Beneficios de la terapia de la risa en los niveles de depresión en niños diagnosticados con cáncer: estudio de caso / Benefits of laughing therapy on depression levels in children diagnosed with cancer: a case study

Fundamentos: El cáncer pediátrico afecta emocionalmente a los infantes causando depresión, la cual se debe intervenir oportunamente como parte fundamental del tratamiento. Por lo tanto, el presente estudio buscó identificar los beneficios de la terapia dela risa en los niveles de depresión en niños y niñas diagnosticados con cáncer de una fundación de Cali, Colombia. Métodos: La muestra estuvo conformada por seis niños en tratamiento oncológico, con edades entre los ocho y doce años. Se aplicó elInventario de Depresión Infantil (CDI) y tres talleres de risoterapia. Se realizo un análisis descriptivo, para las variablescuantitativas se realizaron medidas de tendencia central y para las categóricas se reportaron frecuencias absolutas y relativas. Resultados: Los resultados indicaron que el 83% de los niños presentaron un problema emocional debido a la enfermedad; seevidenciaron cambios favorables en los puntajes de depresión posterior a las intervenciones de la terapia de la risa. Conclusiones: Se concluye que la terapia de la risa es un tratamiento no farmacológico eficaz al combinarse con talleresorientados a fortalecer la expresión de las emociones, autoestima y proyecto de vida, que no solo permite mejorar la salud de losinfantes, sino que previne y reduce la aparición de trastornos emocionales.(AU)

Background: Pediatric cancer emotionally affects infants causing depression which must be intervened in a timely manner asan essential part of the treatment. Therefore, the present study sought to identify the benefits of laughter therapy on the levels ofdepression in children diagnosed with cancer in a foundation in Cali, Colombia. Methods: The sample consisted of six children undergoing cancer treatment, aged between eight and twelve years. TheChildren’sDepression Inventory (CDI) and three laughter therapy workshops were applied. A descriptive analysis was performed, with measures ofcentral tendency for quantitative variables and absolute and relative frequencies for categorical variables. Results: The results indicated that 83% of the children presented an emotional problem due to the disease; favorable changeswere evidenced in the depression scores after the laughter therapy interventions. Conclusions: It is concluded that laughter therapy is an effective non-pharmacological treatment when combined with works-hops aimed at strengthening the expression of emotions, self-esteem and life project, which not only improves the health of children,but also prevents and reduces the appearance of emotional disorders.(AU)

Impact of Laughter Therapy on Anxiety and Pain in Pediatric Dentistry: A Double-Blinded Randomized, Controlled Clinical Trial

Abstract Objective: To evaluate the effect of laughter therapy on reducing anxiety and pain during dental procedures in children 5-7 years of age. Material and Methods: 48 children aged 5-7 years were included in this cross-over double-blinded clinical trial after the parents completed the Screen for Child Anxiety Related Disorder questionnaire (SCARED). After allocation into two groups: laughter intervention (A) and neutral intervention (B), the anxiety as well as pain were determined by Modified Child Dental Anxiety Scale Faces questionnaire (MCDASF) and the Wong-Baker Faces Scale, respectively. Also, the child's behavior during the treatment was recorded using the Sound, Eye, Motor scale (SEM). Data were analyzed by SPSS 21 using Paired t-test, Independent t-test, Chi-square, Mann-Whitney and Wilcoxon's test. Results: The mean score of anxiety in the laughter intervention group (17.42±2.74) was significantly less than (22.06±2.16) in the neutral intervention group (p=0.000) and lower in boys in both groups (p=0.000, p=0.047). The mean pain severity reported by the children in the neutral intervention group (5.33±1.81) was higher than in the laughter intervention group (2.38±1.87; p=0.00) and higher in girls in both groups (p=0.02; p=0.03). Conclusion: The laughter intervention before dental procedures had a significant effect on reducing anxiety and pain during dental treatment (AU).

