Non-pharmacological Interventions Research Articles

New Perspective of Multi-dimensional Approach for the Management of Attention-deficit Hyperactivity Disorder: A Review

One of the most common mental diseases in childhood, attention-deficit/hyperactivity disorder (ADHD) often lasts into adulthood for many individuals. The neurodevelopmental condition known as ADHD impacts three areas of the brain: hyperactivity, impulsivity, and attention. The visual field is where attention is most affected by ADHD. Non-strabismic binocular vision disorder (NSBVD), which impairs eye coordination and makes it challenging to focus, has been linked to ADHD. Through a critical cognitive process called visual attention, humans are able to take in and organize information from their visual environment. This greatly affects how one observes, processes, and understands visual information in day-to-day living. Vision therapy is a non-invasive therapeutic approach that aims to improve visual talents and address visual attention deficits. This study aims to provide an overview of the research on the many approaches to treating ADHD, the relationship between NSBVD and ADHD, and whether vision therapy is a viable treatment option for ADHD. After a comprehensive search of many online resources, relevant studies were found. The review's findings provide insight into the range of ADHD patients' treatment choices. In order to improve treatment outcomes, non-pharmacological treatments can be employed either alone or in conjunction with medicine. Medicine by itself is insufficient and has several severe side effects when used continuously. The efficacy of vision therapy in improving visual attention and making recommendations for potential directions for further research in this field. Multiple studies are needed to identify the most effective treatment modalities for achieving positive outcomes for ADHD patients.

Association between Drug Use and Perception of Mental Health in Women Diagnosed with Fibromyalgia: An Observational Study

Background/Objectives: Fibromyalgia (FM) is a chronic syndrome characterized by widespread musculoskeletal pain, fatigue, sleep disturbances, and mental health issues. It affects approximately 1.78% of the general population; an estimated 4:1 ratio between women and men is observed. It significantly impacts quality of life and carries both clinical and social stigma. This study aims to evaluate the relationship between drug use and mental health in female patients with fibromyalgia. Methods: This study is prospective, observational, and cross-sectional. A questionnaire was administered to 544 subjects, achieving a representative sample size from a population of 800,000 subjects by using an algorithm for proportion estimation with a known sampling frame. The selection was non-random, making the sampling non-probabilistic. Logistic regression models were applied to assess the effect of drug use on perception of mental health; presence of symptoms such as comprehension and memory problems, insomnia, depression, and anxiety; and severity of cognitive symptoms and non-restorative sleep. To quantify the impact, odds ratios and confidence intervals have been observed. Results: The findings indicate the non-recommended use of medications and reveal the ineffectiveness and adverse effects of drug interactions on mental health. The use of benzodiazepines and sedative-hypnotics is significantly associated with a negative perception of mental health. Benzodiazepines do not improve symptoms or significantly reduce their severity. SSRI antidepressants do not enhance mental health perception; however, when used exclusively, they are effective in reducing the severity, but not the prevalence, of cognitive symptoms. Conclusions: The results highlight the complexity of pharmacological management in FM and raise concerns about the inappropriate use of ineffective or counterproductive drug interactions affecting patients’ mental health. They underscore the need for multidisciplinary and personalized strategies that include close and careful monitoring, as well as the simultaneous use of non-pharmacological treatments that have demonstrated evidence in improving quality of life without negatively affecting mental health, such as patient education, psychological therapy, physiotherapy, and mindfulness.

Current Practices and Recent Advances in Perioperative Pain Management for Liver Transplantation Living Donors and Recipients.

Analgesia in liver transplantation patients has been traditionally considered a secondary priority where perioperative management principally focused on survival rates in these critically ill patients. With recent advancements in both surgical and medical management, posttransplant survival rates have steadily improved. Outcome measurements are no longer limited to short-term mortality rates and hospital length of stay but are also measured by patient-centered outcomes, such as pain control and quality of life. As living donor liver transplantation has increased access to transplantation, it has also added a different patient population to manage in the perioperative period. For healthy patients undergoing living donor hepatectomies, it is important to reduce the impact of the surgery with proper perioperative pain management. We performed a literature search for articles related to perioperative pain management for liver transplantation living donors and recipients to identify current practices and recent advances. Neuraxial techniques, peripheral nerve blocks, and enteral and parenteral medications were all found to be feasible analgesia modalities for patients undergoing either liver transplant or donor hepatectomy. Patients may also benefit from nonpharmacological interventions and preoperative counseling. No particular perioperative analgesic modality was deemed superior to any other. For liver transplant living donors and recipients, perioperative pain management should emphasize the application of sustainable patient-centered pain control protocols.

