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Brain Sciences Nov 2023Anxiety and stress plague populations worldwide. Voluntary regulated breathing practices offer a tool to address this epidemic. We examined peer-reviewed published... (Review)
Review
Anxiety and stress plague populations worldwide. Voluntary regulated breathing practices offer a tool to address this epidemic. We examined peer-reviewed published literature to understand effective approaches to and implementation of these practices. PubMed and ScienceDirect were searched to identify clinical trials evaluating isolated breathing-based interventions with psychometric stress/anxiety outcomes. Two independent reviewers conducted all screening and data extraction. Of 2904 unique articles, 731 abstracts, and 181 full texts screened, 58 met the inclusion criteria. Fifty-four of the studies' 72 interventions were effective. Components of effective and ineffective interventions were evaluated to develop a conceptual framework of factors associated with stress/anxiety reduction effectiveness. Effective breath practices avoided fast-only breath paces and sessions <5 min, while including human-guided training, multiple sessions, and long-term practice. Population, other breath paces, session duration ≥5 min, and group versus individual or at-home practices were not associated with effectiveness. Analysis of interventions that did not fit this framework revealed that extensive standing, interruptions, involuntary diaphragmatic obstruction, and inadequate training for highly technical practices may render otherwise promising interventions ineffective. Following this evidence-based framework can help maximize the stress/anxiety reduction benefits of breathing practices. Future research is warranted to further refine this easily accessible intervention for stress/anxiety relief.
PubMed: 38137060
DOI: 10.3390/brainsci13121612 -
Therapeutic Advances in Drug Safety 2021Inappropriate medication prescription is highly prevalent in older adults and is associated with adverse health outcomes. The aim of this study was to examine the... (Review)
Review
BACKGROUND AND AIMS
Inappropriate medication prescription is highly prevalent in older adults and is associated with adverse health outcomes. The aim of this study was to examine the associations between potentially inappropriate medications (PIMS) and potential prescribing omissions with physical function in older adults situated in diverse environments.
METHODS
A systematic search was completed using the following databases: MEDLINE, CINAHL, PsycINFO, EMBASE and COCHRANE. Results were extracted from the included studies.
RESULTS
In total, 55 studies reported on 2,767,594 participants with a mean age of 77.1 years (63.5% women). Study designs comprised 26 retrospective cohort studies, 21 prospective cohort studies and 8 cross-sectional studies. Inappropriate medications in community and hospital settings were significantly associated with higher risk of falls (21 out of 30 studies), higher risk of fractures (7 out of 9 studies), impaired activities of daily living (ADL; 8 out of 10 studies) and impaired instrumental ADL (IADL) score (4 out of 6 studies). Five out of seven studies also showed that PIMs were associated with poorer physical performance comprising the Timed Up and Go test, walking speed, grip strength, time to functional recovery, functional independence and scale of functioning. Many medication classes were implicated as PIMs in falls, fractures and impairment in physical performance including antipsychotic, sedative, anti-anxiety, anticholinergic, antidiabetic, opioid and antihypertensive medications. For patients not receiving musculoskeletal medications, such as calcium, vitamin D and bisphosphonates, older adults were found to be at risk of a hospital admission for a fall or fracture.
CONCLUSION
Inappropriate medication prescriptions are associated with impaired physical function across longitudinal and cross-sectional studies in older adults situated in diverse settings. It is important to support older people to reduce their use of inappropriate medications and prevent prescribing omissions.
