Physiological Effects of Visual Stimulation by a Japanese Low Wooden Table: A Crossover Field Experiment.

The purpose of this study was to evaluate the physiological effects of visual stimulation by a unique Japanese low wooden table on the prefrontal cortex and autonomic nervous activities. A within-participants experiment with 26 male university students was conducted in a Japanese-style room. The visual stimuli were a low wooden table (WT) made of Japanese cypress and a low cloth-covered table (control) for an exposure time of 90 s. Near-infrared spectroscopy was used to measure the prefrontal cortex activity in the left and right prefrontal cortices as an indicator of oxyhemoglobin (oxy-Hb) concentration. Autonomic nervous activity was measured as an indicator of sympathetic (low-frequency/high-frequency component ratio, LF/HF), and parasympathetic (high-frequency components, HF) nervous activities were assessed by heart rate variability. Furthermore, the modified semantic differential method and the Profile of Mood States 2nd edition were used to measure psychological responses. Physiologically, the oxy-Hb concentration in the left prefrontal cortex and ln (LF/HF) were significantly lower during visual exposure to the WT than to the control. Psychologically, more comfortable, relaxed, and natural impressions, as well as improved mood states, were reported during visual stimulation to the WT than to the control. This study demonstrated that viewing a WT led to physiological relaxation and had a positive psychological effect on the participants.

Relaxation Effect of Nature Sound Exposure on Gambling Disorder Patients: A Crossover Study.

Objective: Gambling disorder (GD) has been associated with economic, social, mental, and physical problems. Alternative leisure activities or stress-relieving activities have been adopted as part of GD treatment. Moreover, it has been proven that activities utilizing the natural environment, such as shinrin-yoku, have a relaxing effect on healthy people. In this study, we examined the physiological and psychological responses of patients with GD to determine whether nature therapy could reduce their stress responses. Design: This study included 22 Japanese male participants who were found to be pathological gamblers, with a South Oaks Gambling Screen score of ≤5. We exposed the participants to the digital nature sounds of insects and city sounds of a scramble intersection. The nature and city sounds were presented in a counterbalanced order. Outcome measures: A two-channel near-infrared spectroscopy system was used to measure the changes in oxyhemoglobin (oxy-Hb) concentrations in the bilateral prefrontal cortex. The heart rate variability was measured to evaluate the autonomic nervous activity. Subjective evaluation was performed using the modified version of the semantic differential method and the Profiles of Mood States, Second Edition (POMS2). Results: The oxy-Hb level in the bilateral prefrontal cortex significantly decreased. No significant difference in the high-frequency (HF) and low-frequency/HF ratio was observed. The subjective evaluation indicated that the participants experienced increased comfort and relaxation and had more natural feelings. Nature sounds significantly decreased the POMS2 negative emotion subscale and total mood disturbance scores and increased the positive emotion subscale scores. Nature-based stimulus exposure induces physiological relaxation and other positive effects among individuals even with GD. Conclusion: Exposure to nature-based sounds induces physiological relaxation and other positive responses among individuals with GD. In patients with GD, nature sounds produce the same relaxation response as in healthy individuals. (Umin.ac.jp under registration number: UMIN000042368).

A Functionalistic Stress Recovery Intervention Improves Perceived Recovery Opportunities and Relaxational Behaviors: A Secondary Analysis of a Randomized Controlled Trial.

