Gentle Massage Improves Disease- and Treatment-Related Symptoms in Patients with Acute Myelogenous Leukemia.

OBJECTIVE: Cancer treatment is reported to be stressful, and patients diagnosed with hematologic cancers often exhibit higher levels of anxiety and emotional distress than individuals with other malignancies. Management of these symptoms in patients with hematologic cancer presents significant challenges, as many of them are in and out of the hospital while undergoing high dose chemotherapy. Oncology patients use complementary modalities such as therapeutic massage in an attempt to alleviate disease and treatment-related symptoms, including anxiety and emotional distress. In the current study, the feasibility of a novel massage intervention delivered over the continuum of care, as well as assessment of the immediate and cumulative effects of massage, was examined in patients with acute myelogenous leukemia. METHODS: A mixed-methods, unmasked, prospective, randomized study was conducted with two groups: a usual care alone control group and a massage therapy intervention plus usual care group. RESULTS: Significant improvements in levels of stress and health-related quality of life were observed in the massage therapy group versus the usual care alone group, after adjusting for anxiety level, including both immediate and cumulative effects of massage. CONCLUSIONS: While the findings of the current study regarding acceptability, feasibility, and potential efficacy of therapeutic massage as a complementary health-enhancing intervention in patients diagnosed with acute myelogenous leukemia are very promising, the relatively small size of the study sample limits generalizability.

A high-fiber diet may improve bowel function and health-related quality of life in patients with Crohn disease.

Crohn disease is a chronic disorder characterized by episodes of epithelial inflammation in the gastrointestinal tract for which there is no cure. The prevalence of Crohn disease increased in civilized nations during the time period in which food sources were industrialized in those nations. A characteristic of industrialized diets is the conspicuous absence of cereal fiber. The purpose of this 2-group, randomized, controlled study was to investigate the effects of fiber-related dietary instructions specifying wheat bran consumption on health-related quality of life and gastrointestinal function in individuals diagnosed with Crohn disease, as measured by the Inflammatory Bowel Disease Questionnaire and the partial Harvey Bradshaw Index, respectively. Results demonstrated that consuming a wheat bran-inclusive diet was feasible and caused no adverse effects, and participants consuming whole wheat bran in the diet reported improved health-related quality of life (p = .028) and gastrointestinal function (p = .008) compared to the attention control group. The results of a secondary aim, to investigate differences in measures of systemic inflammation, found no group differences in C-reactive protein or erythrocyte sedimentation rates. This study suggests that diet modification may be a welcomed complementary therapy for individuals suffering gastrointestinal disruption associated with Crohn disease.

Cranial electrical stimulation improves symptoms and functional status in individuals with fibromyalgia.

To investigate the effects of microcurrent cranial electrical stimulation (CES) therapy on reducing pain and its associated symptoms in fibromyalgia (FM), we conducted a randomized, controlled, three-group (active CES device, sham device, and usual care alone [UC]), double-blind study to determine the potential benefit of CES therapy for symptom management in FM. Those individuals using the active CES device had a greater decrease in average pain (p = .023), fatigue (p = .071), and sleep disturbance (p = .001) than individuals using the sham device or those receiving usual care alone over time. Additionally, individuals using the active CES device had improved functional status versus the sham device and UC groups over time (p = .028).

"A feeling of connectedness": perspectives on a gentle yoga intervention for women with major depression.

Major depressive disorder (MDD) is one of the most common and debilitating health conditions in women in the United States and worldwide. Many women with MDD seek out complementary therapies for their depressive symptoms, either as an adjunct or alternative to the usual care. The purpose of this study is to understand the experiences of women who participated in a yoga intervention for their depression. The findings from this interpretive phenomenological study are derived from interviews with and daily logs by 12 women with MDD who took part in an 8-week gentle yoga intervention as part of a larger parent randomized, controlled trial. Results show that the women's experience of depression involved stress, ruminations, and isolation. In addition, their experiences of yoga were that it served as a self-care technique for the stress and ruminative aspects of depression and that it served as a relational technique, facilitating connectedness and shared experiences in a safe environment. Future long-term research is warranted to evaluate these concepts as potential mechanisms for the effects of yoga for depression.

Feasibility, acceptability, and effects of gentle Hatha yoga for women with major depression: findings from a randomized controlled mixed-methods study.

