Clinical Effects of Yoga and Meditational Practices on the Holistic Health of Chronic Kidney Disease Patients: A Systematic Review.

As the world accelerates, sedentary and unhealthy lifestyles have an increasingly negative impact on human physical and emotional well-being. Millions of people globally are thought to have chronic kidney disease (CKD), which is frequently brought on by diabetes, hypertension, and glomerulonephritis. Over time, the illness gets worse and eventually results in irreversible renal failure. A person's life can be seriously affected by CKD in many different ways, including emotionally, socially, physically, and financially. Apart from physiological manifestations like anemia, discomfort, and exhaustion, CKD can also result in psychological problems like anxiety and depression, which can impair one's overall standard of life. Numerous studies have demonstrated the beneficial effects of yoga and meditation on people with chronic renal disease, enhancing their general health and quality of life. Because of therapeutic limitations, familial pressures, financial restraints, and symptoms of end-stage kidney disease, people with CKD frequently experience stress and anxiety. By reducing stress and anxiety, yoga and meditation can help individuals with chronic conditions maintain their health and improve their overall well-being. Recent research has found that yoga can improve blood pressure, sympathetic activity, and basal metabolic rate as well as reduce blood pressure and blood sugar levels by balancing the autonomic nervous system. Furthermore, studies have demonstrated that yoga helps CKD patients live healthier lives by lowering stress, anxiety, and sadness. Healthcare professionals can help patients with chronic renal disease manage their symptoms and enhance their general health and well-being by adding yoga and meditation into their treatment regimens. Modifying lifestyle is essential for both the prevention and treatment of chronic renal disease. CKD often co-occurs with other age-related and sedentary lifestyles and poor diet-related chronic conditions. The dearth of targeted treatment for a large percentage of CKD patients led to the investigation of the therapeutic applications of yoga and meditation in this study. These affordable, non-invasive therapies provide a comprehensive approach to controlling CKD, benefiting both healthy individuals and those with CKD in terms of their physical and mental well-being.

Comprehensive Physiotherapy Approach for Pneumonia After Angioplasty in an 83-Year-Old Hypertensive Male Patient: A Case Report.

Pneumonia is an infection that causes inflammation in the air sacs of the lungs. Coronary artery disease is a condition characterized by the buildup of plaque in the coronary arteries, which supply blood to the heart. This obstruction restricts blood flow, resulting in chest pain (angina) and, in extreme cases, heart attacks. An important part of successfully treating diseases like peripheral artery disease and coronary artery disease is balloon angioplasty, a commonly used medical procedure for treating narrowed or clogged arteries. An 83-year-old man who had pneumonia after angioplasty was the subject of this case study. The patient had pneumonia after angioplasty, which was managed by proper medications and cardio-respiratory physiotherapy. The patient was intubated and referred for cardio-respiratory physiotherapy. Physiotherapy treatments like mild chest vibrations, suctioning, and bed mobility exercises were given initially. After extubation, physiotherapy treatment continued with deep breathing exercises, coughing techniques, relaxation techniques, and mobility exercises for the upper limbs and lower limbs. Effective physical rehabilitation was necessary in order to minimize complications following angioplasty and allow him to resume his daily activities. Several outcome measures, like the ICU mobility scale, CURB-65 score, and chest X-ray grading scores, were used to monitor the patient's progress during rehabilitation. The benefits of pulmonary rehabilitation programs emphasize the need for tailored approaches in addressing individual patient needs for comprehensive recovery.

Técnicas complementarias de relajación y analgesia no farmacológicas durante el parto: revisión sistemática / Complementary techniques of relaxation and non-pharmacological analgesia during childbirth: systematic review

