Effect of laughter exercise versus 0.1% sodium hyaluronic acid on ocular surface discomfort in dry eye disease: non-inferiority randomised controlled trial.

OBJECTIVE: To assess efficacy and safety of laughter exercise in patients with symptomatic dry eye disease. DESIGN: Non-inferiority randomised controlled trial. SETTING: Recruitment was from clinics and community and the trial took place at Zhongshan Ophthalmic Center, Sun Yat-sen University, the largest ophthalmic centre in China, between 18 June 2020 to 8 January 2021. PARTICIPANTS: People with symptomatic dry eye disease aged 18-45 years with ocular surface disease index scores ranging from 18 to 80 and tear film break-up time of eight seconds or less. INTERVENTIONS: Participants were randomised 1:1 to receive laughter exercise or artificial tears (0.1% sodium hyaluronic acid eyedrop, control group) four times daily for eight weeks. The laughter exercise group viewed an instructional video and participants were requested to vocalise the phrases "Hee hee hee, hah hah hah, cheese cheese cheese, cheek cheek cheek, hah hah hah hah hah hah" 30 times per five minute session. Investigators assessing study outcomes were masked to group assignment but participants were unmasked for practical reasons. MAIN OUTCOME MEASURES: The primary outcome was the mean change in the ocular surface disease index (0-100, higher scores indicating worse ocular surface discomfort) from baseline to eight weeks in the per protocol population. The non-inferiority margin was 6 points of this index score. Main secondary outcomes included the proportion of patients with a decrease from baseline in ocular surface disease index score of at least 10 points and changes in dry eye disease signs, for example, non-invasive tear break up time at eight weeks. RESULTS: 299 participants (mean age 28.9 years; 74% female) were randomly assigned to receive laughter exercise (n=149) or 0.1% sodium hyaluronic acid (n=150). 283 (95%) completed the trial. The mean change in ocular surface disease index score at eight weeks was -10.5 points (95% confidence interval (CI) -13.1 to -7.82) in the laughter exercise group and -8.83 (-11.7 to -6.02) in the control group. The upper boundary of the CI for difference in change between groups was lower than the non-inferiority margin (mean difference -1.45 points (95% CI -5.08 to 2.19); P=0.43), supporting non-inferiority. Among secondary outcomes, the laughter exercise was better in improving non-invasive tear break up time (mean difference 2.30 seconds (95% CI 1.30 to 3.30), P<0.001); other secondary outcomes showed no significant difference. No adverse events were noted in either study group. CONCLUSIONS: The laughter exercise was non-inferior to 0.1% sodium hyaluronic acid in relieving subjective symptoms in patients with dry eye disease with limited corneal staining over eight weeks intervention. TRIAL REGISTRATION: ClinicalTrials.gov NCT04421300.

The effects of acupressure, laughter yoga, and a mindfulness-based stress reduction program applied to postmenopausal women for menopause symptoms and quality of life.

OBJECTIVE: This research was conducted to determine the effects of acupressure, laughter yoga, and a mindfulness-based stress reduction program applied to postmenopausal women for menopause symptoms and quality of life. METHODS: A randomized controlled design was used. The study was conducted with a total of 146 women, including 41 acupressure, 31 laughter yoga, 37 mindfulness-based stress reduction, and 37 control group women. The women in the acupressure group were administered acupressure twice a week, which accounted for 16 sessions in total. Women in the laughter yoga and mindfulness-based stress reduction groups received a total of eight sessions of the related intervention, which was performed once a week. Study data were collected using a participant information form, the Menopause Rating Scale (MRS), and the Menopause-Specific Quality of Life Scale (MENQOL). Descriptive statistics, paired-samples t test, χ 2 test, analysis of variance test, and intention to treat analysis were used to analyze the data. Before the intention to treat analysis was performed, the multiple imputation method was employed to deal with missing data. RESULTS: In the study, it was found that there was a decrease in the MRS total score after the intervention in women in all three intervention groups compared to the control group ( P < 0.05). In the laughter yoga group, total MRS scores decreased by 3.16 points ( P < 0.05). In the acupressure group, total MRS scores decreased by 5.46 points ( P < 0.05). In the mindfulness-based stress reduction (MBSR) program group, total MRS scores decreased by 4.65 points ( P < 0.05). It was determined that the mean scores of women in the laughter yoga and acupressure groups on all subscales of the MENQOL decreased after the intervention compared to the control group ( P < 0.05). The comparison of the MBSR group and the control group showed that there was a decrease only in the psychosocial domain subdimension of the MENQOL ( P < 0.05). CONCLUSIONS: In conclusion, it was determined that laughter yoga, acupressure, and MBSR could be effective in reducing menopause symptoms and improving quality of life, although findings require further testing in a rigorously controlled study and in a study with only a single prespecified outcome.

