Swedish massage as an adjunct approach to Help suppOrt individuals Pregnant after Experiencing a prior Stillbirth (HOPES): a convergent parallel mixed-methods single-arm feasibility trial protocol.

BACKGROUND: Women experiencing pregnancy after stillbirth experience high levels of anxiety, fear and depression. Standard antenatal care may be emotionally unsuitable for many women at this time, and there is a lack of evidence on what interventions or approaches to care might benefit these women. Therapeutic massage may assist women after stillbirth by decreasing anxiety, worry and stress. OBJECTIVE: This paper outlines the objectives, methodology, outcome and assessment measures for the Helping suppOrt individuals Pregnant after Experiencing a Stillbirth (HOPES) feasibility trial which evaluates massage as an adjunct approach to care for pregnant women who have experienced a prior stillbirth. It also outlines data collection timing and considerations for analysing the data. METHODS: HOPES will use a convergent parallel mixed-methods, single-arm repeated measures trial design in trained massage therapists' private clinics across Australia. HOPES aims to recruit 75 individuals pregnant after a previous stillbirth. The intervention is massage therapy treatments, and participants will receive up to five massages within a 4-month period at intervals of their choosing. Primary quantitative outcomes are the feasibility and acceptability of the massage intervention. Secondary outcomes include determining the optimal timing of massage therapy delivery and the collection of measures for anxiety, worry, stress and self-management. A thematic analysis of women's experiences undertaking the intervention will also be conducted. A narrative and joint display approach to integrate mixed-methods data is planned. DISCUSSION: The HOPES study will determine the feasibility and preliminary evidence for massage therapy as an intervention to support women who are pregnant after a stillbirth. CLINICALTRIALS: gov NCT05636553. Registered on December 3, 2022, and the trial is ongoing.

Explaining the Impact of the COVID-19 Pandemic on Massage Therapists in Australia and Canada: A Mixed Methods Study.

Background: The COVID-19 pandemic was a time of rapid change and uncertainty, with individual jurisdictions within countries implementing a variety of preventative measures. At the onset of the pandemic, as little was known about how COVID-19 was transmitted, restrictions, such as lockdowns, were implemented to prevent further spread of this virus. In many jurisdictions, massage therapists were deemed as nonessential for a period. This disruption to their livelihood, as a professional group and without autonomy to decide, was unprecedented. This prompted the question as to whether this experience had impacted massage therapists' professional identity. Methods: A sequential explanatory mixed methods design was used and massage therapists in Australia and Canada were recruited to participate. Results from a quantitative questionnaire completed by 649 respondents and from 31 semistructured interviews from a subset of the questionnaire participants were used in the mixed analysis. Results: Massage therapists, impacted by the pandemic, experienced a discord between what it means to be a massage therapist, providing patient-centered care and the public health initiatives implemented during the pandemic. This discord occurred in multiple situations and the type of discord was influenced by a number of factors, including how therapists identified themselves within the workforce (i.e., as a health care provider or a service provider). Conclusion: This study sought to understand how the COVID-19 pandemic impacted massage therapists' professional identity. Massage therapists reported that the pandemic impacted their professional identity through a lack of congruence and discord between their identity-constituting beliefs and what it means to be a massage therapist. The sequela to this discord was therapists experiencing different types of moral distress and or moral injury. Future research is needed to determine the longer-term impacts of COVID-19 on massage therapists.

The Effectiveness of Massage in Managing Pregnant Women with Pelvic Girdle Pain: a Randomised Controlled Crossover Feasibility Study.

Introduction: Pelvic girdle pain is a common problem experienced during pregnancy, with high incidence rates and significant impacts on quality of life. Remedial massage might be able to provide some reduction in pain. Aim: This study aimed to investigate the feasibility of conducting a randomised controlled trial on the effectiveness of massage in treating pregnant women with pelvic girdle pain to determine its merits and viability for use in a large-scale study. Methods: A two-arm pilot randomised feasibility crossover-controlled trial. The two treatment phases were a) remedial pregnancy massage, and b) exercise. Results: Twenty-four women started the study and 19 women completed the study. Data were collected on recruitment and retention rates, crossover study design methodology, participant sub-characteristics, and acceptability of the outcome measures (pain, quality of life, and disability). Conclusion: Recruiting participants for a pregnancy-related pelvic girdle pain study is indeed feasible; however, a crossover study design is not appropriate and future studies should consider a mixed methods study design.