PLAIN LANGUAGE SUMMARY
The use of inappropriate medications is very common in older adults and is associated with harmful health problems. The aim was to examine associations between potentially inappropriate medications and potential prescribing omissions with physical function in older adults situated in diverse environments. Library databases were examined for possible studies to include and a systematic search was completed. Relevant information was obtained from the included studies. In total, 55 studies reported on 2,767,594 participants who were an average age of 77.1 years and about 6 out of 10 were women. A variety of different study designs were used. Inappropriate medication prescriptions in community and hospital settings were significantly associated with higher risk of falls (21 out of 30 studies), higher risk of fractures (7 out of 9 studies), problems with activities of daily living (ADL), such as eating, bathing, dressing, grooming, walking and toileting (8 out of 10 studies) and problems with instrumental ADL such as managing medications, house cleaning and shopping (4 out of 6 studies). Five out of seven studies also showed that inappropriate medications were associated with poorer physical performance involving the Timed Up and Go test, walking speed, grip strength, time to functional recovery, functional independence and scale of functioning. Many types of medication classes were shown to be associated with a risk of falls, fractures and problems with physical performance. Omitted medications were also associated with falls and fractures. Inappropriate medication prescriptions are associated with problems relating to physical function. It is important to support older people to reduce their use of inappropriate medications and prevent prescribing omissions.
PubMed: 34349978
DOI: 10.1177/20420986211030371 -
The Primary Care Companion For CNS... Jun 2023Internet addiction disorder (IAD) is associated with psychological, physical, and social problems, including impaired academic performance. The objective of this review...
Internet addiction disorder (IAD) is associated with psychological, physical, and social problems, including impaired academic performance. The objective of this review was to investigate the relationship between IAD and psychiatric disorders in medical students. A search of PubMed, LILACS (Latin American and Caribbean Health Sciences Literature), Scopus, Cochrane Library, Web of Science, and Science Direct was performed using the following keywords: OR OR OR OR AND AND OR OR OR OR AND . Articles were selected and extracted from the online databases. Articles were included if they were available in English, French, Spanish, and Portuguese; addressed IAD and psychiatric disorders; contained original data; and provided sufficient data for the calculation of effect sizes. Included articles were published between March 2012 and March 2022. The correlations between internet addiction and depression, anxiety, stress, and sleep disorders were estimated using R software and the dmetar package with meta-analytic procedures. A total of 2,226 studies were identified, including 23 studies (21,582) that were eligible for inclusion in this systematic review. All articles were about medical students. There was a small positive correlation between IAD and sleep disorders ( = .0515). There was a moderate correlation between anxiety ( = .022), depression ( = .0002), and stress ( = .0322) and IAD. IAD is comorbid with psychiatric diseases, and this correlation was observed in this review. We suggest early identification and management of IAD, as it results in unfavorable mental health outcomes and impacts the work performance of medical students and physicians. .
Topics: Humans; Internet Addiction Disorder; Students, Medical; Mental Disorders; Anxiety; Sleep Wake Disorders
PubMed: 37310317
DOI: 10.4088/PCC.22r03384 -
Clinical Child and Family Psychology... Dec 2022A substantial empirical base supports the use of psychotherapy to alleviate anxiety symptoms and diagnoses in children and adolescents. However, focusing only on symptom... (Meta-Analysis)
Meta-Analysis Review
A substantial empirical base supports the use of psychotherapy to alleviate anxiety symptoms and diagnoses in children and adolescents. However, focusing only on symptom or diagnostic reduction provides an incomplete picture of clinically meaningful efficacy given that anxiety disorders in this age group are integrally associated with problems in functioning. A systematic review and meta-analysis (N studies = 40, N participants = 3094) evaluating the impacts of psychotherapy for anxiety was conducted on the following outcomes: global functioning, social functioning, academic functioning, and school attendance. Randomised controlled trials with a passive control condition, a child and/or adolescent sample (7-17 years) with a primary anxiety diagnosis, and receiving anxiety-focused psychotherapy were eligible for inclusion if they reported suitable outcome data. Results from the meta-analysis indicated that from pre- to post-treatment, psychotherapy led to significant improvements in global functioning according to clinician (d = 1.55), parent (d = 0.67), and child (d = 0.31) reports and on social functioning according to parent (d = 0.51), but not child (d = 0.31) reports. The qualitative review provided preliminary support psychotherapy's efficacy in increasing family functioning and school attendance, but not so much in enhancing academic performance. These results indicate that psychotherapy improves daily functioning in anxious children and adolescents. The study also highlighted the limited attention paid to measures of functioning in the empirical literature on treatment of childhood anxiety.Trial Registry: This study is registered with PROSPERO under the identification number CRD42021246565.
