Non-pharmacological Interventions Research Articles

The effects of Tai Chi and Baduanjin on breast cancer patients: systematic review and meta-analysis of randomized controlled trials

BackgroundTai Chi and Baduanjin are nonpharmacological interventions that are widely applied among cancer patients.ObjectiveThis meta-analysis aimed to assess the effect of Tai Chi and Baduanjin on breast cancer patients by summarizing and pooling the results of previous studies.MethodsThe PubMed, Embase, Web of Science, Scopus and Cochrane Library and several databases were searched up to December 1, 2023, to identify high-quality RCTs. Relevant terms such as Tai Chi and Baduanjin were used as keywords. Stata 15.0 software and Review Manager (version 5.3; Cochrane Training) were used to screen the studies, extract the data, code the data, and perform the meta-analysis. The mean differences (MDs) and standardized mean differences (SMDs) with 95% CIs were used to calculate continuous variables. The Cochrane risk of bias assessment tool was used to evaluate the risk of bias. The PICOS framework was used to develop the following eligibility criteria: (i) population - breast cancer patients; (ii) intervention - Tai Chi and Baduanjin intervention; (iii) comparison - Tai Chi and Baduanjin group and different intervention (e.g., regular intervention, routine rehabilitation training, waiting list, sham Qigong, usual care, no intervention); (iv) outcomes - cognitive ability, shoulder joint function, anxiety, depression, fatigue, sleep quality, quality of life; and (v) study design - randomized controlled trial.ResultsFrom January 2013 to December 2023, we included a total of 16 RCTs involving 1247 patients. A total of 647 patients were in the experimental group and were treated with Tai Chi and Baduanjin, while 600 patients were in the control group and were treated with traditional methods. The results of our meta-analysis indicate that Tai Chi and Baduanjin yield outcomes that are comparable to those of traditional treatment methods. Specifically, Tai Chi and Baduanjin significantly increased cognitive function, increased shoulder joint function, improved sleep quality indicators and improved quality of life indicators. Furthermore, Tai Chi and Baduanjin significantly reduced anxiety symptoms, depression symptoms, and fatigue symptoms among breast cancer patients. Sensitivity analysis was performed, a funnel plot was constructed. No publication bias was indicated by Egger’s or Begg’s test.ConclusionOverall, Tai Chi and Baduanjin are viable and effective nonpharmacological approaches for treating breast cancer patients, as they yield better results than traditional treatment methods. However, these findings should be interpreted with caution due to the limited number of controlled trials, small sample sizes, and low quality of the evidence.Systematic review registrationhttps://www.crd.york.ac.uk/PROSPERO/, identifier CRD42023469301.

Effectivess of non-pharmacological interventions on physical activity and sedentary behaviour among patients with coronary heart disease: a systematic review and meta-analysis

Abstract Background Coronary heart disease (CHD) is the leading cause of death worldwide. Adequate physical activity has been firmly established as a protective factor against recurrent CHD events. However, emerging evidence highlights sedentary behaviour as an independent contributor to cardiovascular health. It is thereby imperative to identify effective strategies that promote adequate physical activity while currently reducing sedentary behaviour among patients with CHD. Purpose This systematic review aims to identify the best available evidence on the effectiveness of non-pharmacological interventions (NPIs) on promoting physical activity and/or sedentary behaviours among patients with CHD. Methods This review included randomized controlled trials that examine the effects of NPIs on physical activities or sedentary behaviours or both among patients with CHD. Systematic search was conducted in eight electronic databases (Scopus, MEDLINE, Embase, PsycINFO, Web of Science, CENTRAL, CNKI and WanFang) from inception to December 2023. The version 2 of the Cochrane risk-of-bias tool for randomized trials was used to assess the risk of bias of included studies. Meta-analysis was performed by using the Review Manager 5.4, when deem appropriate. A narrative summary was conducted to address studies that could not be included in the meta-analysis. Results A total of 24 articles of 22 studies, involving 5454 patients with CHD were included. The interventions were categorised as motivational interventions (k=6) and behavioural change technique-based interventions (k=18). The findings of this review involved pooling the results from 18 studies through meta-analysis, while a narrative summary was conducted for the remaining 4 studies. Results showed that both motivational interventions (SMD 0.34, 95% CI: 0.24, 0.45, P= 0.02, I2= 48%) and behavioural change techniques-based interventions (SMD 0.23, 95% CI: 0.10, 0.37, P= 0.0008, I2= 0%) increased the total physical activity time. Additionally, motivational interventions improve the moderate-to-vigorous physical activity time (SMD 0.42, 95% CI: 0.19, 0.65, P= 0.0004, I2= 41%). However, no significant improvement on sedentary behaviours was found from the meta-analysis. Conclusions The findings of this review suggests that motivational interventions have the potential effects to enhance total physical activity time and increase the duration of moderate-to-vigorous physical activity. Further studies on effective intervention that improve the physical activity and concurrently reduce sedentary behaviour are warranted for CHD population.Table 1.Charateristics of studiesFigure 1.Forest plot of outcomes