Major depressive disorder (MDD) is a common, debilitating chronic condition in the United States and worldwide. Particularly in women, depressive symptoms are often accompanied by high levels of stress and ruminations, or repetitive self-critical negative thinking. There is a research and clinical imperative to evaluate complementary therapies that are acceptable and feasible for women with depression and that target specific aspects of depression in women, such as ruminations. To begin to address this need, we conducted a randomized, controlled, mixed-methods community-based study comparing an 8-week yoga intervention with an attention-control activity in 27 women with MDD. After controlling for baseline stress, there was a decrease in depression over time in both the yoga group and the attention-control group, with the yoga group having a unique trend in decreased ruminations. Participants in the yoga group reported experiencing increased connectedness and gaining a coping strategy through yoga. The findings provide support for future large scale research to explore the effects of yoga for depressed women and the unique role of yoga in decreasing rumination.

A randomized, controlled, double-blind pilot study of the effects of cranial electrical stimulation on activity in brain pain processing regions in individuals with fibromyalgia.

OBJECTIVE: To investigate the effects of microcurrent cranial electrical stimulation (CES) therapy on activity in pain processing brain regions. DESIGN: A randomized, controlled, three-group, double-blind pilot study. PARTICIPANTS: Persons with physician-diagnosed fibromyalgia. INTERVENTION: Active CES device, sham device, and usual care alone. RESULTS: Those individuals using the active device had a greater decrease in average pain (P = .023) than individuals using the sham device or receiving usual care alone over time. Preliminary analyses of the functional magnetic resonance imaging data on a subset of six participants from each of the two device groups show that individuals using an active CES device had a decrease in activation in the pain processing regions of the brain compared to those using a sham device. CONCLUSIONS: The observed decrease in activation in the pain processing regions may indicate a decrease in neural activity in these regions that may be related to decreased pain. This is the first randomized, controlled trial of CES in patients diagnosed with fibromyalgia to report functional magnetic resonance imaging data.

Population density, distance to public transportation, and health of women in low-income neighborhoods.

OBJECTIVES: The purpose of this research was to determine the impact of two neighborhood walkability (the extent to which the built environment is pedestrian friendly) metrics on health outcomes of women living in low-income urban neighborhoods, both before and after accounting for individual and neighborhood factors. DESIGN AND SAMPLE: A cross-sectional, retrospective design was used. The sample of 1800 low-income women was drawn from Welfare, Children and Families: A Three-City Study (a study of low-income women from three U.S. cities). MEASURES: Using multilevel modeling and geographic information systems, the study sought to determine the effect of distance to public transportation and residential density on health status, mental health symptoms, and health-related limitations. RESULTS: No significant relationship was found between the two walkability metrics and health outcomes. Instead, neighborhood problems that affect crime and safety impacted health status and mental health symptoms. CONCLUSIONS: As cities make changes to the built environment with the hope of affecting residents' health outcomes, public health nurses need to be aware that changing walkability characteristics in a neighborhood may not affect the health of residents of high crime, low-income neighborhoods. Without first addressing neighborhood crime, efforts to improve walkability in low-income neighborhoods may fail.

A complementary care study combining flaxseed oil, caffeine, fasting, and exercise in women diagnosed with advanced ovarian cancer: findings from a case study.

This article presents the experiences of 1 participant with advanced ovarian cancer enrolled in a proof of concept complementary therapy study evaluating the effects of a combined intervention of flaxseed oil, fasting, caffeine, and exercise. Improvements were observed in physical and psychological symptoms. The participant adopted positive lifestyle modifications.

Effect of a computerized insulin dose calculator on the process of glycemic control.

BACKGROUND: Glycemic control is important to patients' outcomes. However, the process of maintaining glycemic control is risk laden and labor intensive for nurses. OBJECTIVES: To examine the effects of using a computerized insulin dose calculator to facilitate management of glycemic control for critically ill cardiac patients. METHODS: A prospective randomized controlled trial was conducted with a sample of 300 intensive care patients, 141 randomized to the calculator group and 159 in the control (paper protocol) group. A convenience sample of 44 intensive care nurses responded to a nurse satisfaction survey. RESULTS: A significantly higher percentage of glucose measurements were in the target range in the calculator group than in the control group (70.4% [SD, 15.2%] vs 61.6% [SD, 17.9%], Z = -4.423, P < .001), and glucose variance was significantly less in the calculator group (35.5 [SD, 18.3] mg/dL vs 42.3 [SD, 21.2] mg/dL, Z = -3.845, P < .001). Fewer hypoglycemic events occurred in the calculator group (7 vs 18), although this difference was not statistically significant. Nurse satisfaction was higher for the calculator group than for the control group (8.4 [SD, 1.4] vs 4.8 [SD, 2.4], Z = -5.055, P < .001). Nurses' deviation from the protocol was also less in the calculator group than in the control group. CONCLUSIONS: Management of glycemic control and nurse satisfaction were improved with use of the dose calculator. Improving nurses' processes of care may improve nurses' use of time and patient care overall. Studies with larger sample sizes over time are needed to determine these relationships.