The recovery perspective on stress management is new and few recovery intervention studies have been conducted. The aim of the study was to evaluate behavioral effects of a functionalistic stress recovery intervention, in which individuals perceiving high levels of stress were encouraged to pay attention to possibilities to perform potential recovery behaviors in everyday life and to choose behaviors that were predicted to lead to resource restoration. Seventy-three individuals were randomly allocated to either a 10-week intervention or a waiting-list control group. Three types of recovery behavior factors during leisure time were studied: perceived recovery opportunities (i.e., control), relaxational behaviors (i.e., relaxation), and positively challenging behaviors (i.e., mastery). In comparison with the control group, the intervention group significantly improved, showing high between-group effect sizes, regarding perceived recovery opportunities (p < 0.001; d = 0.75) and relaxational behaviors (p < 0.001; d = 0.80). Both groups normalized their levels of positively challenging behaviors between pre- and postassessment, and no statistically significant group difference was demonstrated. Analyses of reliable and clinically significant changes demonstrated results in favor of the intervention group regarding perceived recovery opportunities and relaxational behaviors but not positively challenging behaviors. The tested intervention warrants further research, for example, if a modified version of the intervention including components aiming at increasing postwork positively challenging behaviors would be beneficial for the improvement of the behavior and for health.

Spending Time in the Forest or the Field: Investigations on Stress Perception and Psychological Well-Being-A Randomized Cross-Over Trial in Highly Sensitive Persons.

Research suggests that stays in a forest promote relaxation and reduce stress compared to spending time in a city. The aim of this study was to compare stays in a forest with another natural environment, a cultivated field. Healthy, highly sensitive persons (HSP, SV12 score > 18) aged between 18 and 70 years spent one hour in the forest and in the field at intervals of one week. The primary outcome was measured using the Change in Subjective Self-Perception (CSP-14) questionnaire. Secondary outcomes were measured using the Profile Of Mood States (POMS) questionnaire and by analyzing salivary cortisol. We randomized 43 participants. Thirty-nine were allocated and included in the intention-to-treat analysis (90% female, mean age 45 years). CSP-14 in part showed significant differences-total score (p = 0.054, Cohen's d = 0.319), item "integration" (p = 0.028, Cohen's d = 0.365)-favoring the effects of the forest. These effects were more pronounced in summer (August). In October, during rainfall, we detected no relevant differences. POMS only showed a significant difference in the subcategory "depression/anxiety" in favor of the field. The amount of cortisol in saliva was not different between the groups. A short-term stay in a forest in summer caused a greater improvement in mood and well-being in HSP than in a field. This effect was not detectable during bad weather in the fall.

An experimental test of resource recovery from physical and relaxation work break activities.

Actual resource replenishment, a defining part of the stress-recovery process, has hardly been studied. We address this gap in the literature within the context of work breaks to determine which resources are replenished relative to a pre-stressor baseline. Guided by conservation of resources theory and the effort-recovery model, we explored how two different break activities promoted recovery by looking at their effects on recovery experiences (relaxation, psychological detachment), psychological resources (self-regulatory capacity, energy), and an indicator of insufficient recovery (fatigue). In a sample of 160 college students, we experimentally induced a state of resource depletion via mentally demanding tasks and randomly assigned people to a physical (stationary bike) or relaxation (progressive muscle relaxation) recovery break activity. The relaxation activity resulted in higher psychological detachment and relaxation experiences, the physical activity resulted in higher energy levels, and there were no differences between the break activities for self-regulatory capacity or fatigue. Overall, post-break resource levels improved following recovery break activities. Energy levels returned to baseline (replenishment); self-regulatory capacity and fatigue improved beyond baseline (accumulation). These resource replenishment and accumulation findings further the development of recovery theory and help employees select a work break activity that better meets their resource-related needs.

Acute relaxation during pregnancy leads to a reduction in maternal electrodermal activity and self-reported stress levels.