Pengaruh Pemberian Seduhan Kunyit Asam Terhadap Penurunan Tingkat Dismenorea pada Siswi SMPN 19 Bandar Lampung Provinsi Lampung

Background: Menstruation is the process of shedding of the uterine wall (the inner layer of the endometrium) which is accompanied by bleeding that occurs repeatedly every month, except during pregnancy. Dysmenorrhea consists of primary and secondary dysmenorrhea. This study aims to determine the impact of giving sour turmeric infusion on changes in the level of dysmenorrhoea. Giving tamarind turmeric infusion on changes in desmenorrhea in female students at SMPN 19 Bandar Lampung. Research Objective: To determine the impact of giving sour turmeric infusion on changes in the level of dysmenorrhoea in female students at SMPN 19 Bandar Lampung Research Method: The type of research used is quantitative with a cross sectional approach. Pre-experimental research design with a one group pretest-posttest design without a control group. The sampling technique uses the Accidental Sampling technique. The data analysis technique used is the Wilcoxon test. Research result : Giving tamarind turmeric is a feasible intervention given to reduce dysmenorrhea pain experienced by young women. Suggestion for health workers to provide knowledge about treatment non-pharmacological dysmenorrhoea by administering tamarind turmeric drink. Conclusion : Giving tamarind turmeric is a suitable intervention to reduce dysmenorrhea pain experienced by young women. Suggestions for health workers to provide knowledge about non-pharmacological treatment of dysmenorrhoea by giving tamarind turmeric drinks

IOP Reduction in Nonhuman Primates by Microneedle Injection of Drug-Free Hydrogel to Expand the Suprachoroidal Space.

Expansion of the suprachoroidal space (SCS) by a hydrogel injection has been shown to reduce intraocular pressure (IOP) in rabbits as a potential treatment for ocular hypertension in glaucoma. Here, we evaluate the safety and efficacy of this approach in hypertensive and normotensive eyes in nonhuman primates. A microneedle was used to inject a hyaluronic acid-based hydrogel or saline solution (control) into the SCS of cynomolgus monkey eyes that were either normotensive (n = 7 experimental; n = 2 control eyes) or had induced ocular hypertension (n = 6 experimental; n = 3 control eyes). IOP and the degree of SCS expansion were monitored over time by tonometry and ultrasound biomicroscopy, respectively. Safety was evaluated through slit lamp, fundus, and histology examinations. In hypertensive eyes, SCS injection with hydrogel initially reduced IOP by 47.5 ± 16.7%, and IOP returned to baseline in 38 days. In normotensive eyes, hydrogel injection initially reduced IOP by 38.8 ± 8.1% and IOP gradually returned to baseline also in 39 days. Sham injections resulted in mild IOP reduction in hypertensive eyes and normotensive eyes. The hydrogel injections were well tolerated by clinical assessments. IOP was reduced in nonhuman primates for over one month by sustained SCS expansion. This procedure was safe and simple to perform. These data confirm the translational potential of this treatment method. Further optimization of the hydrogel may provide longer durations of IOP reduction. A microneedle injection of hydrogel into the suprachoroidal space may provide a non-surgical, non-pharmacologic treatment for ocular hypertension in glaucoma patients.

Effects and mechanisms of supramaximal high-intensity interval training on extrapulmonary manifestations in people with and without chronic obstructive pulmonary disease (COPD-HIIT): study protocol for a multi-centre, randomized controlled trial