Topics: Adolescent; Humans; Child; Psychotherapy; Anxiety Disorders; Anxiety; Parents; Child Behavior Disorders
PubMed: 35794304
DOI: 10.1007/s10567-022-00402-7 -
EClinicalMedicine Mar 2023Communication is the foundation of a strong doctor-patient relationship. Holistic care of the patient involves good communication and empathy. There are various tools...
BACKGROUND
Communication is the foundation of a strong doctor-patient relationship. Holistic care of the patient involves good communication and empathy. There are various tools and interventions aimed at increasing the Surgeon's performance, but these have the drawback of heavy cost and time commitments. In contrast, patient focused interventions are often simple and cheap. In surgery this is an evolving field, and little is known about the impact these interventions have on clinical encounters. The aim of this review is to determine how patient focussed interventions impact communication in the Surgical Outpatient Consultation.
METHODS
In this systematic review and meta-analysis, two reviewers independently searched MEDLINE (incl. PubMed), EMBASE, EMCARE, CINAHL, and the Cochrane Library for the period starting 01 February 1990 to 01 February 2022. Filtration and screening was performed in accordance with PRISMA guidelines. Conflicts were resolved by discussion. Risk of Bias was assessed using the RoB 2 tool. Meta-analyses were conducted by an independent statistician using Stata Statistical Software. This systematic review was prospectively registered with PROSPERO (ID CRD42022311112).
FINDINGS
After screening, 38 papers were included in the final analysis. These involved 6392 patients consisting of 32 randomised controlled trials (RCT), one crossover RCT, three non-randomised experimental studies, and three cohort studies. All articles were published between 1999 and 2022. Four types of intervention were identified: Patient Decision Aids, Educational Materials, Question Prompt Lists and Patient Reported Outcome Measures. There was much heterogeneity in the reported results but ultimately four recurring domains for assessing quality of communication were identified: Patient knowledge; decisional conflict; satisfaction; and anxiety. Meta-analyses showed that patient focussed interventions increased patient knowledge and reduced decisional conflict. Meta-regression demonstrated significant knowledge increases in females compared with males. Results regarding satisfaction and anxiety were not statistically significant.
INTERPRETATION
Our study suggested that patient focused interventions demonstrate promising results for increasing patient engagement and improving communication. Further multicentre randomised controlled trials with consistent validated endpoints should be conducted to evaluate this evolving field.
FUNDING
There was no funding source for this study.
PubMed: 36942159
DOI: 10.1016/j.eclinm.2023.101893 -
Frontiers in Robotics and AI 2022The degree of successful human-robot collaboration is dependent on the joint consideration of robot factors (RF) and human factors (HF). Depending on the state of the... (Review)
Review
The degree of successful human-robot collaboration is dependent on the joint consideration of robot factors (RF) and human factors (HF). Depending on the state of the operator, a change in a robot factor, such as the behavior or level of autonomy, can be perceived differently and affect how the operator chooses to interact with and utilize the robot. This interaction can affect system performance and safety in dynamic ways. The theory of human factors in human-automation interaction has long been studied; however, the formal investigation of these HFs in shared space human-robot collaboration (HRC) and the potential interactive effects between covariate HFs (HF-HF) and HF-RF in shared space collaborative robotics requires additional investigation. Furthermore, methodological applications to measure or manipulate these factors can provide insights into contextual effects and potential for improved measurement techniques. As such, a systematic literature review was performed to evaluate the most frequently addressed operator HF states in shared space HRC, the methods used to quantify these states, and the implications of the states on HRC. The three most frequently measured states are: trust, cognitive workload, and anxiety, with subjective questionnaires universally the most common method to quantify operator states, excluding fatigue where electromyography is more common. Furthermore, the majority of included studies evaluate the effect of manipulating RFs on HFs, but few explain the effect of the HFs on system attributes or performance. For those that provided this information, HFs have been shown to impact system efficiency and response time, collaborative performance and quality of work, and operator utilization strategy.
