Non-pharmacological Interventions Research Articles

Ten Reasons Why Neurologists Should Refer Patients With Alzheimer Dementia to Music Therapy.

Alzheimer dementia (AD) constitutes a major societal problem with devastating neuropsychiatric involvement. Pharmaceutical interventions carry a heightened risk of side effects; thus, nonpharmacological interventions such as music-based interventions (MBIs), including music therapy, are recommended. The 2023 Neurology release of the Music Based Intervention Toolkit for Brain Disorders of Aging showcased music's emerging role as an intervention to manage symptoms of various brain disorders while defining the building blocks of MBIs to guide research in the exploration of music's therapeutic potential. This study extends beyond the research aspects of the MBI Toolkit to clinical applications by providing neurologists with a summary of MBIs, the MBI Toolkit, how board-certified music therapists (MT-BCs) administered music therapy is a unique MBI, and 10 reasons why they should make referrals to music therapy for their patients with AD.

Virtual Reality Therapy for Chronic Pain: A Scoping Review on Indications, Mechanisms of Action, and Effectiveness

Background: The application of virtual reality (VR) technology as a nonpharmacologic treatment option for chronic pain has been increasingly studied. However, the mechanisms underlying this treatment modality's potential positive effects and appropriate indications are not well understood or summarized in the literature. Objectives: This scoping review aims to better understand the chronic pain populations best indicated for head-mounted display-based VR interventions, explore their efficacy on pain score reduction, and characterize the mechanisms of action underlying their efficacy. Methods: PubMed database systematic searches were conducted including articles from January 2010 to August 2023 with primary qualifying criteria including but not limited to use of head-mounted display VR and adequate VR treatment dosage. Mechanisms of action(s) were deduced via an exploratory approach whereby characteristics of VR treatment interventions were analyzed and categorized. Results: Fourteen studies met qualifying criteria, representing a total treatment group of 327. Study data extracted were solely relative to VR treatment group participants. VR intervention mechanisms of action were best characterized via 2 broad but distinct categories: addressing kinesiophobia and psychobehavioral modulation. Three studies investigating chronic neck pain used addressing kinesiophobia as a mechanism of action and demonstrated a significant improvement [weighted average numerical rating scale (NRS): 4.6 at baseline, 2.5 post-intervention, and 2.5 3 months post-intervention]. Six studies investigated chronic low back pain, for which 5 studies, representing 99% of the subgroup, used psychobehavioral modulation. Each demonstrated significant reduction in pain (weighted average NRS: 5.1 baseline and 3.2 post-intervention). Conclusion: This large-scale within-group analysis review proposes 2 broad mechanisms of action underlying the efficacy of VR interventions for chronic pain indications. VR interventions addressing kinesiophobia seem to be significantly effective in nontraumatic chronic neck pain patients. Psychobehavioral VR interventions demonstrate significant efficacy in the chronic low back pain population. Studies with interventions targeting nonspecific chronic pain populations did not show significant results.

Impact of physical activity on quality of life in patients with epilepsy in a developing country: A cross-sectional, survey-based study

RationalePatients with epilepsy face different barriers based on ignorance and fear of themselves and others while exercising, this situation complicates attempts at exercise and promotes discrimination against patients. Physical activity has been associated with favorable results in the health of this population and can be used as a non-pharmacological treatment seeking to increase the health and improve living conditions of patients. Our study aims to explore how physical activity impacts quality-of-life perception in these patients. MethodsWe performed a cross-sectional, survey-based study conducted at the outpatient Epilepsy Clinic in the National Institute of Neurology and Neurosurgery “Manuel Velasco Suárez”. Patients between 17 and 65 years of age and with an established diagnosis of epilepsy were considered for participation. A 31-item questionnaire was administered to all participants face-to-face or by telephone. The questions included in the survey were selected from the Global Physical Activity Questionnaire and the Quality of Life in Epilepsy Inventory to assess the level of exercise and perceived quality of life of participants. Descriptive and inferential Mann-Whitney U test statistical analysis was done using IBM SPSS Statistics 23.0 software. ResultsParticipants' mean age was 35.69 ± 11.93 years, 45 % were male and 55 % female. Significant differences were found in the domain of perceived quality of life in the self-reported physically active participants (p = 0.0256; 95 % IC: 1.00–15.22), with a mean score of 75.78 ± 16.64 in the active group vs. 67.66 ± 15.86 in the sedentary group. In those who complied with the exercise recommendations according to the WHO, there was significant evidence of improvement in the general quality of life (p = 0.0032; 95 % IC:4.9–23.9), with a mean score of 75.22 ± 15.92 in the active group vs. 60.76 ± 17.836 in the sedentary group. ConclusionsPhysical activity is associated with a significant impact on how patients with epilepsy perceive their quality of life. In addition, it improves memory and concentration in the tasks they perform in their daily lives.

