Music therapy for stress reduction: a systematic review and meta-analysis.

Music therapy is increasingly being used as an intervention for stress reduction in both medical and mental healthcare settings. Music therapy is characterized by personally tailored music interventions initiated by a trained and qualified music therapist, which distinguishes music therapy from other music interventions, such as 'music medicine', which concerns mainly music listening interventions offered by healthcare professionals. To summarize the growing body of empirical research on music therapy, a multilevel meta-analysis, containing 47 studies, 76 effect sizes and 2.747 participants, was performed to assess the strength of the effects of music therapy on both physiological and psychological stress-related outcomes, and to test potential moderators of the intervention effects. Results showed that music therapy showed an overall medium-to-large effect on stress-related outcomes (d = .723, [.51-.94]). Larger effects were found for clinical controlled trials (CCT) compared to randomized controlled trials (RCT), waiting list controls instead of care as usual (CAU) or other stress-reducing interventions, and for studies conducted in Non-Western countries compared to Western countries. Implications for both music therapy and future research are discussed.

New perspectives on the conservative management of osteoradionecrosis of the mandible: A literature review.

Over the last decades, several therapeutic options were considered in the treatment of the osteoradionecrosis (ORN) of the mandible, including supportive measures, ultrasound therapy, corticosteroids, hyperbaric oxygen, surgical resection with reconstruction, and, more recently, drugs capable of reversing the fibroatrophic process. Once established, the ORN does not spontaneously disappear and a standard treatment has not yet been defined. The clear clinical effectiveness of hyperbaric oxygen therapy (HBOT) varies according to the literature and there are some economic/logistic issues to be considered; the triplet tocopherol/pentoxifylline/clodronate demands greater evidence from randomized clinical trials and also resilience from the patient, given the long treatment duration and its possible side effects. Controversy around the ideal treatment of the initial stage ORN of the mandible persists. More rigorous randomized prospective trials are essential. The purpose of this article was to review the relevant literature on the physiopathology of ORN of the mandible and discuss the new perspectives of its conservative treatment. © 2016 Wiley Periodicals, Inc. Head Neck 38: 1708-1716, 2016.

Are Amyotrophic Lateral Sclerosis Caregivers at Higher Risk for Health Problems?

INTRODUCTION: Amyotrophic lateral sclerosis is a rare neurodegenerative disease affecting motor neurons. Patients present with progressive physical impairment, respiratory failure being the main cause of death. A significant portion of patients presents neurobehavioral problems as well. As severe impairment occurs, patients become highly dependent and in general, their families assume the role of primary caregivers, exposing them to stress and other potential causes of disease like insomnia, physical strain from patients' mobilization and changes on eating habits. The aim of this work is to understand if taking care of patients with amyotrophic lateral sclerosis increases disease and health problems on caregivers. MATERIAL AND METHODS: Comprehensive review of the literature published on the electronic databases PubMed and Scopus between 2010 and 2014. RESULTS: Eighteen studies met the inclusion criteria. We found that amyotrophic lateral sclerosis caregivers have higher levels of burden, depression and anxiety with lower quality of life. This is associated to age and gender of caregivers, time spent caring, patients' disability and neurobehavioral changes. Higher sense of support and spirituality on family seem to promote wellbeing. DISCUSSION: On our work, we were able to understand that several factors have influenced caregivers' quality of life and affect their health. Besides, we could understand that the outcomes studied are related between themselves and, as seen in some of the studies, related to patients' quality of life itself. Consequently, it has become essential to adopt a holistic approach of these patients and their families, fighting the deteriorating risk factors and investing on health promoters. CONCLUSION: Despite the large body of research on family caregiving for amyotrophic lateral sclerosis patients, little has changed and the outcomes measured remain almost the same before and after 2010. The work indicates that caregivers have lower levels of health than the general population. Still additional research is required, in order to better understand and characterized the changes on caregivers' health. It is nevertheless clear that health care professionals cannot ignore these health changes and need an approach focused not only on patients but also on caregivers.

