Improving physical and mental health in frontline mental health care providers: Yoga-based stress management versus cognitive behavioral stress management.

The need for brief, low-cost, easily disseminable and effective interventions to promote healthy lifestyles is high. This is especially true for mental health providers. We developed two studies to compare the impacts of Cognitive Behavioral Stress Management (CBSM) and Yoga Based Stress Management (YBSM) interventions for healthcare professionals. Study 1 offered an 8-week YBSM intervention to 37 mental healthcare participants and collected health data pre and post. Study 2 offered YBSM and CBSM classes to 40 randomly assigned mental healthcare providers and collected mental and physical health data at four time points. In Study 1, using t-tests, the YBSM intervention affected a number of mental and physical wellbeing indices pre to post. In Study 2, using linear mixed modeling, both YBSM and CBSM groups improved significantly (p <.05) in fruit and vegetable intake, heart rate, alcohol consumption, relaxation and awareness, professional quality of life, compassion satisfaction, burnout, depression, and stress levels. There was a group by time effect for coping confidence (CBSM increased more, p<.05, F = 4.34), physical activity (YBSM increased more, p<.05, F = 3.47), overall mental health (YBSM increased more, p<.10, F =5.32), and secondary traumatic stress (YBSM decreased more, p<.10, F = 4.89). YBSM and CBSM appear to be useful for healthcare professionals' mental and physical health. YBSM demonstrates some benefit above and beyond the extremely well-studied and empirically supported CBSM, including increased physical activity, overall mental health, and decreased secondary traumatic stress benefits.

Evaluation and management of primary nocturnal enuresis.

Enuresis can be a source of family crisis, and can contribute to a lack of self-esteem in the affected child. It must be stressed to both parent and child that improvement is gradual and largely a function of maturation in cases where no organic problem is identified. Research shows that many enuretic children seem to have small bladder capacities (Long, 1991), and that the majority have a polyuric factor such as a decreased level of AVP that is amenable to replacement therapy with desmopressin (Bloom, 1993; Hamburger, 1993; Hjälmås & Bengtsson, 1993; Nørgaard & Djurhuus, 1993). Utilizing pharmacologic treatment can accelerate spontaneous cure or act as a substitute until time provides nocturnal continence (Nørgaard & Djurhuus, 1993). Nurse practitioners can use multiple modalities in a holistic approach to reframe this problem and to involve children in solving their own problem. The child who is given a basic understanding of the physiology involved in the healing process will be able to identify inner healing resources and utilize external resources available to him or her. This approach begins with children's imaging the desired outcome of urinary control and ends with achieving increased self-esreem and the sense of competence they deserve.

Borrelia burgdorferi decreases hyaluronan synthesis but increases IL-6 production by fibroblasts.

Despite the prevalence of clinical data on human Lyme disease, little is known about the immunopathologic effects of the causative organism on the host. We studied the effect of Borrelia burgdorferi on hyaluronan (hyaluronic acid, HYA) production and the effect on interleukin-6 (IL-6) synthesis by cultured fibroblasts. The cell line employed in this study produced an average of 1406 ng of hyaluronan/ml within 48 h. Using both a morphological staining protocol and a quantitative radiometric assay, we noted that in the presence of a low dose of Borrelia (9.4 x 10(5) cells/ml) the hyaluronan production decreased to an average of 1008 ng/ml, a significant difference (p < 0.05) from the amount of hyaluronan produced by the cells alone. The reduction was even more significant (p < 0.01) when a higher dose of Borrelia (9.4 x 10(6) cells/ml) was used giving an average hyaluronan concentration of 682 ng/ml. In contrast, we found that Borrelia stimulated the cells to produce IL-6 from a baseline of 293 pg/ml to a maximal value of 842 pg/ml (p < 0.01). The spirochetes had no significant effect on cell viability, nor were we able to demonstrate invasion of the cells by the bacteria. Both a decrease in hyaluronan and an increase in IL-6 may correlate with the pathogenicity of Lyme disease in man.