Investigating the Relationship Between Accessibility of Green Space and Adult Obesity Rates: A Secondary Data Analysis in the United States.

OBJECTIVES: In spite of the importance of green space for reducing obesity-related problems, there has been little exploration of whether access to green space (e.g., parks and recreational facilities) influences the obesity rate of adults in the United States. The purpose of the study was to investigate the relationships among accessibility of green space, obesity rates, and socioeconomic and demographic variables among adults living in the State of Indiana, United States. METHODS: We conducted a secondary data analysis to investigate the relationships among accessibility to green space, obesity rates, and socio-demographic variables with employing Geographic Information System in order to measure the accessibility of green space. RESULTS: This study found that accessibility of green space served as a strong predictor of reduced obesity rates among adults (ß=-2.478; p<0.10). In addition, adults with higher education levels, as well as better access to green space, were found to have even lower obesity rates (ß=-0.188; p<0.05). Other control variables such as unemployment rates, food security, and physical inactivity are additional factors that influence obesity rates among adults. CONCLUSIONS: Accessibility of green space may play an important role in facilitating physical activity participation and reducing obesity rates.

Effect of Guided Imagery Along With Breathing Relaxation on Sleep Quality of the Elderly Patients Under Abdominal Surgery: A Randomized Clinical Trial.

Elderly patients undergoing surgery often suffer from sleep disorder. Holistic therapies might help them sleep better. The aim of this research was to determine the effect of guided imagery along with breathing relaxation on sleep quality in elderly patients undergoing abdominal surgery. A double-blind randomized clinical trial was conducted on 90 elderly patients undergoing abdominal surgery in 2 educational hospitals in 2018, Mashhad, Iran. The elderly patients with different abdominal surgical procedures were distributed to the wardrooms and then the rooms were randomly assigned into 2 groups. In the intervention group, the patients learned breathing relaxation the day before surgery and then an audiotape was provided to perform the guided imagery from the day before surgery for 5 days (twice) along with breathing relaxation. St Mary's Hospital Sleep Inventory was completed the night before, 48 hours and 96 hours after the surgery. Data analysis was done using SPSS 21 through analytical tests. Results of the test indicated that the score of sleep quality was significantly higher in the intervention group the night before surgery (P = .001). The total scores of sleep quality in the intervention group 48 and 96 hours after the surgery were significantly higher (P < .001). Based on results of generalized estimating equation model, the score of sleep quality for patients was 8.76 units higher in the intervention group than in the control group by controlling for the effects of time. Guided imagery along with breathing relaxation improved the sleep quality of the elderly patients undergoing abdominal surgery.Trial registration: IRCT20180731040652N1.

Effects of forest bathing on pre-hypertensive and hypertensive adults: a review of the literature.

The aim in this literature review was (1) to explore the physiologically and psychologically therapeutic benefits of forest bathing on adults suffering from pre-hypertension or hypertension, and (2) to identify the type, duration, and frequency of an effective forest bathing intervention in the management of pre-hypertension and hypertension, so as to provide directions for future interventions or research. The electronic databases PubMed, Cochrane Library, CINAHL, PsyINFO, and the China Academic Journals (CAJ) offered through the Full-text Database (CNKI) were searched for relevant studies published from the inception of the databases to April 2019. Of the 364 articles that were identified, 14 met the criteria for inclusion in this review. The synthesis of the findings in the included studies revealed that forest bathing interventions were effective at reducing blood pressure, lowering pulse rate, increasing the power of heart rate variability (HRV), improving cardiac-pulmonary parameters, and metabolic function, inducing a positive mood, reducing anxiety levels, and improving the quality of life of pre-hypertensive or hypertensive participants. Forest walking and forest therapy programs were the two most effective forest bathing interventions. Studies reported that practicing a single forest walking or forest therapy program can produce short-term physiological and psychological benefits. It is concluded that forest bathing, particularly forest walking and therapy, has physiologically and psychologically relaxing effects on middle-aged and elderly people with pre-hypertension and hypertension.