Introdução: A esclerose lateral amiotrófica é uma doença neuro-degenerativa rara que afeta os neurónios motores. Os doentes apresentam-se com incapacidade motora progressiva e, por vezes, alterações neuro-comportamentais e a principal causa de morte é a falência respiratória. Com o agravamento da incapacidade funcional, os pacientes tornam-se altamente dependentes da família, que assume o papel de cuidador primário, expondo-se ao stress e outras potenciais causas de doença como insónias, o esforço físico realizado para a mobilização dos pacientes e alterações nos hábitos alimentares. O principal objetivo do nosso trabalho é perceber se cuidar de doentes com esclerose lateral amiotrófica aumenta os níveis de doença ou problemas de saúde nos cuidadores. Material e Métodos: Através de uma revisão exaustiva, analisámos a bibliografia publicada nas bases de dados eletrónicas PubMed e Scopus entre 2010 e 2015. Resultados: Verificámos que os cuidadores têm níveis mais elevados de sobrecarga, depressão e ansiedade, assim como menor qualidade de vida. Estes resultados relacionam-se com a idade e o género do cuidador e a duração dos cuidados, para além da incapacidade e das alterações neuro-comportamentais do doente. Uma elevada perceção de suporte e a espiritualidade do cuidador promovem o bem-estar. Discussão: No nosso trabalho foi-nos possível perceber que diversos factores influenciam a qualidade de vida dos cuidadores e afetam a sua saúde. Para além disso, pudemos perceber também que os diversos parâmetros avaliados estão relacionados entre si e, como visto em alguns dos estudos, relacionados com a própria qualidade de vida dos doentes. Consequentemente, tornou-se essencial adotar uma abordagem holística destes pacientes e das suas famílias, combatendo os factores prejudiciais e investindo nos promotores da saúde. Conclusão: Apesar de toda a investigação realizada sobre cuidadores de doentes com esclerose lateral amiotrófica, as variáveis analisadas antes e depois de 2010 foram praticamente as mesmas e pouco mudou nos últimos anos. Tendo sido previamente verificado que os cuidadores têm menores níveis de saúde que a população geral, ainda há muito a fazer no sentido de melhor caracterizar e compreender as alterações de saúde que ocorrem nos cuidadores de doentes com esclerose lateral amiotrófica. No entanto, desde já reforçar a ideia de que os profissionais de saúde não podem ignorar estes factos e devem focar a sua atenção nos pacientes e cuidadores.

Connecting to create: expertise in musical improvisation is associated with increased functional connectivity between premotor and prefrontal areas.

Musicians have been used extensively to study neural correlates of long-term practice, but no studies have investigated the specific effects of training musical creativity. Here, we used human functional MRI to measure brain activity during improvisation in a sample of 39 professional pianists with varying backgrounds in classical and jazz piano playing. We found total hours of improvisation experience to be negatively associated with activity in frontoparietal executive cortical areas. In contrast, improvisation training was positively associated with functional connectivity of the bilateral dorsolateral prefrontal cortices, dorsal premotor cortices, and presupplementary areas. The effects were significant when controlling for hours of classical piano practice and age. These results indicate that even neural mechanisms involved in creative behaviors, which require a flexible online generation of novel and meaningful output, can be automated by training. Second, improvisational musical training can influence functional brain properties at a network level. We show that the greater functional connectivity seen in experienced improvisers may reflect a more efficient exchange of information within associative networks of importance for musical creativity.

Phosphorus as an early marker of morbidity and mortality in type 2 chronic kidney disease diabetic patients.