Introducción: Existe la necesidad de proporcionar estrategias de analgesia que alienten y promuevan la participación de la mujer en la toma de decisiones en el momento del parto y las técnicas de relajación podrían ser un método analgésico no far-macológico complementario y/o alternativo a la anestesia epidural ampliamente utilizado. en la estándar atención del trabajo de parto. Objetivo: El objetivode este estudio es analizar los efectos obstétricos de las técnicas de relajación en el manejo del dolor durante el parto. Método: Se realiza una revisión sistemática con lectura crítica de los estudios incluidos. La búsqueda de estudios se realizó en las principales bases de datos MEDLINE, Cochrane Library, Cuiden, LILACS y SciELO. Se incluyen estudios publicados en inglés o español entre 2015 y febrero de 2021. Se incluyen una vez estudios, seis de los cuales son revisados sistemáticamente y cinco son ensayos clínicos aleatorios. Las intervenciones analizadas fueron técnicas de relajación como hipnosis, inyección intradérmica de agua estéril, inmersión en agua tibia, masaje, acu-puntura, musicoterapia, aromaterapia, apoyo continuo y prácticas mente-cuerpo como respiración relajante, yoga y meditación, entre otras. Conclusión: La principal conclusión de este estudio es que las técnicas de relajación pueden disminuir el nivel de dolor durante el trabajo, aunque la evidencia científica actual es limitada y la calidad metodológica varía de baja a moderada. Se necesitan más ensayos controlados aleatorios para apoyar esta investigación (AU)

Introduction:There is a need to provide analgesia strategies that encourage and promote women's participation in decision-making at the time of delivery and relaxation techniques could be a complementary and/or alternative non-pharmacological analgesic method to the widely used epidural anaesthesia in standard labour care. Objective: Theobjective of this study is to analyze the obstetric effects of relaxation techniques on pain management during labour. Method: A systematic review is performed with critical reading of included studies. The search for studies was carried out in the main databases MEDLINE, Cochrane Library, Cuiden, LILACS and SciELO. Studies published in English or Spanish between 2015 and February 2021 were included. Eleven studies were included, six of which are systematic reviews and five are randomised clinical trials. The interventions analysed were relaxation techniques such as hypnosis, intradermal injection of sterile water, warm water immersion, massage, acupuncture, music therapy, aromatherapy, continuous support and mind-body practices like relaxing breathing, yoga and meditation, among others. Conclusion: The main conclusion of this study is that relaxation techniques may decrease the level of pain during labour, although the current scientific evidence is limited and the methodological quality varies from low to moderate. More randomised controlled trials are needed to support this research (AU)

Transdiagnostic therapy compared to progressive muscle relaxation on the emotional health of mothers with premature infants: A randomized controlled trial.

OBJECTIVE: The aim of this study was to compare the effects of transdiagnostic therapy compared to progressive muscle relaxation (PMR) on emotion regulation strategies, self-compassion, maternal role adaptation, and social and work adjustment in mothers of premature infants. MATERIALS AND METHODS: This was a randomized controlled trial with two groups and pre-test, post-test, and a two-month follow-up assessment. Included were 27 mothers randomly assigned to either the transdiagnostic therapy group or the PMR group (13 in the transdiagnostic group and 14 in the PMR group). The experimental group received eight sessions of transdiagnostic therapy while the control group received eight sessions of PMR. The participants completed the following scales: Emotion Regulation Questionnaire, Self-Compassion Scale, Maternal Role Adaptation Scale, and Work and Social Adjustment Scale. RESULTS: Transdiagnostic therapy was significantly more effective than PMR in improving emotion regulation strategies, self-compassion, maternal role adaptation, and social and work adjustment based on the between-group comparison conducted at post-test and follow-up (p < 0.01). CONCLUSION: Transdiagnostic therapy was shown to be effective in improving the emotional health of mothers with premature infants and was more effective than PMR techniques.

Comparative Efficacy of Mitchell's and Benson's Relaxation Techniques in Alleviating Pain and Improving Quality of Life Among Patients With Premenstrual Syndrome: A Randomized Controlled Trial.

Background Most women of reproductive age suffer physical discomfort or distress in the weeks before menstruation. Even though symptoms are typically not severe enough to impede daily activities seriously, they occasionally can. Physical problems like breast discomfort and bloating can also be a problem. The most irritating symptoms are those that affect mood and behaviour. Women of reproductive age experience premenstrual syndrome frequently, necessitating study into non-pharmacological methods for symptom reduction. Methodology The objective of the study was to evaluate and compare the clinical efficacy of Benson's relaxation technique to Laura Mitchell's physiological approach in patients with premenstrual syndrome. Study design was comparative parallel experimental study with patient-reported questionnaire data (online) collected before and post-intervention in tertiary hospital setting. Participants were 70 adult females aged 18 to 35 with premenstrual syndrome. Patients were administered Benson's relaxation technique once a day for a month versus Mitchell's relaxation technique once a day for a month. Both techniques were first taught for one session followed by home program to be performed by patients. The premenstrual syndrome questionnaire and a numerical pain rating scale were used to quantify premenstrual symptoms pre and post-intervention. Results The result revealed significant (p<0.01) improvement in premenstrual symptoms in both groups following the intervention. However, Bensons' relaxation technique was found to be more significant while alleviating the premenstrual symptoms. Conclusions When it comes to lowering the intensity of premenstrual syndrome in young people, Benson's relaxation method is superior to Mitchell's. Both approaches should be entrenched as a regular practice and can be employed on patients to improve their menstrual well-being.