The paradox of the impact of the COVID-19 pandemic on massage therapists in Australia and Canada: The reporting of a qualitative strand of a mixed methods study.

INTRODUCTION: In both Australia and Canada, healthcare providers considered essential were allowed to operate during the COVID-19 pandemic. The impact of the global pandemic on professional identity included opportunities for role expansion, a focus on ethical principles and social accountability, and professional pride. These results were found only for those considered to be essential and do not likely resonate with those classified as non-essential, such as massage therapists, leaving a gap in understanding. MATERIALS AND METHODS: This qualitative strand of a sequential explanatory mixed methods study used qualitative description. Individuals who expressed interest were purposefully selected, based on age, gender, type of practice, and experience with the four key phenomena of interest. Data collected through semi-structured interviews was analyzed using qualitative content analysis. Member checking enhanced the trustworthiness of the results. RESULTS: Thirty-one (16 Australian and 15 Canadian) participants were interviewed. The main theme described was the pandemic paradox. At some point during the pandemic, most participants were labelled by government agencies as a non-essential service. However, participants reported feeling both essential and non-essential. Two subthemes were also described: factors contributing to creating the paradox and consequences of the paradox. CONCLUSION: A number of pre-existing factors around professional identity, such as patient relationships combined with the conditions instituted to manage the COVID-19 pandemic included designating health care services as essential or non-essential, created the paradox experienced by respondents and the subsequent experience of moral distress. Further research into moral distress experienced by massage therapists is needed.

Applying Scientific Rationale to the Current Perceptions and Explanations of Massage and Miscarriage in the First Trimester.

Miscarriage is a relatively common occurrence, impacting 8-15% of clinically recognised pregnancies, and up to 30% of all conceptions. The public perception of the risk factors associated with miscarriage does not match the evidence. Evidence indicates that there are very few modifiable factors to prevent miscarriage, and the majority of the time little could have been done to prevent a spontaneous miscarriage. However, the public perception is that consuming drugs, lifting a heavy object, previous use of an intrauterine device, or massage can all contribute to miscarriage. While misinformation about the causes and risk factors of miscarriage continues to circulate, pregnant women will experience confusion about what activities they can (and cannot) do in early pregnancy, including receiving a massage. Pregnancy massage is an important component of massage therapy education. The resources that underpin pregnancy massage coursework consist of educational print content that includes direction and caution that massage in the first trimester, if done 'incorrectly' or in the 'wrong' location, can contribute to adverse outcomes such as miscarriage. The most common statements, perceptions and explanations for massage and miscarriage cover three broad areas: 1) maternal changes from massage affects the embryo/fetus; 2) massage leads to damage of the fetus/placenta; and 3) aspects of the massage treatment in the first trimester initiate contractions. The goal of this paper is to use scientific rationale to critically consider the validity of the current perceptions and explanations of massage therapy and miscarriage. Whilst direct evidence from clinical trials was lacking, considerations of physiological mechanisms regulating pregnancy and known risk factors associated with miscarriage provide no evidence that massage in pregnancy would increase a patient's risk of miscarriage. This scientific rationale should be addressed when teaching pregnancy massage courses.

Protein-metabolite interactomics of carbohydrate metabolism reveal regulation of lactate dehydrogenase.

Metabolic networks are interconnected and influence diverse cellular processes. The protein-metabolite interactions that mediate these networks are frequently low affinity and challenging to systematically discover. We developed mass spectrometry integrated with equilibrium dialysis for the discovery of allostery systematically (MIDAS) to identify such interactions. Analysis of 33 enzymes from human carbohydrate metabolism identified 830 protein-metabolite interactions, including known regulators, substrates, and products as well as previously unreported interactions. We functionally validated a subset of interactions, including the isoform-specific inhibition of lactate dehydrogenase by long-chain acyl-coenzyme A. Cell treatment with fatty acids caused a loss of pyruvate-lactate interconversion dependent on lactate dehydrogenase isoform expression. These protein-metabolite interactions may contribute to the dynamic, tissue-specific metabolic flexibility that enables growth and survival in an ever-changing nutrient environment.