BackgroundBeyond being a pulmonary disease, chronic obstructive pulmonary disease (COPD) presents with extrapulmonary manifestations including reduced cognitive, cardiovascular, and muscle function. While exercise training is the cornerstone in the non-pharmacological treatment of COPD, there is a need for new exercise training methods due to suboptimal adaptations when following traditional exercise guidelines, often applying moderate-intensity continuous training (MICT). In people with COPD, short-duration high-intensity interval training (HIIT) holds the potential to induce a more optimal stimulus for training adaptations while circumventing the ventilatory burden often associated with MICT in people with COPD. We aim to determine the effects of supramaximal HIIT and MICT on extrapulmonary manifestations in people with COPD compared to matched healthy controls.MethodsCOPD-HIIT is a prospective, multi-centre, randomized, controlled trial with blinded assessors and data analysts, employing a parallel-group designed trial. In phase 1, we will investigate the effects and mechanisms of a 12-week intervention of supramaximal HIIT compared to MICT in people with COPD (n = 92) and matched healthy controls (n = 70). Participants will perform watt-based cycling two to three times weekly. In phase 2, we will determine how exercise training and inflammation impact the trajectories of neurodegeneration, in people with COPD, over 24 months. In addition to the 92 participants with COPD performing HIIT or MICT, a usual care group (n = 46) is included in phase 2. In both phases, the primary outcomes are a change from baseline in cognitive function, cardiorespiratory fitness, and muscle power. Key secondary outcomes include change from baseline exercise tolerance, brain structure, and function measured by MRI, neuroinflammation measured by PET/CT, systemic inflammation, and intramuscular adaptations. Feasibility of the interventions will be comprehensively investigated.DiscussionThe COPD-HIIT trial will determine the effects of supramaximal HIIT compared to MICT in people with COPD and healthy controls. We will provide evidence for a novel exercise modality that might overcome the barriers associated with MICT in people with COPD. We will also shed light on the impact of exercise at different intensities to reduce neurodegeneration. The goal of the COPD-HIIT trial is to improve the treatment of extrapulmonary manifestations of the disease.Trial registrationClinicaltrials.gov: NCT06068322. Prospectively registered on 2023-09-28.

Assessing the Usability of iPREPARED: an Application-Based, Non-Pharmacological Delirium Prevention Intervention

Assessing the Usability of iPREPARED: an Application-Based, Non-Pharmacological Delirium Prevention Intervention

Closing the Dissemination Gap: Accessible Toolkits for the Rapid Replication of Evidence-Informed Interventions to Improve Health Outcomes Among People with HIV.

Despite advances in HIV care and treatment in the U.S., disparities in outcomes along the HIV care continuum persist. The widespread replication of effective and sustainable interventions that prioritize the engagement of underserved populations has been identified as a promising path to ending the HIV epidemic in the U.S. Intervention dissemination products, however, rarely provide the comprehensive and accessible information needed to replicate interventions within community settings. To bridge the divide between research and community-based implementation, the Using Evidence-informed Interventions to Improve Health Outcomes among People Living with HIV (E2i) initiative-grounded in the HIV/AIDS Bureau Implementation Science Framework-created a suite of tools to promote the rapid replication of interventions focused on transgender women, Black men who have sex with men, behavioral health integration, and identifying and addressing trauma. The resulting dissemination products are detailed and digestible multimedia toolkits that follow adult learning theory principles and align with the Template for Intervention Description and Replication criteria for adapting non-pharmacological interventions. Each E2i toolkit consists of five components: implementation guides, narrative videos of site implementation, best practice demonstration videos, interactive learning modules, and recruitment posters and brochures. Over 2 years (2022-2024), the E2i toolkit webpages amassed 7703 unique users and 17,666 pageviews. These toolkits can serve as a blueprint for designing comprehensive and accessible dissemination products for replication of HIV interventions in care settings. Dissemination products that bridge the gap between intervention research and replication in community settings are a crucial missing tool for ending the HIV epidemic.

Non-pharmacological interventions of intermittent fasting and pulsed radiofrequency energy (PRFE) combination therapy promote diabetic wound healing

ObjectiveThis study aims to conduct an unbiased assessment of the synergistic effects of non-pharmacological Interventions of intermittent fasting and pulsed radiofrequency energy (PRFE) combination therapy on the facilitation of diabetic wound healing, while also exploring the underlying mechanisms. The findings of this research will provide a theoretical framework and innovative strategy for unconventional therapeutic interventions aimed at enhancing the healing process of diabetes-related wounds.MethodsIn vivo experiments involved the induction of diabetic models in C57 mice through streptozotocin injection. To simulate a combined therapeutic approach, diabetic mice underwent fasting on days 2 and 6, accompanied by twice daily PRFE applications for 8 days. In vitro experiments were conducted using a serum-free culture medium to replicate fasting conditions. The investigation encompassed wound healing rate, proliferation, migration, angiogenesis, oxidative stress, fibrogenesis, and sensory nerve growth through histological analysis and functional assessments in vivo. Additionally, this study utilized quantitative reverse transcription polymerase chain reaction (qRT-PCR), western blotting (WB), and immunofluorescence staining techniques to elucidate the potential mechanisms underlying the effects of intermittent Fasting and PRFE combination therapy in diabetic wound healing, both in vitro and in vivo.ResultsThe intermittent fasting and PRFE combination therapy demonstrated superior efficacy in enhancing diabetic wound healing compared to either treatment alone. It harnessed the respective strengths of individual therapies, fostering migration, mitigating oxidative stress, and enhancing fibrogenesis. Furthermore, the combination therapy manifested a synergistic effect in promoting proliferation, tube formation, angiogenesis, and sensory nerve growth.ConclusionThis study demonstrates that intermittent fasting and PRFE combination therapy enhance diabetic wound healing, effectively leveraging the strengths of both therapies and even yielding synergistic benefits. Moreover, it indicates the potential engagement of the P75/HIF1A/VEGFA axis in mediating these effects.