Nature-based rehabilitation for adults with acquired brain injury: a scoping review.

The objective of this review was to provide an overview of the existing knowledge of the benefits of nature-based rehabilitation for patients with impairments after acquired brain injury. Systematic searches were conducted across PubMed, CINAHL, PsycINFO and Scopus, and seven studies were found to be included for review. Results suggest that nature-based rehabilitation may benefit individuals with acquired brain injury, as both motor - and sensory-motor functions, as well as cognitive functions were significantly improved. Furthermore, two studies found an improvement in quality of life. The benefits on anxiety and depression were not clear. The studies used different approaches, outcome measures and study designs that made comparisons difficult. Recommendations for future studies are offered.

Does Jacobson's relaxation technique reduce consumption of psychotropic and analgesic drugs in cancer patients? A multicenter pre-post intervention study.

BACKGROUND: Cancer patients often suffer from emotional distress as a result of the oncological process. The purpose of our study was to determine whether practice of Jacobson's relaxation technique reduced consumption of psychotropic and analgesic drugs in a sample of cancer patients. METHODS: This was a multicenter pre-post intervention design. Participants were 272 patients aged over 18 years attending 10 Spanish public hospitals with oncological pathologies and anxiety symptoms. The intervention consisted of a protocol of abbreviated progressive muscle relaxation training developed by Bernstein and Borkovec. This was followed up by telephone calls over a 1-month period. The intervention was performed between November 2014 and October 2015. Sociodemographic variables related to the oncological process, mental health variables, and intervention characteristics were measured. RESULTS: A reduction in the consumption of psychotropic and analgesic drugs was observed throughout the follow-up period. Improvement was observed throughout the 4-week follow-up for all the parameters assessed: anxiety, relaxation, concentration, and mastery of the relaxation technique. CONCLUSIONS: The practice of abbreviated Jacobson's relaxation technique can help to decrease the consumption of psychotropic and analgesic drugs. Patients experienced positive changes in all the evaluated parameters, at least during the 1-month follow-up. To confirm these findings, additional long-term studies are needed that include control groups. TRIAL REGISTRATION: ISRCTN 81335752 , DOI 10.1186/ISRCTN81335752 17. Date of registration: 22/11/2016 (retrospectively registered).

Use of mental techniques for competition and recovery in professional athletes.

BACKGROUND: The present study aims to describe knowledge about and usage of mental techniques to prepare before competitions and after sport-associated injuries (SAIs) by professional athletes (team sports) in Austria. METHODS: In this cross-sectional study, 191 professional athletes (basketball, football, hockey, ice hockey, and volleyball teams, m:f = 142:49, 24 ± 5, 18-39 years) filled in a questionnaire assessing socio-demographic data, duration/frequency of sport practice, rate and severity of SAIs. Furthermore, the use of mental techniques and of spiritual practices before competitions and for recovery after SAI was assessed. The use of mental techniques before competitions and after SAI was correlated with socio-demographic data, duration and frequency of sport practice, and injury patterns of SAIs of the last 24 months. RESULTS: Approximately, 96 % reported knowledge about at least one mental technique. Only 13 participants used them for regeneration after SAI. Approximately, 31 % of males and 13 % of females reported the use before competitions (p = 0.017). 54 % of participants using spiritual practices used mental techniques before competitions, whereas only 13 % of participants not using spiritual practices used them (p < 0.001). 67 % of participants not using mental techniques before competitions and 88 % using them believed in the effectiveness of mental techniques in the regeneration after a SAI (p = 0.03). A significant increase of the probability of using mental techniques before competition with increasing age was found [Odds ratio (OR) = 1.101, confidence interval (CI) = (1.03, 1.18), p = 0.006]. CONCLUSION: Mental techniques seem to be well-accepted but rarely used among professional athletes. Further studies are needed to give new information about this relevant topic in professional sports.

The Effectiveness of Noninvasive Interventions for Temporomandibular Disorders: A Systematic Review by the Ontario Protocol for Traffic Injury Management (OPTIMa) Collaboration.

