Impact of Laughter Therapy on Anxiety and Pain in Pediatric Dentistry: A Double-Blinded Randomized, Controlled Clinical Trial

Abstract Objective: To evaluate the effect of laughter therapy on reducing anxiety and pain during dental procedures in children 5-7 years of age. Material and Methods: 48 children aged 5-7 years were included in this cross-over double-blinded clinical trial after the parents completed the Screen for Child Anxiety Related Disorder questionnaire (SCARED). After allocation into two groups: laughter intervention (A) and neutral intervention (B), the anxiety as well as pain were determined by Modified Child Dental Anxiety Scale Faces questionnaire (MCDASF) and the Wong-Baker Faces Scale, respectively. Also, the child's behavior during the treatment was recorded using the Sound, Eye, Motor scale (SEM). Data were analyzed by SPSS 21 using Paired t-test, Independent t-test, Chi-square, Mann-Whitney and Wilcoxon's test. Results: The mean score of anxiety in the laughter intervention group (17.42±2.74) was significantly less than (22.06±2.16) in the neutral intervention group (p=0.000) and lower in boys in both groups (p=0.000, p=0.047). The mean pain severity reported by the children in the neutral intervention group (5.33±1.81) was higher than in the laughter intervention group (2.38±1.87; p=0.00) and higher in girls in both groups (p=0.02; p=0.03). Conclusion: The laughter intervention before dental procedures had a significant effect on reducing anxiety and pain during dental treatment (AU).

Palhaçoterapia em ambiente hospitalar: uma revisão de literatura / Clown therapy in the hospital setting: A review of the literature

Resumo A inserção do palhaço no hospital é relativamente recente e mais de 700 organizações realizam a palhaçoterapia nessas instituições no Brasil e em outras ao redor do mundo. Dada a ênfase na integralidade do cuidado e humanização da assistência à saúde, torna-se oportuno compreender e analisar a produção nacional e internacional do conhecimento científico sobre esta prática que desafia o modelo hegemônico de cuidado e potencialmente contribui na recuperação da saúde. Foi realizada uma revisão de literatura utilizando análise de conteúdo temática que analisou 18 publicações. As categorias que emergiram foram: respostas fisiológicas, comportamentais e emocionais; ansiedade pré-operatória; e ressignificação das práticas e do ambiente hospitalar. A literatura analisada aponta que a palhaçoterapia provoca diminuição significativa da ansiedade pré-operatória em crianças, comparativamente maior do que a obtida com o uso de um fármaco indutor de anestesia. A maior parte dos estudos investigou o uso da palhaçoterapia na adaptação à hospitalização, auxiliando na atribuição de novos significados. Apesar da baixa representatividade do tema no campo científico e mesmo não sendo amplamente aceita como prática de saúde, os resultados encontrados sugerem benefícios na utilização da palhaçoterapia em ambiente hospitalar.

Abstract The presence of clowns in hospitals is relatively recent and more than 700 organizations now perform clown therapy in hospitals in Brazil and around the world. Considering the emphasis on comprehensive care and the humanization of health, it is timely to understand and analyze the national and international scientific literature on clown therapy. This practice challenges the hegemonic biomedical model and potentially helps in the recuperation of health. A review of the literature was conducted and 18 publications were analyzed using thematic content analysis. The following categories arose from the analysis: physiological, behavioral, and emotional responses; presurgical anxiety and attribution of new meanings to practices and the hospital environment. Results have shown that clown therapy leads to a significant decrease in preoperative anxiety in children, even compared with the results obtained with the use of anesthesia-inducing drugs. Most studies investigated the use of clown therapy during patients' adaptation to hospitalization, helping them to attribute new meanings to this situation. Despite its low representation in the scientific field and the fact that it has not been widely accepted as a health practice, several studies have shown the benefits of using clown therapy in the hospital setting.

A terapia aquática como coadjuvante na variação do humor em mulheres pós-menopáusicas / Aquatic Therapy Supporting the Variation of humor in women post menopausal women

Objetivo: Observar a influência de um programa de exercícios terapêuticos em piscina, nas sintomatologias menopáusica e depressiva em um grupo de mulheres na menopausa. Material e Métodos: Estudo de intervenção do tipo longitudinal, com abordagem quantitativa e medidas pré e pós-tratamento, em população de mulheres menopáusicas. Instrumentos de coleta de dados: Índice Menopausal de Blatt e Kuppermanne Escala de Depressão Geriátrica de Black & Yesavage. Osdados foram analisados utilizando-se o software Statiscal Package for the Social Sciences (SPSS) versão 16.0 para Windows, além do teste estatístico Wilcoxon e do teste de Correlação de Spearman. Resultados: No que diz respeito àsintomatologia menopáusica, observou-se Média (SD) antes de 11,73 (9,90) e depois da intervenção de 7,60 (5,60), com uma diferença significativa (z=-3,293; p=0,001) entre as medidas pré e pós-tratamento. Quanto aos sintomas de depressão, observou-se Média (SD) antes de 13,3 (5,5) e depois de 9,0 (5,9), houve diferença significativa (z=-2,003;p=0,045) entre as medidas pré e pós-tratamento, resultados confirmados pelo teste de Correlação de Spearman.Conclusão: Verificou-se que a hidroterapia proporciona benefícios físicos e funcionais, tais como alívio nas ondas de calor e melhoria no humor e na imagem corporal,aumentando a auto-estima feminina e diminuindo asintomatologia depressiva abundantemente encontrada nas mulheres menopáusicas.

Objective: To observe the influence of an aquatic therapeuticexercise program on menopausal symptoms and depressionin a group of menopausal women. Material and Methods:This was a longitudinal intervention study, with a quantitativeapproach and pre- and post-treatment measures in apopulation of menopausal women. Instruments for datacollection: Blatt and Kuppermann Menopausal Index and Black& Yesavage Geriatric Depression Scale. Data were analyzedusing the software Statistical Package for Social Sciences(SPSS) version 16.0 for Windows, in addition to Wilcoxonstatistical test and Spearman’s correlation test. Results: The mean (SD) of menopausal symptoms before and afterintervention was found to be 11.73 (9.90) and 7.60 (5.60),respectively, with a significant difference (z=-3.293; p=0.001) between pre- and post-treatment measures. For symptoms of depression, means (SD) of 13.3 (5.5) and 9.0 (5.9) were observed before and after intervention, with a significant difference (z=-2.003; p=0.045) between pre- and post treatment measures, confirmed by the Spearman correlationtest. Conclusion: Hydrotherapy was found to provide physicaland functional benefits, such as relief of heat waves and improvement in mood and body image, increasing female self esteem and reducing depression symptoms abundantly found in menopausal women.