The Use of Massage to Support Emotional and Physical Health in a Pregnancy After Stillbirth: a Case Study.

Objective: To observe the effects of massage aiming to support a mum in her pregnancy after a previous stillbirth. The client's goal varied over the course of her pregnancy, but her main motivation was to help manage the anxiety and stress of pregnancy after a previous stillbirth. Methods: A 32-year-old pregnant woman received seven massages over a seven-month period. The Measure Yourself Concerns and Wellbeing (MYCaW) outcome measure was used at each session to identify the client's concerns at that time point. Written feedback was also sought from the client just prior to her giving birth. Results: The client's concerns included anxiety, sciatica, stress, shoulder tension/soreness, and a lack of sleep. The client experienced a decrease in each concern after each treatment over the seven sessions and experienced improved well-being after each session. The client self-reported that the massage helped her cope, saying: "I'm not sure how I would have coped if I didn't have her sessions." Conclusions: Massage is a treatment option for women experiencing pregnancy after stillbirth, which can provide physical and emotional support.

Impact of the COVID-19 Pandemic on the Professional Identity of Massage Therapists: The Reporting of a Quantitative Strand of a Mixed-Methods Study.

Introduction: In late 2019, a pathogen outbreak occurred that rapidly spread, resulting in the coronavirus disease 2019 (COVID-19) global pandemic. Governments responded to the pandemic with a range of strategies, including forced quarantines and nationwide lockdowns. Research on professional identity during the pandemic has predominately focused on health care providers declared as "essential" rather than "nonessential." In this study, the authors examine the impacts on the professional identity of massage therapists (MTs) who were predominately deemed as nonessential health care providers during the COVID-19 pandemic. Materials and methods: An online, questionnaire-based study sought to answer "In what ways has the professional identity of MTs in Canada and Australia been impacted by the COVID-19 global pandemic?" MTs in Canada and Australia were recruited using convenience sampling through e-mail and social media. A questionnaire was developed and pilot tested before implementation. Results: Six hundred and forty-nine MTs participated (329 from Canada and 316 from Australia). Known constructs of professional identity that were affected during the pandemic included not feeling respected as a health care practitioner, feeling less professional than other health care providers, and experiencing burnout. New constructs that may have developed out of the pandemic and the measures established to manage them included being classified as nonessential and feeling a sense of camaraderie and belonging. Conclusions: This study is the first of its kind to report the impact of the COVID-19 pandemic on the professional identity of MTs. The emerging constructs reported will be used to create interview questions for the subsequent qualitative strand of this explanatory mixed-methods study. In the qualitative study, respondents will be invited to share their experiences with their own voice to further the understanding of the impact of the COVID-19 pandemic on MTs' professional identity.

Partner delivered relaxation massage to support mild antenatal anxiety; views of participants.

BACKGROUND: Approximately one-fifth of pregnant women suffer from anxiety and/or depression. These mental health conditions are associated with increased infant and maternal morbidity. Relaxation massage has the potential to improve mental health and may provide a vaulable option for pregnant women. This paper reports on participants' experiences of partner delivered massage as a technique to manage mild antenatal anxiety. METHODS: We conducted a feasibility study with 44 pregnant women who self-assessed as mildly anxious. The women were randomised into massage therapy (14 women/partner dyads) or to an active control group (13 women). 4-6 weeks after the birth of their baby, massage group participants were invited to be interviewed about their experiences; twelve women and four partners agreed. The qualitative data was analysed using reflective thematic analysis. RESULTS: Four themes emerged from the data; Supporting mental health, Connecting, Useful and adaptable and Making it happen. Partner delivered massage was an accessible and practical method to manage mild anxiety for pregnant women in this study. The massage program also provided useful skills for participants to apply in their lives after the birth of their child, which has the potential to continue to support maternal mental health as well as partner connection. CONCLUSION: Partner delivered massage offers low-cost, accessible option for pregnant women to manage their mild anxiety. These findings have particular relevance in the context of the COVID-19 pandemic, where anecdotal reports indicate that antenatal stress is increasing and women may have limited access to healthcare services.

The biochemical basis of mitochondrial dysfunction in Zellweger Spectrum Disorder.