Enriched environment enhances angiogenesis in ischemic stroke through SDF-1/CXCR4/AKT/mTOR pathway

Environmental-gene interactions significantly influence various bodily functions. Enriched environment (EE), a non-pharmacological treatment method, enhances angiogenesis in ischemic stroke (IS). However, underlying the role of EE in angiogenesis in aged mice post-IS remain unclear. This study aimed to determine the potential mechanism by which EE mediates angiogenesis in 12-month-old IS mice and oxygen-glucose deprivation/reperfusion (OGD/R)-induced bEnd.3 cells. In vivo, EE treatment alleviated the neurological deficits, enhanced angiogenesis, upregulated SDF-1, VEGFA, and the AKT/mTOR pathway. In addition, exogenous SDF-1 treatment had a protective effect similar to that of EE treatment in aged mice with IS. However, SDF-1 neutralizing antibody, AMD3100 (CXCR4 inhibitor), ARQ092 (AKT inhibitor), and rapamycin (mTOR inhibitor) treatment blocked the neuroprotective effect of EE treatment and inhibited angiogenesis in IS mice. In vitro, exogenous SDF-1 promoted migration of OGD/R-induced bEnd.3 cells and activated the AKT/mTOR pathway. AMD3100, ARQ092, and rapamycin inhibited SDF-1-induced cell migration. Collectively, these findings demonstrate that EE enhances angiogenesis and improves the IS outcomes through SDF-1/CXCR4/AKT/mTOR pathway.

Breaking the Cycle: A Scoping Review Exploring Non-Pharmacological Treatment Programs for Amphetamine-Type Stimulant Use for People in Contact with the Justice System

Breaking the Cycle: A Scoping Review Exploring Non-Pharmacological Treatment Programs for Amphetamine-Type Stimulant Use for People in Contact with the Justice System

A scoping review of global patterns in reporting race, ethnicity, nationality, or religion in palliative care randomized controlled trials: Recommendations for transparency.

Though randomized controlled trials of non-pharmacological palliative care interventions have shown positive outcomes, findings are often generalized with limited consideration for the impact of the influence of race, ethnicity, nationality, or religion on said outcomes. To identify trends and gaps in global reporting of racial, ethnic, nationality, and religious demographics in non-pharmacological palliative care randomized controlled trials. We conducted a scoping review guided by the Joanna Briggs methodology. Global randomized controlled trials published in English, between 1999 and 2021 extracted from databases: Cochrane, PubMed, and Scopus. Inclusion criteria were non-pharmacological palliative care interventions for people with serious conditions reporting on one or more of the demographics of race, ethnicity, nationality, or religion. Our review included 131 (44%) articles published from 19 countries, predominantly the USA (n = 84, 64%). Most studies focused on cancer (n = 71, 54%) in inpatient settings (n = 85, 64%). Race was the most commonly reported demographic (n = 93, 70%), followed by ethnicity (n = 54, 41%), religion (n = 46, 35%), nationality (n = 20, 15%). Within racial reporting, 86 (92%) indicating a majority White/Caucasian sample. Only 14 (10%) articles provided context connecting participant demographics to intervention outcomes. Demographic data was discussed only as a limitation to generalizability in 18 cases (41%). Improving greater transparency in study reporting of social and historical context about population demographics, including specific demographic data collected, may better identify unmet palliative needs, facilitate cross-cultural interpretation, and improve adaptation and implementation of non-pharmacological palliative care interventions.