A protocol for the systematic review and meta-analysis of clinical trials of interventions to improve sleep in people with mild cognitive impairment or dementia.

Background While sleep disturbance is common in advanced dementia, leading to negative outcomes, there is growing evidence that sleep disturbance begins early in prodromal dementia and may contribute to cognitive decline. Sleep is therefore an important treatment target throughout the natural history of dementia. The existing literature regarding interventions for sleep in people with cognitive impairment is beset by wide heterogeneity in the sleep measurement tools used and outcome measures reported, which limits data synthesis and impedes the development of a robust evidence base for these interventions. Aim We propose to undertake a systematic review and meta-analysis to assess the evidence base from clinical trials for both pharmacological and non-pharmacological interventions to improve sleep in people with cognitive impairment. We will also extract data regarding the sleep measurement tools and outcome measures used in these studies to underpin the development of a core outcome set for future clinical trials in the area. Methods This systematic review and meta-analysis will include randomised and non-randomised controlled clinical trials that assess interventions to improve sleep in participants with mild cognitive impairment or dementia. Medline, CINAHL, PsycINFO, and the Cochrane CENTRAL database will be searched from inception to present. A flow chart will illustrate the study selection process in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-analysis (PRISMA) guidelines. The methodological quality and risk of bias of included studies will be assessed. Heterogeneity will be tested. A narrative synthesis will be undertaken where meta-analysis is not feasible. Conclusion This systematic review and meta-analysis will help inform clinical practice by evaluating the available evidence for interventions to improve sleep in people with mild cognitive impairment or dementia. It will also facilitate the development of a core outcome set that will improve the coherence and utility of data emerging from future clinical trials.

Impact of Hatha and Iyengar Yoga on Physical Function and Quality of Life in Knee Osteoarthritis: A Systematic Review

Background: Osteoarthritis (OA) is a chronic degenerative disorder that primarily affects the articular cartilage of synovial joints. This condition leads to pain, joint stiffness, decreased muscle performance, and decreased aerobic capacity, which can negatively impact a patient's quality of life (QOL) and increase their risk of disability. This systematic review aims to investigate the effectiveness of two non-pharmacological treatment regimens, Hatha yoga, and Iyengar yoga, on QOL, physical function, and mental health in patients with knee OA. Methods: This systematic review was conducted in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) statement. A comprehensive search was performed across three electronic databases: PubMed, Google Scholar, and ScienceDirect, to identify eligible studies that examined the beneficial effects of Hatha Yoga and Iyengar Yoga on improving physical function, mental health, and QOL in patients with knee OA. Results: Out of 61 reports initially identified, 51 were excluded based on the pre-defined inclusion and exclusion criteria. The results of this systematic review suggest that the combination of Hatha Yoga and Iyengar Yoga can enhance physical function, mental health, and QOL in patients with knee OA. Conclusion: Both Hatha Yoga and Iyengar Yoga can serve as effective complementary treatments alongside conventional treatment to improve the overall well-being of individuals with knee OA.

Making decisions about antidepressant use during pregnancy: a qualitative interview study of a sample of women in the United Kingdom.