BACKGROUND: Prenatal maternal stress can have adverse effects on birth outcomes and fetal development. Relaxation techniques have been examined as potential countermeasures. This study investigates different relaxation techniques and their effect on self-reported stress levels and physiological stress levels in pregnant women. METHODS: In this cross-sectional study, 38 pregnant women in their 30th to 40th gestational week were assigned to one of three, 20-min lasting relaxation groups: listening to music (N = 12), following a guided imagery (N = 12) or resting (N = 12). The intervention, i.e., acute relaxation (music, guided imagery or resting) took place once for each study participant. Study inclusion criteria were age over 18 years, German speaking, singleton and uncomplicated pregnancy during the 30th and 40th week of gestation. The stress levels were determined during the study. Current stress level during the study was assessed by a visual analogue scale. Chronic stress levels were assessed by the Trier Inventory of Chronic Stress and the Pregnancy Distress questionnaire. Multivariate analyses of covariance were performed and dependent measures included stress levels as well as physiological measures, i.e., cardiovascular activity (electrocardiogram) and skin conductance levels. RESULTS: All three forms of relaxation led to reduced maternal stress which manifested itself in significantly decreased skin conductance, F(3,94) = 18.011, p = .001, ηp2 = .365, and subjective stress levels after the interventions with no significant group difference. Post-intervention stress ratings were further affected by gestational age, with less subjective relaxation in women later in gestation, F (1, 34)=4.971, p = .032, ηp2 = .128. CONCLUSION: Independent of relaxation technique, single, 20-min relaxation intervention (music, guided imagery or resting) can significantly reduce maternal stress. Notably, women at an earlier stage in their pregnancy reported higher relaxation after the intervention than women later in gestation. Hence, gestational age may influence perceived stress levels and should be considered when evaluating relaxation or stress management interventions during pregnancy. TRIAL REGISTRATION: Not applicable.

The effects of viewing a winter forest landscape with the ground and trees covered in snow on the psychological relaxation of young Finnish adults: A pilot study.

Forest bathing is an outdoor activity, and it might be a promising preventive treatment for social problems involving stress. A vast number of studies confirm the positive effects of this activity on people's health. Nevertheless, little is known about the influence of winter forest bathing when conducted in an environment with snow cover on the ground and trees. Thus, a crossover experiment was designed in this study, with the participation of twenty-two healthy university students from Finland. During the experiment, a short exposition by a forest environment or landscape with buildings (as a control) was applied. Participants self-reported their psychological relaxation before and after the exposition, and the results were analyzed and compared. The mood, emotions, restorativeness, and subjective vitality were recorded as indices reflecting the psychological relaxation effect. The negative mood indices decreased significantly after exposition by the snow-covered environment, but the positive 'vigor' indices did not increase or decrease significantly. The level of negative emotions increased after the exposition with the control environment. Likewise, positive emotions decreased after the interaction with the control. Restorativeness was significantly increased after the exposition by the experimental forest but decreased after the viewing of the control buildings. The size of the effect in terms of restorativeness was the highest in this experiment. The subjective vitality was lowered as affected by the control, but it did not increase or decrease after the exposition with the experimental forest. There is probably an effect from the slight interruption in the process from the influence of the forest greens on participants because their vigor and vitality did not increase after the exposition with this environment in the study. However, snow might influence the participants as a calming and emotion-lowering component of the environment, but this idea needs to be further explored with the involvement of participants from other countries who would be viewing forest environments with snow cover and whose psychological relaxation could be measured.

Comparing Relaxation Versus Mastery Microbreak Activity: A Within-Task Recovery Perspective.

Recovery from work is generally thought to occur outside of the workplace. However, employees may also have the opportunity to recover within the work day via microbreaks during demanding work tasks. Two major strategies for mitigating fatigue include psychological detachment (i.e., mentally disengaging) and replenishing motivational incentives via positive affect. This study examined whether 40-s "microbreaks" improve work recovery and to what extent different microbreak content (mastery vs. relaxation activities) boost performance. Using an experimental study, we randomly assigned individuals to receive a relaxation microbreak (n = 59), a mastery microbreak (n = 68), or no break (n = 72) in the middle of a monotonous work task and assessed work performance. Microbreaks improved task performance and within-task recovery, but only for psychological detachment (not positive affect). Mastery breaks also resulted in more psychological detachment than relaxation breaks, but this increased detachment did not explain performance differences between break types. These results build on existing recovery theories by further demonstrating within-task recovery and provide practical implications for organizations to consider the importance of microbreaks.

The Effect of Natural Ocean Sound Exposure and Ocean-Side Relaxation on Chronic Tinnitus Patients: A Pilot Study in Korea.