Non-Pharmacological Interventions for Pain Management in Hemodialysis: A Narrative Review.

This narrative review aims to summarize non-pharmacological interventions for pain management in hemodialysis patients, assessing their potential benefits and limitations in enhancing patient well-being and quality of life. We reviewed the current literature on five primary non-pharmacological interventions: acupuncture, cognitive behavioral therapy, relaxation techniques, virtual reality, and alternative methods such as transcutaneous electrical nerve stimulation, music therapy, and aromatherapy. We analyzed the evidence regarding their effectiveness, feasibility, and optimal implementation strategies. The existing evidence supports the potential benefits of these interventions in managing pain and improving the well-being of hemodialysis patients. However, further high-quality research is needed to confirm their effectiveness, establish implementation best practices, and assess their long-term impact on patient outcomes. Non-pharmacological interventions hold promise for pain management in hemodialysis patients. Additional research is required to optimize these interventions and validate their effectiveness, contributing to comprehensive pain management strategies for this vulnerable patient population.

O relaxamento como técnica de redução da ansiedade da pessoa com doença mental: revisão integrativa da literatura / Relaxation as a technique to reduce the anxiety of people with mental illness: an integrative literature review / La relajación como técnica para reducir la ansiedad de las personas con enfermedad mental: una revisión integrativa de la literatura

Resumo Contexto: As perturbações da ansiedade estão entre as perturbações mentais mais prevalentes, caracterizando-se por uma resposta exagerada e desadequada a um estímulo. A probabilidade do seu aparecimento na pessoa com doença mental aumenta consideravelmente, quando comparado com a população em geral. Torna-se perentório a implementação de intervenções de âmbito psicoterapêutico que incluem a técnica de relaxamento. Objetivo: Sistematizar a evidência científica sobre os resultados obtidos com a utilização da técnica de relaxamento, na redução da ansiedade na pessoa com doença mental. Métodos: Revisão integrativa da literatura, através da pesquisa nas bases de dados eletrónicas (CINAHL e MEDLINE) realizada em junho de 2022. Sendo aplicado um conjunto de descritores e critérios de inclusão e exclusão, obteve-se uma amostra final de 7 estudos, publicados entre 2012-2022. Resultados: A evidência científica analisada demonstra resultados benéficos na utilização da técnica de relaxamento na redução da ansiedade e sintomas psicóticos na pessoa com doença mental, devendo ser implementada como intervenção de âmbito psicoterapêutico. Os avanços tecnológicos (realidade virtual e programas online) são um grande aliado para potencializar os seus efeitos imediatos, produzindo efeitos positivos na audição, visão e sensoriais, melhorando consideravelmente a experiência do relaxamento. Conclusões: Os resultados obtidos revelam que a implementação de diversos métodos de técnica de relaxamento (muscular, respiração, imaginação guiada, yoga, biofeedback, bodywareness e meditação guiada) apresentam um potencial terapêutico benéfico na redução imediata dos sinais e sintomas de ansiedade, sendo potencializado através da exposição contínua à intervenção. Contudo, os seus efeitos a longo prazo devem ser alvo de mais estudo.

Abstract Context: Anxiety disorders are among the most prevalent mental disorders, characterized by an exaggerated and inadequate response to a stimulus. The probability of its appearance in people with mental illness increases considerably when compared to the general population. It is imperative to implement psychotherapeutic interventions that include the relaxation technique. Objective: To systematize the scientific evidence on the results obtained with the use of the relaxation technique, in reducing anxiety in people with mental illness. Methods: Integrative literature review, through research in electronic databases (CINAHL and MEDLINE) carried out in June 2022. Applying a set of descriptors and inclusion and exclusion criteria, a final sample of 7 published studies was obtained between 2012-2022. Results: The analyzed scientific evidence demonstrates beneficial results in the use of the relaxation technique in reducing anxiety and psychotic symptoms in people with mental illness and should be implemented as a psychotherapeutic intervention. Technological advances (virtual reality and online programs) are a great ally to enhance their immediate effects, producing positive effects on hearing, vision and sensory, considerably improving the experience of relaxation. Conclusions: The results obtained reveal that the implementation of various methods of relaxation techniques (muscle, breathing, guided imagery, yoga, biofeedback, bodywareness and guided meditation) have a beneficial therapeutic potential in the immediate reduction of signs and symptoms of anxiety, being enhanced through continuous exposure to the intervention. However, its long-term effects need to be studied further.