Patterns of yoga practice and physical activity following a yoga intervention for adults with or at risk for type 2 diabetes.

BACKGROUND: The current study described patterns of yoga practice and examined differences in physical activity over time between individuals with or at risk for type 2 diabetes who completed an 8-week yoga intervention compared with controls. METHODS: A longitudinal comparative design measured the effect of a yoga intervention on yoga practice and physical activity, using data at baseline and postintervention months 3, 6, and 15. RESULTS: Disparate patterns of yoga practice occurred between intervention and control participants over time, but the subjective definition of yoga practice limits interpretation. Multilevel model estimates indicated that treatment group did not have a significant influence in the rate of change in physical activity over the study period. While age and education were not significant individual predictors, the inclusion of these variables in the model did improve fit. CONCLUSIONS: Findings indicate that an 8-week yoga intervention had little effect on physical activity over time. Further research is necessary to explore the influence of yoga on behavioral health outcomes among individuals with or at risk for type 2 diabetes.

"I could move mountains": adults with or at risk for type 2 diabetes reflect on their experiences with yoga practice.

PURPOSE: The purpose of this study was to describe firsthand experiences with yoga as shared by adults with or at risk for type 2 diabetes and to examine their beliefs regarding maintenance of yoga practice over time. METHODS: In this qualitative study, 13 adults with or at risk for type 2 diabetes described their experiences with yoga and their beliefs regarding maintenance of yoga practice over time. Semistructured interviews occurred 16 to 20 months after completion of an 8-week yoga-based clinical trial. RESULTS: Themes of readiness for continuing yoga, environmental support for yoga, and integrating yoga emerged through data analysis. CONCLUSIONS: Findings indicate that yoga is appealing to some individuals with diabetes, but maintaining yoga practice over time is a challenge. Diabetes educators may be able to support maintenance by discussing specific strategies with individuals who express interest in yoga practice.

Pilot feasibility study of binaural auditory beats for reducing symptoms of inattention in children and adolescents with attention-deficit/hyperactivity disorder.

INTRODUCTION: The purpose of this pilot study was to explore the potential for the use of binaural auditory beat stimulation to reduce the symptom of inattention in children and adolescents with attention-deficit/hyperactivity disorder. METHODS: This pilot study had a randomized, double-blind, placebo-controlled design. Twenty participants were randomly assigned to listen to either an audio program on compact disk that contained binaural auditory beats or a sham audio program that did not have binaural beats for 20 minutes, three times a week for 3 weeks. The Children's Color Trails Test, the Color Trails Test, the Test of Variables of Attention (TOVA), and the Homework Problem Checklist were used to measure changes in inattention pre- and postintervention. RESULTS: Repeated measures analysis of variance was used to analyze pre- and postintervention scores on the Color Trails Tests, Homework Problem Checklist, and the TOVA. The effect of time was significant on the Color Trails Test. However, there were no significant group differences on the Color Trails Test or the TOVA scores postintervention. Parents reported that the study participants had fewer homework problems postintervention. DISCUSSION: The results from this study indicate that binaural auditory beat stimulation did not significantly reduce the symptom of inattention in the experimental group. However, parents and adolescents stated that homework problems due to inattention improved during the 3-week study. Parents and participants stated that the modality was easy to use and helpful. Therefore, this modality should be studied over a longer time frame in a larger sample to further its effectiveness to reduce the symptom of inattention in those diagnosed with attention-deficit/hyperactivity disorder.

Top-down and bottom-up mechanisms in mind-body medicine: development of an integrative framework for psychophysiological research.