Sound therapy is a treatment modality for tinnitus patients by increasing the background neuronal activity in the auditory system and inducing relative alleviation of the tinnitus. This study was performed to evaluate the efficacy of natural ocean sound exposure and ocean-side relaxation in chronic tinnitus patients. We prospectively enrolled all 18 chronic tinnitus patients (≥6 months) from July to November 2018. All patients completed 90 hours of our programs. The improvement in their subjective tinnitus severity, moods, the quality of life, and sleep was serially assessed using several questionnaires at baseline, immediately, and 1 month after the program. Changes in serum stress hormone levels of the patients were also compared between the baseline and immediately after the program. Average total Tinnitus Handicap Questionnaire score and factor 2 (hearing difficulty related to tinnitus) score significantly improved over time (P = .024 and P = .002). Patient's serum cortisol and epinephrine level did not show significant decrease, and serum norepinephrine and serotonin level significantly increased immediately after our program (P < .001 and P < .001). Natural ocean sound exposure and ocean-side relaxation for short-term period has a potential efficacy on chronic tinnitus patients.

Infants relax in response to unfamiliar foreign lullabies.

Music is characterized by acoustic forms that are predictive of its behavioural functions. For example, adult listeners accurately identify unfamiliar lullabies as infant-directed on the basis of their musical features alone. This property could reflect a function of listeners' experiences, the basic design of the human mind, or both. Here, we show that US infants (N = 144) relax in response to eight unfamiliar foreign lullabies, relative to matched non-lullaby songs from other foreign societies, as indexed by heart rate, pupillometry and electrodermal activity. They do so consistently throughout the first year of life, suggesting that the response is not a function of their musical experiences, which are limited relative to those of adults. The infants' parents overwhelmingly chose lullabies as the songs that they would use to calm their fussy infant, despite their unfamiliarity. Together, these findings suggest that infants may be predisposed to respond to common features of lullabies found in different cultures.

Effects of Relaxation-Focused Nursing Care in Women in Preterm Labor.

BACKGROUND: Threatened preterm labor is a common problem that causes women to be hospitalized. During this period, physical problems such as a decrease in muscle functions, edema and pain, and psychological problems such as anxiety and stress may develop. OBJECTIVE: This study aimed to investigate the effect of relaxation-focused nursing care state anxiety, cortisol, contraction severity, nursing care satisfaction, knowledge, and birth weeks on threatened preterm labor. METHOD: This study was a pre-post single-blind randomized controlled trial. The study was conducted with 66 women in the threatened preterm labor process, 33 in the intervention group and 33 in the control group. The intervention group received relaxation-focused nursing care, which comprises a 2-day program in four stages. The data were collected before and after the relaxation-focused nursing care, and after the birth. RESULTS: In the intervention group, state anxiety, cortisol level, and contraction severity were lower than those in the control group (p < .05). The knowledge level about threatened preterm labor, satisfaction from nursing care, and birth weeks were higher in the intervention group (p < .05). CONCLUSION: Relaxation-focused nursing care was found to reduce the state anxiety in women, improve the knowledge level about threatened preterm labor and birth weeks, and decrease the level of cortisol. Therefore, it is recommended to use relaxation-focused nursing care in threatened preterm labor.

Short-term noise annoyance and electrodermal response as a function of sound-pressure level, cognitive task load, and noise sensitivity.

