Effectiveness of non-pharmacologic strategies for parental smoking cessation to protect children: A meta-analytic review

@#<p style="text-align: justify;"><strong>Aims:</strong> This meta-analysis aims to synthesize available evidence from published studies on the effectiveness of parental non-pharmacologic smoking cessation programs which aim to reduce children's exposure to secondhand smoke.</p><p style="text-align: justify;"><strong>Methodology:</strong> A database search using The Cochrane Library, PubMed®, Medline, Embase, and Google Scholar, was done by the investigators. This study included 20 randomized controlled trials published up to 2020. Pooled estimates of risk ratio (RR) for quit rates were computed using the random effects model.</p><p style="text-align: justify;"><strong>Results:</strong> Overall, the quit rate among those who underwent parental smoking cessation was 13.4% while the quit rate for controls was 11.9%. The pooled RR demonstrated that the parental smoking cessation program was significantly associated with higher quit rates (RR = 1.22, 95%CI = 1.01 to 1.46, p-value = 0.04). The studies demonstrated moderate heterogeneity only (I2 = 54%). Among studies published prior to year 2000, no significant difference was observed between parental smoking cessation program and control (RR = 1.02, 95% CI = 0.62 to 1.70, p-value = 0.93). On the other hand, the pooled RR demonstrated that among studies published after 2020, parental smoking cessation program was significantly associated with higher quit rates (RR = 1.27, 95%CI = 1.03 to 1.56, p-value <0.0001). Among studies with self-help interventions, parental smoking cessation program has no additional benefit on quit rates (RR = 1.20, 95%CI = 0.94 to 1.58, p-value = 0.14). Among studies with biofeedback intervention also, no significant difference was observed (RR = 1.27, 95% CI = 0.86 to 1.89, p-value = 0.23).</p><p style="text-align: justify;"><strong>Conclusions:</strong> This meta-analysis demonstrated sufficient evidence that non-pharmacologic interventions for parental smoking cessation are effective.</p>

Low magnitude whole-body vibration and postmenopausal osteoporosis / 生物医学工程学杂志

Postmenopausal osteoporosis is a type of osteoporosis with high bone transformation rate, caused by a decrease of estrogen in the body, which is a systemic bone disease characterized by decreased bone mass and increased risk of fracture. In recent years, as a kind of non-pharmacologic treatment of osteoporosis, defined by whole-body vibration less than 1 ( = 9.81 m/s ), low magnitude whole-body vibration is widely concerned, mainly because of its small side effects, simple operation and relative safety. Studies have shown that low magnitude whole-body vibration can improve bone strength, bone volume and bone density. But a lot of research found that, the therapeutic effects of low magnitude whole-body vibration are different depending on ages and hormone levels of subjects for animal models or human patients. There has been no definite vibration therapy can be applied to each subject so far. Studies of whole-body and cellular level suggest that low magnitude whole-body vibration stimulation is likely to be associated with changes of hormone levels and directed differentiation of stem cells. Based on the analysis of related literature in recent years, this paper made a review from vibration parameters, vibration effects and the mechanisms, to provide scientific basis and clinical guidance for the treatment of postmenopausal osteoporosis with low magnitude whole-body vibration.

The Revised Korean Practice Parameter for the Treatment of Attention-Deficit Hyperactivity Disorder (IV): Non-Pharmacologic Treatment

Attention-deficit hyperactivity disorder (ADHD) is a neuropsychiatric disorder that begins in early childhood and can persist throughout adulthood. ADHD causes difficulties in various area of life, such as academic achievement, peer relationships, family functioning, employment and marriage. Although ADHD is known to respond well to medication, such treatment is more effective when combined with psychosocial (non-pharmacologic) therapy in terms of alleviating the core symptoms and improving appropriate functions. Psychosocial treatment interventions are divided into psychoeducation, behavioral parent training, school intervention, cognitive behavior therapy, social skill training, parent-child interaction therapy, play therapy, other treatments (coaching, complementary and alternative medicine), neurofeedback and Cogmed. Adult ADHD cognitive behavioral therapy is described separately. These practice parameters summarize the evidence for psychosocial treatment. Based on this evidence, specific recommendations are provided for psychosocial interventions.