Effects of Laughter Therapy on Life Satisfaction and Loneliness in Older Adults Living in Nursing Homes in Turkey: A Parallel Group Randomized Controlled Trial.

PURPOSE: This study examined the effects of laughter therapy on life satisfaction and loneliness in older adults living in nursing homes. DESIGN: A single-blind, parallel-group, randomized controlled trial (ClinicalTrials NCT03687788) with a pretest-posttest design was conducted. METHODS: There were 31 experimental participants and 31 controls. The experimental group received laughter therapy twice a week for 6 weeks, along with usual care. The control group received usual care only. Loneliness was measured with the De Jong Gierveld Loneliness Scale, and life satisfaction was measured with the Satisfaction With Life Scale. FINDINGS: After 6 weeks, there was a statistically significant difference in De Jong Gierveld Loneliness Scale total score between the two groups, and the subscale scores of the experimental group decreased. CONCLUSIONS: Laughter therapy may reduce loneliness in older adults. CLINICAL RELEVANCE: Healthcare professionals, especially nurses, can potentially use laughter therapy to reduce loneliness in older adults.

Effect of humor intervention on well-being, depression, and sense of humor in hemodialysis patients / Efecto del uso del humor en el bienestar, depresión y sentido del humor en pacientes en hemodiálisis

Objective: To evaluate whether visualization of humor movies during hemodialysis sessions improves subjective well-being and sense of humor, while decreasing stress / anxiety and depression levels, in hemodialysis patients. Material and Method: A pre-test / post-test design study with a non-equivalent control group was carried out in patients with chronic kidney disease undergoing hemodialysis, in two hemodialysis units of Diaverum Clinics. The study included 34 patients in the intervention group and 33 patients in the control group. The intervention consisted in the visualization of humor movies during hemodialysis sessions for ten sessions over a four-week period. The control group watched neutral movies. Data were collected using a sociodemographic and health information questionnaire (age, gender, nationality, education, occupation, marital status, dialysis session length, presence of hypertension and diabetes); the Subjective Happiness Scale; the satisfaction with life in general; the Depression Anxiety Stress Scale 21, and the Multidimensional Sense of Humor Scale. Student t-tests and t-tests for paired samples were performed. The response to change was evaluated using: the percentage of change, ceiling effect and floor effect, effect size, and the standardized response mean. Results: The levels of subjective happiness and sense of humor increased in the intervention group, but there were no significant increases in satisfaction with life in general. Only depression levels decreased significantly in the intervention group. Conclusions: The visualization of humor movies as a nursing intervention improved the levels of subjective happiness and sense of humor, while decreasing the perception of depressive symptoms

Objetivo: Evaluar si la visualización de películas de humor durante las sesiones de hemodiálisis mejora el bienestar subjetivo y el sentido del humor, al tiempo que disminuye los niveles de estrés / ansiedad y depresión, en pacientes con hemodiálisis. Material y Método: Se realizó un estudio pre-post intervención con un grupo de control no equivalente, en pacientes con enfermedad renal crónica en hemodiálisis, en dos unidades de hemodiálisis de Diaverum Clinics. El estudio incluyó a 34 pacientes en el grupo de intervención y 33 pacientes en el grupo de control. La intervención consistió en la visualización de películas de humor durante diez sesiones de hemodiálisis en un período de cuatro semanas. El grupo control vio películas neutrales. Los datos se recogieron mediante un cuestionario de información sociodemográfica y de salud (edad, sexo, nacionalidad, educación, ocupación, estado civil, duración de la sesión de diálisis, presencia de hipertensión y diabetes); la escala subjetiva de felicidad; la escala de satisfacción general con la vida; la escala de depresión, ansiedad y estrés (DASS-21) y la escala multidimensional de sentido del humor. Se emplearon pruebas t-Student y pruebas t para muestras pareadas. La respuesta al cambio se evaluó utilizando: el porcentaje de cambio, el efecto pico y el efecto base, el tamaño del efecto y la media de respuesta estandarizada. Resultados: Los niveles de felicidad subjetiva y de sentido del humor aumentaron en el grupo de intervención, pero no hubo aumento significativo en la satisfacción general con la vida. Solo los niveles de depresión disminuyeron significativamente en el grupo de intervención. Conclusiones: La visión de las películas de humor como una intervención de enfermería mejoró los niveles de felicidad subjetiva y de sentido del humor, al tiempo que disminuyó la percepción de los síntomas depresivos