INTRODUCTION: Two aspects of noise annoyance were addressed in the present laboratory study: (1) the disturbance produced by vehicle pass-by noise while engaging in a challenging non-auditory task, and (2) the evaluative response elicited by the same sounds while imagining to relax at home in the absence of a primary activity. METHODS AND MATERIAL: In Experiment 1, N = 29 participants were exposed to short (3-6 s) pass-by recordings presented at graded levels between 50 and 70 dB(A). Concurrent with each sound presentation, they performed a visual multiple-object tracking task, and subsequently rated the annoyance of the sounds on a VAS scale. In Experiment 2, N = 30 participants judged the sounds while imagining to relax, without such a cognitive task. RESULTS AND DISCUSSION: Annoyance was reduced when participants were engaged in the cognitively demanding task, in Experiment 1. Furthermore, when occupied with the task, annoyance slightly, but significantly increased with task load. Across both experiments, the magnitude of simultaneously recorded skin conductance responses in the first 1-4 s after the onset of stimulation increased significantly with sound pressure level. Annoyance ratings tended to be elevated across all sound levels, though significantly only in Experiment 2, in participants classified as noise sensitive based on a 52-item questionnaire. CONCLUSIONS: The results suggest that noise annoyance depends on the primary activity the listener is engaged in. They demonstrate that phasic skin conductance responses may serve as an objective correlate of the degree of annoyance experienced. Finally, noise sensitivity is once more shown to augment annoyance ratings in an additive fashion.

A Multimodal Stress-Prevention Program Supplemented by Telephone-Coaching Sessions to Reduce Perceived Stress among German Farmers: Results from a Randomized Controlled Trial.

This study compared the effectiveness of a 12-day stress-prevention program (SGS) supplemented by individualized, structured, four-session telephone-coaching to that of an SGS without telephone-coaching in entrepreneurs from the green professions presenting with increased stress levels. All participants went through the SGS before being randomized either to the telephone-coaching group (TC) or to the control group without telephone-coaching (noTC). SGS included four key therapeutic elements: stress-management intervention, relaxation, physical exercise, and balneotherapy. The primary outcome was the current degree of subjectively experienced stress assessed with the Perceived Stress Questionnaire (PSQ) at a 9-month follow-up. Secondary outcomes included burnout symptoms, well-being, health status, sleep disorders, expectation of self-efficacy, depression, anxiety, ability to work, pain, and days of sick leave. Assessments were conducted at baseline, 12 days (end of program), and 1 (start telephone-coaching), 3, 6 (end of telephone-coaching), and 9 months. Data from 103 adults (TC = 51; noTC = 52), mostly fulltime farmers, were available for analysis (mean age: 55.3; 49.1% female). Participants experienced significant immediate improvement in all outcome measurements, which declined somewhat during the first three months after the end of SGS and then remained stable for at least another six months. While within-group changes from baseline to 9 months showed significant improvements at medium to large effect sizes for all target variables (PSQ-total, TC: -13.38 (±14.98); 95%-CI: (-17.68; -9.07); noTC: -11.09 (±14.15); 95%-CI: (-15.11; -7.07)), no statistically significant differences were found between the groups at any time and for any target variable (between-group ANCOVA for PSQ-total at 9 months, parameter estimator for the group: -1.58; 95%-CI: (-7.29; 4.13)). The stress-prevention program SGS is a feasible, effective, and practical way to reduce perceived stress and improve participants' resources. Four subsequent telephone-coaching sessions do not seem to contribute to a further improvement in the results.

An experimental examination of worry and relaxation on cardiovascular, endocrine, and inflammatory processes.

BACKGROUND: Worry increases risk for long-term health issues by prolonging the physiological stress response. In contrast, relaxation may ameliorate the psychological and physiological burden resulting from worry. This study examined the impact of experimentally induced worry and relaxation on cortisol, heart rate variability (HRV), and inflammation. METHOD: Participants (N = 80) completed both a worry and relaxation induction (presented in a fixed order) while HRV was collected continuously. Three blood samples were taken (at baseline, after the worry induction, and after the relaxation induction) to measure IL-6, IFN-γ, TNF-α and serum cortisol. RESULTS: There were significant changes in IL-6 (p < 0.001), IFN-γ (p < 0.01), HRV (p < .001), and cortisol (p <  .001) but not in TNF-α (p = 0.65) across conditions. HRV decreased significantly from baseline to worry and then increased following relaxation. IL-6 was higher during relaxation compared to worry and baseline. Cortisol decreased significantly across conditions. Several patterns of covariance between inflammation and HRV and/or cortisol also emerged. CONCLUSIONS: These findings offer novel insight into how worry influences the immune system and emphasize the utility of a multi-methods approach to understanding the impact of worry on physical health.