Peroxisomal biogenesis disorders (PBDs) are genetic disorders of peroxisome biogenesis and metabolism that are characterized by profound developmental and neurological phenotypes. The most severe class of PBDs-Zellweger spectrum disorder (ZSD)-is caused by mutations in peroxin genes that result in both non-functional peroxisomes and mitochondrial dysfunction. It is unclear, however, how defective peroxisomes contribute to mitochondrial impairment. In order to understand the molecular basis of this inter-organellar relationship, we investigated the fate of peroxisomal mRNAs and proteins in ZSD model systems. We found that peroxins were still expressed and a subset of them accumulated on the mitochondrial membrane, which resulted in gross mitochondrial abnormalities and impaired mitochondrial metabolic function. We showed that overexpression of ATAD1, a mitochondrial quality control factor, was sufficient to rescue several aspects of mitochondrial function in human ZSD fibroblasts. Together, these data suggest that aberrant peroxisomal protein localization is necessary and sufficient for the devastating mitochondrial morphological and metabolic phenotypes in ZSDs.

Labour induction massage: A thematic content analysis of Australian massage therapists' website pages.

BACKGROUND AND PURPOSE: There is limited evidence on the efficacy and safety of induction massage; however, there are some massage therapists in Australia who offer induction massage. The aim of this paper is to determine the information being provided to consumers on websites pages of Australian massage therapists who provide 'induction massage'. MATERIALS AND METHODS: A qualitative summative content analysis methodology employing both manifest and latent content analysis was used to examine website pages of Australian massage therapists offering 'induction massage'. RESULTS: Twenty-eight websites met the criteria for inclusion. The qualitative theme was a façade of hope with three subthemes: a) misconception and equivocation, b) marketing scieneploitation and c) lack of empowerment. CONCLUSION: While there were only a small number of websites that provided induction massage, these webpages generally failed to provide accurate and complete information and used deceptive and misleading statements and language that made 'induction massage' appear more efficacious and legitimate than current evidence suggests it is, thus potentially giving false hope to potential consumers.

Acupressure and Acupuncture Use in the Peripartum Period.

Acupuncture is the procedure of inserting fine needles into specific points on the body for therapeutic purposes. Acupuncture and its derivatives (acupressure, moxibustion, electroacupuncture, and transcutaneous electric nerve stimulation on acupoints) are a popular treatment choice in the peripartum period (32 wk' gestation to 14 d postdelivery). There is substantial research evidence supporting acupuncture and its derivatives in the peripartum period. Benefits in the use of acupressure to reduce labor pain intensity and a reduction in the duration of labor with acupressure have been found. There is mixed evidence for the use of both moxibustion and moxibustion with acupuncture for noncephalic presentations and for acupressure for reducing intraoperative nausea. There is limited evidence available on acupuncture use in women with high-risk pregnancies or multifetal gestations.

Massage During Pregnancy and Postpartum.

Massage is systematic touch and manipulation of the soft tissues of the body that is increasingly being used as an adjunctive therapy for stress relief and to promote relaxation and wellbeing during pregnancy and as an alternative to pharmacologic or invasive forms of analgesia during labor. Literature to support the use of massage in pregnancy and labor is limited; however, evidence to support its use has been increasing over the past 30 years. Massage has been shown to be valuable to pregnant women with anxiety, depression, leg, and back pain, and has shown significant benefit in perception of pain during labor.

The pyruvate-lactate axis modulates cardiac hypertrophy and heart failure.

The metabolic rewiring of cardiomyocytes is a widely accepted hallmark of heart failure (HF). These metabolic changes include a decrease in mitochondrial pyruvate oxidation and an increased export of lactate. We identify the mitochondrial pyruvate carrier (MPC) and the cellular lactate exporter monocarboxylate transporter 4 (MCT4) as pivotal nodes in this metabolic axis. We observed that cardiac assist device-induced myocardial recovery in chronic HF patients was coincident with increased myocardial expression of the MPC. Moreover, the genetic ablation of the MPC in cultured cardiomyocytes and in adult murine hearts was sufficient to induce hypertrophy and HF. Conversely, MPC overexpression attenuated drug-induced hypertrophy in a cell-autonomous manner. We also introduced a novel, highly potent MCT4 inhibitor that mitigated hypertrophy in cultured cardiomyocytes and in mice. Together, we find that alteration of the pyruvate-lactate axis is a fundamental and early feature of cardiac hypertrophy and failure.

