Global advances in integrative medicine and health最新文献

Mounting evidence suggests that the long-term effects of trauma and adversity are rooted not only in psychological distress, but in persistent dysregulation of the body's stress response and its associated neuroendocrine systems. This physiological dysregulation has emerged as a critical contributor to health outcomes, yet remains under-addressed in conventional clinical care. Emotional states are integrated with core physiological functions through dynamic, bidirectional autonomic signaling between the heart, lungs, brainstem, limbic system, and higher cortical areas. This interconnected network enables conscious regulation of breathing, heart rhythms and emotions to influence autonomic and higher cortical functions. Research has demonstrated that heart rhythm patterns become more ordered during HeartMath's^® self-regulation techniques. This stable, high-oscillatory pattern, termed "coherence", can be observed using heart rate variability biofeedback and induced through slow, deep breathing or experiencing regenerative emotions such as gratitude. Coherence is a state of physiological and emotional regulation that reflects increased vagal activity and synchronization across organ systems, promoting more efficient function. In addition to reductions in perceived stress, research has demonstrated improvements in energy, anxiety, mood, sleep, and cognitive performance with daily coherence practice over weeks. Gradually, coherent heart rhythm patterns can become a more familiar set-point for the body through repeated afferent input to the brain, supporting the emergence of a healthier, more regulated physiological baseline. This narrative review explores HeartMath as an emerging non-pharmacological intervention with therapeutic potential for emotional and physiological dysregulation, highlighting evidence and mechanisms by which coherence shifts the body toward a healthier, more resilient state.

Purpose: Fear of cancer recurrence (FCR) is highly common and, if poorly managed, can be distressing and impairing. We developed a virtual, mind-body resiliency intervention for fear of cancer recurrence in survivorship (IN FOCUS), which was shown to be feasible and improved FCR post-intervention. This report aimed to describe coping processes associated with FCR and effects of IN FOCUS on coping over time.

Method: A single-blinded, 2-arm, randomized controlled trial was conducted from July 2021 to March 2022 comparing IN FOCUS (8 weekly, 90-minute, synchronous virtual group classes teaching cognitive behavioral techniques, relaxation training, meditation, adaptive health behaviors, and positive psychology skills) to usual care (synchronous virtual community group support referral) among cancer survivors with non-metastatic disease and clinically elevated FCR (FCR Inventory severity ≥16). Measures included coping styles (Brief COPE) and perceived coping skills (Measure of Current Status-Part A). Intent-to-treat analyses with separate general linear mixed models were used to identify group-by-time effects (Cohen's d; 0.5 a medium effect, 0.8 a large effect) from baseline through 2 months and 5 months.

Results: Sixty-four survivors enrolled (age M = 52 years, time since completing primary cancer treatment M = 5 years). By 5 months, survivors randomized to IN FOCUS (vs usual care) demonstrated multiple effects on coping in the medium to large range. Compared to usual care, IN FOCUS increased problem-focused coping, such as using instrumental support (d = 0.60), planning (d = 0.60), positive reframing (d = 0.48), and active coping (d = 0.45). Similarly, IN FOCUS improved emotion-focused coping, specifically venting (d = 0.70), acceptance (d = 0.58), humor (d = 0.50), and religion (d = 0.48). IN FOCUS also enhanced survivors' coping confidence (d = 0.79), relaxation skills (d = 0.57), and assertiveness (d = 0.46). Avoidance-focused coping and awareness of physical tension exhibited less robust changes by 5 months.

Conclusions: Cancer survivors can enhance multiple aspects of coping with FCR through interventions such as IN FOCUS that teach mind-body resiliency techniques.

Background: There is surging interest in workplace mindfulness programs to address employee stress, resilience, and performance, however, significant gaps in knowledge remain around feasibility, acceptability, effectiveness, and predictors of therapeutic change.

Objective: This study evaluated whether a brief, 4-session Mindfulness Skills Course (MSC) for university employees, covered by the institution's wellness benefits, was effective in reducing stress, increasing mindfulness, improving feelings toward oneself and others, and increasing work performance.

Methods: Prospective observational cohort study design. Participants completed self-report surveys before and after the MSC. Class attendance and home mindfulness practice were recorded to assess feasibility and adherence. Paired t-tests and Pearson correlations were used to evaluate program effectiveness and predictors of change.

