Effects of Drama Therapy on Depressive Symptoms, Attention, and Quality of Life in Patients With Dementia.

BACKGROUND: The prevalence of dementia in Taiwan continues to rise, and related patient care is becoming challenging for family members and caregivers. Nondrug treatments are often used as a care strategy to alleviate the behaviors associated with worsening dementia. Many international researchers have examined the effectiveness of drama therapy on dementia care. However, there is a lack of related studies in Taiwan. PURPOSE: The aim of this study was to examine the effects of drama therapy in terms of improving depressive symptoms, attention, and quality of life in patients with senile dementia. METHODS: A two-group pretest-and-posttest design was employed in this randomized controlled trial. Cluster sampling was employed at four dementia daycare centers in central Taiwan. Two centers were randomly assigned to the experimental group, and the other two centers were assigned to the control group. RESULTS: Forty-two patients with dementia (23 in the experimental group and 19 in the control group) participated in this study. The study results showed that, after 8 weeks of drama therapy, the experimental group showed a significant improvement in depressive symptoms (ß = -5.07, p < .001), attention (ß = 5.86, p < .001), and quality of life (ß = -6.08, p < .001). Furthermore, after 12 weeks of drama therapy, the experimental group continued to show a significant improvement in depressive symptoms (ß = -4.65, p < .01), attention (ß = 6.76, p < .001), and quality of life (ß = -4.94, p < .01). CONCLUSIONS: On the basis of the results of this study, patients with senile dementia who participate in 8- and 12-week drama therapy programs significantly improved in terms of depressive symptoms, attention, and quality of life. The authors hope that the findings of this study provide a reference for the intervention method, content, frequency, and timing of drama therapy in patients with dementia.

Effects of Art and Reminiscence Therapy on Agitated Behaviors Among Older Adults With Dementia.

BACKGROUND: Cognitive degeneration and agitated behavior symptoms of dementia in older adults are the main causes of disability and inability and increase the cost of medical care. Agitated behavior symptoms of dementia are the main causes of early institutionalization and make caregivers exhausted. PURPOSE: The aim of this study was to examine the effects of art therapy and reminiscence therapy on the alleviation of agitated behaviors in older adults with dementia. METHODS: An experimental research design with two experimental groups and one comparison group was conducted to examine the effects for each group on agitated behaviors. Participants were recruited from two dementia care centers in central and northern Taiwan. The study included 54 older individuals who met the sampling criteria and completed the data collection process. The participants were randomly allocated into the art therapy group (n = 24), the reminiscence therapy group (n = 22), and the comparison group (n = 8). The intervention consisted of 50-minute sessions conducted weekly for 12 weeks. Regular activities were continued in the comparison group. The structured questionnaires were completed, and observations of agitated behaviors were collected before the intervention and at 1 and 6 weeks after the intervention. RESULTS: Significant differences were found in agitated behavior symptoms at the three time points in the art therapy group, whereas reminiscence therapy was found to have had a clear and immediate effect on decreasing agitated behavior. The generalized estimating equation exchange model test revealed a significant and sustained, postintervention effect of art therapy on agitated behavior. In contrast, no significant and sustained effect on agitated behavior was observed in the reminiscence therapy group. CONCLUSIONS: The findings of this study support that art therapy may have a positive effect on dementia-associated agitated behaviors in institutionalized older adults. Reminiscence therapy activities conducted weekly for 50 minutes each session did not reach statistically significant implications. It is suggested that future studies consider conducting art and reminiscence therapies for a 16-week duration with two weekly sessions to evaluate the effectiveness of the therapy. The duration of follow-up should be extended as well in future studies.

[The Spiritual Health Status and Spiritual Care Behaviors of Nurses in Intensive Care Units and Related Factors].

BACKGROUND: Patients suffer sudden and life-threatening conditions in intensive care units (ICU), which frequently result in traumatic changes in physical, mental, and spiritual health. Little research has been conducted on the spiritual health and spiritual care behaviors of nurses in ICU. PURPOSE: To explore the relationship among demographic characteristics, spiritual health, and spiritual care behaviors in ICU nurses. METHODS: A descriptive correlational research was used and 219 nurses from three teaching hospitals were enrolled as study participants. A structured questionnaire consisting of a demographic datasheet, a spiritual health scale, and a spiritual care behavior scale was used for data collection. SPSS for Windows version 22.0 was used for statistical analysis. RESULTS: The participants received few hours of spiritual-care education. The highest scored item for spiritual health was "connecting with people". The highest scored item for spiritual care behavior was "helping the patient out of adversity". Participants who were older in age and who had more years of clinical experience exhibited spiritual care behaviors such as "helping the patient out of adversity" and "retaining hope" more frequently with their ICU patients. CONCLUSIONS / IMPLICATIONS FOR PRACTICE: The older and more clinically experienced nurses in this study performed spiritual care behaviors at a higher frequency than their younger, less experienced counterparts. Therefore, it is recommended that hospitals retain more-experienced nursing staff to elevate the level of holistic health care. Concurrently, training in spiritual care skills should be provided to younger and less experienced nurses in order to facilitate more spiritual care behaviors. The results of this study provide a reference for providing spiritual care behaviors to patients.