Physical Activity Component of the Greek Interventional Geriatric Study to Prevent Cognitive Impairment and Disability (GINGER): Protocol Development and Feasibility Study

Background/Objectives: Individuals with subjective cognitive decline (SCD) have an increased risk of developing dementia, while non-pharmacological multicomponent lifestyle interventions are recommended for prevention/management. The Greek Interventional Geriatric Initiative to Prevent Cognitive Impairment and Disability (GINGER) is such a multicomponent approach, encompassing simultaneous interventions (cognitive training, depression and sleep management, etc.). Exercise/Physical activity (PA) is suggested as one such intervention. This study (i) presents the exercise protocol developed for GINGER and (ii) explores its feasibility (acceptability, applicability, adherence, users’ satisfaction and reliability). Methods: Exercise/PA protocol development, targeting SCD individuals aged > 55 years, utilized relevant guidelines/literature followed by focus group involving exercise specialists. Data were synthesized through consensus to design optimal exercise interventions prescribed on participant’s physical capacity (heart rate, exertion, etc.), comprising 6-month combined aerobic, strengthening, balance and dual-task exercises, delivered 3 times/weekly in two group-based supervised sessions (in-person and online) and one home-based session. Physical outcomes include balance, aerobic capacity [2-Minute Walk Test (2 MWT), IPAQ-7], strength [Hand Grip Strength (HGS), Sit-to-Stand], fear of falling. Eligibility for entering intervention is low IPAQ-7, 2 MWT or HGS scoring. Feasibility was explored with adherence (exercise diaries and Exercise Adherence Rating Scale) and satisfaction (Patient Satisfaction Questionnaire) Results: Intervention was easily delivered with good reliability across testers’ assessments on 13 SCD participants (ICCs = 0.62–0.99), and improved physical outcomes, whereas users’ adherence and satisfaction scored highly. Conclusions: The exercise protocol for SCD was feasible, acceptable, applicable, reliable, demonstrating adherence and satisfaction, while improving physical parameters. It is thus integrated in the GINGER study, where multiple simultaneous interventions will take place to prevent/enhance cognitive function.

Evaluate the effectiveness of using non-pharmacological intervention during childbirth: an improvement project in Jordanian maternity hospitals.

Unnecessary childbirth interventions are still common in most hospitals in Jordan. Despite the recommendations from the WHO that unnecessary interventions during childbirth should be avoided, these interventions are still used. Non-pharmacological pain management interventions are considered a convenient alternative to unnecessary childbirth interventions because they can prevent unsafe side effects for mothers during childbirth. The study aims to determine the feasibility of non-pharmacological pain management interventions during childbirth and then to evaluate their influence on mothers' experience. Between May and June 2022, we implemented a quality improvement project with a bundle of non-pharmacologic comfort measures during childbirth. We started our project by (1) approaching all low-risk pregnant mothers who visited the hospital's antenatal clinic with a gestational age greater than 36 weeks. (2) Following the agreement, the researcher indicated that she would accompany the mother during the birthing process. (3) The researcher discussed different non-pharmacological pain management techniques and asked the mothers to choose how and when to utilize them. Non-pharmacological pain management techniques include breathing exercises, back massages, enabling mothers to move around, and providing modest amounts of water and soft food. (4) A few days after birth, the mother was interviewed one-to-one utilizing semi-structured audio-recorded interviews. The researcher interviewed eighteen postpartum mothers at a place of their choosing. Three main themes emerged from the interview analysis. The following themes were selected from the participants' own words: "Positive, respectful, and satisfying childbirth experience"; "Maintain mother's sense of control and cope with childbirth pain"; and "Birth outcome". These themes are connected and impacted by one another. Different research studies from diverse cultures recommend limiting the unnecessary use of interventions during childbirth and not interfering with childbirth unless medically necessary. Our participants expressed satisfaction with the use of culturally appropriate birth interventions during childbirth. These interventions were generally simple and safe, resulting in a satisfying birthing experience. The study findings contribute to achieving Sustainable Development Goal #3, "Good health and well-being" by reducing maternal and neonatal mortality, providing evidence of the effectiveness of non-pharmacological pain management, and avoiding unnecessary childbirth interventions.