Maternal mental health and partner-delivered massage: A pilot study.

BACKGROUND: Anxiety and depression affects many pregnant women. Massage may be beneficial for supporting mental wellbeing during this time. The aim of this study was to assess the feasibility and acceptability of a partner-delivered relaxation massage program for pregnant women, and its impact on symptoms of antenatal anxiety, stress and depression. METHODS: A feasibility randomised controlled trial was conducted to compare partner-delivered relaxation massage (intervention) with self-directed stress management (control). Women attended an initial workshop at 28-32 weeks gestation followed by completion of a self-directed massage or stress management program. Qualitative data about the feasibility and acceptability (primary outcomes) were collected via online participant diaries and post-birth interviews. Anxiety, depression and stress symptoms (secondary outcomes) were assessed using the Depression and Anxiety Stress Scale (DASS-21). Birth outcomes were collected at the post- birth interview. RESULTS: A total of 14 women/partner dyads in the massage group and 13 women in the self-directed stress management group, attended the initial workshops. When interviewed, participants from both groups reported that the programs were feasible and acceptable. Women's mean scores on all subscales of the DASS-21significantly decreased over time in both the intervention and the control group. CONCLUSION: Pregnant women found the partner-delivered massage program to be feasible and acceptable. Both programs decreased women's symptoms of anxiety, depression and stress with no significant differences identified between the two groups. An adequately powered experimental study with a large representative sample is needed to determine whether partner-delivered relaxation massage reduces pregnant women's symptoms of anxiety, depression and stress.

Callyspongiolide Is a Potent Inhibitor of the Vacuolar ATPase.

Callyspongiolide is a marine-derived macrolide that kills cells in a caspase-independent manner. NCI COMPARE analysis of human tumor cell line toxicity data for synthetic callyspongiolide indicated that its pattern of cytotoxicity correlated with that seen for concanamycin A, an inhibitor of the vacuolar-type H+-ATPase (V-ATPase). Using yeast as a model system, we report that treatment with synthetic callyspongiolide phenocopied a loss of V-ATPase activity including (1) inability to grow on a nonfermentable carbon source, (2) rescue of cell growth via supplementation with Fe2+, (3) pH-sensitive growth, and (4) a vacuolar acidification defect visualized using the fluorescent dye quinacrine. Crucially, in an in vitro assay, callyspongiolide was found to dose-dependently inhibit yeast V-ATPase (IC50 = 10 nM). Together, these data identify callyspongiolide as a new and highly potent V-ATPase inhibitor. Notably, callyspongiolide is the first V-ATPase inhibitor known to be expelled by Pdr5p.

Australian massage therapists' views and practices related to preconception, pregnancy and the early postpartum period.

BACKGROUND AND PURPOSE: Massage is commonly used by the Australian public and is often sought by expectant mothers. Despite its popularity there is no regulatory body to enforce minimum educational standards, guidelines or evidence-based best practice for massage therapists. The aim of this paper is to critically examine the views and practices of massage therapists who offer preconception, antenatal or postnatal massage. MATERIALS AND METHODS: An online survey was administered to Australian massage therapists who provide massage in the preconception, antenatal or postnatal periods. RESULTS: Ninety-nine therapists completed the survey. The majority of respondents had received training in pregnancy massage (n = 72; 72.7%) only. The most confident respondents were those that had both training and experience. CONCLUSION: There are potential gaps in training for massage therapists including up-to-date curriculum and a fragmentation around industry training requirements for pregnancy massage, which may impact on the safety and benefits of pregnancy massage.

Mitochondrial fatty acid synthesis coordinates oxidative metabolism in mammalian mitochondria.