Effects of Qigong Exercise on Biomarkers and Mental and Physical Health in Adults With at Least One Risk Factor for Coronary Artery Disease.

Current medical technology permits the early detection of risk factors for coronary artery disease (CAD) in adults, and interventions are available to prevent CAD-related morbidity and mortality. The goal of this study was to determine the effectiveness of a Qigong exercise intervention in improving biomarker levels and mental and physical health outcomes in community-dwelling adults diagnosed with CAD risk factors, in a southern Taiwanese city. Participants were randomly assigned to an experimental (n= 84) group that participated in a 60-min Qigong group session 3 times per week for 3 months or a control (n= 61) group that did not receive the intervention. Self-perceived mental and physical health assessed with the Chinese Health Questionnaire-12, and body fat percentage were measured at baseline and 6, 12, and 16 weeks. Blood samples were collected at baseline and 12 weeks for analysis of lipid profiles, high-sensitivity C-reactive protein (hs-CRP), glycated hemoglobin (HbA1c), and fasting plasma sugar. Linear mixed model analyses revealed that experimental participants had significantly improved perceived mental and physical health and body fat percentage compared to the control group at 6 and 12 weeks but not 16 weeks. The lipid profiles were significantly more improved in the Qigong group than in the control group at 12 weeks. Qigong exercise, however, had no significant effects on hs-CRP, HbA1c, or fasting plasma sugar. Findings suggest that Qigong exercise improves a limited number of CAD risk factors in community-dwelling adults aged 40 years and over.

Effects of Yoga on Stress, Stress Adaption, and Heart Rate Variability Among Mental Health Professionals--A Randomized Controlled Trial.

BACKGROUND: Mental health professionals experiencing work-related stress may experience burn out, leading to a negative impact on their organization and patients. AIM: The aim of this study was to examine the effects of yoga classes on work-related stress, stress adaptation, and autonomic nerve activity among mental health professionals. METHODS: A randomized controlled trial was used, which compared the outcomes between the experimental (e.g., yoga program) and the control groups (e.g., no yoga exercise) for 12 weeks. Work-related stress and stress adaptation were assessed before and after the program. Heart rate variability (HRV) was measured at baseline, midpoint through the weekly yoga classes (6 weeks), and postintervention (after 12 weeks of yoga classes). RESULTS: The results showed that the mental health professionals in the yoga group experienced a significant reduction in work-related stress (t = -6.225, p < .001), and a significant enhancement of stress adaptation (t = 2.128, p = .042). Participants in the control group revealed no significant changes. Comparing the mean differences in pre- and posttest scores between yoga and control groups, we found the yoga group significantly decreased work-related stress (t = -3.216, p = .002), but there was no significant change in stress adaptation (p = .084). While controlling for the pretest scores of work-related stress, participants in yoga, but not the control group, revealed a significant increase in autonomic nerve activity at midpoint (6 weeks) test (t = -2.799, p = .007), and at posttest (12 weeks; t = -2.099, p = .040). LINKING EVIDENCE TO ACTION: Because mental health professionals experienced a reduction in work-related stress and an increase in autonomic nerve activity in a weekly yoga program for 12 weeks, clinicians, administrators, and educators should offer yoga classes as a strategy to help health professionals reduce their work-related stress and balance autonomic nerve activities.

Effects of music aerobic exercise on depression and brain-derived neurotrophic factor levels in community dwelling women.

A randomized clinical trial was utilized to compare the improvement of depression and brain-derived neurotrophic factor (BDNF) levels between community women with and without music aerobic exercise (MAE) for 12 weeks. The MAE group involved 47 eligible participants, whereas the comparison group had 59 participants. No significant differences were recorded in the demographic characteristics between the participants in the MAE group and the comparison group. Forty-one participants in the MAE group and 26 in the comparison group completed a pre- and posttest. The MAE group displayed significant improvement in depression scores (p = 0.016), decreased depression symptoms in crying (p = 0.03), appetite (p = 0.006), and fatigue (p = 0.011). The BDNF levels of the participants significantly increased after the 12-week MAE (p = 0.042). The parallel comparison group revealed no significant changes in depression scores or BDNF levels. In summary, the 12-week MAE had a significant impact on the enhancement of BDNF levels and improvement of depression symptoms. Middle-aged community women are encouraged to exercise moderately to improve their depression symptoms and BDNF levels.

Effect of back massage intervention on anxiety, comfort, and physiologic responses in patients with congestive heart failure.