Prognostic Factors in Patients Undergoing Physiotherapy for Chronic Low Back Pain: A Level I Systematic Review

Background: Low back pain is common. For patients with mechanic or non-specific chronic LBP (cLBP), the current guidelines suggest conservative, nonpharmacologic treatment as a first-line treatment. Among the available strategies, physiotherapy represents a common option offered to patients presenting with cLBP. The present systematic review investigates the prognostic factors of patients with mechanic or non-specific cLBP undergoing physiotherapy. Methods: In September 2024, the following databases were accessed: PubMed, Web of Science, Google Scholar, and Embase. All the randomised controlled trials (RCTs) which evaluated the efficacy of a physiotherapy programme in patients with LBP were accessed. All studies evaluating non-specific or mechanical LBP were included. Data concerning the following PROMs were collected: the pain scale, Roland Morris Disability Questionnaire (RMQ), and Oswestry Disability Index (ODI). A multiple linear model regression analysis was conducted using the Pearson Product–Moment Correlation Coefficient. Results: Data from 2773 patients were retrieved. The mean length of symptoms before the treatment was 61.2 months. Conclusions: Age and BMI might exert a limited influence on the outcomes of the physiotherapeutic management of cLBP. Pain and disability at baseline might represent important predictors of health-related quality of life at the six-month follow-up. Further studies on a larger population with a longer follow-up are required to validate these results.

The effect of acupressure on postpartum pain and comfort after cesarean delivery: a randomized controlled trial

ABSTRACT This randomized controlled study aims to investigate the effect of acupressure on pain and postpartum comfort following a cesarean section. The study was conducted with 60 women who underwent cesarean delivery. The participants were randomly assigned to either the intervention or control group. In the intervention group, acupressure was applied to the LI4, SP6, and P6 points for 15 minutes at the 2nd and 4th hours after the cesarean section. In the control group, acupressure was not applied and only routine nursing care was given. Data was collected using a personal information form, Visual Analog Scale (VAS), and Postpartum Comfort Questionnaire (PCQ). Acupressure application was applied to the intervention group at the 2nd and 4th hour after cesarean section. All data collection forms were filled out by women in the intervention group before starting acupressure application at 2 hours after cesarean section. VAS was filled out again after acupressure application at 2 hours. VAS was filled out before and after acupressure application at 4 hours after cesarean section. PSQ was filled out in both groups before discharge. In the study, the intervention group’s 2nd (3.03 ± 1.24, p < .001) and 4th (4.06 ± 1.22, p < .001) hour posttest VAS scores were lower and PCQ posttest scores (140.6 ± 9.01, p < .001) were higher than the control group. The results indicate that acupressure intervention applied to points LI4, SP6, and P6 was a useful nonpharmacological treatment for postpartum pain and comfort for the study group.

Relationship Between Obstructive Sleep Apnea and Sports—Systematic Review and Meta-Analysis

The primary objective of this research is to analyze and compare the effects of physical activity on patients diagnosed with obstructive sleep apnea (OSA), a condition characterized by repeated episodes of partial or complete obstruction of the upper airway during sleep, leading to disrupted sleep and various health complications. Methods: A systematic and strategic search of 16 peer-reviewed articles was conducted to assess the impact of different types of physical exercise on the apnea–hypopnea index (AHI), a key metric used to quantify the severity of OSA. The selected studies focused on two main exercise modalities: aerobic exercise alone and a combination of aerobic and resistance training. These modalities were examined to determine their respective influences on the AHI among individuals with OSA. Results: The findings revealed that aerobic exercise alone did not significantly alter the apnea–hypopnea index (p = 0.15), suggesting limited effectiveness in reducing the severity of OSA when performed in isolation. However, in patients who engaged in combined physical activity—incorporating both aerobic and resistance exercises—a significant reduction in the AHI was observed (p &lt; 0.01), indicating a more substantial therapeutic effect. Conclusions: This study concludes that a structured exercise program combining aerobic and resistance training produces a significant improvement in the apnea–hypopnea indices of patients with obstructive sleep apnea. These results highlight the potential of combined exercise regimens as a non-pharmacological intervention that could complement traditional OSA treatments, offering a viable approach to managing the condition and improving patient outcomes. Future research should aim to explore the optimal exercise intensity, duration, and frequency to maximize these benefits.

Effectiveness of electroacupuncture and acupuncture in alleviating cold hypersensitivity in the hands and feet: A randomized controlled trial.