Non-Psychopharmacologic Therapy of Tic or Tourette's Disorder

Tic disorder is a childhood neuropsychological disorder characterized by abrupt, involuntary, and repetitive stereotyped muscle movement or vocal sound. Tourette's disorder shows a chronic prognosis, and can last for life if no treatment is applied. Although tic disorder has been known for ages, the underlying cause is still not well known. Non-pharmacological treatments have long been used for the tic disorder, but few clinical studies were conducted. However, the European Society for the Study of Tourette's Syndrome recently issued non-pharmacologic guidelines for treatment of tic disorders based on the research findings obtained so far. In addition, guidelines for non-pharmacologic evidence-based treatment were reported in Canada, North America. By synthesizing the newly reported foreign guidelines for treatment and review articles, the aim of this study is to investigate the non-pharmacologic therapies used for treatment of tic disorder or Tourette's disorder.

Exercício físico controla pressão arterial e melhora qualidade de vida / Exercise control blood pressure and improvement quality of life

INTRODUÇÃO: Para o tratamento correto da hipertensão arterial, é plausível a hipótese de que diante da prática regular de exercícios físicos estes pacientes não necessitariam de fármacos anti-hipertensivos. OBJETIVO: Avaliar o efeito do tratamento exclusivo com exercício físico na pressão arterial (PA) e qualidade de vida (QV) de hipertensos. MÉTODO: Ensaio clínico com 32 hipertensos sedentários, 55±9 anos, que estavam sob tratamento farmacológico (TF) aleatoriamente alocados em Grupo Exercício (GE) e Grupo Controle (GC). No GE, 18 indivíduos (50% mulheres) após pelo menos dez dias de interrupção do TF iniciaram programa de exercício de dez semanas, 3x/semana, 30 minutos de exercício aeróbio seguidos por exercícios resistidos, enquanto 14 do GC (57% mulheres) se mantiveram sob TF. Foi verificada PA sistólica (PAS) e diastólica (PAD) no início e final do estudo pelo método auscultatório clássico e QV pelo questionário MINICHAL. Os dados foram expressos por M±DP, usou-se teste t de Student, U de Mann-Whitney e Wilcoxon, considerando-se p < 0,05 significativo. RESULTADOS: No início e final da pesquisa, não foram observadas diferenças na PA entre os grupos. Intragrupos, a PA no GE manteve-se semelhante aos valores antes da retirada dos fármacos (PAS 132,2 ± 13,3 x 134,4 ± 10 mmHg; PAD 85,0 ± 9 x 85,3 ± 10 mmHg p = ns), assim como no GC (PAS 127,2 ± 19 x 130,2 ± 16 mmHg; PAD 82,1 ± 16 x 85,3 ± 12 mmHg p = ns). Para a QV, entregrupos não foi observada diferença dos escores no início e final, intragrupos melhora significativa no aspecto emocional do GE (p = 0,02). CONCLUSÃO: A terapêutica anti-hipertensiva, exclusivamente por meio do exercício físico na comparação com tratamento farmacológico convencional, possibilitou idêntico controle da PA e melhor percepção de QV.

BACKGROUND: Hypertension can be correctly treated when exercise is regularly practiced and hence, patients would not need anti-hypertensive drugs. PURPOSE: To evaluate the effect of treatment exclusively with exercise on blood pressure (BP) and quality of life (QL) of hypertensive subjects. METHODS: Clinical trial with 32 sedentary hypertensive subjects, aged 55 ± 9 years, under pharmacological treatment (PT) randomly allocated to Exercise Group (EG) and Control Group (CG). At EG, 18 subjects (50% women) at least 10 days after the cessation of PT started the exercise program of 10 weeks, 3x/week, 30 minutes of aerobic exercise followed by resistance exercises, while 14 CG (57% women) remained under PT. Systolic blood pressure (SBP) and diastolic blood pressure (DBP) was evaluated by auscultation at the beginning and end and QL was evaluated using the questionnaire MINICHAL. Data were expressed as mean ± SD and statistical analysis was performed using t test, Mann Whitney U and Wilcoxon tests. RESULTS: At the beginning and end of the study, no significant differences in were observed in BP between groups. Within groups, BP in EG remained similar to the values before drugs were removed (SBP 132.2 ± 13.3 x 134.4 ± 10 mmHg, DBP 85.0 ± 9 x 85.3 ± 10 mmHg p = ns) and the CG (SBP 127.2 ± 19 x 130.2 ± 16 mmHg, DBP 82.1 ± 16 x 85.3 ± 12 mmHg p = ns).For QL, no inter-group difference was observed in scores at the beginning and end; intra-group significant improvement in the emotional aspect of the EG (p = 0.02). CONCLUSION: The anti-hypertensive therapy with exercise only in comparison to conventional pharmacological treatment allowed the same BP control and better QL perception.