It has become increasingly evident that bidirectional ("top-down and bottom-up") interactions between the brain and peripheral tissues, including the cardiovascular and immune systems, contribute to both mental and physical health. Therapies directed toward addressing functional links between mind/brain and body may be particularly effective in treating the range of symptoms associated with many chronic diseases. In this paper, we describe the basic components of an integrative psychophysiological framework for research aimed at elucidating the underlying substrates of mind-body therapies. This framework recognizes the multiple levels of the neuraxis at which mind-body interactions occur. We emphasize the role of specific fronto-temporal cortical regions in the representation and control of adverse symptoms, which interact reciprocally with subcortical structures involved in bodily homeostasis and responses to stress. Bidirectional autonomic and neuroendocrine pathways transmit information between the central nervous system and the periphery and facilitate the expression of affective, autonomic, hormonal, and immune responses. We propose that heart rate variability (HRV) and markers of inflammation are important currently available indices of central-peripheral integration and homeostasis within this homeostatic network. Finally, we review current neuroimaging and psychophysiological research from diverse areas of mind-body medicine that supports the framework as a basis for future research on the specific biobehavioral mechanisms of mind-body therapies.

Effects of cranial electrical stimulation on sleep disturbances, depressive symptoms, and caregiving appraisal in spousal caregivers of persons with Alzheimer's disease.

PURPOSE: The purpose of this work was to investigate the effects of cranial electrical stimulation (CES) on sleep disturbances, depressive symptoms, and caregiving appraisal. METHODS: Thirty-eight participants were randomly assigned to receive active CES or sham CES for 4 weeks. RESULTS: Both intervention groups demonstrated improvement in study measures from baseline scores. A trend toward statistically significant differences in daily sleep disturbances was found between the groups. No differences in depressive symptoms and caregiving appraisal were found between the groups. CONCLUSIONS: These findings did not fully support the efficacy of the short-term use of active CES versus sham CES to improve sleep disturbances, depressive symptoms, or caregiving appraisal.

Effects of antioxidant supplementation on insulin sensitivity, endothelial adhesion molecules, and oxidative stress in normal-weight and overweight young adults.

The objective of the study was to determine whether short-term antioxidant (AOX) supplementation affects insulin sensitivity, endothelial adhesion molecule levels, and oxidative stress in overweight young adults. A randomized, double-blind, controlled study tested the effects of AOXs on measures of insulin sensitivity (homeostasis model assessment [HOMA]) and quantitative insulin sensitivity check index), endothelial adhesion molecules (soluble intercellular adhesion molecule-1, vascular adhesion molecule, and endothelial-leukocyte adhesion molecule-1), adiponectin, and oxidative stress (lipid hydroperoxides) in overweight and normal-weight individuals (N = 48, 18-30 years). Participants received either AOX (vitamin E, 800 IU; vitamin C, 500 mg; beta-carotene, 10 mg) or placebo for 8 weeks. The HOMA values were initially higher in the overweight subjects and were lowered with AOX by week 8 (15% reduction, P = .02). Adiponectin increased in both AOX groups. Soluble intercellular adhesion molecule-1 and endothelial-leukocyte adhesion molecule-1 decreased in overweight AOX-treated groups by 6% and 13%, respectively (P < .05). Plasma lipid hydroperoxides were reduced by 0.31 and 0.70 nmol/mL in the normal-weight and overweight AOX-treated groups, respectively, by week 8 (P < .05). Antioxidant supplementation moderately lowers HOMA and endothelial adhesion molecule levels in overweight young adults. A potential mechanism to explain this finding is the reduction in oxidative stress by AOX. Long-term studies are needed to determine whether AOXs are effective in suppressing diabetes or vascular activation over time.

A feasibility study of valerian extract for sleep disturbance in person with arthritis.

OBJECTIVES: To present a pilot study of valerian to explore issues of feasibility and efficacy in studies of sedative herbs for arthritis-related sleep disturbance. METHODS: Fifteen persons with arthritis and mild sleep disturbance were randomized to receive 600 mg valerian (Valeriana officinalis, n = 7) or placebo (n = 8) for five nights. RESULTS: Protocol adherence (dosing and data collection) was high. Allocation concealment was successful using a novel approach for matching the placebo on the distinctive odor of valerian. Nonsignificant differences between the groups were found on all sleep outcomes, measured by daily diaries and wrist actigraphy. CONCLUSION: The study methods were feasible, except for recruitment issues (addressed in the discussion), and may guide the testing of other sedative herbs for persons with arthritis. Although efficacy outcomes were inconclusive due to the small sample size of this study, recent evidence from larger trials of valerian also does not support its efficacy.

The biobehavioral effects of relaxation guided imagery on maternal stress.