Cold hypersensitivity in the hands and feet(CHHF) is a common condition that reduces the quality of life and causes daily discomfort. The current treatments are primarily pharmacological. This study aimed to expand treatment options by comparing the efficacy of electroacupuncture (EA) and acupuncture (AC) with that of no treatment (control). A three-group randomized controlled trial was conducted with 72 women diagnosed with cold hypersensitivity in the hands and feet, as confirmed by subjective symptoms and objective temperature differences. Participants were randomly assigned to the EA, AC, or control groups. Outcome measures included hand and feet visual analog scale (VAS) scores, temperature changes measured using a non-contact thermometer, and World Health Organization Quality of Life-BREF (WHOQOL-BREF) scores assessed at pretreatment (T0), posttreatment (T1), and follow-up (T2). Repeated measures ANOVA and 2-way mixed-model ANOVA were used to evaluate group, time, and interaction effects. Both the EA and AC groups showed significant improvements in hand and feet VAS and WHOQOL-BREF scores compared with those of the control group posttreatment (T1). Notably, the EA group demonstrated sustained benefits at follow-up (T2), with significant reductions in feet VAS scores and positive changes in several WHOQOL-BREF domains. Interaction effects between group and time were observed, indicating that the changes in the EA and AC groups were meaningfully different form those in the control group. The control group also exhibited a statistically significant reduction in the VAS scores at follow-up (T2), likely due to the natural variability of cold extremity symptoms and psychological factors. This study demonstrated that EA and AC are effective in alleviating the symptoms of CHHF and enhancing the quality of life compared to no treatment. EA showed long-lasting effects than those of AC, suggesting its potential to regulate the autonomic nervous system. These findings provide a foundation for expanding non-pharmacological treatment options for CHHF and offer clinical guidance on the use of EA and AC.

Impact of Non-Pharmacological Cognitive Interventions on Real-World Daily Function in Children With Cancer: A Systematic Review.

Childhood cancer survivors (CCS) frequently experience cognitive challenges, which impact their ability to participate in functional activities. This systematic review examines the effects of nonpharmacological cognitive interventions on functional outcomes (e.g., activities of daily living). We systematically searched eight databases (e.g., PubMed, EMBASE) from 2012 to 2023. Two team members independently screened articles and extracted article, intervention, sample characteristics, and outcome data. We assessed intervention reporting with the Template for Intervention Description and Replication. Fourteen studies met inclusion criteria, representing 12 unique trials. Four of the six trials evaluating Cogmed, a computerized working memory training program, demonstrated functional benefits; small to large effects were observed for academic achievement (Cohen's d = 0.28-0.87) and decreased inattention in daily life (d = -0.36 and -0.98). Other interventions included exergaming, math or reading interventions, occupational therapy, and neurofeedback. Less than half of studies reported on intervention personalization (n = 5), fidelity assessment (n = 4), or cost (n = 1). Study heterogeneity limited our ability to meta-analyze results for functional outcomes. Limited evidence and gaps in quality of intervention reporting are barriers to addressing the cognitive challenges of CCS. Standardizing functional outcome measurement, identifying effective interventions, and improving the quality of intervention reporting could accelerate the translation of intervention research to clinical practice.

Internet Use Maintains Cognitive Function among middle- and old-aged Chinese: A Five-year Longitudinal Study.

Cognitive decline poses one of the greatest global challenges for health and social care, particularly in China, where the burden on the elderly population is most pronounced. Despite the rapid expansion of internet access, there is still limited understanding of the long-term cognitive impacts of internet usage among middle-aged and elderly individuals. This study aims to explore the association between internet usage and age-related cognitive decline among middle- and old-aged Chinese. To gain a more comprehensive understanding of the effects of internet usage, we also focused on assessing the impact of both the frequency of internet use and the types of internet devices on cognition. Moreover, we assessed the mediating role of internet usage on cognitive function for characteristics significantly linked to cognition in stratified analysis. We analyzed data based on 12,770 dementia-free participants aged ≥ 45 years from the China Health and Retirement Longitudinal Study. We employed a fixed-effects model to assess the relationship between internet usage and cognitive decline, and further validated it using multiple linear regression, generalized estimating equations (GEE), propensity score matching (PSM), inverse probability of treatment weighting (IPTW), and overlap weighting (OW). We further examined the varying effects of internet device type and frequency on cognitive function using fixed-effects models and Spearman's rank correlation. The Karlson-Holm-Breen (KHB) method was used to estimate the mediating role of internet usage in the urban-rural cognitive gap. Participants using the internet (n=1,005) were younger, more likely to be male, more educated, married, retired, living in an urban area, and had higher cognitive assessment scores compared with non-users (n=11,765). After adjusting for demographic and health-related risk factors, there was a positive correlation between internet use and cognitive function (β=0.551, 95% CI 0.391 to 0.710). Over the follow-up period, persistent internet users had a markedly lower 5-year incidence of neurodegenerative diseases at 2.2% (15/671) compared with non-users at 5.3% (379/7,099; P<.001). The negative impact of aging (> 50) on cognitive function was consistently less pronounced among internet users compared to non-users. Furthermore, increased frequency of internet usage was associated with greater cognitive benefits for middle-aged and elderly individuals (rs = 0.378, P<.001). Among digital devices used for internet access, cellphones (β=0.398, 95% CI 0.283 to 0.495) seem to have a higher level of cognitive protection compared to computers (β=0.147, 95% CI 0.091 to 0.204). The urban-rural disparity in cognitive function was partially attributed to the disparity in internet use (34.2% of the total effects, P<0.001). This study reveals that the use of internet by individuals aged 45 years and older is associated with a reduced risk of cognitive decline. Internet usagehas the potential to be a viable, cost-effective, non-pharmacological intervention forcognitive decline among middle-aged and elderly individuals.