Role of nonpharmacological concussion management in children: systematic review of randomized controlled trials.

Concussion is a global public health problem that affects many children worldwide. Most patients present with postconcussion syndrome and normal brain imaging find- ings. Despite the high incidence of concussion in children, published research on nonpharmacological management is lacking and much more often concerns pharmacological interventions. This systematic review aimed to evaluate the role of nonpharmacological interventions in managing concussion based on randomized controlled trials. The PubMed, Scopus, Web of Science, and Cochrane data- bases were extensively searched for articles published between January 2013 and July 2023. A modified patient intervention, comparison, and outcome framework was used to construct the search strategy and eligibility criteria. Risk of bias was assessed using the Risk of Bias-2 tool. A total of 16 studies conducted between January 2013 and July 2023 were analyzed. Three studies were conducted in an acute care setting (<24-hour postinjury) involving rest, computer time, and doing nothing, while the other 13 studies were conducted in a chronic care setting (>24-hour postinjury) and included aerobic exercise, collaborative care intervention, cervical spine rehabilitation, education by physiotherapists, a hyperbaric oxygen therapy protocol, family intervention therapy, virtual reality, traditional occupational therapy, virtual rehabilitation, oculomotor control exercises, vestibular rehabilitation, coordination exercises, and balance exercises. This systematic review highlights the importance of nonpharmacological therapy in pediatric concussion cases. Active rehabilitation may yield promising outcomes. Another interesting approach may be useful in pediatric concussion management. How- ever, this systematic review shows a lack of high-quality literature supporting nonpharmacological pediatric con- cussion treatments.

Euterpe music therapy methodology and procedure algorithms

IntroductionAs highlighted by the scientific literature, music therapy (MT) represents a significant non-pharmacological intervention within neurorehabilitation programs. MT offers benefits in the recovery process and enhances the quality of life for patients with neurodevelopmental disorders. A review of the literature reveals a lack of MT models focusing on real-time personalized composition using electronic music techniques. Furthermore, studies on MT conducted within a multisensory therapeutic context are limited. Recent literature reviews on MT in telerehabilitation have highlighted that the application of the Euterpe Method (EM) is complex due to limited technical information available and the combined background required for music therapists to replicate the EM protocol.MethodsThis paper presents a manual which specifies the procedures and algorithms of the EM, developed during a research program conducted in a pediatric hospital in Italy. The prerogative of the EM is the use of procedures aimed at creating personalized therapeutic compositions within a multisensory environment.DiscussionThe efficacy and resilience of the EM have been demonstrated in two experimental studies. The first focused on the use of telerehabilitation in children with developmental disorders, while the second involved hospitalized children with cerebral palsy.ConclusionThis study integrates medicine, neuroscience, and MT to develop personalized interventions in pediatrics, fostering collaboration among specialists and families, enhancing patient well-being, and opening new therapeutic perspectives, while ensuring the replicability of the EM approach.