OBJECTIVE: To determine the effectiveness and cost-effectiveness of noninvasive interventions for temporomandibular disorders (TMD). METHODS: We systematically searched MEDLINE, EMBASE, CINAHL, PsycINFO, and Cochrane Central register from 1990 to 2014 for effectiveness studies and the Cochrane Health Technology Assessment Database, EconLit, NHS Economic Evaluation Database, and Tufts Medical Center Cost-Effectiveness Analysis Register from 1990 to 2014 for cost-effectiveness studies. Random pairs of independent reviewers critically appraised eligible studies using the Scottish Intercollegiate Guidelines Network criteria. Evidence from eligible studies was synthesized using best-evidence synthesis methodology. RESULTS: Our search for effectiveness studies yielded 16,995 citations; 31 were relevant and 7 randomized controlled trials (published in 8 articles) had a low risk of bias. We found no relevant cost-effectiveness studies. The evidence suggests that for persistent TMD: (1) cognitive-behavioral therapy and self-care management lead to similar improvements in pain and disability but cognitive-behavioral therapy is more effective for activity interference and depressive symptoms; (2) cognitive-behavioral therapy combined with usual treatment provides short-term benefits in pain and ability to control pain compared with usual treatment alone; (3) intraoral myofascial therapy may reduce pain and improve jaw opening; and (4) structured self-care management may be more effective than usual treatment. The evidence suggests that occlusal devices may not be effective in reducing pain and improving motion for TMD of variable duration. Evidence on the effectiveness of biofeedback is inconclusive. DISCUSSION: The available evidence suggests that cognitive-behavioral therapy, intraoral myofascial therapy, and self-care management are therapeutic options for persistent TMD.

Mind-Body Medicine in the Secondary Prevention of Coronary Heart Disease.

BACKGROUND: In mind-body medicine (MBM), conventional lifestyle modification measures such as dietary counseling and exercise are supplemented with relaxation techniques and psychological motivational elements. This review studied the effect of MBM on cardiac events and mortality in patients with coronary heart disease (CHD). METHODS: This review is based on publications up to and including January 2015 that were retrieved by a systematic search in PubMed, the Cochrane Library, and Scopus. Randomized controlled trials of the effect of MBM programs (versus standard treatment) on cardiac events, overall mortality, and/or cardiac mortality were analyzed. Atherosclerosis, blood pressure, LDL cholesterol, and the body mass index (BMI) were chosen as secondary outcomes. Random-effects meta-analyses were performed. The risk of bias was assessed with the Cochrane tool. RESULTS: Twelve trials, performed on a total of 1085 patients, were included in the analysis. Significant differences between groups were found with respect to cardiac events (odds ratio [OR]: 0.38; 95% confidence interval [CI]: 0.23-0.61; p<0.01; heterogeneity [I2]: 0%), but not overall mortality (OR: 0.82; 95% CI: 0.46-1.45; p = 0.49; I2: 0%) or cardiac mortality (OR: 0.98; 95% CI: 0.43-2.25; p = 0.97; I2: 0%). Significant differences between groups were also found with respect to atherosclerosis (mean difference [MD] = -7.86% diameter stenosis; 95% CI: -15.06-[-0.65]; p = 0.03; I2: 0%) and systolic blood pressure (MD = -3.33 mm Hg; 95% CI: -5.76-[-0.91]; p<0.01; I2: 0%), but not with respect to diastolic blood pressure, LDL cholesterol, or BMI. CONCLUSION: In patients with CHD, MBM programs can lessen the occurrence of cardiac events, reduce atherosclerosis, and lower systolic blood pressure, but they do not reduce mortality. They can be used as a complement to conventional rehabilitation programs.

Stress Management and Relaxation Techniques use among underserved inpatients in an inner city hospital.