Background An increasing number of pregnant women now take antidepressants. Many pregnant women experience 'decisional conflict' when deciding whether to take antidepressants, but little is known about the attitudes and experiences influencing these decisions. Aim To explore the attitudes and experiences influencing women's decisions about antenatal antidepressant use. Design and setting A qualitative study using in-depth interviews with a sample of UK women who experienced antenatal depression or took antidepressants antenatally within the preceding three years. Method Recruitment adverts were placed by a perinatal mental health charity and on parenting forums and social media platforms, resulting in a convenience sample. Interview data was coded and analysed with thematic analysis using QSR NVivo. Results Twenty-two women were interviewed; half had taken antidepressants during pregnancy. Most women had concerns about adverse effects and viewed antidepressants as adjunctive to non-pharmacological treatments, which were reported as difficult to access. Some women reported that professional advice was insufficiently detailed. Women described the need to cope with their symptoms, their baby, and existing responsibilities, and related their decisions to their perceived ability to cope. This perception was influenced by physical and emotional challenges relating to pregnancy. Women's decisions were influenced by their previous experiences and by the perceived societal expectations placed on pregnant women. Conclusion Decision-making is a complex and dynamic process, personal to each woman's circumstances. Perceived ability to cope is an important factor in decision-making. Detailed information should be offered to women to support with decision-making in relation to antenatal medication use.

Nursing-Based Sleep Promotion Intervention Effectiveness for Post Cardiac Surgery Patients: Systematic Review.

Sleep is a fundamental prerequisite for physical and mental health. Poor quality of sleep is common among post-cardiac surgery patients and leads to serious health conditions. To conduct a systematic review that investigates the effectiveness of eye masks, earplugs and deep-breathing exercise on sleep quality among post-cardiac surgery patients. A systematic review of interventional studies was established to meet the PRISMA guidelines. PRISMA guidelines were used to assess the findings of 11 selected studies that met the inclusion criteria, published between 2007 and 2023 across four databases: CINAHL, JDNR, MEDLINE and PubMed. The search was conducted on 23 November 2023. The 11 most eligible studies were analysed. All of them were interventional, encompassing a total of 787 participants. Randomised controlled trials were the most common design. Interventions included eye masks, earplugs and deep-breathing exercises. The Richards-Campbell Sleep Questionnaire was the most used assessment scale. Most of the reviewed studies found that the use of non-pharmacological interventions (eye masks, earplugs and deep-breathing exercise) significantly improves the quality of sleep. These interventions were also found to have potentially positive effects on reducing pain and delirium experienced by patients after undergoing cardiac surgery. Non-pharmacological interventions (eye masks, earplugs and deep-breathing exercise) were found to be cost-effective interventions that could be easily applied in the clinical setting and are effective in improving the quality of sleep among patients after cardiac surgery.

The Hidden Dangers of Sedentary Living: Insights into Molecular, Cellular, and Systemic Mechanisms

With the aging of the global population, neurodegenerative diseases are emerging as a major public health issue. The adoption of a less sedentary lifestyle has been shown to have a beneficial effect on cognitive decline, but the molecular mechanisms responsible are less clear. Here we provide a detailed analysis of the complex molecular, cellular, and systemic mechanisms underlying age-related cognitive decline and how lifestyle choices influence these processes. A review of the evidence from animal models, human studies, and postmortem analyses emphasizes the importance of integrating physical exercise with cognitive, multisensory, and motor stimulation as part of a multifaceted approach to mitigating cognitive decline. We highlight the potential of these non-pharmacological interventions to address key aging hallmarks, such as genomic instability, telomere attrition, and neuroinflammation, and underscore the need for comprehensive and personalized strategies to promote cognitive resilience and healthy aging.

Research Review: Pharmacological and non-pharmacological treatments for adolescents with attention deficit/hyperactivity disorder - a systematic review of the literature.

Attention Deficit/Hyperactivity Disorder (ADHD) demonstrates unique developmental manifestations in adolescence with implications for optimized, age-appropriate treatment. This 10-year update is the third in a series of systematic reviews examining the efficacy and safety of adolescent ADHD treatments. We broadly examined efficacy on ADHD symptoms, impairments, and other reported outcomes. Acute and long-term efficacy, and treatment moderators, were considered. We performed PubMed, EMBASE, and PsycINFO searches for articles published or in press from 2013 to 2024, integrated with hand search and randomized controlled trials (RCTs) identified in this series' earlier reviews. RCTs examining the safety or efficacy of interventions delivered to adolescents (ages 10.0-19.9) with a diagnosis of ADHD were included. Study characteristics were extracted and reviewed, quality of evidence was assessed using GRADE, and effect sizes were calculated for individual studies and illustrated using forest plots. Sixty-three RCTs were identified. Quality of evidence ranged from high (medication; k = 29) to very low (nutrient supplementation, neurofeedback, occupational therapy; k = 1 each). Medications demonstrated consistent strong impact on ADHD symptoms and inconsistent impact on impairment. Diverse cognitive/behavioral treatments (C/BTs) demonstrated inconsistent impact on ADHD symptoms but strong and consistent impact on impairment and executive function skills, plus moderate benefits on internalizing symptoms. No interventions demonstrated significant safety concerns. Long-term maintenance (up to 3 years post-treatment) was demonstrated for C/BTs, though moderate quality of evidence was noted because participants cannot be fully blinded to receipt of treatment. The effects of C/BTs and medication appear complementary, not duplicative. Combining medication and C/BT is advised at treatment outset to maximize engagement, maintenance, and response breadth (i.e. improving both ADHD symptoms/cognitive performance and coping skills/functional impairments). Engagement strategies (e.g. motivational interviewing) may facilitate uptake. Novel treatments do not yet demonstrate effects on ADHD symptoms or impairments in adolescents but remain a promising area for research.