PubMed: 35187093
DOI: 10.3389/frobt.2022.799522 -
Frontiers in Psychiatry 2023Social cognition impairments may be associated with poor functional outcomes, symptoms, and disability in social anxiety disorder (SAD) and generalized anxiety disorder... (Review)
Review
Social cognition impairments may be associated with poor functional outcomes, symptoms, and disability in social anxiety disorder (SAD) and generalized anxiety disorder (GAD). This meta-analysis aims to determine if emotion recognition and theory of mind (ToM) are impaired in SAD or GAD compared to healthy controls. A systematic review was conducted in electronic databases (PubMed, PsycNet, and Web of Science) to retrieve studies assessing emotion recognition and/or ToM in patients with SAD or GAD, compared to healthy controls, up to March 2022. Meta-analyses using random-effects models were conducted. We identified 21 eligible studies: 13 reported emotion recognition and 10 ToM outcomes, with 585 SAD patients, 178 GAD patients, and 753 controls. Compared to controls, patients with SAD exhibited impairments in emotion recognition (SMD = -0.32, CI = -0.47 - -0.16, = -3.97, < 0.0001) and ToM (SMD = -0.44, CI = -0.83 -0.04, = -2.18, < 0.01). Results for GAD were inconclusive due to the limited number of studies meeting the inclusion criteria (two for each domain). Relevant demographic and clinical variables (age, sex, education level, and anxiety scores) were not significantly correlated with emotion recognition or ToM impairments in SAD and GAD. Further studies employing ecological measures with larger and homogenous samples are needed to better delineate the factors influencing social cognition outcomes in both SAD and GAD.
PubMed: 37275989
DOI: 10.3389/fpsyt.2023.1192683 -
The Cochrane Database of Systematic... Apr 2021Bronchiectasis is characterised by excessive sputum production, chronic cough, and acute exacerbations and is associated with symptoms of dyspnoea and fatigue, which... (Meta-Analysis)
Meta-Analysis
BACKGROUND
Bronchiectasis is characterised by excessive sputum production, chronic cough, and acute exacerbations and is associated with symptoms of dyspnoea and fatigue, which reduce exercise tolerance and impair quality of life. Exercise training in isolation or in conjunction with other interventions is beneficial for people with other respiratory diseases, but its effects in bronchiectasis have not been well established.
OBJECTIVES
To determine effects of exercise training compared to usual care on exercise tolerance (primary outcome), quality of life (primary outcome), incidence of acute exacerbation and hospitalisation, respiratory and mental health symptoms, physical function, mortality, and adverse events in people with stable or acute exacerbation of bronchiectasis.
SEARCH METHODS
We identified trials from the Cochrane Airways Specialised Register, ClinicalTrials.gov, and the World Health Organization trials portal, from their inception to October 2020. We reviewed respiratory conference abstracts and reference lists of all primary studies and review articles for additional references.
SELECTION CRITERIA
We included randomised controlled trials in which exercise training of at least four weeks' duration (or eight sessions) was compared to usual care for people with stable bronchiectasis or experiencing an acute exacerbation. Co-interventions with exercise training including education, respiratory muscle training, and airway clearance therapy were permitted if also applied as part of usual care.
DATA COLLECTION AND ANALYSIS
Two review authors independently screened and selected trials for inclusion, extracted outcome data, and assessed risk of bias. We contacted study authors for missing data. We calculated mean differences (MDs) using a random-effects model. We used the GRADE approach to assess the certainty of evidence.