Results: 190 employees enrolled for the in-person course during the first year of roll-out. Of those, 164 (86%) completed pre-course surveys, 134 (82%) attended at least three class sessions, and 123 (75%) completed the post-course surveys and program evaluation. Paired samples t-tests showed improvements for perceived stress, mindfulness, and relational wellbeing with moderate to large effect sizes (d = .44 - .78; P's < .001). Self-perceived work performance increased with a small effect (d = .33; P < .001). More frequent home meditation practice was positively correlated with a larger increase in mindfulness (r = .20; P < .05). Increased mindfulness correlated with reduced stress (r = -.55), greater positive emotions towards self (r = .38), and reduced negative emotions towards self (r = -.40) and others (r = -.42) (all P's < .001). Reduced stress was correlated with increased perceived work performance (r = -.22; P < .05). Higher baseline stress levels predicted greater increases in mindfulness (β = .37, R² = .14, P < .001), while lower baseline mindfulness predicted greater reduction in stress (β = .27, R² = .07, P < .01).

Conclusion: Taken together, these results support the feasibility and effectiveness of a brief, 4-wk, employer-sponsored mindfulness skills course, which may be most helpful for individuals with higher stress and lower trait mindfulness.

Background: Some practitioner-delivered (eg, acupuncture) and self-directed (eg, yoga) complementary and integrative health (CIH) therapies are evidence-based for chronic pain management. Providers often follow recommendations to encourage patients to take active roles in their health care by using self-directed therapies in addition to CIH therapies they deliver. Doing so might be more effective than using practitioner-delivered CIH therapies alone, however we are unaware of studies qualitatively examining this issue.

Objective: As part of our VA pragmatic study APPROACH (Assessing Pain, Patient-Reported Outcomes and Complementary and Integrative Health) among 6453 veterans with chronic musculoskeletal pain, we qualitatively examined patients' narrative reports of CIH therapy use to explore how using practitioner-delivered CIH therapies with and without self-directed CIH therapies affected their health and well-being.

Methods: We conducted qualitative telephone interviews with 125 patients at six VA medical centers from March 2022 March 2023, asking if their use of CIH therapies affected several health conditions: depression, anxiety, pain, fatigue, sleep, quality of life, and self-empowerment to take care of one's own health. We used deductive and inductive thematic analysis.

Results: Half or more of reported CIH therapies helped their pain, quality of life, depression, sleep, and self-empowerment to take care of their own health, but few reported the therapies affected fatigue. Using a combination of practitioner-delivered and self-directed CIH therapies appeared more helpful than using only practitioner-delivered therapies for depression, anxiety, quality of life, fatigue, and self-empowerment. However, for pain or sleep, similar percentages of patients reported using a combination or only practitioner-delivered CIH therapies helped.

Conclusions: Using a combination of practitioner-delivered CIH therapies appear more helpful than using only practitioner-delivered therapies for most examined health conditions, except they appeared similarly helpful for pain and sleep. Chiropractors, acupuncturists and massage therapists might want to encourage patients to participate in self-directed therapies.

Background: Mindfulness-Based Cognitive Therapy (MBCT) reduces depression relapse, yet graduates have expressed a need for structured guidance post-program to maintain mindfulness practice and sustain benefits. To address this, we created MBCT for Depression-Taking it Further (MBCT-D-TiF).

Objective: To refine and pilot test feasibility and acceptability of MBCT-D-TiF.

Methods: We collected qualitative focus group data to inform refinements and quantitative data to pilot test feasibility and acceptability of MBCT-D-TiF. In round one, participants received MBCT-D-TiF (n = 14), consisting of 4 weekly and then monthly sessions delivered via group videoconferencing. In round two (n = 20), participants were randomized 1:1 to MBCT-D-TiF or waitlist control. Surveys were completed at baseline, 1 and 4 months by all participants. We explored participants' experiences with MBCT-D-TiF in two focus groups (n = 7 in each) conducted via videoconferencing. We used descriptive statistics and mixed linear models to analyze quantitative data and thematic content analysis to analyze qualitative data.

Results: MBCT-D-TiF participants (n = 25) attended all weekly sessions (100%) and at least 75% of the monthly sessions (76%); found the weekly sessions very or extremely helpful (77.1%), and the monthly sessions very or extremely helpful (66.7%). The following themes emerged: (1) the importance of the group for participants' social connection, support, and practice community that enhanced their meditative experience, helped improve their mental health, and facilitated accountability; (2) MBCT-D-TiF provided mental health benefits, including tools to lessen the negative impact of depression and anxiety, increase connections to the world, and enhance positive experiences; (3) participants' home practices were reinvigorated during the weekly MBCT-D-TiF sessions, but fell short of their goals thereafter.