Infant and parent heart rates during a babywearing procedure: Evidence for autonomic coregulation

Babywearing is the practice of carrying an infant in a baby carrier, which may provide an inexpensive, nonpharmacological intervention for the parent-infant dyads to handle mental stressors, such as pain and anxiety, especially among vulnerable infants. This study investigated the influence of babywearing on parent-infant autonomic coregulation based on the changes in the HR of mother-infant and father-infant dyads for infants with neonatal abstinence syndrome (NAS). Guided by the Calming Cycle Theory as the framework, the correlation between parent HR and infant HR and the difference in the mother-infant dyad (n = 17) compared to the father-infant dyad (n = 8) were examined. Although only the mother-infant HRs reached statistical significance during babywearing (r̅ =.52, p = .03), both parent-infant dyads had strong correlations during babywearing (compared to pre- and post-babywearing conditions), indicating that babywearing, for parents and their infants with NAS, may influence autonomic coregulation.

Soundscape augmentation as a nonpharmacological intervention to reduce the behavioural effect of dementia: a randomized controlled trial

Soundscape is an important environmental factor that influences people's behaviour and well-being. People with dementia can benefit from a personalized soundscape to improve the behavioural and psychological syndrome of dementia. This paper is based on a single-blind, repeated-measure pilot randomized clinical trial of soundscape augmentation on the treatment effect of people with severe dementia. Participants were randomized to a personalized soundscape intervention delivered in their room in the morning and evening or treatment-as-usual, with two baseline weeks and four weekly post-randomization assessments of the primary and secondary behavioural outcomes. A linear mixed effects model showed that the soundscape intervention was possible and acceptable. There were improvements in the Neuropsychiatric Inventory (resistance to care) and a significant reduction in aggression in the soundscape group. This study is the first pilot randomized controlled trial of a soundscape intervention for older adults with dementia to improve the behavioural and psychological syndrome of dementia. In this pilot study, soundscape augmentation was a feasible and effective non-pharmacological approach to reducing resistance and improving participants' behaviour. Further studies with larger samples are recommended to confirm our findings. Longitudinal studies are necessary to investigate the long-term effect of an augmented sonic environment on people with dementia.

Environmental, climatic, socio-economic factors and non-pharmacological interventions: A comprehensive four-domain risk assessment of COVID-19 hospitalization and death in Northern Italy

IntroductionUp to now, studies on environmental, climatic, socio-economic factors, and non-pharmacological interventions (NPI) show diverse associations, often contrasting, with COVID-19 spread or severity. Most studies used large-scale, aggregated data, with limited adjustment for individual factors, most of them focused on viral spread than severe outcomes. Moreover, evidence simultaneously evaluating variables belonging to different exposure domains is scarce, and none analysing their collective impact on an individual level. MethodsOur population-based retrospective cohort study aimed to assess the comprehensive role played by exposure variables belonging to four different domains, environmental, climatic, socio-economic, and non-pharmacological interventions (NPI), on individual COVID-19-related risk of hospitalization and death, analysing data from all patients (no. 68472) tested positive to a SARS-CoV-2 swab in Modena Province (Northern Italy) between February 2020 and August 2021.Using adjusted Cox proportional hazard models, we estimated the risk of severe COVID-19 outcomes, investigating dose-response relationships through restricted cubic spline modelling for hazard ratios. ResultsSeveral significant associations emerged: long-term exposure to air pollutants (NO2, PM10, PM2.5) was linked to hospitalization risk in a complex way and showed an increased risk for death; while humidity was inversely associated; temperature showed a U-shaped risk; wind speed showed a linear association with both outcomes. Precipitation increased hospitalization risk but decreased mortality. Socio-economic and NPI indices showed clear linear associations, respectively negative and positive, with both outcomes. ConclusionsOur findings offer insights for evidence-based policy decisions, improving precision healthcare practices, and safeguarding public health in future pandemics. Refinement of pandemic response plans by healthcare authorities could benefit significantly.