Family participatory clown therapy in venipuncture in hospitalized children: A non-randomized controlled trial.

OBJECTIVE: To explore the effectiveness of family participatory clown therapy in venipuncture in hospitalized children. METHODS: We recruited 104 children aged 3 to 6 years for a non-randomized controlled trial from March to December 2022. All participants required peripheral venepuncture infusions for treatment. The children were assigned to either the control group (n = 52) or the experimental group (n = 52).Standard care was utilized in the control group. In the experimental group, two clown nurses and a parent provided family participatory clown therapy for 35-45 minutes per child before, during, and after venipuncture. We assessed children's pain (FLACC and W-B FPS), anxiety (VAS-A), medical fear (CFS), crying incidence, compliance, parental anxiety (S-AI), and parental satisfaction. RESULTS: At venipuncture, the FLACC score was lower in the experimental group (4.46±2.053) compared to the control group (5.96±2.441), the W-B FPS score was also lower in the experimental group (4.96±2.392) than in the control group (6.35±2.266), with a statistically significant difference (P<0.05).The children in the experimental group had lower levels of anxiety, medical fear, crying, and parental anxiety than the control group. In addition, child compliance and parent satisfaction were higher in the experimental group than in the control group, with statistically significant differences (P<0.05). CONCLUSION: Family participatory clown therapy can reduce pain, anxiety, medical fear, and crying during venipuncture in children. It can also improve venipuncture compliance, reduce parental anxiety, and increase parental satisfaction.

Effects of Laughter Yoga on Patients Receiving Hemodialysis: A Systematic Review.

When it comes to end-stage renal disease patients, hemodialysing is one of the most critical treatments they can receive. Even if they received hemodialysis (HD) treatment regularly, patients would experience many complications such as cardiovascular disease, fatigue, anxiety, depression, sleep disturbances, and a declining quality of life. Laughter Yoga has been reported to have many positive effects on patients with chronic illnesses. By removing or reducing stress, Laughter Yoga (LY) helps to improve patients' quality of life, Thus, they have a longer chance of survival. However, the effect of Laughter Yoga on HD patients is generally inconclusive. Objective is to evaluate LY's impact on HD patients. We searched electronic databases that included Web of Science, Embase, PubMed, the Cochrane Library, Wanfang, China National Knowledge Infrastructure, and clinical trial registries. The search period was from their inception to January 29, 2023. The search keywords included laughter therapy, laughter yoga, laugh, hemodialysis, dialysis, and renal dialysis. The systematic review included both randomized controlled trials (RCTs) and quasi-experiments studies. Three RCTs and three non-RCTs met the inclusion criteria. Laughter Yoga showed patients having improvement in several outcomes such as life quality, pain severity, sleep quality, subjective well-being, mood, depression, blood pressure, and vital capacity. A well-designed RCT will be developed to further test the potential benefits of LY for HD patients.