Cells harbor two systems for fatty acid synthesis, one in the cytoplasm (catalyzed by fatty acid synthase, FASN) and one in the mitochondria (mtFAS). In contrast to FASN, mtFAS is poorly characterized, especially in higher eukaryotes, with the major product(s), metabolic roles, and cellular function(s) being essentially unknown. Here we show that hypomorphic mtFAS mutant mouse skeletal myoblast cell lines display a severe loss of electron transport chain (ETC) complexes and exhibit compensatory metabolic activities including reductive carboxylation. This effect on ETC complexes appears to be independent of protein lipoylation, the best characterized function of mtFAS, as mutants lacking lipoylation have an intact ETC. Finally, mtFAS impairment blocks the differentiation of skeletal myoblasts in vitro. Together, these data suggest that ETC activity in mammals is profoundly controlled by mtFAS function, thereby connecting anabolic fatty acid synthesis with the oxidation of carbon fuels.

In human, plant and other eukaryotic cells, fats are an important source of energy and also play many other roles including waterproofing, thermal insulation and energy storage. Eukaryotic cells have two systems that make the building blocks of fats (known as fatty acids) and one of these systems, called the mtFAS pathway, operates in small compartments known as mitochondria. This pathway only has one known product, a small fat molecule called lipoic acid, which mitochondria attach to several enzymes to allow them to work properly. The main role of mitochondria is to break down fats and other molecules to release chemical energy that powers many processes in cells. They achieve this using large groups of proteins known as ETC complexes. To build these complexes, families of proteins known as ETC assembly factors carefully coordinate the assembly of many proteins and small molecules into specific structures. However, it remains unclear precisely how this process works. Here, Nowinski et al. used a gene editing technique to mutate the genes encoding three enzymes in the mtFAS pathway in mammalian cells. The experiments found that the mutant cells had fewer ETC complexes and seemed to be less able to break down fats and other molecules than 'normal' cells. Furthermore, a family of ETC assembly factors were less stable in the mutant cells. These findings suggest that the mtFAS pathway controls how mitochondria assemble ETC complexes. Further experiments indicated that lipoic acid is not involved in the assembly of ETC complexes and that the mtFAS pathway produces another, as yet unidentified, product that regulates this process, instead. MEPAN syndrome is a rare neurological disorder that leads to progressive loss of control of movement, slurred speech and impaired vision in children. Patients with this syndrome have genetic mutations affecting components of the mtFAS pathway, therefore, a better understanding of how the pathway works may help researchers develop new treatments in the future. More broadly, these findings will have important ramifications for many other situations in which the activity of ETC complexes in mitochondria is modified.

Pregnancy-related Pelvic Girdle Pain and Pregnancy Massage: Findings from a Subgroup Analysis of an Observational Study.

BACKGROUND: Pregnancy-related pelvic girdle pain (PPGP) significantly impacts women's lives both physically and psychologically. Given the severity and impact of PPGP on pregnancy, the authors anticipated that pregnant women with PPGP might respond differently to massage than pregnant women without PPGP. PURPOSE: The aim of the study was to further analyze a published 2017 study to assess the response of pregnancy massage in participants with and without PPGP. SETTING: Two massage clinics, one in Sydney and one in Melbourne, recruited participants from December 2016 to December 2017. PARTICIPANTS: Nineteen women with PPGP and 78 without PPGP. RESEARCH DESIGN: PPGP and non-PPGP women receiving at least one massage, with outcome measures assessed immediately prior to and after massage, and again one week postmassage. MAIN OUTCOME MEASURES: Visual analog scales for pain, stress, range of movement, sleep, and self-reported side effects of massage. RESULTS: Both groups changed significantly and similarly over time for measures of pain, stress, range of motion, and sleep (all p < .05). Post hoc analysis found significant reduction in all outcome measures immediately following massage, but returned to baseline at one week postmassage for all measures except pain, which remained reduced for the PPGP group (49.79±25.68 to 34.75±34.75, p = .03, effect size 0.593), and stress remained reduced in the non-PPGP group (33.36±21.54 to 24.90±19.18, p = .002, effect size 0.373). The PPGP group entered the study with higher baseline levels of pain (p = .01) and a greater restriction in range of motion (p = .006) than the non-PPGP group. There was no difference in the number of side effects experienced between the two groups (p = .130). CONCLUSIONS: Although PPGP clients report greater pain and restriction in range of motion at baseline than non-PPGP clients, the response to pregnancy massage was similar. Results support a role of pregnancy massage in the management of PPGP. More research on massage for PPGP is needed to confirm a lasting effect of pain reduction from massage.