Efficacy and feasibility of a humor training for people suffering from depression, anxiety, and adjustment disorder: a randomized controlled trial.

BACKGROUND: Humor trainings have positive effects on mental health and well-being. However, studies investigating the effects of humor trainings in clinical samples are still rare. This study investigated the efficacy and feasibility of a humor training for people suffering from depression, anxiety and adjustment disorders. METHODS: Based on a diagnostic interview (SCID I and II), 37 people were randomized into a training (n = 19) or wait list control group (n = 18) and completed questionnaires at pre, post, and 1 month follow-up. After the training group had completed its training and evaluation measures, the wait list control group received the training and the outcomes of the group were additionally evaluated (post2 and follow-up2). RESULTS: After training, improvements in humor-related outcomes were observed for the training group, but these were relativized when compared to the wait list control group. Secondary outcomes remained unaffected by the training. In addition, the training group reported interpersonal difficulties. Within-group analyses of the wait list control group after completion of their training showed effects on almost all primary and secondary outcomes and feedback indicated a better atmosphere. CONCLUSIONS: In summary, the different outcomes of the two groups are surprising and can show potential moderators of efficacy, such as interpersonal and group-specific climate variables. Since moderators of humor trainings in clinical samples have not been investigated at all, future studies should consider integrating them into their design. TRIAL REGISTRATION: The study was retrospectively registered in the German Clinical Trials Register ( DRKS00012443 ) on May 16, 2017.

The Effect of Therapeutic Clowning on Handwashing Technique and Microbial Colonization in Preschool Children.

PURPOSE: This study aimed to determine the effect of therapeutic clowning on handwashing technique and microbial colonization in preschool children. DESIGN: This randomized controlled trial was conducted using pre-test and post-test experimental and control groups. METHODS: The study was conducted between March and June 2016 in two kindergartens in eastern Turkey. The study was completed with a total of 195 students, including 90 students in the experimental group and 105 students in the control group. A questionnaire was used for data collection. This questionnaire included sections about the subjects' descriptive characteristics and the results of the bacterial cultures of their hand swabs. For the collection of these swabs, the subjects were informed in advance, and samples were collected at predetermined times. The swabs were analyzed to determine the bacterial colonization of the subjects' hands. Clowns and video activities were used as intervention tools in the study. FINDINGS: In the post-test, the microbial growth was ≤103 in 68.9% and >103 in 31.1% of the subjects in the experimental group. In contrast, the growth was ≤103 in 34.3% and >103 in 65.7% of the control group subjects. The difference in the post-test microbial growths of the two groups was statistically significant (p < .000). CONCLUSIONS: The hygienic handwashing technique taught in the therapeutic clowning and videos reduced the bacterial colonization on the preschool children's hands by 50%. Moreover, this method was effective in reducing the growth rate of coliform bacteria that indicate undesirable, poor hygiene of the hands. CLINICAL RELEVANCE: Considering these results, we recommend that pediatric healthcare professionals use entertaining methods such as those involving clowns to teach and guide children regarding hygienic handwashing techniques.

Clowns in Paediatric Surgery: Less Anxiety and More Oxytocin? A Pilot Study.