Conclusion: MBCT-D-TiF was well attended and rated very or extremely helpful by most participants, supporting its feasibility and acceptability. Qualitative data showed that additional steps to help participants sustain home practice are needed, offering a target for refinement and further testing.

Background: Pain is a significant complication following cardiac surgery. While pharmacological treatments are standard, non-pharmacological interventions like music offer a promising, low-cost adjunct for pain management.

Objective: To evaluate the effect of a music intervention on pain and vital signs during the first postoperative bed bath for patients recovering from cardiac surgery.

Methods: This study was a single-blind, randomized controlled trial involving 38 patients who had undergone Coronary Artery Bypass Grafting (CABG). Patients were allocated to either an experimental group (n = 19), which listened to self-selected music via headphones, or a control group (n = 19), which wore headphones with no audio. The primary outcome, pain, was measured using the Numerical Rating Scale (NRS) and the Wong-Baker FACES Scale (WBS) during and after the bed bath.

Results: The music intervention group demonstrated a statistically significant reduction in pain scores both during and after the bath. Compared to the control group, the experimental group's pain scores decreased by a mean of 2.41 points on the NRS (P < 0.001) and 2.11 points on the WBS (P < 0.001). Furthermore, a significant reduction in heart rate (P = 0.019) was observed in the experimental group.

Conclusion: Music intervention effectively reduced pain and stabilized heart rate during a potentially painful routine procedure in the immediate postoperative period of cardiac surgery.

Background: Paracetamol is one of the popular causes of liver injury primarily mediated by oxidative stress and increased inflammation within the liver. Bersama abyssinica has active ingredients with antioxidant activities and is traditionally used to treat liver diseases. However, its effects have not been confirmed by in vivo studies.

Objective: This study was aimed at evaluating the hepatoprotective effect of a methanolic extract of Bersama abyssinica leaf on paracetamol-induced hepatotoxicity in Swiss albino mice.

Methods: The study was conducted on thirty male Swiss albino mice, randomly grouped into six groups of five mice each; normal, negative, and positive control groups received 1 mL/kg of distilled water, paracetamol 250 mg/kg only, and silymarin (100 mg/kg) orally with paracetamol, respectively. While treatment groups I, II, and III received 200, 400, and 600 mg/kg of the Bersama abyssinica leaf methanolic extract with paracetamol 250 mg/kg, respectively. At the end of the experiment, the mice were sacrificed after being anesthetized, and blood samples were collected via cardiac puncture, and the liver was removed for histopathological investigation. Data were entered into Epi Data version 3.1 and exported to SPSS version 25 for further analysis using a one-way ANOVA.

Results: The negative control group showed higher levels of ALT, AST, ALP, GGT, and bilirubin compared to the normal control. However, significant hepatoprotective effects were noted in the treatment and positive control groups, as evidenced by the substantially reduced levels of these liver biomarkers towards the normal range. The significantly lower levels of indirect bilirubin were seen among treatment groups II and III as compared to group II. Abnormal liver architectures were observed in the negative control group; however, these changes were reversed following administration of the leaf extract.

Conclusion: The study found that the methanolic leaf extract of Bersama abyssinica exhibited hepatoprotective effects against paracetamol-induced liver injury.

Background: Chronic pain has been linked to increased awareness of but decreased accuracy in detecting internal sensations. Interoception, the sense of signals from inside the body, may be a therapeutic target to improve pain. No studies have examined the feasibility of targeting interoceptive skills within a yoga intervention for chronic pain - where direct engagement with challenging sensations may be difficult - or whether yoga improves any measure of interoception among persons with chronic pain.

Objective: The primary aim was to determine the feasibility and acceptability of a 6-week interoception-based yoga intervention in a population of mixed chronic pain. The second aim was to examine the preliminary effectiveness on 2 measures of interoception (interoceptive sensibility and interoceptive accuracy), pain and psychosocial outcomes.

Methods: This was a single-arm feasibility study. Primary outcomes were feasibility and acceptability. Secondary outcomes included self-report measures of interoceptive sensibility (Multidimensional Assessment of Interoceptive Awareness, Version 2), pain intensity, pain interference, mindfulness, spiritual well-being and physical and mental health-related quality of life. Interoceptive accuracy was assessed with heartbeat counting. All measures were collected at baseline and after 6 weeks.