Beneficios de la terapia de la risa en los niveles de depresión en niños diagnosticados con cáncer: estudio de caso / Benefits of laughing therapy on depression levels in children diagnosed with cancer: a case study

Fundamentos: El cáncer pediátrico afecta emocionalmente a los infantes causando depresión, la cual se debe intervenir oportunamente como parte fundamental del tratamiento. Por lo tanto, el presente estudio buscó identificar los beneficios de la terapia dela risa en los niveles de depresión en niños y niñas diagnosticados con cáncer de una fundación de Cali, Colombia. Métodos: La muestra estuvo conformada por seis niños en tratamiento oncológico, con edades entre los ocho y doce años. Se aplicó elInventario de Depresión Infantil (CDI) y tres talleres de risoterapia. Se realizo un análisis descriptivo, para las variablescuantitativas se realizaron medidas de tendencia central y para las categóricas se reportaron frecuencias absolutas y relativas. Resultados: Los resultados indicaron que el 83% de los niños presentaron un problema emocional debido a la enfermedad; seevidenciaron cambios favorables en los puntajes de depresión posterior a las intervenciones de la terapia de la risa. Conclusiones: Se concluye que la terapia de la risa es un tratamiento no farmacológico eficaz al combinarse con talleresorientados a fortalecer la expresión de las emociones, autoestima y proyecto de vida, que no solo permite mejorar la salud de losinfantes, sino que previne y reduce la aparición de trastornos emocionales.(AU)

Background: Pediatric cancer emotionally affects infants causing depression which must be intervened in a timely manner asan essential part of the treatment. Therefore, the present study sought to identify the benefits of laughter therapy on the levels ofdepression in children diagnosed with cancer in a foundation in Cali, Colombia. Methods: The sample consisted of six children undergoing cancer treatment, aged between eight and twelve years. TheChildren’sDepression Inventory (CDI) and three laughter therapy workshops were applied. A descriptive analysis was performed, with measures ofcentral tendency for quantitative variables and absolute and relative frequencies for categorical variables. Results: The results indicated that 83% of the children presented an emotional problem due to the disease; favorable changeswere evidenced in the depression scores after the laughter therapy interventions. Conclusions: It is concluded that laughter therapy is an effective non-pharmacological treatment when combined with works-hops aimed at strengthening the expression of emotions, self-esteem and life project, which not only improves the health of children,but also prevents and reduces the appearance of emotional disorders.(AU)

"I made you a small room in my heart": how therapeutic clowns meet the needs of older adults in nursing homes.

Therapeutic clowns are increasingly common in nursing homes, where residents often encounter factors that can undermine their quality of life and dignity. We aimed to understand the strategies of successful therapeutic clowning with a diverse older adult population, and the unique contributions of elder-clowning to the nursing home experience. Using an interpretivist descriptive methodology, twenty-three (n=23) experienced therapeutic clowns from eight countries were interviewed to understand the needs of nursing home residents met by elder-clowns, and strategies and techniques the clowns use to address them. Participants identified five major needs: to escape routine; for reassurance of worth; for meaningful, personalized social interaction unrestricted by communication barriers; to have culturally meaningful opportunities for reminiscence; and to have a space where residents could be unapologetically themselves. The artistic and emotional strategies used by the therapeutic clowns to address these needs illustrate how creativity, imagination and relational presence can provide nursing home residents with a sense of being known and belonging. Elder-clowns also positively affect the nursing home staff and enrich the interpersonal interactions in the residence. Through their focus on the social and emotional needs of residents, elder-clowns can play an important and distinct role in creating an optimal nursing home experience.

Clowntherapy in paediatric dentistry: The psychological approach to the paediatric patient.

AIM: Anxiety towards dental treatments and visits in children are often cause for the avoidance and/or failure of the treatment itself, as well as a reason for stress in both the patient and the orthodontist. The aim of the research is to understand if the use of clown therapy in dental waiting rooms is efficient in bringing down the level of preoperative anxiety in paediatric dental patients. METHODS: Two psychometric tests were used: CFSS-DS (Dental Subscale of the Children's Fear Survey Schedule) and FIS (Facial Image Scale), after the translation of the original versions, to both the patients and their parents. The CFSS-DS is the most used instrument in order to assess dental fear in children, it is composed by 15 questions that outline situations which children and adolescents will have to face while on the dental chair. The FIS is a visual analogical scale that uses faces as indicators of anxiety. CONCLUSION: Clowntherapy proves to be an efficient non-pharmacological method to reduce anxiety and dental fear in paediatric patients, offeringa valid and practical support for paediatric dentists.

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).