The effects of weather and mobility on respiratory viruses before and during the COVID-19 pandemic

Abstract Background The flu season is caused by a combination of different pathogens, including influenza viruses, which cause the flu, and non-influenza respiratory viruses, that cause common colds or influenza-like illness. These viruses exhibit similar dynamics and, given that outbreaks occur mostly in the winter and there is almost no circulation during the summer, in temperate regions, meteorological conditions have historically been regarded as a principal modulator of their epidemiology. However, after the emergence of SARS-CoV2, in late 2019, the dynamics of these respiratory viruses were strongly perturbed worldwide: some infections displayed near-eradication, while others experienced temporal shifts or occurred “off-season”. This disruption raised questions regarding the dominant role of weather while also providing an unique opportunity to investigate the roles of other determinants in their epidemiological dynamics. Methods Weather, mobility and epidemiological surveillance data was collected for Influenza, RSV, hCOV and hMPV, from Canada and the USA, from 2016 to 2023. Statistical analysis and modeling were employed to test the effects of weather and mobility on viral dynamics, before and during the COVID-19 pandemic. Results Using Beta Regressions, we found that whereas in the pre-COVID-19 pandemic period, weather had a strong effect, in the pandemic period, this effect was strongly reduced post-pandemic with mobility playing a more significant role. Conclusions These results, together with previous studies, dispute the general belief that respiratory viral dynamics are mostly dictated by weather and indicate that behavioral changes resulting from the non-pharmacological interventions implemented to control SARS-CoV2, played a key role. This disruption of past dynamical equilibrium raises important questions regarding the factors that modulate them, particularly in a context of climate change. Key messages • We took advantage of the disruption caused by COVID-19 to study dynamics of other respiratory viruses and to disentangle the effects of weather from those of human behavior. • While before 2020 cold temperatures were highly correlated with incidence, afterwards cold weather was no longer a necessary condition and human mobility became central.

Haemolysis and acute tubular injury after pulsed field ablation compared to radiofrequency: An observational study

Abstract Background Pulsed field ablation (PFA) represents a novel promising non-thermal alternative in non-pharmacological treatment of atrial fibrillation (AF). However, infrequent cases of acute renal failure secondary to intravascular haemolysis after a PFA procedure have been described. Objective To investigate the impact of ablation technology (PFA vs. radiofrequency ablation (RFA)) on the level of plasma cell-free haemoglobin (CFH) and the concentration of serum neutrophil gelatinase-associated lipocalin (NGAL) as a marker of tubular injury. Methods This was a prospective observational trial. In a consecutive cohort of patients who underwent AF ablation (PFA of RFA), blood samples were drawn just before the procedure (Sample 1: CFH and NGAL), immediately after the procedure (Sample 2: CFH) and one day after the procedure (Sample 3: CFH and NGAL). Plasma CHF level and serum NGAL concentration were analysed using the ELISA technique. Results Among 70 patients enrolled (mean age 64.3 ± 10.3 years, 61 % male), 23 underwent RFA and 47 PFA (22 pulmonary vein isolation (PVI) only and 25 PVI with other additive lesions). Baseline serum creatinine levels of both groups were comparable (91.7 ± 22.1 µmol/L vs. 88.8 ± 22.1 µmol/L P = 0.44). In the PFA cohort, a significant peak of CFH concentration was observed just after the procedure with a subsequent decrease within 12 hours (Sample 1 vs. Sample 2: 93.4 ± 65.1 µg/mL vs. 2394.9 ± 1966.1 µg/mL P &amp;lt; 0.001, Sample 1 vs. Sample 3: 93.4 ± 65.1 µg/mL vs. 97.2 ± 68.5 µg/mL P = 0.75). No significant differences were observed in the RFA cohort. Compared to baseline, neither the PFA nor the RFA group showed a significant difference in NGAL levels (PFA 98.6 ± 31.7 ng/mL vs. 98.5 ± 38.1 ng/mL P = 0.78, RFA 108.3 ± 33.8 ng/mL vs. 116.3 ± 32.2 ng/mL P = 0.49). Conclusions Compared to RFA, PFA leads to significant peri-procedural haemolysis. However, no differences in the concentration of the tubular injury marker NGAL were observed on the first day after the procedure.