Resumen Contexto: Los trastornos de ansiedad se encuentran entre los trastornos mentales más prevalentes, caracterizados por una respuesta exagerada e inadecuada a un estímulo. La probabilidad de su aparición en personas con enfermedad mental aumenta considerablemente en comparación con la población general. Es imperativo implementar intervenciones psicoterapéuticas que incluyan la técnica de relajación. Objetivo: Sistematizar la evidencia científica sobre los resultados obtenidos con el uso de la técnica de relajación, en la reducción de la ansiedad en personas con enfermedad mental. Métodos: Revisión integrativa de la literatura, mediante investigación en bases de datos electrónicas (CINAHL y MEDLINE) realizada en junio de 2022. Aplicando un conjunto de descriptores y criterios de inclusión y exclusión, se obtuvo una muestra final de 7 estudios publicados entre 2012-2022. Resultados: A evidencia científica analizada demuestra resultados beneficiosos en el uso de la técnica de relajación en la reducción de la ansiedad y los síntomas psicóticos en personas con enfermedad mental, y debería implementarse como una intervención psicoterapéutica. Los avances tecnológicos (realidad virtual y programas online) son un gran aliado para potenciar sus efectos inmediatos, produciendo efectos positivos en la audición, la visión y los sentidos, mejorando considerablemente la experiencia de relajación. Conclusiones: Los resultados muestran que la implementación de diversos métodos de técnicas de relajación (muscular, respiratoria, imaginería guiada, yoga, biofeedback, bodywareness y meditación guiada) tienen un potencial terapéutico beneficioso en la reducción inmediata de signos y síntomas de ansiedad, siendo potenciado a través de exposición continua a la intervención. Sin embargo, sus efectos a largo plazo deben estudiarse más a fondo.

Adaptación y evaluación de la eficacia de un programa psicoeducativo de navegación para disminuir síntomas de ansiedad y depresión en mu-jeres mexicanas con cáncer de mama / Design and evaluation of the efficacy of a psychoeducational navigation program to reduce symptoms of anxiety and depression in Mexican women with breast cancer

Objetivo:El cáncer de mama (CAM) es un problema de salud pública mundial. La ansiedad y depresión son las principales comorbilidades que aquejan a este sector, el programa psicoeducativo de navegación (PPN) se presenta como una estrategia psicosocial eficaz en hospitales públicos de México. Método: Se realizó la adaptación del PPN y la evaluación de eficacia en 47 mujeres con CAM de tres hospitales de la Zona Metropolitana de Guadalajara. El PPN integró acompañamiento emocional, educación para la salud y técnicas de relajación. Se evaluaron los síntomas y los niveles de ansiedad y depresión, pre-post intervención con la Escala Hospitalaria de Ansiedad y Depresión (HADS). Resultados: Se encontró una disminución en los síntomas de ansiedad pre-test (M= 6,79, DT= 4,01) y pos-test (M= 4,19, DT= 3,03), igual que en los síntomas de depresión antes (M= 6,02, DT= 4,07) y después (M= 4,23, DT= 3,05). Se obtuvieron diferencias estadísticamente significativas entre las evaluaciones pre y post intervención tanto en las dimensiones, como en la puntuación global (p<0,001). Conclusiones: El PPN mostró eficacia para disminuir los síntomas y los niveles de ansiedad y depresión en mujeres mexicanas con CAM. Sugerimos replicar el programa en otros contextos de atención oncológica en seguimiento a las normativas nacionales (AU)

