique aspect to the literature on circulating levels of IL-6 as an immune marker of hepatobiliary pathology by showing that high levels of circulating IL-6 in plasma are not related to infection with O. viverrini, but to the development of the advanced and often lethal pathologies resulting from chronic O. viverrini infection

The need for national medical licensing examination in Saudi Arabia

<p>Abstract</p> <p>Background</p> <p>Medical education in Saudi Arabia is facing multiple challenges, including the rapid increase in the number of medical schools over a short period of time, the influx of foreign medical graduates to work in Saudi Arabia, the award of scholarships to hundreds of students to study medicine in various countries, and the absence of published national guidelines for minimal acceptable competencies of a medical graduate.</p> <p>Discussion</p> <p>We are arguing for the need for a Saudi national medical licensing examination that consists of two parts: Part I (Written) which tests the basic science and clinical knowledge and Part II (Objective Structured Clinical Examination) which tests the clinical skills and attitudes. We propose this examination to be mandated as a licensure requirement for practicing medicine in Saudi Arabia.</p> <p>Conclusion</p> <p>The driving and hindering forces as well as the strengths and weaknesses of implementing the licensing examination are discussed in details in this debate.</p