Thirty-five years of personalized promotion. The contribution of medicine in the workplace

Abstract Issue/problem Occupational medicine has always had the task of identifying and solving problems caused by exposure to occupational risks and improving the health conditions of workers. This traditional prevention task can be advantageously associated with promotional activities to reduce the incidence of non-communicable diseases. Description of the problem Since the end of the 1980s we have conducted health promotion interventions in the workplace, integrated into the company’s occupational prevention plan. The results, discussed internationally, have allowed the improvement of projects such as the one presented here, aimed at the prevention of cardiovascular and metabolic risks. Results Workers carry out a clinical check integrated with blood chemistry tests, actigraphic measurement of physical activity and sleep, bioimpedance measurement and plicometry, to objectify the data of interest. Furthermore, they keep a food diary and answer questionnaires on lifestyle, stress, and sleep. They receive personalized non-pharmacological treatment aimed at making salutogenic changes to diet, sleep, physical activity, and relaxation methods. They are monitored monthly and carry out a follow-up after six months. The pilot study, conducted on 20 healthcare workers with previously undiagnosed metabolic problems, indicates a significant improvement in abdominal circumference, systolic blood pressure and sleep duration in the third month. Workers report a high level of satisfaction with the initiative, a lower level of occupational stress and a higher quality of sleep. Lessons Accumulated experience demonstrates that projects of this type are feasible, sustainable, and advantageous and can be applied to companies of all sizes, regardless of the quantity of resources available. Key messages • Health promotion in the workplace can contribute to the reduction of chronic non-communicable diseases. • The active participation of workers in health promotion activities contributes to improving job engagement and satisfaction derived from work.

Beyond Pain: Innovative Approaches to Tension-Type Headache Management and Treatment

Introduction: Tension-type headache (TTH) is a common neurological disorder characterized by bilateral head pain and muscle tension, affecting up to 78% of the population. Despite its prevalence, TTH has historically received less attention than migraines. However, recent years have seen increased interest in understanding its pathophysiology and treatment options. This review comprehensively analyzes TTH management, covering non-pharmacological and pharmacological approaches to guide clinical practice and future research effectively. State of Knowledge: TTHs manifest as bilateral, pressing, encircling head pain, profoundly affecting individuals' quality of life. Recent years have witnessed increased interest in TTH understanding and treatment. Non-pharmacological interventions, including behavioral modifications, exercise, dietary adjustments, sleep hygiene, physical therapy, psychotherapy, and pharmacological treatments like over-the-counter medications, prophylactic drugs, psychedelics, and botulinum toxin A, have shown promise in alleviating symptoms. Conclusion: This review highlights the multifaceted management of TTH. Non-pharmacological interventions, including behavioral modifications and psychotherapy, offer symptom relief. Body awareness therapy, exercise, and psychotherapy benefit TTH symptoms and quality of life. Paracetamol, ibuprofen, and amitriptyline are standard treatments, with emerging options like psychedelics and botulinum toxin A. Personalizing treatment and understanding TTH mechanisms pose challenges. A multidisciplinary approach is essential for enhancing management and outcomes. More research is required to identify optimal treatments and long-term efficacy. Despite challenges, progress in TTH management brings hope for better patient care.

Transcutaneous auricular vagus nerve stimulation mitigates gouty inflammation by reducing neutrophil infiltration in BALB/c mice

Gouty inflammation, caused by uric acid crystal deposition, primarily affects tissues around the toe joints and triggers potent inflammatory responses. Current treatments focus on alleviating inflammation and pain using pharmaceutical agents, which can lead to side effects and complications. This has generated interest in non-pharmacological interventions, such as non-invasive vagus nerve stimulation (VNS). In this study, we explored the anti-inflammatory mechanisms of transcutaneous auricular vagus nerve stimulation (taVNS) in a mouse model of acute gout. Gouty inflammation was induced by injecting monosodium urate (MSU) crystals into the ankle joints of BALB/c mice. The effects of taVNS on the expression of inflammatory cytokines and chemokines in the ankle joint tissue were assessed using real-time quantitative PCR (qPCR), western blotting, histological assessments (H&E staining), and immunohistochemistry (IHC). The role of α7 nicotinic acetylcholine receptors (α7nAChR) was also evaluated by signal blocking. Our findings revealed that MSU significantly elevated gout-associated inflammatory cascades and mediators in the ankle joint. Notably, taVNS at 200 µA and 25 Hz effectively reduced these inflammatory responses, decreasing neutrophil infiltration and chemoattraction within the tissue. taVNS showed significant anti-inflammatory properties by suppressing neutrophil activity, offering a novel therapeutic approach for gout beyond conventional pharmacological methods. Additionally, taVNS holds potential for managing various chronic joint diseases. These results highlight taVNS as a promising non-pharmacological therapy for chronic inflammation.