Objective: Breast cancer (BC) is a public health problem. Anxiety and depression are the main comorbidities that afflict this sector, the navigation psychoeducational program (NPP) is presented as an effective psychosocial strategy in public hospitals in Mexico.Method: The NPP was adapted and its efficacy evaluated in 47 women with BC from three hospitals in the Guadalajara Metropolitan Area. The NPP integrated emotional accompaniment, health education and relaxation techniques. Symptoms and levels of anxiety and depression were evaluated pre-post intervention with the Hospital Anxiety and Depression Scale (HADS). Results: A decrease was found in anxiety symptoms pre-test (M= 6.79, SD= 4.01) and post-test (M= 4.19, SD= 3.03), the same as in depression symptoms before (M= 6.02, SD= 4.07) and after (M= 4.23, SD= 3.05). Statistically significant differences were obtained between the pre- and post-intervention evaluations both in the dimensions and in the global score (p<0.001).Conclusions: The NPP showed efficacy in reducing symptoms and levels of anxiety and depression in Mexican women with BC. We suggest replicating the program in other cancer care contexts in compliance with national regulations (AU)

Slow breathing for reducing stress: The effect of extending exhale.

INTRODUCTION: Slow breathing techniques are commonly used to reduce stress. While it is believed by mind-body practitioners that extending the exhale time relative to inhale increases relaxation, this has not been demonstrated. METHODS: We conducted a 12-week randomized, single-blinded trial among 100 participants to compare if yoga-based slow breathing with an exhale greater inhale versus an exhale equals inhale produces measurable differences in physiological and psychological stress among healthy adults. RESULTS: Participants mean individual instruction attendance was 10.7 ± 1.5 sessions out of 12 offered sessions. The mean weekly home practice was 4.8 ± 1.2 practices per week. There was no statistical difference between treatment groups for frequency of class attendance, home practice, or achieved slow breathing respiratory rate. Participants demonstrated fidelity to assigned breath ratios with home practice as measured by remote biometric assessments through smart garments (HEXOSKIN). Regular slow breathing practice for 12 weeks significantly reduced psychological stress as measured by PROMIS Anxiety (-4.85 S.D. ± 5.53, confidence interval [-5.60, -3.00], but not physiological stress as measured by heart rate variability. Group comparisons showed small effect size differences (d = 0.2) with further reductions in psychological stress and physiological stress from baseline to 12 weeks for exhale greater than inhale versus exhale equals inhale, however these differences were not statistically significant. CONCLUSION: While slow breathing significantly reduces psychological stress, breath ratios do not have a significant differential effect on stress reduction among healthy adults.

Stress Management Methods in Children and Adolescents: Past, Present, and Future.

BACKGROUND: Stress is a natural automatic reaction of organisms to challenging or threatening stimuli. Prevalence rates reveal an increasing number of students both in elementary and secondary education suffering from anxiety and other stress-related disorders and illnesses [The Journal of Pediatrics. 2009 Mar;154(3):322-6]. Literature shows a plethora of stress management techniques being used with children and adults to achieve stress reduction and inner peace. This narrative review primarily aimed at summarizing evidence-based relaxation techniques currently used by minors, contrasting them with data from the past and directions for the future. *(Additional content can be found at the bottom page of this review). SUMMARY: Literature research revealed a plethora of stress management techniques, including breathing practices or exercises, meditation, guided imagery, clinical hypnosis, cognitive behavioral therapy, behavioral therapy, third wave therapies, interpersonal therapies, progressive muscle relaxation, autogenic training, biofeedback training, and mindfulness, that are deemed to be effective to treat stress and a variety of stress-related disorders such as anxiety disorders, depression, post-traumatic stress disorder, obsessive-compulsive disorder (OCD), headaches, abdominal pain, perioperative anxiety and postoperative pain, cancer, and attention-deficit hyperactivity disorder. These evidence-based stress management techniques have been successfully employed in various settings such as schools, waiting rooms, dental offices, or inpatient settings. KEY MESSAGES: Stress management techniques used by children and adolescents are important to reduce anxiety, stress, and depressive symptoms, improve social skills, reduce stress-related physical pain, and achieve academic improvement across settings and diagnoses.

Rehabilitation of Traumatic Acute Subdural Hematoma and Subarachnoid Hemorrhage: A Case Report.