PURPOSE: The purpose of this pilot study was to investigate the effects of relaxation-guided imagery (R-GI) on perceived stress, anxiety, and corticotropin-releasing hormone (CRH) levels in pregnant African American women beginning in the second trimester. METHODS: This prospective, longitudinal study of 59 women used a controlled randomized experimental design with two groups conducted over 12 weeks. The intervention was a set of three R-GI CDs developed and sequenced to influence study outcomes. Study measures included the Perceived Stress Scale (PSS), State-Trait Anxiety Inventory, and plasma CRH levels collected at three time points. Participants completed a daily Numeric Rating Scale of Stress (NRSS) and daily practice logs, which provided information on intervention use in the R-GI group. FINDINGS: State anxiety significantly decreased over time in the R-GI group, and it increased over time in the usual-care (UC) group. Although a significant difference was not found for perceived stress, as measured by the PSS, the R-GI group had a greater decrease in weekly Numeric Rating Scale of Stress NRSS scores over time compared to the UC group. The R-GI group also had significant decreases in NRSS scores before and after using R-GI. There were no significant differences in CRH levels between groups over time. CONCLUSIONS: Findings support the feasibility and effectiveness of an R-GI intervention in reducing anxiety and daily stress levels in pregnant African American women beginning in the second trimester. The pilot study is an important first step in evaluating the effectiveness of R-GI as a primary prevention intervention to reduce preterm birth.

Predictors of genital injury after nonconsensual intercourse.

Understanding differences in genital injuries after nonconsensual and consensual intercourse is an important element of prosecuting sexual assault cases. In order to determine if the injury patterns and total surface area of genital injuries can differentiate between the types of intercourse (consensual or non-consensual), eighty women were examined after non-consensual (retrospective chart review, n = 40) and consensual (recruited, n = 40) intercourse within 48 hours using colposcopy, toluidine blue dye, and digital photography to document genital injuries. Differences between types of injuries found in the nonconsensual and consensual groups, based on the univariate analysis, were found with the number of sites (NoS) with ecchymosis (p < 0.01) and NoS with redness (p < 0.01). Based on the logistic hierarchical regression model, 85% of the nonconsensual group and 90% of the consensual group were classified correctly by using the NoS with tears, ecchymosis, abrasions, and redness and SA of injury when controlling for time from intercourse to examination. The NoS with redness (p = 0.017), NoS with ecchymosis, and SA of injury (p = 0.039) were individually predictive. The NoS with ecchymosis were also a significant finding when addressed as an individual block (p < 0.001). In this small sample, exploratory study, while controlling for time, the injury patterns and total SA of genital injuries were able to correctly classify the nonconsensual group 85% of the time. Replication of this study with a larger sample is essential.

Effects of noninvasive interactive neurostimulation on symptoms of osteoarthritis of the knee: a randomized, sham-controlled pilot study.

OBJECTIVE: To explore the effects of noninvasive interactive neurostimulation used as an adjunct to usual care, on pain and other symptoms in adults with osteoarthritis of the knee. DESIGN: Randomized, sham-controlled trial. SETTING: A university in the southern United States. SUBJECTS: Thirty-seven (37) adults with knee osteoarthritis (based on American College of Rheumatology diagnostic criteria). INTERVENTIONS: Seventeen (17) noninvasive interactive neurostimulation (active or sham) sessions over 8 weeks with a week 12 follow-up. OUTCOME MEASURES: Eleven-point numeric rating scale for weekly pain; Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC), patient global assessment, and Short-Form Health Survey (SF-36) completed at baseline and weeks 4, 8, and 12. RESULTS: For the main outcome, pain, the differences between the groups over time did not reach statistical significance (all p > 0.05). However, a clinically important reduction in pain (defined as a 2-point or 30% reduction on an 11-point numeric rating scale) was maintained at week 12 by the active noninvasive interactive neurostimulation group (2.17 points, 34.55% reduction) but not the sham group (1.63, 26.04% reduction). Pain improved over time in participants regardless of group membership (numeric rating scale average pain, p = 0.002; numeric rating scale worst pain, p < 0.001; and WOMAC pain, p < 0.001), as did WOMAC function, WOMAC stiffness, and WOMAC total score (all p < 0.001). Repeated measures ANOVA revealed a statistically significant difference between the groups over time for the SF-36 Vitality scale, F (3, 105) = 3.54, p = 0.017. In addition, the active device group improved on the patient global assessment from baseline to week 8 compared to the sham device group, F (1, 35) = 4.025, p = 0.053. CONCLUSIONS: In this pilot study, clinically important reductions in knee pain were maintained at week 12 in the active, but not the sham, noninvasive interactive neurostimulation group. Further study of this noninvasive therapy is warranted.