Abstract 4136561: Music therapy for postprocedural pain in patients undergoing cardiac surgery: a meta-analysis of randomized controlled trials

Background: Patients undergoing cardiac surgeries often experience significant levels of pain and anxiety, which can impair effective recovery. Music therapy has been proposed as a non-pharmacological intervention to alleviate these symptoms. This meta-analysis aimed to evaluate the effectiveness of music therapy in patients undergoing cardiac surgeries. Methods: We systematically searched PubMed, Embase, and Cochrane databases for randomized controlled trials (RCTs) analyzing music therapy in patients undergoing cardiac surgeries. We pooled mean differences (MD), and standardized mean differences (SMD) for continuous outcomes with 95% confidence intervals (CI) with a random-effects model. We performed a trial sequential analysis (TSA) to assess the random risk of pain, and conducted a subgroup analysis to compare heart and respiratory rate between children and adults. We used R version 4.3.2 and TSA version 0.9.5.10 for statistical analyses. Results: Our meta-analysis included 20 RCTs comprising 1379 patients, of whom 715 (51.9%) were randomized to music therapy. Compared with control, music significantly reduced postoperative pain (SMD -0.59; 95% CI: -0.76 to -0.41; p&lt;0.05; Figure A), and anxiety (SMD -0.59; 95% CI: -0.74 to -0.44; p&lt;0.05; Figure B). There was a significant difference between groups in heart rate (MD -5.68 bpm; 95% CI: -9.73 to -1.63; p&lt;0.05), overall there was an important subgroup interaction between children and adults (p=0.01). In children, music therapy reduced the respiratory rate (MD -5.98 ipm; 95% CI: -6.71 to -5.25) compared to control, whereas in adults, no significant differences were observed among these groups, overall, there was a significant subgroup interaction (p&lt;0.01). For the primary endpoint, TSA suggested a low risk of type 1 error, therefore these results may be conclusive. Conclusion: In patients undergoing cardiac surgery, music therapy reduced postoperative pain, anxiety, heart rate, and respiratory rate.

Effects of Non-Pharmacological Interventions on the Swallowing Function of Patients With Post-Stroke Dysphagia: A Systematic Review and Network Meta-Analysis.

Post-stroke dysphagia can lead to serious complications and appropriate rehabilitation can significantly improve swallowing function. However, the best rehabilitation method for post-stroke dysphagia patients is not clear at the present stage, so it is necessary to conduct a comprehensive network meta-analysis and systematic review of different interventions for dysphagia. To compare the effectiveness and ranking of different interventions for improving swallowing function, and feeding and daily function in patients with post-stroke dysphagia. Seven databases were searched from the date of inception to September 1, 2022. Two investigators independently conducted literature searches, selected randomized controlled trials on dysphagia interventions, and assessed study quality. Network meta-analysis was conducted by using Stata software. A total of 33 studies involving 1,341 patients were included. According to the ranking probabilities, acupuncture was rated as the most effective of all interventions to enhance patients' swallowing function (surface under cumulative ranking curve values [SUCRCV]: 99.0%, standardized mean difference [SMD]: -2.40, 95% confidence interval [CI]: -3.38 to -1.43), followed by the chin tuck against resistance exercise (CTAR, SUCRA: 89.9%, SMD: -1.83, 95% CI: -2.69 to -0.97). Among all the interventions, acupuncture was the most effective for feeding and daily function (SUCRCV: 88.4%, SMD: -1.62, 95% CI: -2.94 to -0.30). The results showed that acupuncture was the most effective in the rehabilitation of patients with post-stroke dysphagia, followed by CTAR. Considering that CTAR is a low-cost and highly feasible intervention, we suggest that CTAR should be selected as a rehabilitation measure for patients with post-stroke dysphagia to improve their swallowing function.