BACKGROUND: Patients suffering from congestive heart failure (CHF) frequently feel physical suffering and anxiety. OBJECTIVES: The researchers investigated whether back massage could reduce anxiety, discomfort, and physical suffering in patients with CHF. The effects of gender and severity-dependent response of back massage on anxiety and discomfort in patients were also analyzed. DESIGN: The study used a quasi-experimental design with one group pretest and posttest. PARTICIPANTS: Sixty-four participants were recruited in southern Taiwan. OUTCOME MEASURES: The modified State Anxiety Inventory, the discomfort Visual Analogue Scale, electronic blood pressure (BP) gauges, stethoscopes and the pulse oximetry were used in this study. RESULTS: The participants' systolic BP (F (3, 189)=18.91, p<0.01), diastolic BP (F (3, 189)=13.40, p<0.01), heart rate (F (3, 189)=26.28, p<0.01), and respiratory rates (F (3, 189)=5.77, p<0.01) were significantly decreased after back massage. Oxygen saturation levels showed significant increases (F (3, 189)=42.82, p<0.01). Male participants revealed a more significant reduction in anxiety than the female participants (F (1, 50)=7.27, p=0.01). Those with more severe heart failure and greater levels of anxiety (F (2, 61)=4.31, p=0.02) and systolic BP (F (2, 61)=3.86, p=0.03) demonstrated significantly greater responses to back massage. CONCLUSIONS: Back massage significantly reduced anxiety in the study population. Systolic BP decreased to a greater degree in the male participants, particularly in those with severe heart failure and greater levels of anxiety and higher systolic BP. This study was conducted without a control group. Randomized clinical trials are needed to validate the effectiveness of back massage on patients with CHF.

[An experience applying a spiritual care model to a first-time stroke patient].

Patients with stroke-related disabilities are at risk of depression and social isolation. This can make it difficult for the patient to cope with his or her disease and increase caregiver burden. While good at dealing with physical illness, nurses are often poor at attending to patients' mental and spiritual needs. In this paper, the authors introduce their experience using a spiritual care model to care for a stroke patient. The patient, a 69 year-old retiree, was admitted to our hospital due to an acute stroke. During hospitalization, he suffered from acute confusion and persistent focal weakness. His disability resulted in physical dependence, which did not improve during rehabilitation. We used a model of spiritual care and in-depth evaluation to identify several underlying psychological issues. These included feelings of hopelessness and loss of control and motivation. The authors established trust through active listening. In addition to standard nursing education and physical care, we, in cooperation with the patient's children, provided encouragement and support to help the patient cope with his disease burden and actively participate in rehabilitation. We applied a multi-dimensional spiritual care approach to help the patient shift from hopelessness to hopefulness. This enhanced his motivation to participate in rehabilitation and improved his self-care abilities. We hope this case report on the application of a spiritual-care model is useful reference for nurses responsible to care for stroke patients.

Increased complement factor H with decreased factor B determined by proteomic differential displays as a biomarker of tai chi chuan exercise.

BACKGROUND: Exhaustive exercise can be associated with short-term immune suppression, but moderate exercise such as tai chi chuan (TCC) has been shown to have beneficial effects on immunity. The mechanisms for the health benefits of exercise remain to be determined, and no potential biomarkers for these beneficial health effects have been identified. This study investigated serum proteomic markers in individuals participating in TCC exercise. METHODS: Two-dimensional fluorescence difference gel electrophoresis was used to compare proteomic markers in 3 individuals before and after 12 weeks of TCC exercise. The different protein spots were identified by mass spectrometry and validated in an additional 20 individuals by western blot analysis. RESULTS: We identified 39 protein spots for 18 proteins with a noticeable increase or decrease after TCC exercise. Validation of the differentially displayed proteins with 20 paired pre- and postexercise samples revealed a significant increase in complement factor H (P = 0.0034) associated with decreases in C1 esterase inhibitor (P = 0.0038) and complement factor B (P = 0.0029). CONCLUSIONS: In this first study of proteomic biomarkers of TCC exercise, we found an increase in complement factor H associated with a decrease in complement factor B. Complement factor H is involved in protection from microangiopathy and macular degeneration and may represent a useful marker of the health effects of exercise.

Effect of 12-week tai chi chuan exercise on peripheral nerve modulation in patients with type 2 diabetes mellitus.

OBJECTIVE: To examine the effect of tai chi chuan exercise on peripheral nerve modulation in patients with type 2 diabetes mellitus. DESIGN: Parallel group comparative study with a pre- and post- design. SUBJECTS: Twenty-eight participants with diabetes mellitus and 32 healthy adult controls from communities in Kaohsiung, Taiwan. METHODS: Cheng's tai chi chuan, 3 times a week for 12 weeks. Fasting blood glucose levels, insulin resistance index and nerve conduction studies were measured. RESULTS: A 12-week tai chi chuan programme significantly improved fasting blood glucose (p = 0.035) and increased nerve conduction velocities in all nerves tested (p = 0.046, right; p = 0.041, left) in diabetic patients. Tai chi chuan exercise did not advance the nerve conduction velocities of normal adults; however, it significantly improved the motor nerve conduction velocities of bilateral median and tibial nerves, and distal sensory latencies of bilateral ulnar nerves in diabetic patients. Tai chi chuan exercise had no significant effect on amplitudes of all nerves tested in diabetic patients. CONCLUSIONS: Results from this study suggest that fasting blood glucose and peripheral nerve conduction velocities in diabetic patients can be improved by 12 weeks tai chi chuan exercise. A further larger randomized controlled clinical trial with longer follow-up time is needed.