Comparative efficacy of non-pharmacological interventions on xerostomia and salivary flow rate among hemodialysis patients: a systematic review and network meta-analysis

Abstract Background Xerostomia is a distressing symptom experienced by patients undergoing dialysis. We sought to compare and rank the efficacy of different non-pharmacological interventions on xerostomia and salivary flow rate among dialysis patients. Methods A systematic search was conducted in six English databases: Pubmed, CINAHL, Scopus, Web of Science, Embase, and Cochrane trials, in April 2023. Screening, quality appraisal, and data extraction were undertaken by two independent reviewers. A network meta-analysis was performed to assess the relative efficacy of different non-pharmacological interventions. Results The analysis included 11 randomized controlled trials involving 739 patients and eight non-pharmacological interventions. The pairwise analysis indicated that in comparison with the control group, sugarless candy, chewing sugarless gum, acupressure auricular, and licorice mouthwash had a significant positive effect on reducing the severity of xerostomia, also transcutaneous electrical nerve stimulation (TENS), licorice mouthwash, sugarless chewing gum, photobiomodulation, and pure water mouthwash, significantly improved saliva flow rate. The network analysis indicated that sugarless chewing gum significantly reduced the symptoms of xerostomia, while TENS and sugarless chewing gum were effective in improving UWS. Chewing sugarless gum and using TENS were the top-ranked interventions for relieving xerostomia and enhancing saliva flow rate among dialysis patients, respectively. Conclusions Several non-pharmacological interventions have demonstrated effectiveness in relieving xerostomia and enhancing saliva flow rates. While further research may be needed to confirm and refine these findings the interventions used in this review offer promising results and should be incorporated into the standard care of dialysis patients experiencing these symptoms to enhance their quality of life and oral health.

Is It Possible to Combine Non-Invasive Brain Stimulation and Evidence-Based Psychosocial Interventions in Schizophrenia? A Critical Review

In schizophrenia, it was suggested that an integrated and multimodal approach, combining pharmacological and non-pharmacological interventions, could improve functional outcomes and clinical features in patients living with schizophrenia (PLWS). Among these alternatives, evidence-based psychosocial interventions (EBPIs) and Non-Invasive Brain Stimulation (NIBS) represent feasible treatment options targeting the clinical features that are unmet needs of PLWS (especially negative and cognitive symptoms). As no clear evidence is available on the combination of these non-pharmacological approaches, this review aimed to collect the available literature on the combination of EBPIs and NIBS in the treatment of PLWS. We demonstrated that the field of combining EBPIs and NIBS in schizophrenia is in its infancy, as only 11 studies were reviewed. In fact, only a few trials, with divergent results, combined these non-pharmacological modalities; while emerging evidence is available on the combination of cognitive remediation and rTMS/iTBS, inconclusive results were obtained. Conversely, albeit preliminary, more solid findings are available on the combination of HF-rTMS and family intervention. Moreover, despite the fact that cognitive activation could not be considered an EBPI, promising results are available in combination with tDCS to improve the working memory domain. To overcome these limitations, we considered several methodological issues to promote research in this field.

Music Therapy for Pain and Anxiety Reduction in Pediatric Patients Undergoing Procedures: A Systematic Review and Meta-Analysis Protocol