A head injury or cerebrovascular illness may be the cause of acute intracranial hemorrhage. Making a precise diagnosis is challenging since diagnostic imaging might be challenging in both situations. In this case report, an aneurysmal rupture related head injury resulted in an acute subdural hematoma (SHD) after the patient lost consciousness. A 54-year-old male was found in a state of unconsciousness on the ground and was brought to the nearest hospital. Computed tomography (CT) scan showed an oblique fracture involving the bilateral frontal and right parietal bones along with underlying SDH, subarachnoid hemorrhage (SAH), and hemorrhagic contusion along with midline shift. The case report highlights the rehabilitation journey of a patient with acute SDH and SAH. The patient can now sit independently and stand with minimal assistance. Vasospasm detection, prevention, and treatment need to be the norm at that time. This case demonstrates the effectiveness of a comprehensive rehabilitation approach in promoting mobility and independence for patients with traumatic brain injuries.

Concordance of Patient Expectations Regarding Guideline Recommendations for Management of Psychosocial Factors in Low Back Pain: A Cross-sectional Study.

BACKGROUND: Guidelines for low back pain (LBP) management recommend addressing psychosocial risk factors such as stress and depression, which have been shown to play a prognostic role in nonspecific LBP. LBP management has been found to diverge from published recommendations. The reasons why remain unclear and may be related to patient views and expectations regarding the causes and treatment of LBP. OBJECTIVES: We examined the degree to which patient views regarding psychosocial factors coincided with core recommendations and statements of the German national guideline for nonspecific LBP, as well as factors affecting those views. STUDY DESIGN: Cross-sectional study. SETTING: Data were gathered from June 2018 through September 2018 in 13 general practices in Mecklenburg-Wets Pomerania, Germany. METHODS: Practice staff approached all patients entering the practice, regardless of the reason for consultation, during 3 consecutive days and offered study participation. After providing informed consent, patients received a questionnaire to complete prior to consultation. Nonresponse bias was addressed by using inverse probability weights. Descriptive analysis and multivariate logistic regression models were performed. RESULTS: A total of 977 patient questionnaires were included in the analysis. One-third to one-half of the patients disagreed and one-third agreed that psychological problems and their treatment play a role in LBP management. A significant proportion (13-25%) was undecided. However, relaxation techniques were well accepted. Patients with higher education levels, poorer health status, and more severe LBP but no pain medication in the last 12 months were more likely to expect psychosocial diagnostics and treatment and regarded relaxation techniques as potentially helpful. More severe pain and lower levels of education were associated with disagreement with guideline recommendations and statements regarding management of psychosocial factors. LIMITATIONS: Recall bias is possible, as patients were asked to recall their LBP history. However, we limited the recall time to the last 12 months. Data on income, employment status and co-morbidities were not collected and may have affected the responses. However, educational status, health status, and age were collected. CONCLUSION: A significant portion of patients did not agree that psychosocial aspects should be addressed in LBP. Pain severity, health status, level of education, and previous treatment experience appear to affect patient views. These results highlight the importance of careful patient counseling regarding psychosocial factors and screening for psychosocial problems in LBP, when indicated. Additionally, educational initiatives may help bring patient expectations into agreement with recommendations.

Cognitive-behavioral therapy for insomnia for primary care: Review of components and application for residents in primary care.

Healthy sleep patterns are a significant component of good physical and mental health. Quality sleep can be affected by such things as stress, age, pregnancy, physical health problems, and shift work. Behaviors related to sleep problems can be one of three types: predisposing, precipitating, and perpetuating. Additionally, cognitive processes related to sleep quality tend to be predominated by sleep thinking or insomnia thinking. Multiple medical organizations promote Cognitive Behavioral Therapy for Insomnia as a best practice for clinical management of sleep problems and disorders. Cognitive Behavioral Therapy for Insomnia consists of five components aimed at addressing both the behavioral and cognitive impediments to high quality sleep. These components are sleep hygiene, relaxation, sleep restriction, stimulus control, and cognitive therapy. This paper will address each component, as well as provide a patient education pattern well suited for primary care settings.

Vocalization during the second stage of labor to prevent perineal trauma: A randomized controlled trial.