Primary Osteoporosis Induced by Androgen and Estrogen Deficiency: The Molecular and Cellular Perspective on Pathophysiological Mechanisms and Treatments

Primary osteoporosis is closely linked to hormone deficiency, which disrupts the balance of bone remodeling. It affects postmenopausal women but also significantly impacts older men. Estrogen can promote the production of osteoprotegerin, a decoy receptor for RANKL, thereby preventing RANKL from activating osteoclasts. Furthermore, estrogen promotes osteoblast survival and function via activation of the Wnt signaling pathway. Likewise, androgens play a critical role in bone metabolism, primarily through their conversion to estrogen in men. Estrogen deficiency accelerates bone resorption through a rise in pro-inflammatory cytokines (IL-1, IL-6, TNF-α) and RANKL, which promote osteoclastogenesis. In the classic genomic pathway, estrogen binds to estrogen receptors in the cytoplasm, forming a complex that migrates to the nucleus and binds to estrogen response elements on DNA, regulating gene transcription. Androgens can be defined as high-affinity ligands for the androgen receptor; their combination can serve as a ligand-inducible transcription factor. Hormone replacement therapy has shown promise but comes with associated risks and side effects. In contrast, the non-genomic pathway involves rapid signaling cascades initiated at the cell membrane, influencing cellular functions without directly altering gene expression. Therefore, the ligand-independent actions and rapid signaling pathways of estrogen and androgen receptors can be harnessed to develop new drugs that provide bone protection without the side effects of traditional hormone therapies. To manage primary osteoporosis, other pharmacological treatments (bisphosphonates, teriparatide, RANKL inhibitors, sclerostin inhibitors, SERMs, and calcitonin salmon) can ameliorate osteoporosis and improve BMD via actions on different pathways. Non-pharmacological treatments include nutritional support and exercise, as well as the dietary intake of antioxidants and natural products. The current study reviews the processes of bone remodeling, hormone actions, hormone receptor status, and therapeutic targets of primary osteoporosis. However, many detailed cellular and molecular mechanisms underlying primary osteoporosis seem complicated and unexplored and warrant further investigation.

Study to Evaluate the Comparative Efficacy of Medhya Rasayana (Pharmacological) Versus Nonpharmacological Interventions in Management of Gadget Addiction in Children: Protocol for Parallel, Triple-Arm, Randomized Clinical Trial.

Gadget addiction is a common behavioral problem among children. It is known to hamper social and academic life as well as adversely affect the lives of children. Ayurveda offers many therapeutic modalities and Ayurvedic medicines that can be used in the management of gadget addiction in children. The purpose of this study is to evaluate and compare the effectiveness of nonpharmacological therapies and the pharmaceutical intervention Medhya Rasayana in treating childhood gadget addiction. This study aims to provide a detailed description of the study methodology that will be used to compare the efficacy of nonpharmacological versus pharmaceutical interventions in the treatment of children's gadget addiction. A randomized, parallel, triple-arm interventional study will be conducted on diagnosed participants of gadget addiction with an age group of 6- to 16-year-old children, which will be selected and equally distributed in 2 groups. Group P will be given Medhya Rasayana (pharmacological intervention), group N will be nonpharmacological Ayurveda intervention, and group C (cognitive behavioral therapy) will be an external group. The Study duration is 180 days with assessment at baseline, midpoint, and endpoint Appropriate statistical techniques, such as ANOVA and regression analysis, will be used to examine the data and evaluate the efficacy of the 3 groups' interventions. We will perform subgroup analysis according to initial addiction severity, gender, and age. Primary outcome measures include a reduction in gadget addiction and changes in the psychosocial well-being of participants. Standardized questionnaires and instruments will be used to collect data. In December 2023, the randomized controlled study got underway. Since participants may begin at any time, our goal is for everyone to be finished by December 2024. This research will provide crucial new information about the relative effectiveness of Ayurveda nonpharmacological therapies and Medhya Rasayana in treating children's gadget addiction. The results will guide evidence-based treatments aimed at reducing the negative impact of excessive gadget use on this susceptible population's psychosocial development. In the end, the findings are meant to help policy makers and medical professionals create sensible plans to deal with the rising issue of childhood gadget addiction. PRR1-10.2196/51833.