AIMS: To evaluate the association of different phosphorus levels with cardiovascular mortality and hospitalizations risk in type-2 diabetic patients in phase 3/4 of CKD. METHODS: An observational, prospective study involving 119 patients divided into groups according to baseline phosphorus levels: 1, ≤3.60 mg/dL; 2, 3.60-4.60 mg/dL; and 3, >4.60 mg/dL. Baseline characteristics were analyzed and compared. Multivariate Cox regression and Multivariate Logistic regression were used to find out the predictors of cardiovascular mortality and hospitalizations, respectively. T-test was used to investigate the association of phosphorus and start of hemodialysis. RESULTS: Patients of group 3 presented lower clearance and Hb and increased PTH, Ca×P, LVMI, HOMA, uric acid, IL-6 and more hospitalization days. Patients' mean survival on groups 1, 2 and 3 was 62.5 ± 1.95, 60.1 ± 2.85 and 52.6 ± 2.84 months, respectively (p = 0.001). Phosphorus and creatinine levels were independent predictors of mortality, and phosphorus, creatinine, PTH and age were independent predictors of hospitalizations in this population. Patients who entered hemodialysis presented greater phosphorus levels than those who did not (5.04 ± 1.31 vs. 4.14 ± 1.09; p = 0.001). CONCLUSIONS: Phosphorus was a predictor of cardiovascular mortality and hospitalizations. Phosphorus levels might have a significant clinical use, possibly translated as an early marker of mortality and hospitalizations in this population.

Psicologia Comunitária e Biodança: contribuições da categoria vivência

A Psicologia Comunitária pode ser definida como uma área da Psicologia Social da Libertação (Góis, 2005), voltada para a compreensão da atividade comunitária como atividade social significativa e consciente e para a compreensão dos seus reflexos nas dimensões objetivas e subjetivas. O presente artigo busca compreender como a abordagem da Biodança pode dialogar e contribuir para a construção do marco teórico-metodológico da Psicologia Comunitária.Ametodologia utilizada foi a pesquisa teórica. Fundamentar-se no paradigma da complexidade representa a possibilidade de legitimar um conhecimento que se reconhece essencialmente transdisciplinar. Esse artigo possibilitou um avanço na sistematização e legitimação do diálogo transdisciplinar entre Biodança e Psicologia Comunitária, integrando a categoria vivência no arcabouço teórico-metodológico da Psicologia Comunitária e na formação dos psicólogos comunitários.(AU)

Community Psychology can be defined as an area of the Social Psychology of Liberation (Góis, 2005), dedicated to the understanding of community activity as a significant and aware social activity and to the understanding of its impacts on the objective and subjective dimensions. This article aims to understand in which way the approach of Biodance can dialogue and contribute to the construction of the theoretical and methodological framework of Community Psychology. The methodology used was theoretical research. Supporting on the paradigm of complexity represents the chance to validate a knowledge that is recognized primarily as transdisciplinary. This article has allowed a breakthrough in the systematization and legitimacy of the transdisciplinary dialogue between Biodance and Community Psychology, integrating the category experience in theoretical and methodological framework of Community Psychology and training of community psychologists.(AU)

Psicologia comunitária e biodança: contribuições da categoria vivência / Community psychology and biodance: contributions on experience category

A Psicologia Comunitária pode ser definida como uma área da Psicologia Social da Libertação (Góis, 2005), voltada para a compreensão da atividade comunitária como atividade social significativa e consciente e para a compreensão dos seus reflexos nas dimensões objetivas e subjetivas. O presente artigo busca compreender como a abordagem da Biodança pode dialogar e contribuir para a construção do marco teórico-metodológico da Psicologia Comunitária.Ametodologia utilizada foi a pesquisa teórica. Fundamentar-se no paradigma da complexidade representa a possibilidade de legitimar um conhecimento que se reconhece essencialmente transdisciplinar. Esse artigo possibilitou um avanço na sistematização e legitimação do diálogo transdisciplinar entre Biodança e Psicologia Comunitária, integrando a categoria vivência no arcabouço teórico-metodológico da Psicologia Comunitária e na formação dos psicólogos comunitários.

Community Psychology can be defined as an area of the Social Psychology of Liberation (Góis, 2005), dedicated to the understanding of community activity as a significant and aware social activity and to the understanding of its impacts on the objective and subjective dimensions. This article aims to understand in which way the approach of Biodance can dialogue and contribute to the construction of the theoretical and methodological framework of Community Psychology. The methodology used was theoretical research. Supporting on the paradigm of complexity represents the chance to validate a knowledge that is recognized primarily as transdisciplinary. This article has allowed a breakthrough in the systematization and legitimacy of the transdisciplinary dialogue between Biodance and Community Psychology, integrating the category experience in theoretical and methodological framework of Community Psychology and training of community psychologists.