Sobre la contribución de la terapia ocupacional en el manejo no farmacológico de los síntomas psicológicos y conductuales asociados a la demencia / About the contribution of occupational therapy to non-pharmacologic approaches for the treatment of psychological and behavioral symptoms associated with dementia

El aumento de la población adulta mayor en Chile y el mundo, ha determinado un cambio epidemiológico que desafía nuevos abordajes para situaciones de salud de relevancia emergente. Los trastornos cognitivos y las demencias son una situación de alta prevalencia con la edad avanzada y tienen un alto impacto en el bienestar individual y familiar. La inexistencia de tratamiento curativo para la demencia determina que las intervenciones busquen una mejor calidad de vida de quienes padecen la enfermedad y sus cuidadores. Uno de los problemas asociados que afecta de gran forma el bienestar de la persona y su familia, corresponde a los síntomas conductuales y psicológicos asociados a la demencia, por lo que las estrategias farmacológicas y no farmacológicas para el manejo de estos síntomas son un eje relevante de acción para todo profesional involucrado en el área. Visualizando la terapia ocupacional como un abordaje no farmacológico de estos síntomas, este trabajo busca reflexionar sobre la contribución de la profesión en el manejo y prevención de éstos, vinculando marcos conceptuales sobre demencia y síntomas conductuales y psicológicos asociados, con la perspectiva disciplinar propia y la incorporación de la ocupación como una estrategia de abordaje.

The increase in elderly population in Chile and the world, has determined an epidemiological shift that leads us to pay attention to emerging health situations and new strategies for treatment. Cognitive disorders and dementias are a situation of high prevalence when associated with age and have a high impact on wellbeing of the individual and the family. The absence of curative treatment for dementia determines that interventions focus on achieving a better quality of life of those with the disease and their caregivers. One of the problems that affect the quality of life of the person and family remains on the behavioral and psychological symptoms associated with dementia so that pharmacologic and non-pharmacologic strategies for managing these symptoms are an axis of action and demands interest from all professionals involved in the area. Considering occupational therapy as a non-pharmacological approach to dementia, this work seeks to reflect on the contribution of the profession in the management and prevention of behavioral and psychological symptoms associated, linking conceptual frameworks on behavioral and psychological symptoms associated with dementia with the own disciplinary perspective that incorporates occupation as a main approach.

Psychosocial treatment of psychiatric disorders of the elderly

Interest in psychosocial treatment as non-pharmacologic treatment in the elderly has been increasing, and this treatment has became an important therapeutic approach for the following common psychiatric disorders: depressive disorder, anxiety disorder, some psychological conditions, and some cognitive disorders. Some examples of the psychosocial treatments frequently used with older people with psychiatric disorders are cognitive behavior therapy, interpersonal therapy, individual psychotherapy, reality orientation, validation therapy, reminiscence therapy, and cognitive training. Those treatment options should be used carefully in light of individual needs and optimal objectives for the elderly and their caregivers. It is crucial for the clinician to understand the characteristics and clinical applications of each psychosocial treatment for the elderly in particular. Further studies are needed to demonstrate the feasibility and effectiveness of old and new psychosocial treatment modalities for older people with psychiatric disorders. Psychosocial treatments are very important with or without pharmacological treatment in the elderly with psychiatric problems. Clinician should become familiar with various psychosocial treatments.

The Effectiveness of School Based Short-Term Social Skills Training in Children with Attention-Deficit/Hyperactivity Disorder(ADHD)

OBJECTIVES: Children with attention-deficit hyperactivity disorder (ADHD) often have difficulties in social behavior. The aim of this study was to evaluate the effectiveness of a short-term training program for improving social skills, selfperception and attention deficits. METHODS: The subjects were nine children diagnosed with ADHD with (or without) other mental disorders using the Diagnostic Interview Schedule for Children (DISC-ADHD) module. Children were given eight sessions of a social skills training program. Parents of children simultaneously participated in their own training which was designed to support their children's generalization of skills. Assessments included child, parent and teacher ratings of social skills, self-perception and attention deficit at baseline and post-treatment. RESULTS: Social skills training led to significant improvements in child-reported measures of self-esteem, in teacherreported measures of social skills, and in parent-reported measures of attention deficit. CONCLUSION: This study suggests that short-term social skills training programs for children with ADHD may improve their social skills, self-perception and attention deficits.