MAIN RESULTS
We included six studies, two of which were published as abstracts, with a total of 275 participants. Five studies were undertaken with people with clinically stable bronchiectasis, and one pilot study was undertaken post acute exacerbation. All studies included co-interventions such as instructions for airway clearance therapy and/or breathing strategies, provision of an educational booklet, and delivery of educational sessions. The duration of training ranged from six to eight weeks, with a mix of supervised and unsupervised sessions conducted in the outpatient or home setting. No studies of children were included in the review; however we identified two studies as currently ongoing. No data were available regarding physical activity levels or adverse events. For people with stable bronchiectasis, evidence suggests that exercise training compared to usual care improves functional exercise tolerance as measured by the incremental shuttle walk distance, with a mean difference (MD) between groups of 87 metres (95% confidence interval (CI) 43 to 132 metres; 4 studies, 161 participants; low-certainty evidence). Evidence also suggests that exercise training improves six-minute walk distance (6MWD) (MD between groups of 42 metres, 95% CI 22 to 62; 1 study, 76 participants; low-certainty evidence). The magnitude of these observed mean changes appears clinically relevant as they exceed minimal clinically important difference (MCID) thresholds for people with chronic lung disease. Evidence suggests that quality of life improves following exercise training according to St George's Respiratory Questionnaire (SGRQ) total score (MD -9.62 points, 95% CI -15.67 to -3.56 points; 3 studies, 160 participants; low-certainty evidence), which exceeds the MCID of 4 points for this outcome. A reduction in dyspnoea (MD 1.0 points, 95% CI 0.47 to 1.53; 1 study, 76 participants) and fatigue (MD 1.51 points, 95% CI 0.80 to 2.22 points; 1 study, 76 participants) was observed following exercise training according to these domains of the Chronic Respiratory Disease Questionnaire. However, there was no change in cough-related quality of life as measured by the Leicester Cough Questionnaire (LCQ) (MD -0.09 points, 95% CI -0.98 to 0.80 points; 2 studies, 103 participants; moderate-certainty evidence), nor in anxiety or depression. Two studies reported longer-term outcomes up to 12 months after intervention completion; however exercise training did not appear to improve exercise capacity or quality of life more than usual care. Exercise training reduced the number of acute exacerbations of bronchiectasis over 12 months in people with stable bronchiectasis (odds ratio 0.26, 95% CI 0.08 to 0.81; 1 study, 55 participants). After an acute exacerbation of bronchiectasis, data from a single study (N = 27) suggest that exercise training compared to usual care confers little to no effect on exercise capacity (MD 11 metres, 95% CI -27 to 49 metres; low-certainty evidence), SGRQ total score (MD 6.34 points, 95%CI -17.08 to 29.76 points), or LCQ score (MD -0.08 points, 95% CI -0.94 to 0.78 points; low-certainty evidence) and does not reduce the time to first exacerbation (hazard ratio 0.83, 95% CI 0.31 to 2.22).
AUTHORS' CONCLUSIONS
This review provides low-certainty evidence suggesting improvement in functional exercise capacity and quality of life immediately following exercise training in people with stable bronchiectasis; however the effects of exercise training on cough-related quality of life and psychological symptoms appear to be minimal. Due to inadequate reporting of methods, small study numbers, and variation between study findings, evidence is of very low to moderate certainty. Limited evidence is available to show longer-term effects of exercise training on these outcomes.
Topics: Adult; Bias; Breathing Exercises; Bronchiectasis; Cough; Disease Progression; Dyspnea; Exercise; Exercise Tolerance; Hospitalization; Humans; Mental Health; Physical Endurance; Physical Functional Performance; Quality of Life; Respiration Disorders; Walk Test
PubMed: 33822364
DOI: 10.1002/14651858.CD013110.pub2 -
Upsala Journal of Medical Sciences 2023Social anxiety is common and can have far-reaching implications for affected individuals, both on social life and working performance. Usage of virtual reality exposure... (Meta-Analysis)
Meta-Analysis Review
INTRODUCTION
Social anxiety is common and can have far-reaching implications for affected individuals, both on social life and working performance. Usage of virtual reality exposure therapy (VRET) has gained traction. The aim of the present systematic review was to evaluate the effect of stand-alone VRET on social anxiety symptoms.