BACKGROUND AND PURPOSE: Most women suffer some degree of perineal trauma during vaginal delivery. Second stage management strategies, including vocalization, to protect the perineum have been investigated. OBJECTIVE: To compare the frequency and degree of perineal trauma at vaginal delivery, with and without use of the vocalization maneuver during the second stage of labor. MATERIALS AND METHODS: This is an open-label, randomized controlled trial. We conducted the study at the Center for Normal Deliveries of IMIP. We included low-risk women without prior cesarean deliveries. Women who met the inclusion criteria and signed the informed consent form were randomized to one of two groups: Group A (experimental) and Group B (control). A physical therapist encouraged women in Group A to maintain an open glottis during pushing and to emit sounds when exhaling (vocalization). Women in Group B underwent routine humanized vaginal deliveries. The outcomes of the study were perineal integrity and degree of perineal laceration. These were measured by the study team immediately after completion of the third stage of labor. RESULTS: Women in Group A tended to have less severe perineal tear (less second and third degree lacerations) and smaller lacerations than women in group B. The vocalization maneuver reduced the risk of a perineal tear greater than 2 cm by 68% (NNT 2.2). There was no difference in other outcomes. CONCLUSION: Encouraging women to follow a vocalization protocol coached by a physical therapist during the second stage of labor can be a helpful labor assistance technique, since this study showed that vocalization is associated with less extensive perineal tears. CLINICAL TRIAL REGISTRATION: This study was registered on ClinicalTrials.gov (www. CLINICALTRIAL: gov) registration number: NCT03605615.

Effectiveness of relaxation techniques 'as an active ingredient of psychological interventions' to reduce distress, anxiety and depression in adolescents: a systematic review and meta-analysis.

BACKGROUND: Adolescent depression and anxiety are among the leading contributors to health burden worldwide. 'Relaxation Techniques (RTs)' are a "set of strategies to improve physiological response to stress" and are frequently cited as an active ingredient of trans-diagnostic, psychosocial interventions for scaling-up care for preventing and treating these conditions in adolescents. However, there is a little evidence on the effectiveness of 'relaxation techniques' for this age group. AIM: As a part of the Wellcome Trust's Active Ingredients commission, we did a systematic review and meta-analysis to evaluate the effectiveness of RTs to reduce the symptoms of distress, anxiety and depression in young people, aged 14 to 24 years old, globally. METHODS: We searched 10 academic databases to include 65 Randomized Controlled Trials (RCTs) of relaxation-based interventions for young people with the symptoms of anxiety and depression. Primary outcomes were reduction in symptoms of distress, anxiety and/or depression. We employed the Cochrane risk of bias tool and GRADE (Grading of Recommendations, Assessment, Development and Evaluations) guidelines to assess certainty of outcomes pertaining to anxiety, depression and distress. Standardized mean difference was estimated using effect size. RESULTS: The analysis of 65 RCTs with 8009 young people showed that RTs were highly effective in treating anxiety (pooled effect size of (Standardized Mean Difference-SMD) - 0.54 (95% CI - 0.69 to - 0.40); moderately effective in reducing distress (SMD = - 0.48, 95% CI - 0.71 to - 0.24) and had only a weak effect on improving depression in young people (SMD = - 0.28 (95% CI - 0.40% to - 0.15). Face-to-face delivered relaxation techniques yielded higher effect size (SMD = - 0.47, 95% CI - 0.64 to - 0.30) compared to online delivery (SMD = - 0.22, 95% CI - 0.48 to 0.04) for anxiety. CONCLUSION: Most of the included studies were from High Income Countries (HICs) and had a high risk of bias. Further high-quality studies with low risk of bias, especially from low resource settings are needed to evaluate the evidence for effectiveness of RTs as an active ingredient of psychological interventions to reduce the symptoms of distress, anxiety and depression in young people.

Relaxation techniques as an intervention for chronic pain: A systematic review of randomized controlled trials.

Chronic pain increases the risk of sleep disturbances, depression and disability. Even though medical treatments have limited value, the use of prescription-based analgesics have increased over the recent years. It is therefore important to evaluate the effect of non-pharmacological treatments. A systematic search for studies evaluating the effect of relaxation techniques on chronic pain was conducted. Randomized controlled trials were included. Significant effects on pain, or on pain and one or more secondary outcome measure, were found in 21 studies. Four studies found significant effects on secondary outcome measures only. Four studies showed no significant effects on any outcome measure. Thus, most of the studies reported that relaxation techniques reduced pain and/or secondary outcome measures. However, the included studies have evaluated effects across a wide variety of chronic pain conditions and relaxation techniques. Hence, there is a large degree of heterogeneity among the included studies. This complicates the effect evaluation and makes it difficult to draw a clear and unambiguous conclusion. Relaxation techniques are probably most effective when used through regular and continued practice. Future studies should therefore investigate long-term effects of relaxation technique interventions, evaluate the dose-response relationship and examine efficacy differences across pain conditions and interventions.