Effects of TABATA Exercise Volume and Royal Jelly Supplementation on NLRP3 Inflammasome and lncRNA-H19 Expression in Obese Men

Background: Both coding and long non-coding RNAs (lncRNAs) have emerged as vital regulators in almost every cellular process, and their expression can be modulated by external stimuli, such as physical exercise. Objectives: The current research aimed to investigate the effects of different volumes of TABATA-high-intensity interval training (HIIT) exercises combined with royal jelly (RJ) supplementation on the NLRP3 inflammasome and lncRNA-H19 expression in obese males. Methods: Forty-two healthy men [Body Mass Index (BMI) = 30 kg/m², waist-to-hip ratio = 0.95, age range: 40 - 60 years] volunteered to participate in the study. The individuals were randomly divided into five experimental groups (N = 35) and one control + placebo group (N = 7). The high-volume (HV) or low-volume (LV) TABATA exercise programs were performed twice a week for 8 weeks. Participants in the RJ supplementation groups received a 1000 mg capsule once a day for 8 weeks. The expression of NLRP3 and lncRNA-H19 genes was evaluated using the real-time PCR method. Results: The NLRP3 gene expression in the Bruce test, measured before and after the 8-week exercise interventions and RJ supplementation, showed insignificant changes across the different groups. However, the H19 gene expression in the Bruce test showed a significant reduction in the HV-TABATA HIIT intervention groups, which was more pronounced than in the LV groups after 8 weeks: HV group (P = 0.004), RJ group (P = 0.001), HV + RJ group (P = 0.007), and LV + RJ group (P = 0.002). After 8 weeks of non-pharmacological interventions involving exercise training and supplementation, a significant decrease in NLRP3 and a significant increase in H19 gene expression were detected in the HV group compared to the LV group (P = 0.05 and P = 0.010). Significant improvement was also found in the resting H19 levels between the RJ and LV groups (P = 0.011) and the LV + RJ group (P = 0.44). Moreover, a significant reduction in resting NLRP3 gene expression was observed between the RJ + LV and LV groups (P = 0.038). Conclusions: Chronic HV TABATA HIIT exercise, when combined with RJ supplementation, is effective in attenuating inflammatory responses to acute stress.

Multisensory stimulation to reduce procedural pain in retinopathy of prematurity: A randomized controlled trial.

Retinopathy is frequently seen in the neonatal intensive care unit (NICU), and its examination is a painful procedure for infants. This randomized active-controlled trial aimed to investigate the impact of multisensory stimulation (MSS) on neonatal pain during retinopathy of prematurity (ROP) examinations, in comparison with a white noise (WN) and control group receiving standard care. Conducted as a three-arm, randomized controlled trial, the study was implemented in the NICU of a local university hospital. Recruitment spanned from July 2023 to November 2023, with preterm infants (gestational age < 37 weeks) randomly assigned to either a MSS, WN or a control group. MSS components included visual, auditory, tactile, olfactory and gustatory stimuli, all designed to create a synergistic, comforting environment for the infant during the procedure. Procedural pain, heart rate and oxygen saturation were assessed at various stages before and after ROP examinations. Analysis of 90 participants revealed that the MSS group exhibited lower Premature Infant Pain Profile (PIPP) scores than the WN and control groups (mean difference: -2.12, 95% confidence interval [CI]: -2.62 to -1.62; odds ratio [OR]: 0.004, 95% CI [0.001, 0.012], p < 0.001). Additionally, heart rates were significantly lower in the MSS group (mean difference: -15.3 beats/min, 95% CI: -20.5 to -10.1; OR: 0.025, 95% CI [0.008, 0.073], p < .001) and oxygen saturation levels were higher (mean difference: 3.2%, 95% CI: 1.8% to 4.6%; OR: 1.12, 95% CI [1.05, 1.20], p < .001) than in the other groups. MSS emerges as a favourable, safe and non-pharmacological intervention for pain management in ROP and similar procedures. Multisensory stimulation can be effectively integrated into the routine care provided by critical care nurses during retinopathy of prematurity examinations in preterm infants. This non-pharmacological intervention offers a practical approach for critical care nurses to reduce procedural pain and improve physiological stability in this vulnerable population.