THE EFFECT OF SELF-ACUPRESSURE ON REDUCING BLOOD PRESSURE, HEADACHE AND SLEEP QUALITY DISORDERS IN HYPERTENSIVE PATIENTS

Hypertension is still a major health problem in Indonesia. Various efforts to overcome the problem of hypertension have been made, both pharmacological and non-pharmacological treatments. A therapy based on the patient's habits or culture will certainly be easier to implement and obey by. Therefore, this study aims to analyze the effect of self-acupressure on blood pressure, headache, and sleep quality of hypertensive patients. The research method used is a quasi-experiment, single-group pre-post-test design. The sample in this study were hypertensive patients who fit the inclusion and exclusion criteria at Wonokerto Health Centre, Pekalongan Regency. The data analysis used was univariate and bivariate analysis. Bivariate analysis used paired group t-test technique. The results showed that there was an effect of self-acupressure in reducing systolic blood pressure (p-value: 0.004), headache pain scale (p-value: 0.001), and decreased sleep quality disorder score (p value: 0.000). Massaging at acupressure points has the effect of improving blood flow, stimulating endorphin hormones and providing a relaxing effect so that it can reduce blood pressure, headache pain scale and sleep quality disturbance scores. Recommendations for future research are to add a control group and/or compare it with other independent complementary therapy techniques.

Evaluating the effectiveness of a multi-component lifestyle therapy program versus psychological therapy for managing mood disorders (HARMON-E): protocol of a randomised non-inferiority trial

BackgroundMood disorders, including unipolar and bipolar depression, contribute significantly to the global burden of disease. Psychological therapy is considered a gold standard non-pharmacological treatment for managing these conditions; however, a growing body of evidence also supports the use of lifestyle therapies for these conditions. Despite some clinical guidelines endorsing the application of lifestyle therapies as a first-line treatment for individuals with mood disorders, there is limited evidence that this recommendation has been widely adopted into routine practice. A key obstacle is the insufficient evidence on whether lifestyle therapies match the clinical and cost effectiveness of psychological therapy, particularly for treating those with moderate to severe symptoms. The HARMON-E Trial seeks to address this gap by conducting a non-inferiority trial evaluating whether a multi-component lifestyle therapy program is non-inferior to psychological therapy on clinical and cost-effectiveness outcomes over 8-weeks for adults with major depressive disorder and bipolar affective disorder.MethodsThis trial uses an individually randomised group treatment design with computer generated block randomisation (1:1). Three hundred and seventy-eight adults with clinical depression or bipolar affective disorder, a recent major depressive episode, and moderate-to-severe depressive symptoms are randomised to receive either lifestyle therapy or psychological therapy (adjunctive to any existing treatments, including pharmacotherapies). Both therapy programs are delivered remotely, via a secure online video conferencing platform. The programs comprise an individual session and six subsequent group-based sessions over 8-weeks. All program aspects (e.g. session duration, time of day, and communications between participants and facilitators) are matched except for the content and program facilitators. Lifestyle therapy is provided by a dietitian and exercise physiologist focusing on four pillars of lifestyle (diet, physical activity, sleep, and substance use), and the psychological therapy program is provided by two psychologists using a cognitive behavioural therapy approach. Data collection occurs at baseline, 8-weeks, 16-weeks, and 6 months with research assistants blinded to allocation. The primary outcome is depressive symptoms at 8 weeks, measured using the Montgomery-Åsberg Depression Rating Scale (MADRS) (minimal clinically important difference = 1.6). A pre-specified within-trial economic evaluation will also be conducted.DiscussionShould lifestyle therapy be found to be as clinically and cost effective as psychological therapy for managing mood disorders, this approach has potential to be considered as an adjunctive treatment for those with moderate to severe depressive symptoms.Trial registrationAustralia and New Zealand Clinical Trials Register (ANZCTR): ACTRN12622001026718, registered 22nd July 2022.Protocol version: 4.14, 26/06/2024