Introduction: Many children undergo invasive and noninvasive procedures in the pediatric medical setting, which can be associated with pain and anxiety. Both pharmacological and nonpharmacological interventions are currently being used to minimize pain and anxiety in pediatric patients in the medical setting. Music therapy is an evidence-based, cost-effective, and nonpharmacological service administered by a board-certified music therapist which may reduce pediatric pain and anxiety during procedures. We will undertake a systematic review and meta-analysis that will comprehensively analyze the quantitative publications that detail the effects of music therapy on pediatric pain and anxiety for patients undergoing invasive or noninvasive medical procedures. Method: This protocol is reported according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses Protocols (PRISMA-P) statement and is registered in the International Prospective Register of Systematic Reviews (Prospero; CRD42023474635 ). A three-step, iterative search strategy will include (1) an initial scoping search, (2) development and execution of a comprehensive search strategy, and (3) a search for additional publications. Procedures for disagreements among reviewers and the article screening process are outlined. Statistical analyses including analysis of outcomes and sensitivity analysis has been determined. A plan for critical appraisal of sources using the Grading Recommendations Assessment, Development, and Evaluation (GRADE) and quality of evidence using the Outcome Reporting Bias in Trials (ORBIT) of evidence is also present in this protocol. Conclusion: This protocol is presented with the intention to execute and publish results of this systematic review and meta-analysis to help inform clinical practice and future research.

Exercise as a therapeutic approach to alleviate diabetic kidney disease: mechanisms, clinical evidence and potential exercise prescriptions

Diabetic kidney disease (DKD) is a global and severe complication that imposes a significant burden on individual health, families, and society. Currently, the main treatment approaches for DKD include medication, blood glucose control, protein-restricted diet, and blood pressure management, all of which have certain limitations. Exercise, as a non-pharmacological intervention, has attracted increasing attention. This review introduces the mechanisms and clinical evidence of exercise on DKD, and proposes potential exercise prescriptions. Exercise can improve blood glucose stability related to DKD and the renin-angiotensin-aldosterone system (RAAS), reduce renal oxidative stress and inflammation, enhance the crosstalk between muscle and kidneys, and improve endothelial cell function. These mechanisms contribute to the comprehensive improvement of DKD. Compared to traditional treatment methods, exercise has several advantages, including safety, effectiveness, and no significant side effects. It can be used as an adjunct therapy to medication, blood glucose control, protein-restricted diet, and blood pressure management. Despite the evident benefits of exercise in DKD management, there is still a lack of large-scale, long-term randomized controlled trials to provide more evidence and develop exercise guidelines for DKD. Healthcare professionals should actively encourage exercise in DKD patients and develop personalized exercise plans based on individual circumstances.

Effects of Traditional Chinese Martial Arts and Stretching Exercises on Symptoms of Fibromyalgia: A Systematic Review and Meta-Analysis.

Fibromyalgia syndrome (FMS) is a chronic condition characterized by widespread musculoskeletal pain and various associated symptoms. Non-pharmacological interventions have gained attention for managing FMS and improving patient outcomes. We reviewed past research to investigate the effects of traditional Chinese martial arts (TCMA) and stretching training (ST) on symptoms of patients with FMS. We searched Web of Science, Medline via PubMed, the Cochrane Library, and EMBASE from their inceptions to June 1, 2023. Across selected studies, we evaluated TCMA and ST using Fibromyalgia Impact Questionnaire (FIQ) scores, pain symptoms, fatigue levels, and sleep quality as outcome measures. Compared with control groups, participants receiving TCMA and ST interventions showed significantly lower FIQ scores (Standard Mean Difference (SMD) = -3.01, 95% Confidence Interval (CI) [-4.83,-1.19]), improved pain symptoms (SMD = -0.77, 95% CI [-1.07,-0.47]), less fatigue (SMD = 1.31, 95% CI [0.50,2.11]), and enhanced sleep quality (SMD = -0.55, 95% CI [-0.97,-0.12]). Subgroup analyses revealed that, irrespective of intervention duration, both TCMA and ST interventions were effective in relieving pain symptoms in these patients. ST interventions showed significant improvement in fatigue symptoms, while TCMA interventions positively influenced sleep quality. These findings highlight potential non-pharmalogical benefits of TCMA and ST interventions in managing FMS. However, future research should explore the optimal duration, frequency, intensity, and types of interventions for TCMA and ST and design targeted exercise intervention programs to study the effects of these interventions on different characteristics of FMS patients. Attention should be given to the effects of short-term interventions on improving fatigue symptoms, sleep quality, and pain relief, to provide more personalized and effective FMS treatment plans.

Unmet Needs in Spondyloarthritis: Pathogenesis, Clinical Trial Design, and Nonpharmacologic Therapy.