Efectos del clown de hospital en la calidad de vida de personas en una unidad de cuidados paliativos pediátricos oncológicos / Effects of hospital clowns on the quality of life of patients in a paediatric oncology palliative care unit

Objetivo: El objetivo de esta investigación es comprender las percepciones de las familias acerca de los efectos de clowns de hospital en la calidad de vida de niños y familias en una unidad de cuidados paliativos pediátricos oncológicos de un hospital público chileno. Método: Bajo un diseño de tipo cualitativo, emergente, transversal y estrictas consideraciones éticas, utilizamos la técnica de entrevistas en profundidad y grupo de discusión. 16 madres que pasaron por la experiencia de cuidados paliativos con sus hijos fueron entrevistadas usando un guion en base a 6 dimensiones de calidad de vida: percepción sobre actividad física y salud, estado psicológico, autoestima, familia, amistades y escuela. Además, se efectuó un grupo de discusión con las madres para consolidar lo social de los temas del análisis de las entrevistas. Las transcripciones y los documentos se analizaron primero por separado y luego se realizó un proceso de triangulación de datos. Un paradigma interpretativista guía el análisis a través de las técnicas teoría fundamentada y análisis del discurso. Resultados: Los discursos de las participantes revelan que la presencia de clowns produce efectos psicológicos en la regulación emocional, además de ser un mecanismo para sobrellevar tanto los periodos de cuidados paliativos como los de después del fallecimiento al establecer vínculos “familiares” con los clowns. Asimismo, tanto los clowns como el espacio que estos ocupan en el hospital inciden en la construcción de comunidad en este contexto sanitario, aspecto de suma relevancia para las familias en el cuidado provisto. Conclusiones: La presencia de clowns incide especialmente en 2 de las 6 dimensiones de calidad de vida, el estado psicológico y las relaciones familiares, siendo además de suma relevancia en este contexto para proporcionar cuidado humanizado, contribuyendo a sobrellevar la situación a las madres durante los cuidados paliativos y tras el fallecimiento de sus hijos. (AU)

Objective: The aim of this research was to understand the perceptions of families about the effects of hospital clowns on the quality of life of children and their families in an Oncological Palliative Care Unit of a Chilean public hospital. Method: Under a qualitative, emergent, cross-sectional design and strict ethical considerations, we used an in-depth interview technique and discussion group. Sixteen mothers who went through the experience of palliative care with their children were interviewed using a script based on 6 quality of life dimensions: perception of physical activity and health, psychological state, self-esteem, family, friends and school. In addition, a discussion group was held to consolidate the topics of the analysis of the interviews. The transcripts and documents were first analyzed separately and then a data triangulation process was performed. An interpretivist paradigm guides the analysis, through discourse analysis and grounded theory techniques. Results: The discourses of participants reveal that the presence of clowns produces psychological effects on emotional regulation, as well as being a mechanism to cope with both the periods of palliative care and after death by establishing “family” ties with clowns. Likewise, both the clowns and the space they occupy in the hospital affect the construction of community in this health context, an aspect of great relevance for families in the the type of care provided. Conclusions: The presence of clowns has impacts especially on 2 of the 6 quality-of-life dimensions, psychological state and family relationships, being also highly relevant in the context of delivering humanized care, helping mothers to cope with the situation during palliative care and after the death of their children. (AU)

Effects of Laughter Therapy on Life Satisfaction and Loneliness in Older Adults Living in Nursing Homes in Turkey: A Parallel Group Randomized Controlled Trial.

PURPOSE: This study examined the effects of laughter therapy on life satisfaction and loneliness in older adults living in nursing homes. DESIGN: A single-blind, parallel-group, randomized controlled trial (ClinicalTrials NCT03687788) with a pretest-posttest design was conducted. METHODS: There were 31 experimental participants and 31 controls. The experimental group received laughter therapy twice a week for 6 weeks, along with usual care. The control group received usual care only. Loneliness was measured with the De Jong Gierveld Loneliness Scale, and life satisfaction was measured with the Satisfaction With Life Scale. FINDINGS: After 6 weeks, there was a statistically significant difference in De Jong Gierveld Loneliness Scale total score between the two groups, and the subscale scores of the experimental group decreased. CONCLUSIONS: Laughter therapy may reduce loneliness in older adults. CLINICAL RELEVANCE: Healthcare professionals, especially nurses, can potentially use laughter therapy to reduce loneliness in older adults.