How does daily performance affect next-day emotional labor? The mediating roles of evening relaxation and next-morning positive affect.

The present study examined the daily relationship between job performance, relaxation, positive affect, and emotional labor. Drawing on the effort-recovery model and broaden-and-build theory, we proposed that job performance on a particular day fosters evening relaxation and next-morning positive affect and that this leads to increased deep acting and decreased surface acting the next day. To test our propositions, we conducted 2 diary studies using the experienced sampling method. In Study 1, 93 flight attendants participated in morning and end-of-workday surveys for 5 workdays. In Study 2, 98 hotel employees responded to morning, end-of-workday, and evening surveys for 5 workdays. In both studies, we found positive relationships between daily job performance, evening relaxation, next-morning positive affect, and next-day deep acting. We further found support for the indirect effect of daily job performance on next-day deep acting through evening relaxation and next-morning positive affect. Although next-morning positive affect had a marginally negative relationship with next-day surface acting in Study 1, this relationship became nonsignificant when next-morning negative affect was included in the model (Study 2). The robustness of these findings was validated in supplementary analyses. (PsycInfo Database Record (c) 2020 APA, all rights reserved).

Effects of Types of Horticultural Activity on the Physical and Mental State of Elderly Individuals.

This study aimed to evaluate the effect of types of horticultural activities among elderly individuals in a senior citizen learning camp. We arranged four horticultural activities: Grass Doll, Kokedama, Rocky Leaf Prints, and Herb Tasting and Smelling. Twenty-seven senior citizens (60 to 76 years) were recruited to participate. We assessed their physiological and mental state before and after the activities by measuring heart rate variability (HRV), pulse rate, blood pressure, salivary amylase activity (SAA), and Profile of Mood States (POMS). Results showed that SAA was significantly lower after the Rocky Leaf Prints, Herb Tasting and Smelling, and Kokedama. Pulse rate had a downward trend after the four horticultural activities. The ratio of low frequency (LF) over high frequency (HF) results showed that the Rocky Leaf Prints had a larger downward trend, followed by Herb Tasting and Smelling. POMS scores indicated significant improvement for Rocky Leaf Prints and Herb Tasting and Smelling. The types including artistic creation and food tasting were promising methods for psychological relaxation, stress reduction, and vigor enhancement for elderly persons. Findings showed that the impact of activities involving contact with plants was more significant in short-term activities. We hope this study can help plan the horticultural activities of the elderly in the future.

The Mechanism of Relaxation by Viewing a Japanese Garden: A Pilot Study.

AIM: To explore people's visual attention and psychological and physiological responses to viewing a Japanese garden (an asymmetrically designed garden) and an herb garden (a symmetrically designed garden). BACKGROUND: There are few studies of eye movements when observing different style gardens, and how they are connected to the interpretation of the space, and physiological and psychological responses. METHOD: Thirty subjects were recruited and their physiological and psychological responses to viewing the garden types were assessed using a heart-rate monitor and questionnaire. Eye movements while viewing projected slide images of the gardens were tracking using an eye-tracking monitor. RESULTS: A significant decrease in heart rate was observed when subjects were viewing the Japanese garden as opposed to viewing the herb garden. Mood was significantly improved in both gardens, but eye-gaze patterns differed. The Japanese garden elicited far more comments about expectations for the coming season; unlike the herb garden, it also induced memories of viewing other landscapes. CONCLUSION: The physiological and psychological responses to viewing gardens differs based on the quality of landscape design and the prior experience of viewers.

High-frequency electrical stimulation of the anterior thalamic nuclei increases vigilance in epilepsy patients during relaxed and drowsy wakefulness.