METHOD
We searched systematically in , , , and in May 2022 for studies with participants with social anxiety symptoms receiving stand-alone VRET. Two reviewers independently selected relevant studies in a two-step procedure, and the risk of bias was assessed.
RESULTS
Of 158 hits, 7 studies were selected for full-text reading, 6 were chosen for evaluation, and 5 were included in meta-analyses. VRET resulted in a significantly lower anxiety score in treated individuals with a standard mean difference of -0.82, 95% confidence interval -1.52 to -0.13, compared to controls.
CONCLUSION
Stand-alone VRET may reduce social anxiety symptoms. However, despite promising results, there is still uncertainty as the effect estimate is based on few studies with few participants each and a high risk of bias.
Topics: Humans; Virtual Reality Exposure Therapy; Anxiety
PubMed: 37807998
DOI: 10.48101/ujms.v128.9289 -
Frontiers in Public Health 2023The body of evidence supporting the beneficial effects of Tai Chi in reducing anxiety and depressive symptoms in older adults is steadily increasing. Nonetheless, there... (Meta-Analysis)
Meta-Analysis
BACKGROUND
The body of evidence supporting the beneficial effects of Tai Chi in reducing anxiety and depressive symptoms in older adults is steadily increasing. Nonetheless, there remains a scarcity of studies directly comparing the clinical effectiveness of various Tai Chi exercises in addressing anxiety and depressive symptoms in older adults. Thus, this study aimed to systematically review and analyze the therapeutic efficacy of four types of Tai Chi interventions in enhancing anxiety and depressive symptoms in older adults.
METHODS
During the period up to July 26, 2023, searches were conducted in the Web of Science, PubMed, the Cochrane Library, CNKI, and the Chinese Scientific Journal Database (VIP). The language scope encompassed both English and Chinese. Two independent reviewers conducted the literature review and data extraction. Review Manager 5.4 was employed for traditional meta-analysis and risk assessment, while version 15 of STATA software was used for generating evidence and funnel plots for network meta-analysis. This study was registered in PROSPERO number CRD 42023442270.
RESULT
In this analysis, a total of 20 studies were included, involving 1798 participants. The findings of the pairwise meta-analysis revealed that Tai Chi intervention was more effective than the control group in reducing anxiety (SMD: -1.19, 95% CI: -2.04, -0.34, < 0.05) and depression (SMD: -0.65, 95% CI: -0.95, -0.65, < 0.05) symptoms among older adults. The network meta-analysis specifically focused on anxiety symptoms and found that Yang-style Tai Chi (69.9%) had the most favorable outcome, followed by the 24-form Simplified Tai Chi (66.8%). In terms of depression symptoms, the Tai Chi Exercise Program (92.6%) had the highest performance, followed by Yang-style Tai Chi (77.9%).
CONCLUSION
The findings of this study imply that Tai Chi can have beneficial outcomes in the reduction of anxiety and depressive symptoms among older individuals. Specifically, when examining various forms of Tai Chi interventions, it was observed that Yang-style Tai Chi exhibited a greater efficacy in alleviating anxiety symptoms, whereas Tai Chi exercise programs demonstrated a higher effectiveness in improving depressive symptoms. Nonetheless, it is strongly advised that older adults select an exercise program that aligns with their interests and preferences, as this can enhance social integration and overall well-being.
SYSTEMATIC REVIEW REGISTRATION
https://www.crd.york.ac.uk/prospero/display_record.php?ID=CRD42023442270, identifier [CRD42023442270].
Topics: Humans; Aged; Network Meta-Analysis; Depression; Tai Ji; Anxiety; Anxiety Disorders
PubMed: 38259770
DOI: 10.3389/fpubh.2023.1295342