Effectiveness of hospital clowns for symptom management in paediatrics: systematic review of randomised and non-randomised controlled trials.

OBJECTIVE: To evaluate evidence from randomised controlled trials and non-randomised controlled trials on the effectiveness of hospital clowns for a range of symptom clusters in children and adolescents admitted to hospital with acute and chronic conditions. DESIGN: Systematic review of randomised and non-randomised controlled trials. DATA SOURCES: Medline, ISI of Knowledge, Cochrane Central Register of Controlled Trials, Science Direct, Scopus, American Psychological Association PsycINFO, Cumulative Index to Nursing and Allied Health Literature, and Latin American and Caribbean Health Sciences Literature. STUDY SELECTION: Randomised and non-randomised controlled trials were peer reviewed using the following eligibility criteria: children and adolescents who were admitted to hospital for acute conditions or chronic disorders, studies comparing use of hospital clowns with standard care, and studies evaluating the effect of hospital clowns on symptom management of inpatient children and adolescents as a primary outcome. DATA EXTRACTION AND SYNTHESIS: Two investigators independently screened studies, extracted data, and appraised the risk of bias. Methodological appraisal was assessed by two investigators independently using the Jadad scale, the revised Cochrane risk-of-bias tool for randomised controlled trials (RoB 2), and the risk of bias in non-randomised studies (ROBINS-I) tool for non-randomised controlled trials. RESULTS: 24 studies (n=1612) met the inclusion criteria for data extraction and analysis. Most studies were randomised controlled trials (n=13). Anxiety was the most frequently analysed symptom (n=13), followed by pain (n=9), psychological and emotional responses and perceived wellbeing (n=4), stress (n=4), cancer related fatigue (n=3), and crying (n=2). Five studies used biomarkers, mainly cortisol, to assess stress or fatigue outcome following hospital clowns. Most of the randomised controlled trials (n=11; 85%) were rated as showing some concerns, and two trials were rated with a high risk of bias. Most non-randomised controlled trials (n=6; 55%) were rated with a moderate risk of bias according to ROBINS-I tool. Studies showed that children and adolescents who were in the presence of hospital clowns, either with or without a parent present, reported significantly less anxiety during a range of medical procedures, as well as improved psychological adjustment (P<0.05). Three studies that evaluated chronic conditions showed favourable results for the intervention of hospital clowns with significant reduction in stress, fatigue, pain, and distress (P<0.05). CONCLUSIONS: These findings suggest that the presence of hospital clowns during medical procedures, induction of anaesthesia in the preoperative room, and as part of routine care for chronic conditions might be a beneficial strategy to manage some symptom clusters. Furthermore, hospital clowns might help improve psychological wellbeing in admitted children and adolescents with acute and chronic disorders, compared with those who received only standard care. SYSTEMATIC REVIEW REGISTRATION: PROSPERO CRD42018107099.

The importance of humour in oncology: a survey of patients undergoing radiotherapy.

Background: Humour has long been considered an important coping tool for patients with cancer, but published quantitative data about its significance are limited. The purpose of our study was to survey patients with cancer undergoing radiotherapy regarding their opinions about the use of humour in their care. Methods: An anonymous 35-item questionnaire evaluating the patient experience, including the value of humour, was developed by an interdisciplinary team of health care providers (hcps) working within the Radiation Medicine program. This anonymous, voluntary, paper-based survey for self-completion required approximately 10 minutes to finish and was administered during the fall of 2018 and the spring of 2019. Results: For the 199 patients who completed the survey [108 women, 89 men (2 respondents did not specify)], median age was 68 years. That group represents approximately 30%-35% of the patients on treatment during the study period. Almost all respondents (86%) indicated that, during their visits to the cancer centre, it was "somewhat important" or "very important" for health care providers (hcps) to use appropriate humour, and 61% of respondents indicated using humour "frequently" or "always" when dealing with their individual cancers. Most respondents (79%) said that humour decreased anxiety, and 86% indicated that laughing was considered "somewhat important" or "very important." Approximately 4% of respondents even listed "sense of humour" as being the most important quality that they looked for in their interactions with their hcps. Conclusions: Cancer patients undergoing radiotherapy clearly view humour as being important for coping and dealing with their disease, and oncology hcps should routinely consider incorporating the use of appropriate humour into the care that they provide.