Background Hospital stays and medical interventions are accompanied by worries and anxiety in children and parents. Recent studies show that hospital clowns may reduce anxiety and enhance well-being. However, so far studies are based solely on subjective measures and clowns are usually not integrated in medical routine. With this pilot study, we aim to provide both psychological and physiological evidence of positive effects of clowns' interventions in hospitalized children. Patients/Method In a consecutive randomized intervention-control group design with 31 children aged 4 to 13 years, 17 patients were accompanied by a clown prior to surgery or during ward round (intervention group) and 14 were not (control group). Saliva samples for oxytocin measurement were taken from all patients before hospitalization (T1) and prior to surgery or after ward round (T2). Self- and parents-reports were obtained at T1, T2 as well as at time of discharge from hospital (T3) regarding children's anxiety (STAI), worries and well-being. Clowns evaluated their success in cheering up the child. Health professionals were asked for their acceptance of clowns in hospitals. Results Children in the intervention group had lower anxiety ratings and a higher oxytocin concentration at T2 as compared with T1; the control group showed no changes. Parents rated the well-being of their children higher if their child had clown's contact and were more willing to recommend the hospital. The staff judged the clowns as helpful for patients. Discussion Consistent psychological and physiological results suggest the positive impact of a clown's intervention in hospitalized children.

Clowning as a Complementary Approach for Reducing Iatrogenic Effects in Pediatrics.

Hospitalized children who undergo painful procedures are more susceptible than others to experiencing iatrogenic effects, such as anxiety, pain, and severe stress. Clowns in clinical setting have been found to be effective in reducing children's experiences of these effects during hospitalization and before procedures. This article provides an overview of clowning in health care settings; reviews major studies conducted on clowning for hospitalized children, discussing evidence that clown interventions decrease pain and distress in pediatric patients; and concludes with a discussion of health care clowning as a profession.

Parental perceptions of clown care in paediatric intensive care units.

AIM: The objective of this study was to report family satisfaction with regards to the presence of clowns in the paediatric intensive care unit (PICU). METHODS: This is a single-centre survey-based study, conducted over 4 months in a 12-bed third level PICU in a university hospital. All parents present at the bedside of their child during clowning were considered as potential participants. Eligible parents were approached by one of the two intensivists as investigators and asked to complete a survey within the 48 h following the clowns' intervention. RESULTS: Thirty-three parents consented to complete the survey. Median age of children was 14 months (15 days to 16 years) and median Pediatric Logistic Organ Dysfunction (PELOD) score was 1 (0-22). Twenty-four (72.7%) were considered as clinically stable while the clowns intervened. Twenty-eight parents (84.8%) and 27 (81.8%) considered that clowns had a positive effect on themselves and on their child, respectively. Clown care was considered as necessary in 19 cases (57.6%), optional in 13 (39.4%) and unnecessary in 1 (3.0%). The degree of parental satisfaction was not significantly associated with the child's clinical stability. CONCLUSION: We suggested that medical clowning in the PICU is well accepted by parents, regardless of severity of their child's condition. This study supports the adoption of medical clowning in PICUs as a patient- and family-centred care practice.

Hospital clowning: a paediatrician's view.

This study investigates the current position of hospital clowns from the perspective of paediatricians and paediatric residents. A total of 14 attending paediatricians and paediatric residents participated in two focus group sessions. Data were analysed using Atlas.ti 5.0. In general, physicians reported positive experiences regarding the interaction between hospital clowns and paediatric patients on the ward. Physicians were more interested in research on children's perception of hospital clowns than in research on the clinical efficacy of hospital clowning. No direct collaboration between physicians and hospital clowns was reported. However, physicians proposed conditions which may streamline their encounters with hospital clowns such as clear communication prior to hospital clown visits, and the condition that visits do not impede medical interventions. CONCLUSION: Overall, paediatricians and paediatric residents view the positive impact on paediatric patients as the most important aspect of hospital clown visits, rather than the clinical efficacy of hospital clowning. In light of the growing number of hospital clowns worldwide, this article provides recommendations for arranging their encounters with paediatricians and paediatric residents to maintain optimal health care. What is known: • Previous studies show a clinically significant pain- and anxiety-reducing effect of hospital clowning in paediatric patients admitted to hospitals or undergoing (invasive) medical procedures. • In general, paediatricians have positive ideas about hospital clowns, aside from personal prejudices. What is new: • This novel study gives deeper insight into day-to-day interaction between paediatricians and hospital clowns on the ward. • This study provides recommendations for clinical practice to arrange encounters between physicians and hospital clowns during hospital clown visits.