OBJECTIVE: High-frequency deep brain stimulation (DBS) of anterior thalamic nuclei (ANT) reduces the frequency and intensity of focal and focal to bilateral tonic-clonic epileptic seizures. We investigated the impact of high-frequency ANT-DBS on vigilance in epilepsy patients during relaxed and drowsy wakefulness, to better understand the effects and the mechanisms of action of this intervention in humans. METHODS: Four patients with different structural epileptic pathologies were included in this retrospective case-cohort study. Short- and long-term electroencephalography (EEG) was used to determine states of relaxed or drowsy wakefulness and the vigilance changes during stimulation-on and stimulation-off intervals. RESULTS: In relaxed, wakeful patients with eyes closed, the eyelid artifact rate increased acutely and reproducibly during stimulation-on intervals, suggesting an enhanced vigilance. This effect was accompanied by a slight acceleration of the alpha rhythm. In drowsy patients with eyes closed, stimulation generated acutely and reproducibly alpha rhythms, similar to the paradoxical alpha activation during eyes opening. The occurrence of the alpha rhythms reflected an increase in the vigilance of the drowsy subjects during ANT-DBS. SIGNIFICANCE: This is the first demonstration that ANT-DBS increases the vigilance of wakeful epilepsy patients. Our results deliver circumstantial evidence that high-frequency ANT-DBS activates thalamocortical connections that promote wakefulness.

The Effect of Lotus Position on Dyspnoea Management in Intensive Care Unit.

OBJECTIVE: To determine the effect of lotus position on dyspnea management. METHODS: The case-control study was conducted from June to November 2016 at a training and research hospital in Istanbul, Turkey, and comprised patients with lung disease in an intensive care unit. The patients were divided into an experimental group who were exposed to lotus position for dyspnoea management, while the control group was subjected to Orthopnoeic position. Data was collected using a patient description form, and the Medical Research Council Scale. Respiratory rate, oxygen saturation, heart rate and blood pressure for all subjects were noted. SPSS 22 was used for data analysis. RESULTS: Of the 35 subjects, 17(48.5%) were cases and 18(51.4%) were controls. The overall mean age was 61.48±15.51 years. There was a significant improvement in the intra-group respiratory rate, oxygen saturation, heart rate and systolic blood pressure in both groups (p<0.05). Patients in both groups were similar in their vital signs both before and after the intervention (p>0.05). CONCLUSIONS: Both lotus and Orthopnoeic positions significantly improved dyspnoea-related variables, and lotus position was as effective as Orthopnoeic position.

"Breaking" the Emergency Department: Does the Culture of Emergency Medicine Present a Barrier to Self-Care?

INTRODUCTION: Our goal was to critically examine emergency physician's (EP) beliefs about taking breaks for self-care on shift. Our operational definition of a break for self-care included time not engaging in direct patient care, eating, drinking, using the bathroom, or leaving a clinical area for a mental break. Using focus groups, the study aimed to accomplish the following: 1) identify barriers to why residents and faculty at our academic center may not take breaks in the emergency department; 2) generate hypotheses for empirical testing; and 3) generate solutions to include in a departmental breaks initiative. METHODS: We convened eight focus groups comprised separately of resident and faculty physicians. Group discussion was guided by eight questions representing a priori themes. The groups were recorded for transcription and subjected to a "cut-and-sort" process. Six themes were identified by consensus after independent review by three of the co-authors, which were confirmed by participant validation. RESULTS: We identified six themes that represented the pooled outcomes of both resident and faculty focus groups: 1) Physiological needs affect clinical performance, 2) EPs share beliefs around taking breaks that center on productivity, patient safety and the dichotomy of strength/weakness, 3) when taking breaks EPs fear worst-case scenarios, 4) breaking is a learned skill, 5) culture change is needed to allow EPs to engage in self-care; and 6) a flexible, individualized approach to breaking is necessary. Our central finding was that productivity and patient safety are of key importance to EPs when considering whether to take a break for self-care. We identified a dichotomy with the concept of strength related to productivity/patient safety, and the concept of weakness related to self-care. CONCLUSION: The current practice culture of emergency medicine and the organization of our unique work environment may present barriers to physicians attempting to engage in self-care.