OBJECTIVE: Little is known about the use of Stress Management and Relaxation Techniques (SMART) in racially diverse inpatients. We hope to identify socioeconomic status (SES) factors, health behavior factors, and clinical factors associated with the use of SMART. DESIGN AND MAIN OUTCOME MEASURES: We conducted a secondary analysis of baseline data from 623 hospitalized patients enrolled in the Re-Engineered Discharge (RED) clinical trial. We assessed socio-demographic characteristics and use of SMART. We used bivariate and multivariate logistic regression to test the association of SMART with socio-demographic characteristics, health behaviors, and clinical factors. RESULTS: A total of 26.6% of participants reported using SMART and 23.6% used mind body techniques. Thirty six percent of work disabled patients, 39% of illicit drug users, and 38% of participants with depressive symptoms used SMART. Patients who both reported illicit drug use and screened positive for depression had significantly increased odds of using SMART [OR=4.94, 95% CI (1.59, 15.13)]. Compared to non-Hispanic whites, non-Hispanic blacks [0.55 (0.34-0.87)] and Hispanic/other race individuals [0.40 (0.20-0.76)] were less likely to use SMART. CONCLUSIONS: We found greater utilization of SMART among all racial groups compared to previous national studies. In the inner city inpatient setting, patients with depression, illicit drug use, and work disability reported higher rates of using SMART.

Improving Adherence to Cancer Treatment by Addressing Quality of Life in Patients With Advanced Gastrointestinal Cancers.

CONTEXT: Many patients with potentially curable cancer do not complete their prescribed treatment regimens because of the toxicity. There is evidence that the common endpoints of many of these toxicities are amenable to quality of life (QOL)-directed interventions. OBJECTIVES: This study was conducted to determine the effect of a multidisciplinary QOL-directed intervention on patients' adherence to planned chemoradiation (CR) regimens. METHODS: The results of two randomized controlled trials that used the same QOL intervention were pooled to form a cohort of 61 patients with advanced localized gastrointestinal cancer. Of these 61 subjects, 29 participated in six to eight bi- to triweekly sessions that included exercise, education, and relaxation, and 32 received usual medical care. The primary endpoint was completion of their prescribed CR regimens. Secondary outcomes included hospitalization during CR, rates of adverse postoperative events, and complete pathological response in those undergoing neoadjuvant therapy. RESULTS: Significantly, more members of the intervention than the control group completed their planned CR regimens (77.8 vs. 38.2%, P = 0.003). More participants in the control (n = 14) than the intervention (n = 5) group (P = 0.063) required hospitalization. Among those undergoing neoadjuvant CR, those in the intervention group were significantly more likely to complete CR as planned (81.0% vs. 37.5%, P = 0.005) and less likely to be hospitalized (14.3% vs. 50.0%, P = 0.011). CONCLUSION: A structured multidisciplinary QOL-directed intervention delivered to patients undergoing CR may increase the proportion of patients who complete CR as planned and reduce unplanned hospitalizations. Utilization is an important outcome in QOL-directed intervention trials.

A perspective on complementary/alternative medicine use among survivors of hematopoietic stem cell transplant: Benefits and uncertainties.

The widespread use of complementary and alternative medicine (CAM) in cancer survivors is well known despite a paucity of scientific evidence to support its use. The number of survivors of hematopoietic stem cell transplant (HCT) is growing rapidly and HCT clinicians are aware that many of their patients use CAM therapies consistently. However, due to a paucity of data regarding the benefits and harms of CAM therapies in these survivors, clinicians are reluctant to provide specific recommendations for or against particular CAM therapies. A systematic literature review was conducted with a search using PubMed, the Cochrane Database of Systematic Reviews, and Ovid online for each CAM therapy as defined by the National Center of Complementary and Alternative Medicine. The search generated 462 references, of which 26 articles were deemed to be relevant for the review. Due to extensive heterogeneity in data and limited randomized trials, a meta-analysis could not be performed but a comprehensive systematic review was conducted with specified outcomes for each CAM therapy. In randomized controlled trials, certain mind and body interventions such as relaxation were observed to be effective in alleviating psychological symptoms in patients undergoing HCT, whereas the majority of the other CAM treatments were found to have mixed results. CAM use is an understudied area in HCT survivorship and clinicians should convey the benefits and uncertainties concerning the role of CAM therapies to their patients.