Evaluation of a Laughter-based Exercise Program on Health and Self-efficacy for Exercise.

Background: Despite health benefits of physical activity (PA) and risks of physical inactivity, many older adults do not accumulate sufficient levels of PA to achieve associated health benefits. Lack of PA enjoyment may be a barrier to PA participation. Combining simulated laughter and PA for strength, balance, and flexibility is a potential solution for helping older adults maintain independence in activities of daily living through enjoyable participation in PA. Purpose of the study: The purpose of this study is to assess whether combining simulated laughter exercises with a moderate-intensity strength, balance, and flexibility PA program (i.e., LaughActive) increases participation in PA, health, and self-efficacy for PA among older adults residing in 4 assisted living facilities (ALFs). Design and methods: The 12-week wait list control pilot study used pre- and 6-week post-intervention comparisons within and between groups identified by paired sample t-test results among those who participated in twice-weekly LaughActive classes (n = 27). Results: Significant improvements (p < .05-.10) were observed in mental health (SF-36v2), aerobic endurance (2-minute step test), and self-efficacy for exercise (OEE). Implications: PA programs that elicit positive emotions through simulated laughter have the potential to improve health, physical performance, and self-efficacy for PA among older adults and may positively influence participant adherence.

Medical clowns reduce pre-operative anxiety, post-operative pain and medical costs in children undergoing outpatient penile surgery: A randomised controlled trial.

AIM: The aim of this paper is to investigate prospectively the potential benefits of the participation of the medical clowns in the outpatient paediatric penile surgery programme. METHODS: Eighty children undergoing meatotomy, age 2 to 16 years, were randomised into two groups (40 each). In the first group, the medical clown was an integral part of the medical team, and in the second group, the treatment was given without participation of the medical clown. The following parameters were measured: the level of pre-operative anxiety, the level of the post-operative pain, the amount of pain medication use in the first 24 h after surgery and the time needed to return to normal activities. The operating room time and hospital costs were calculated. RESULTS: The patients from the first group demonstrated a lower pre-operative anxiety index upon (P = 0.0319) and after surgery (P = 0.0042), required less induction time for anaesthesia (P < 0.001), spent overall less time in the operating room (P < 0.0001) and required less time to recover from the surgery and to be discharged (P = 0.0172). The overall OR time and post-operative unit care savings of 20 and 155 min, respectively, led to the cost savings of $467. CONCLUSION: Our data demonstrated that the use of the medical clown functioning as an integral part of the operating team reduces children pre-operative anxiety and leads to a shortening of the overall time in the hospital thereby reducing the overall medical cost justifying the participation of medical clown as an integral part of the health team in a paediatric urology outpatient surgical unit.

Seriously clowning: Medical clowning interaction with children undergoing invasive examinations in hospitals.

This qualitative study examined the subjective experience of children undergoing an invasive examination in the hospital when accompanied by a medical clown. In-depth semi-structured interviews were conducted with nine such children and nine of their accompanying parents. The children were patients in two outpatient departments (Pediatric Gastroenterology and a Center for the Sexually Abused) in a hospital in Israel. Interviews were coded thematically using an Atlas.ti software program. Analysis of the interviews indicated that the intervention of the clown positively changed the children's perceptions of the hospital, of experiencing the examination, and of their life narrative. Medical clowns thus appear to be a central, meaningful, and therapeutic source for children undergoing invasive examinations in hospital, as well as for their parents. Therefore, it may be advisable to incorporate medical clowns as an integral part of medical teams performing invasive procedures and to include the clowns in all stages of the hospital visit.