Results: The 6-week interoception-based yoga intervention demonstrated feasibility and high acceptability in a sample of mixed chronic pain. Twenty-six participants consented, 24 started the intervention (mean age 42.5 years, 75% female) and 19 (79%) completed 6-week post-intervention testing. The average attendance rate was 69%. There were no serious adverse events and acceptability ratings were high (>5/7). While not powered to make conclusions, preliminary analyses revealed a statistically significant increase in interoceptive sensibility and interoceptive accuracy, and reduction in pain (p's < .05). There were no correlations between the 2 measures of interoception.

Conclusion: The intervention appears feasible and acceptable and shows promise for improving pain and multiple dimensions of interoception, especially those involved in consciously attending to the body. Future studies examining the efficacy of interoception-oriented yoga interventions for chronic pain are warranted.

Clinicaltrialsgov registration: NCT06268197 Registered February 12, 2024.

Objective: Musculoskeletal disorders (MSDs) include different pathological conditions of the locomotor system, characterized by pain and limitations in mobility and functioning. The most frequent arthropathies include joint disorders and arthritis. Yoga is an ancient mind-body discipline which has received great attention in clinical research. This critical review intends to analyze the updated literature on clinical outcomes of yoga interventions for MSDs.

Methods: Prospective clinical studies evaluating the effects of yoga for MSDs have been searched in Web of Sciences, Scopus and PubMed databases using yoga-related keywords in association with numerous disorders affecting the musculoskeletal system. We explored all protocols to identify similar movements or asana reported with different (uncommon) names or imprecise description, and to be useful for clinicians, we summarized yoga exercises with specific target for body areas and related pathologies.

Results: Overall, 1150 articles were screened, among which 52 prospective clinical studies (total 4151 patients) were selected. The clinical outcomes of yoga were compared with active control groups (rehabilitation, drugs) or passive controls (self-care education or no intervention). The analysis was performed towards specific musculoskeletal disease, affected body area, study type, yoga protocol details, and outcomes in measured and self-reported parameters. All 52 studies showed marked benefits in every or some parameters: measurable outcomes as well as self-reported improvements were higher in yoga groups than in controls, and in some studies even better than drug therapy.

Conclusions: This review highlights the potential benefits of yoga interventions for MSDs. Data highlights that yoga may help improve mobility, reduce reliance on medications, and enhance quality of life and could be considered as a complementary approach alongside conventional medical treatments. However, the heterogeneity of protocols, outcomes, and potential risks of bias highlight the need for rigorous trials to strengthen confidence in these findings and to identify the most effective protocols.

Background: Individuals with gastrointestinal neoplasms undergoing chemotherapy may develop symptoms related to anxiety, fatigue, and sleep disturbances, which are components of neuropsychological symptom clusters. Among non-pharmacological strategies that may aid in symptom management, laser auriculotherapy-a modality of acupuncture-has emerged as a promising approach in symptom management studies.

Objective: This study aims to present a research protocol designed to evaluate the effect of laser auriculotherapy in reducing neuropsychological symptom clusters associated with anxiety, fatigue, and sleep disturbances in patients with gastrointestinal neoplasms undergoing chemotherapy.

Methods: A randomized, controlled, double-blind clinical trial will be conducted, involving 62 patients recruited with gastrointestinal cancer initiating chemotherapy treatment at a University Hospital that is a reference in the treatment of cancer patients. Participants will be randomly assigned to one of two groups: (1) Experimental Group: laser auriculotherapy applied to predetermined and validated acupuncture points, or (2) Control Group: Sham laser auriculotherapy (placebo). Patients will be followed for 4 weeks. Two important moments will be considered to evaluate the results of the intervention (Pre-intervention and Post-intervention). The primary outcomes will include the reduction in anxiety scores measured by the BAI, the reduction in fatigue scores measured by the Piper Fatigue Scale, and the reduction in sleep scores measured by the Pittsburgh Sleep Quality Index. The secondary outcome will evaluate changes in vital parameters ((blood pressure, heart rate, respiratory rate, temperature and oxygen saturation).

Discussion: The study aims to contribute to the reduction of the cluster of neuropsychological symptoms in patients with gastrointestinal cancer, using a non-pharmacological strategy that can be inserted into the clinical practice of health professionals and oncology reference centers.