A program focused on pathogenesis, clinical trial design, and nonpharmacologic mind-body therapy for of spondyloarthritis (SpA) was presented at the Spondylitis Association of America Unmet Needs Conference IV. SpA pathogenesis is incompletely understood but involves a complex set of drivers, including genetics, biomechanical stress, and microbial factors. Affected tissues may include axial and peripheral joints, entheses, skin, uvea, and intestines. The specific role of key cytokines like interleukin (IL)-23, IL-17, and tumor necrosis factor in the phases of this inflammatory process remains unclear. New insights into pathogenesis will continue to generate targets for novel therapeutics. How to optimally evaluate those therapeutics in clinical trials, and for the various manifestations of SpA, remains less clear. Future trials need better generalizability, robust subgroup analyses to assess differential responses for distinct disease manifestations, a focus on comparative efficacy, and outcomes relevant to the clinician and the patient. Additionally, study designs need to leverage available technology to facilitate subject participation in trials. In view of the interplay between biologic, physical, and psychological aspects of disease, there is increasing attention to nonpharmacologic agents, with the aim of maximizing long-term health-related quality of life through the control of symptoms and inflammation. Recent studies provide encouraging evidence that mind-body interventions such as tai chi, qigong, yoga, and meditation have benefits for patients with SpA, particularly those with pain. The advances in our understanding of pathogenesis, novel therapeutics, and nonpharmacologic interventions have revolutionized the management of SpA, but numerous questions around optimal management remain.

Pharmacological and Non-Pharmacological Interventions in the Management of Puerperal Psychosis

Pharmacological and Non-Pharmacological Interventions in the Management of Puerperal Psychosis

Clinical indications associated with new opioid use for pain management in the United Kingdom: using national primary care data.

Prescription opioids for noncancer pain in the United Kingdom have increased over the past 2 decades, alongside associated harms. Policies addressing opioid prescribing must be tailored to individual patient needs with specific disease systems. The aim of this study was to evaluate clinical conditions associated with new opioid initiation in noncancer pain using nationally representative UK data. Primary care electronic health records from January 1, 2006, to September 31, 2021, were used from the Clinical Research Practice Datalink to identify incident opioid prescriptions. Patient histories were reviewed using code lists for opioid-related conditions with a 5-year look-back for chronic conditions and a 1-year look-back for surgical indications before opioid initiation. In total, 3,030,077 new opioid use episodes in 2,027,402 patients were identified, with 61% being women, 77% aged 45 years and older, and 48% from the highest deprivation quintile. Ten systems associated with opioid initiation were identified, which were not mutually exclusive, as patients could have opioids prescribed for multiple indications. The most common were musculoskeletal (80.8%), respiratory (57.6%), infections (30.4%), trauma/injury (20.4%), neurology (19.9%), and postsurgical indications (5.5%). Osteoarthritis (60.7%) and low back pain (41.0%) were the most frequent musculoskeletal conditions. Orthopedic surgeries accounted for 41.2% of all postsurgical indications. This is the first study in the United Kingdom evaluating large-scale national data to assess indications associated with opioid initiation. Nearly 3 quarters of new opioid prescriptions for noncancer pain were in patients with musculoskeletal conditions, often for conditions with limited evidence for opioid efficacy. These findings could inform targeted interventions and future policies to support nonpharmacological interventions in the most common conditions where opioid harms outweigh benefits.

Beyond Painkillers: A Meta-Analysis of Non-Pharmacological Approaches for Managing Dysmenorrhea Symptoms