Management of COPD / 대한내과학회지

The prevalence of chronic obstructive pulmonary disease (COPD) in Korea is reported to be 17.5% in aged over 45 years. The overall approach should be individualized and dependent upon the severity of the disease and clinical status of the patient. Objectives of COPD treatment are improvement of airflow obstruction, prevention and management of co-morbidity and complication of COPD and upgrading in the quality of life. Pharmacologic therapy includes bronchodilators such as beta-2 agonists, anticholinergic and theophylline. Another key pharmacologic agent is glucocorticosteroid which reduces acute exaceerbation and inflammatory burden in COPD airways. Non-pharmacologic management is not less important. Education including smoking cessation, rehabilitation, home oxygen therapy along with appropriate vaccination. More importantly, doctor-patient-patron relationship plays a central role in long-term management of COPD.

Predictors of Change Following Participation in Non-Pharmacologic Interventions for CFS

The purpose of this study was to evaluate predictors of change in physical function in individuals diagnosed with chronic fatigue syndrome (CFS) following participation in nurse delivered, non-pharmacologic interventions. Participants diagnosed with CFS were randomly assigned to one of four, 6-month interventions including cognitive behavior therapy, cognitive therapy, anaerobic exercise, or a relaxation control group. Baseline measures including immune function, actigraphy, time logs, sleep status, and past psychiatric diagnosis significantly differentiated those participants who demonstrated positive change over time from those who did not. Understanding how patient subgroups differentially respond to non-pharmacologic interventions might provide insights into the pathophysiology of this illness.

Sedação e analgesia em neonatologia / Sedation and analgesia in neonatology

JUSTIFICATIVA E OBJETIVOS: A importância do estudo da dor em Neonatologia se deve ao fato de que a sensação de dor e estresse significa sofrimento e desconforto para os recém-nascidos e, apesar desse conhecimento, pouco tem sido feito para minimizá-los. Nessa revisão foram discutidas: a prevenção da dor, as medidas não-farmacológicas e farmacológicas para o seu tratamento e a sedação em recém-nascidos. CONTEUDO: Várias são as medidas não-farmacológicas que podem ser tomadas com intuito de prevenir a dor nas Unidades de Terapia Intensiva Neonatal e também para tornar o ambiente mais humanizado e menos estressante para os pacientes e seus familiares. O tratamento da dor no recém-nascido consiste em medidas não-farmacológicas (sucção não-nutritiva, glicose) e farmacológicas (analgésicos não-opióides, opióides e anestésicos locais). A sedação em recém-nascidos é produzida por fármacos que agem diminuindo a atividade, a ansiedade e a agitação do paciente, podendo levar à amnésia de eventos dolorosos ou não-dolorosos. A sedação pode ser feita pela administração de hidrato de cloral, barbitúricos, propofol e benzodiazepínicos. CONCLUSÕES: A prevenção da dor e a indicação de analgesia devem ser individualizadas e sempre consideradas em todos os recém-nascidos portadores de doenças potencialmente dolorosas e/ou submetidos a procedimentos invasivos, cirúrgicos ou não.

BACKGROUND AND OBJECTIVES: The study of pain in neonatology is important because pain and stress mean suffering and discomfort for newborns and, despite it, very little has been done to minimize them. In this revision we discuss: prevention of pain, non-pharmacological and pharmacological treatment, and sedation in newborns. CONTENTS: Several non-pharmacological measures can be taken to prevent pain in Neonatal Intensive Care Units, and to humanize and reduce the stress on the environment for patients and their families. Pain treatment in the newborn consists of non-pharmacological (non-nutritive suckling, glucose) and pharmacological (non-opioid analgesics, opioids, and local anesthetics) measures. Sedation in the newborn is achieved with drugs that decrease activity, anxiety, and agitation of the patient, and that could lead to amnesia of painful and non-painful events. Sedation can be accomplished with chloral hydrate, barbiturates, propofol, and benzodiazepines. CONCLUSIONS: Prevention of pain and the indication of analgesia should be individualized and always considered in every newborn with potentially painful disorders and/or undergoing invasive procedures, surgical or not.