Progressive Muscle Relaxation and Guided Imagery in Breast Cancer: A Systematic Review and Meta-analysis of Randomised Controlled Trials.

Breast cancer affects the mental well-being of patients who may need psychological support. The combined practice of progressive muscle relaxation (PMR) and guided imagery (GI) is known to improve psychological health. Its effect has been studied in patients with breast cancer. We need to systematically review and analyse the available data to outline its role in various stages of disease management. We wanted to evaluate the effect of the combined practice of PMR and GI on stress, anxiety, depression and mood. We also wanted to study the impact on quality of life and chemotherapy-related adverse effects. A systematic search and evaluation of the literature was performed. Five randomised controlled trials were selected for data extraction and construction of forest plots. The intervention was effective for stress and anxiety. It positively improved the quality of life but saw no significant improvement in chemotherapy-related adverse effects.

The Synergistic Effects of a Complementary Physiotherapeutic Scheme in the Psychological and Nutritional Treatment in a Teenage Girl with Type 1 Diabetes Mellitus, Anxiety Disorder and Anorexia Nervosa.

Type 1 diabetes mellitus (T1DM) is a chronic disease that can affect the physical and mental health of children and adolescents, often leading to anxiety disorders with chronic activation of the hypothalamic axis (HPA). Moreover, a great proportion of adolescents with T1DM also demonstrate anorexia nervosa (AN), due to the increased preoccupation with food and the need to have an acceptable body image. Herein is described the first case study of an adolescent patient diagnosed with T1DM, anxiety disorder (AD), and AN. A 14-year-old girl with T1DM since the age of 12 years presented weight loss at age 13 years and 3 months and low body mass index (BMI), which did not improve despite dietary recommendations and adequate disease control. Additionally, she presented menstrual disorders at the age of 12 years and 11 months (menstrual age 12 years and 1 month). A psychological evaluation of the teenager was conducted using a semi-structured interview that assessed perceived stress, health status, quality of life, and depression. AD and AN were diagnosed and the patient initiated an intervention focusing on psychological health and nutrition and which incorporated physiotherapeutic relaxation sessions and breathing exercises. After 3 months of treatment, the patient's BMI was increased, and a normal menstrual cycle was apparent. These results have since remained consistent. Stress leads to the appearance of AN and menstrual disorders. Therefore, physiotherapeutic programs could reduce stress and effectively ameliorate AN and AD.

Stress Management during the Intracytoplasmic Sperm Injection Cycle May Slow Down First Embryo Cleavage and Accelerate Embryo Compaction: A Pilot Randomized Controlled Trial.

INTRODUCTION: A firm consensus on the effectiveness of psychological interventions during infertility treatment has not been reached yet in terms of mental health and pregnancy rates. Moreover, the influence of these interventions on embryo cleavage kinetics has not been investigated. OBJECTIVE: The aim of this work was to study whether stress management in couples undergoing an intracytoplasmic sperm injection (ICSI) cycle influences stress levels, mitochondrial DNA (mtDNA) levels in granulosa cells, and cleavage-stage embryos. METHODS: Infertile couples were randomized into a treatment as usual (TAU) group (n = 30) and stress management program (SMP) group (n = 29) at the beginning of an ICSI cycle. Couples in the SMP group attended education and relaxation sessions at each visit to the clinic for folliculometry. The perceived stress scale (PSS) was used to assess stress levels at the beginning and end of the cycle. Moreover, mtDNA levels of granulosa cells and embryo morphokinetics were evaluated. RESULTS: Post-intervention, women in the SMP group had significantly lower PSS scores than their initial PSS (p < 0.001; effect size, ES = 0.5) and than the final PSS of the TAU group (p = 0.02; ES = 0.09). Additionally, mtDNA levels were significantly lower in luteal granulosa cells of the SMP group than the TAU group (p = 0.02). An earlier time of pronuclei appearance (p = 0.03) and time to 2 cells (p = 0.015) and a faster time to full compaction (p = 0.045) were detected in the embryos of the SMP group compared with the TAU group. CONCLUSION(S): The implemented program may reduce stress levels, retard first embryo cleavage, and accelerate embryo compaction. Further studies with an active control group are needed to confirm these results.