Use of movement therapies and relaxation techniques and management of health conditions among children.

CONTEXT: Use of complementary and alternative medicine (CAM) by children under 18 y of age in the United States is becoming more prevalent. According to an analysis of procedures in chiropractic practices in 2010, more than 96% of chiropractors in the United States recommended use of movement therapies (MT) and relaxation techniques (RT) to their patients. The extent of use of these methods as treatment options for specific health conditions in children, however, has been underexplored in the United States. OBJECTIVES: The current study assessed use of MT and RT in children for treatment of various health conditions, as reported in the 2007 National Health Interview Survey (NHIS), and also examined variations in use across various sociodemographic categories. DESIGN: Secondary data from the 2007 National Health Interview Survey (NHIS) Child Alternative Medicine file were analyzed, and the research team generated weighted frequencies and inferential statistics. OUTCOME MEASURES: Odds ratios (OR) and 95% confidence intervals (CI) were computed through binary logistic regression to assess use of MT and RT as functions of various sociodemographic variables. RESULTS: Within the 12 mo prior to the survey, MT and RT use was reported by 2.5% and 2.9% of respondents, respectively. MT, primarily yoga, was used for the control and reduction of anxiety and stress (31.4%), asthma (16.2%), and back/neck pain (15.3%). Alternatively, RT, such as controlled breathing exercises (2.1%) and meditation (2.3%), was used for anxiety and stress (41.4%) and attention-deficit disorders (ADDs) (16.0%). Although data screening did not produce obvious predictors for RT use, age, gender, race/ethnicity, and parents' education levels were potential predictors of MT use. For example, respondents aged <10 y reported lower MT use than those >10 y (OR = 0.4; 95% CI, 0.3-0.6), and males reported lower MT use than females (OR = 0.5; 95% CI, 0.3-0.7). CONCLUSION: MT and RT are used by several million children in the United States each year. The current research suggests that early training on MT and RT can be seen as a useful tool that can help prevent or manage certain health problems. In addition to an examination of their role in primary prevention, the use of MT and RT should be explored further to determine how these therapies work with respect to specific health conditions.

[Diagnostic and therapy of tension-type headache]. / Diagnose und Therapie des Kopfschmerzes vom Spannungstyp.

Episodic headache of the tension type is the most prevalent primary headache with a lifetime prevalence of about 78 %. Clinical characteristics are a dull, moderate, holocephalic headache without accompanying autonomic or vegetative symptoms. The episodic tension-type headache often lasts only 30 min up to a maximum of a few days. In contrast to this clinically often undemanding headache, chronic tension-type headache can cause considerable disability in patients. The 1-year prevalence is 1-3 % of the population. All therapy strategies combine nonpharmaceutical therapy such as education of the patient, regular aerobic exercise, and psychological treatment (e.g., Jacobson's progressive muscle relaxation etc.) with pharmaceutical treatment such as tricyclic antidepressants or combined serotonergic and noradrenergic antidepressants. Combination therapy has been proven to be more effective than singular strategies; however, the chronic tension-type headache still poses a therapeutic problem.

Patterns of utilization of complementary and alternative medicine in 2 pediatric gastroenterology clinics.

OBJECTIVES: The aim of the present study was to assess the prevalence and patterns of complementary and alternative medicine (CAM) use among pediatric patients with gastrointestinal (GI) disorders at academic clinics in Canada. METHODS: The survey was carried out at 2 hospital-based gastroenterology clinics: the Stollery Children's Hospital in Edmonton and the Children's Hospital of Eastern Ontario (CHEO) in Ottawa. RESULTS: CAM use at the Stollery was 83% compared with 36% at CHEO (P < 0.001). The most common reason for not using CAM was lack of knowledge about it. Most respondents felt comfortable discussing CAM in their clinic and wanted more information on CAM. The most common CAM products being taken were multivitamins (91%), calcium (35%), vitamin C (32%), probiotics (14%), and fish oil/omega-3 fatty acids (13%). The most common CAM practices being used were massage (43%), chiropractic (27%), faith healing (25%), and relaxation (18%). Most respondents believed that CAM was helpful, and most of the 23 reported adverse effects were minor. Seven were reported as moderate, and 3 were reported as severe. Many (42%) patients used CAM at the same time as prescription medicines, and of these patients, concurrent use was discussed with their physician (76%) or pharmacist (52%). CONCLUSIONS: CAM use is high among pediatric patients with GI disorders and is much greater among those in Edmonton than in Ottawa. Most respondents reported their CAM use as helpful, with little or no associated harm. Many patients fail to disclose their concurrent use of CAM and conventional medicines to their doctors, increasing the likelihood of interactions.