JUSTIFICATIVA Y OBJETIVOS: La importancia del estudio del dolor en neonatología se debe al hecho de que la sensación de dolor y de estrés significa sufrimiento e incomodidad para los recién nacidos y, a pesar de ese conocimiento poco se ha hecho para reducirlo. Dentro de esa revisión se discutieron: la prevención del dolor, las medidas no farmacológicas ye farmacológicas para su tratamiento y la sedación en recién nacidos. CONTENIDO: Varias son las medidas no-farmacológicas que pueden ser tomadas con el objetivo de prevenir el dolor en Unidades de Terapia Intensiva Neonatal y también para hacer el ambiente más humanizado y menos estresante para los pacientes y sus familiares. El tratamiento del dolor en el recién nacido consiste en medidas no farmacológicas (succión no nutritiva, glicosis) y farmacológicas (analgésicos no-opioides, opioides y anestésicos locales). La sedación en recién nacidos es producida por fármacos que actúan disminuyendo la actividad, la ansiedad y la agitación del paciente, pudiendo conllevar a la amnesia de eventos dolorosos o no dolorosos. La sedación puede ser hecha a través del uso de hidrato de cloral, barbitúricos, propofol y benzodiazepínicos. CONCLUSIONES: La prevención del dolor y la indicación de analgesia deben ser individualizadas y siempre consideradas en todos los recién nacidos portadores de enfermedades potencialmente dolorosas y/o sometidos a procedimientos invasivos, quirúrgicos o no.

The Korean Practice Parameter for the Treatment of Attention-Deficit Hyperactivity Disorder(IV): Non-Pharmacologic Treatment

This practice parameter for non-pharmacological treatment for attention-deficit hyperactivity disorder(ADHD) review the domestic and international literature on the psychosocial treatment of children and adolescents with ADHD. This parameter include the parental training & education, cognitive behavior therapy(group or individual), social skill training, family therapy, play therapy(individual psychotherapy) and non-traditional therapy(art therapy, herbal therapy et al). Among them, there is some proven evidence only in parental training & education and cognitive behavior therapy. So, this parameter describes some details only in the field of parental training & education and cognitive behavior therapy. The efficacy or effectiveness, especially, cost-effectiveness of specific psychosocial treatment method for ADHD cannot be fairly assessed due to the scarcity of controlled clinical data. Based on the clinical expert consensus and limited evidence, we cautiously suggest the practice recommendations about the non-pharmacological psychosocial treatment for children and adolescents with ADHD.

Guidelines for Clinical Management of Premenstrual Syndrome

Premenstrual syndrome(PMS) refers to a group of menstruation-related symptoms that impair daily activity and interpersonal relationship. The therapeutic modality for PMS consists of non-pharmacologic and pharmacologic treatment. Generally, after confirmation of PMS, a set of non-pharmacologic treatments is recommended before pharmacologic treatment. Patients can be benefited from non-pharmacological treatments such as patient education, cognitive therapy, behavioral therapy, and dietary supplementation. Pharmacologic therapy including psychotropic agents, diuretics, and prostaglandin inhibitors may be used, when PMS symptoms are not sufficiently improved after non-pharmacologic treatments, or when symptoms fit the diagnostic criteria of premenstrual dysphoric disorder(PMDD). When treatment fails, hormonal therapy to manipulate menstrual cycle may be considered, and several trials showed improvement of physical and mood symptoms.

Medidas no farmacológicas para el alivio del dolor / Non pharmacologic measures for relief of pain

El objetivo de esta revisión es discutir algunos aspectos de las terapias no farmacológicas para aliviar el dolor y el sufrimiento las cuales no han recibido la atención que merecen por parte del personal de la salud. Se incluyen elementos de la terapia física como el calor, el frío, el ejercicio, la neuroestimulación y la acupuntura; la terapia cognoscitiva y conductual con métodos como la educación, la retroalimentación, la relajación, la musicoterapia, la hipnosis, la distracción, la sustitución de pensamientos e imágenes y la terapia grupal y familiar. Se discuten aspectos de la asistencia espiritual y el tacto humanizado. Todo esto con el fin de lograr un acercamiento humanizado al hombre que sufre.

In this review the author discusses some aspectsof non-pharmacologic therapies for relief of painand suffering; both physical and psychologicalapproaches are included; the former include heatand cold applicatio", exercises, neurostimulationand acupuncture; the latter are education,biofeedback, relaxation, musictherapy, hypnosis,thought sustitution, images and group and familytherapy. Aiso discussed are spiritual assistanceand humanized touch. The goal of theseapproaches is to obtain proximity with the sufferinghuman being