The effects of laughter therapy on depression symptoms in patients undergoing center hemodialysis: A pragmatic randomized controlled trial.

INTRODUCTION: People with end-stage renal disease undergoing hemodialysis are at increased risk for stress, anxiety, and depression. The study objective was to measure the effect of intradialytic group laughter therapy on depressive symptoms in people on hemodialysis (HD). METHODS: Pragmatic randomized controlled trial conducted with prevalent HD patients in 10 centers in Northern California. The intervention group received a once weekly, 30-minute group laughter therapy session for 8 weeks. Primary outcome was the number of people with depressive symptoms as measured using the four Item Patient Health Questionnaire. Secondary outcomes were anxiety, subjective well-being, and patient-reported outcome measures. FINDINGS: In all, 151 participants completed both predepression and postdepression symptom measures (72 intervention and 79 control). The proportion of patients with self-reported depressive symptoms changed from 17 (22%) to 16 (20%), in the control and from 11 (17%) to 5 (8%) in the intervention arms, respectively (P = 0.04). In the control arm, 7 out of the 17 patients with self-reported depressive symptoms at baseline continued to report depressive symptoms at follow up compared to the intervention arm where only 1 of 12 patients continued to report depressive symptoms. No differences were noted between the groups for reported anxiety, patient-reported dialysis symptoms, and subjective well-being. DISCUSSION: This study found intradialytic group laughter can decrease the number of people with depressive symptoms receiving hemodialysis. Larger and long-term studies are required to evaluate the effect of intradialytic laughter on patient related outcomes and quality of life.

Humour and laughing in patients with prolonged incurable cancer: an ethnographic study in a comprehensive cancer centre.

PURPOSE: Most people are familiar with the expression 'laughter is the best medicine'. By enhancing cognitive flexibility and strengthening relationships, laughter can be considered a holistic care-approach. Yet, in medical oncology, especially the palliative phase, using humour can be considered inappropriate or taboo. We aimed to explore the acceptability and functions of humour and laughter in patients with prolonged incurable cancer. METHODS: This study was performed in a Dutch Comprehensive Cancer Centre. We included four short conversations with patients, eighteen in-depth patient-interviews and eleven observational fieldnotes in which humour was a major topic of the conversation. We further administered an online questionnaire to thirty-three oncology clinicians about their experiences with humour. Qualitative data were thematically analysed. We specifically distinguished between humour and laughter. RESULTS: Nearly all specialists reported using humour (97%), and all reported sometimes laughing during consultations; 83% experienced a positive effect of laughter. These results were in line with patients' experiences: Patients noted that humour always stayed alive despite medical difficulties. Apart from this human aspect, patients also used humour to broach difficult topics and downplay challenges. Patients and specialists acknowledged that using humour is sometimes inappropriate, partly because they did not always share the same humour. Laughter, in contrast, was regarded as 'lighter' than humour, and could, accordingly, more easily be implemented. Specialists cautioned against patients using laughter to avoid broaching difficult topics. CONCLUSION: Many conversations were full of laughter. Hierarchy as usually experienced between healthcare professionals and patients/relatives seemed to disappear when using laughter. If applied appropriately, adding shared laughter may help optimize shared decision-making.

A digital media attention diversion improves mood and fear in patients receiving chemotherapy for recurrent gynecologic malignancies: results of a randomized trial.