The Therapy Beneath the Fun: Medical Clowning During Invasive Examinations on Children.

OBJECTIVE: The qualitative research presented here is part of a larger project on the significance of medical clowning during invasive examinations in children in the Department of Gastroenterology and the Center for the Sexually Abused in a hospital in Israel. It investigated what makes up the essence of medical clowning, what skills and techniques are used by medical clowns, and whether their work contains therapeutic elements. METHODS: A total of 9 children undergoing invasive examinations and 9 of their accompanying parents participated in semistructured interviews, which were analyzed using a thematic analysis methodology assisted by an Atlas-ti software program. RESULTS: The interviews revealed that the medical clowning intervention during invasive examinations was essentially therapeutic, with the clown using theatrical and clowning tools to incorporate therapeutic elements such as empowerment, reversal of role, reframing, and building a therapeutic alliance. In addition, during the invasive examinations, the medical clowning followed the model of brief crisis intervention therapy. CONCLUSION: The study advances the need to incorporate medical clowns as an integral part of medical teams performing invasive procedures and to include clowns in all stages of the hospital visit when children undergo invasive examinations.

Estrategia para el bienestar emocional en niños escolares hospitalizados: Villa Clara: 2013 / Strategy for the emotional well-being in hospitalized school children

Los niños hospitalizados sufren un cambio abrupto, desaparece el hogar, la escuela, el barrio, los hermanos, amigos, las actividades que solía desarrollar y aparece aburrimiento por pobre estimulación y monotonía de las rutinas, condiciones pésimas para la recuperación. La atención sicológica a estos niños enfermos ingresados es insuficiente, por lo que es necesario resolver la situación emocional negativa que genera la hospitalización, la enfermedad y los tratamientos, y así restablecer su salud y su bienestar sicológico. Objetivo: Evaluar el diseño de una estrategia con enfoque intersectorial para mejorar el bienestar emocional en niños hospitalizados. Metodología: Matriz DAFO, método Delphy, criterio de especialistas, encuestas. Intervinieron en el diseño cinco prestadores; muestra para la evaluación, 15 especialistas, seleccionados en “Bola de nieve”. Resultados: Se describió la estrategia diseñada, conformada por cinco dimensiones, nueve programas, veintisiete subprogramas y más de ochenta acciones y se obtuvo un criterio positivo de especialistas sobre el diseño. Conclusiones: Se diseñó una estrategia para mejorar el bienestar emocional en niños escolares hospitalizados con enfoque salubrista. A juicio de especialistas la estrategia es pertinente y apropiada, es factible su aplicación y puede ser eficaz para mejorar el bienestar emocional en niños hospitalizados.(AU)

Background: Hospitalized children suffer an abrupt change. Home, school, neighborhood, siblings, friends and usual activities disappear besides boredom due to poor stimulation and monotony of the routines and all of these make recovery very poor. Objective: To assess the design of a strategy with an intersectorial approach to enhance emotional well-being in hospitalized children. Methodology: Delphy method, SWOT matrix, specialists criteria and interviews. Five providers intervened in the design and 15 specialists were taken as samples for evaluation by using the Snow Ball method. Results: The designed strategy was described, consisting of five dimensions, nine programs, 27 subprograms and more than eighty actions and a positive criterion of experts is taken. Conclusions: A strategy was designed to improve the emotional well-being in hospitalized school children with a health approach. The strategy isrelevant and appropriate, feasible to be applied and can be very effective to improve the emotional well-being in hospitalized school children.(AU)

Humor.

Humor has not been taken as seriously as it should be. Humor has many positive effects in the daily lives of patients and clinicians need to take advantage of these. Many indices of stress are attenuated and this serves to improve the therapeutic alliance. Freudian, rational emotive therapy, and kleinian views are presented, as well as examples of how to use playful therapy. In addition, advice on how to develop humor is given.