Does perceived control predict Complementary and Alternative Medicine (CAM) use among patients with lung cancer? A cross-sectional survey.

PURPOSE: Scant literature exists on the use of complementary and alternative medicine (CAM) among patients with lung cancer. Preliminary data indicates that perceived control is an important factor leading patients to CAM. This study aimed to evaluate the relationship between perceived control and CAM use in patients with lung cancer. METHODS: We performed a cross-sectional survey in patients with lung cancer under active treatment and follow-up at the oncology clinic of an academic medical center. Self-reported CAM use was the primary outcome. Multivariate logistic regression was performed to determine the relationship between perceived control and CAM use, controlling for other factors. RESULTS: Among 296 participants, 54.4 % were female, 83.5 % were Caucasian, 57.6 % were ≤65 years old, 52.4 % were in stage IV, and 86.4 % had non-small cell lung cancer; 50.9 % of patients had used CAM, most commonly vitamins (31.5 %), herbs (19.3 %), relaxation techniques (16 %), and special diets (15.7 %). In multivariate analysis, CAM use was associated with having greater perceived control over the cause of cancer (adjusted odds ratio (AOR) 2.27, 95 % confidence interval (CI) 1.35-3.80), age ≤ 65 (AOR 1.64, 95 % CI 1.01-2.67), higher education (AOR 2.17, 95 % CI 1.29-3.64), and never having smoked tobacco (AOR 2.39, 95 % CI 1.25-4.54). Nearly 60 % of patients who used CAM were receiving active treatment. CONCLUSION: Over half of lung cancer patients have used CAM since diagnosis. Greater perceived control over the cause of cancer was associated with CAM use. Given the high prevalence of CAM, it is essential that oncologists caring for patients with lung cancer discuss its use.

Complementary and alternative medicine utilization in Texas hospices: prevalence, importance, and challenges.

The purpose of this study was to describe the prevalence, importance, and challenges of complementary and alternative medicine (CAM) utilization in Texas hospices. Mail surveys were sent to 369 hospices in Texas, and 110 useful surveys were returned. Results showed that a majority (n = 62, 56.4%) of hospices offer CAM to their clients, with the most popularly offered CAMs being massage, music, and relaxation therapies. Despite the availability of CAM services in most hospices, and that the utilization of CAM has the potential to improve overall quality of life of patients, our results showed that a sizeable proportion of patients in these hospices are not utilizing the provided CAMs. Funding and personnel constraints were substantial obstacles to offering CAM.

The use and effectiveness of complementary and alternative medicine for pain in sickle cell anemia.

Pain is the clinical hallmark for sickle cell disease (SCD). The objective of this study was to survey the extent and effectiveness of complementary and alternative medicine (CAM) use for pain control among adults with SCD. Of a total of 227 African-American adults with SCD, 208 (92%) admitted to using at least one type of CAM. The three most common types of CAM were prayer (61%), relaxation technique (44%), and massage (35%). Multiple logistic regression showed that marital status was associated with use of relaxation techniques (p = 0.044), and age between 18 and 24 years and at least a high school level of education were associated with use of prayer (p = 0.008 and p = 0.004 respectively). Our study showed that CAM use is common among adult patients with SCD. Further well designed prospective studies are needed to help develop best practices that emphasize an optimized balance of conventional and evidence based CAM therapies.