BACKGROUND: Recurrent gynecologic cancer patients experience symptoms that affect psychologic, emotional, social, and physical well-being. Chemotherapy can further exacerbate these symptoms. Poor mood, pain, and fatigue are linked and are detrimental to quality of life. Interventions targeting these symptoms may improve patient-reported outcomes and performance status. OBJECTIVES: To determine the ability of a humorous digital media attention diversion to improve symptom domains of positive and negative mood during chemotherapy for patients with recurrent gynecologic cancers. STUDY DESIGN: This randomized, crossover clinical trial enrolled women with recurrent gynecologic cancers. Subjects participated over three cycles of chemotherapy. The primary outcome was the change in mood on the validated Positive and Negative Affect Scale-Extended (PANAS-X) instrument, which measures positive and negative affect domains. All subjects completed the PANAS-X after receiving chemotherapy during cycle 1 on study. In atudy arm 1, subjects watched their choice of humorous movies on a digital media device while receiving chemotherapy during cycle 2 on study. They selected from non-humorous movies during cycle 3 on study. In arm 2, the order of movies was reversed. After each cycle, mood, fatigue, and other patient-reported outcomes were assessed for comparison with baseline measurements. RESULTS: The target enrollment of 66 subjects was achieved. Subjects watched humorous content for an average of 96.0 min and non-humorous content for an average of 62.5 min. Negative mood improved after exposure to humorous (p=0.017) and non-humorous content (p=0.001). Patient-reported fear also improved after exposure to both humorous (p=0.038) and non-humorous content (p=0.002). Subjects reported higher use of affiliating and self-effacing humor types. CONCLUSIONS: Offering patients a choice of digital media during chemotherapy significantly improved negative mood and fear. This was seen with both humorous and non-humorous content. This low-cost and low-risk intervention should be implemented as an attention diversion to improve negative mood and fear for patients receiving chemotherapy.

Effectiveness of Integrative Laughter Therapy to Reduce Anxiety, Improve Self-Esteem and Increase Happiness: A Naturalistic Study at a Day Hospital for Addictive Disorders.

Little is known about the effectiveness of laughter therapy as an adjunctive treatment for patients with addictive disorders. This study aims to evaluate the benefits of integrative laughter therapy (ILT) on levels of self-esteem, anxiety, and happiness in patients treated for addiction at a day hospital (DH). A prospective, naturalistic study with a pre-post design was conducted. All 185 participants received the standard, multicomponent treatment at the DH (treatment as usual; TAU). The participants were also invited to attend weekly ILT sessions. Upon completion of the 2-month DH treatment program, patients were classified according to their attendance at the ILT sessions: patients who attended ≥80% constituted the experimental group (TAU + ILT group) while those who attended <80% were considered controls. Although both groups achieved statistically significant increases in self-esteem and happiness with a decrease in trait anxiety, the improvement on these variables was significantly greater in the TAU + ILT group. Subject to the limitations inherent to quasi-experimental research, the findings of the present study suggest that the addition of an ILT module to the standard treatment in a DH for addictive disorders may yield greater improvement in self-esteem, anxiety, and happiness compared to TAU.

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

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 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.

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.

Benefits of medical clowning in the treatment of young children with autism spectrum disorder.

We investigated the contribution of group therapy delivered by a medical clown to young children diagnosed with autism spectrum disorder (ASD). So far, scientific publications regarding medical clowning focus on general health advantages. The current study is the first controlled research examining the use of medical clowning in the therapy for children with ASD. Twenty-four children aged 2-6 years old with ASD enrolled in our special education intensive program were examined before and after group sessions with clown intervention (CI) and other intervention (OI). We tested stereotypic behaviors, verbal expression, play reciprocity, and social smiles. Data was collected during 12 weeks of intervention, and the trajectory of change was evaluated in addition to the pre-/post-intervention.Conclusion: improvement over time in all measures: Significant increase in word production, play reciprocity, and amount of social smiles during CI as compared with OI. We also found a reduction in frequency of stereotypic behaviors during and following CI as compared with before CI. These preliminary results indicate that medical clowning may be beneficial for young children with ASD, since it promotes communication and social reciprocity in a fun and lively interventional setting. What is Known: • Many therapies are used and proven as efficacious interventions for children with ASD. • So far, medical clowning was not tested as an intervention or therapy for ASD. What is New: • Medical clowning sessions with children with ASD elicited enhanced communication during the interventions as compared with other interventions. • Medical clowning sessions contributed to a decrease in frequency of stereotypic movements over time, in children with ASD.