Dysmenorrhea, commonly known as painful menstruation, is a highly prevalent gynecological condition affecting millions of women globally. While pharmacological interventions offer temporary relief, they often come with undesirable side effects. Non-pharmacological approaches present a potentially safer and more sustainable alternative for managing dysmenorrhea symptoms. A comprehensive search of electronic databases, including PubMed, Scopus, and Web of Science, was conducted to identify randomized controlled trials (RCTs) published between 2014 and 2024 that investigated the effectiveness of non-pharmacological interventions for dysmenorrhea. The primary outcome was pain intensity reduction, while secondary outcomes included quality of life, absenteeism, and medication use. Data were pooled using a random-effects model, and standardized mean differences (SMDs) were calculated. Six RCTs met the inclusion criteria, encompassing a total of 600 participants. The non-pharmacological interventions evaluated included aerobic exercise, yoga, acupuncture, transcutaneous electrical nerve stimulation (TENS), heat therapy, and relaxation techniques. The pooled analysis revealed significant reductions in pain intensity across all interventions compared to control groups (SMD = -2.00, 95% CI: -2.39 to -1.61, p &lt; 0.001). Aerobic exercise and yoga demonstrated the largest effect sizes (SMD = -2.5 and -2.5, respectively). Significant improvements were also observed in quality of life, absenteeism, and medication use. Non-pharmacological approaches, particularly aerobic exercise and yoga, are effective in managing dysmenorrhea symptoms. These findings strongly support the integration of non-pharmacological interventions into clinical practice as a first-line or adjunctive treatment option for dysmenorrhea.

Insular monoaminergic deficits in prodromal α-synucleinopathies.

This study assessed data from two cohorts of patients with alpha-synucleinopathies (University of Brescia and University of Rome Tor-Vergata cohorts). Consecutive participants with video-polysomnography-confirmed iRBD, Parkinson's disease (PD), dementia with Lewy bodies (DLB) and controls underwent neurological, clinical and 123I-FP-CIT SPECT imaging assessments. Individuals with iRBD were longitudinally monitored to collect clinical phenoconversion to PD or DLB. The main outcome was to identify whole brain 123 I-FP-CIT SPECT measures reflecting monoaminergic deficits in each clinical group as compared to controls. The cohort (n = 184) included 45 patients with iRBD, 47 PD, 42 DLB and 50 age-matched controls. Individuals with iRBD were categorized as RBD-DAT- (n = 32) and RBD-DAT+ (n = 13), according to nigrostriatal assessment used in clinical practice. Compared to controls, RBD-DAT- showed an early involvement of the left insula, which increased in RBD-DAT+, and was present in patients with Parkinson's disease and dementia with Lewy bodies. Longitudinal cox regression analyses revealed a higher risk of phenoconversion in individuals with iRBD and insular monoaminergic deficits [HR = 3.387; CI 95%: 1.18-10.27]. In this study, altered insular monoaminergic binding in iRBD was associated with phenoconversion to DLB or PD. These findings may provide a helpful stratification approach for future pharmacological or non-pharmacological interventions.

Physical Activity Regulates and Mediates the Signaling Pathway and Pathophysiological Mechanisms of the Neuroinflammation and Neurodegenerative

Context: The correlation between neuroinflammation and neurodegenerative disorders has been extensively documented. Elevated levels of inflammatory cytokines in the bloodstream have been demonstrated to impair memory function and heighten susceptibility to neurodegenerative disorders. Furthermore, elevated quantities of reactive oxygen species (ROS) in the body, known as oxidative stress, exacerbate neurodegenerative illnesses and negatively affect learning and memory. Neuroprotection prevents neuronal cell death by intervening and blocking the pathogenetic process that leads to cellular malfunction and death. Methods: We evaluated several studies in the WEB of SCIENCE, SCOPUS, and PubMed. Furthermore, we identified the central genes and signaling pathways associated with neurogenesis, the neural system, and neuroplasticity through data mining, a literature review of artificial intelligence, and an in-silico study. Results: Physical exercise (PE) benefits various physiological systems, including the central nervous system. The beneficial impacts of physical activity on cognitive performance, neural well-being, and safeguarding neurons against different brain injuries are extensively documented. Furthermore, research has demonstrated that PE is a powerful non-pharmacological intervention that enhances cognitive function, including learning and memory, while decreasing the likelihood of developing neurodegenerative disorders. Additionally, engaging in moderate physical activity that does not result in extreme fatigue has a beneficial impact on reducing inflammation and promoting antioxidant effects. According to the hormesis theory, physical inactivity and extreme overtraining can decrease physiological function. Conclusions: In summary, a combination of moderate aerobic exercise, HIIT, and resistance training, performed at appropriate intensities, is most beneficial for neuroprotection and cognitive health. Regular engagement in these activities can help mitigate the risk of neurodegenerative diseases and enhance overall brain function.