The Role of Mindfulness Approaches in Integrative Medicine

Moradi S., Keshavarzi A., Tabatabaee S.-.

Stress hyperglycemia is a transient increase in blood glucose during an acute physiological stress in the absence of diabetes. Stress hyperglycemia can be occurred in certain clinical conditions such as trauma, burns, sepsis and strokes in adults. In this study we aimed to evaluate the incidence of stress hyperglycemia among patients admitted to the Firouzgar hospital.In this analytical cross sectional study, all patients who referred to emergency department of Firouzgar hospital due to one of the causes of trauma, myocardial infarction (MI), subarachnoid hemorrhage (SAH), head trauma, sepsis, CVA, and abdominal surgery and had stress hyperglycemia during 2012-2014 were evaluated. Blood glucose test including random blood sugar (BS) and glycosylated hemoglobin (HbA1C) was performed for patients at admission. Patients with BS>180 mgmg/dl and no previous history of diabetes were enrolled in this study. Patients were referred to endocrinology clinic after 3 months of the first test and were re-evaluated for diabetes mellitus. Fasting Blood Sugar (FBS), HbA1C and 2 h post glucose load test blood sugar were measured. Diabetes was confirmed if FBS was above 126 mg/dl or 2 h post glucose load BS was over 200 mg/dl.A total of 98 (67 males & 31 women) patients enrolled in the study. No significant statistical relation found between mean of HBA1C at 3 months after admission and the background event (P=0.138). No statistical relation found between BMI and developing diabetes (P=0.352). 26 and 8 percent of the participants developed diabetes, and 25.8% were in pre-diabetic state. There was a statistical relation between gender and developing diabetes (P=0.027) and men developed diabetes more than women. Based on logistic regression the Odds Ratio (OR) was 1.017.Our study demonstrates a significant relationship between stress hyperglycemia and development of diabetes. Stress hyperglycemia could be a predicting factor of development of diabetes.

Demarzo M.M., Montero-Marin J., Cuijpers P., Zabaleta-del-Olmo E., Mahtani K.R., Vellinga A., Vicens C., Lopez-del-Hoyo Y., Garcia-Campayo J.

Siddiqui A., Madhu S.V., Sharma S.B., Desai N.G.

This study was carried to ascertain whether stress responses are associated with abnormalities in glucose tolerance, insulin sensitivity and pancreatic beta cell function and risk of type 2 Diabetes Mellitus. Salivary cortisol, a marker of hypothalamic-pituitary-adrenal (HPA) axis and salivary α-amylase, a marker of sympathetic nervous system (SNS) were compared in 125 subjects of newly detected diabetes mellitus (NDDM) and normal glucose tolerance (NGT) subjects who were diagnosed on the basis of oral glucose tolerance test (OGTT). Assessment of stress in them was done through stress scales - presumptive stressful life events scale (PSLES), perceived stress scale (PSS) and sense of coherence (SOC) and correlated with these and other stress response markers. Significantly higher 10 pm salivary cortisol and post dexamethasone salivary cortisol were found in NDDM subjects as compared to NGT. 10 pm salivary cortisol correlated significantly with fasting plasma glucose (FPG), 2 h plasma glucose (2h PG) and glycated hemoglobin (HbA1c) while post dex salivary cortisol correlated with 2h PG, HbA1c and salivary α-amylase with 2h PG. Stepwise logistic regression analysis showed that body mass index (OR: 1.840), SOC (OR: 0.688) and 10 pm salivary cortisol (OR: 1.427) were the strongest predictors of NDDM. The results of the present study indicate that NDDM subjects display significantly higher chronic stress and stress responses when compared to subjects with NGT. Chronic stress and endocrine stress responses are significantly associated with glucose intolerance, insulin resistance and diabetes mellitus.

Hill P.L., Turiano N.A.

Having a purpose in life has been cited consistently as an indicator of healthy aging for several reasons, including its potential for reducing mortality risk. In the current study, we sought to extend previous findings by examining whether purpose in life promotes longevity across the adult years, using data from the longitudinal Midlife in the United States (MIDUS) sample. Proportional-hazards models demonstrated that purposeful individuals lived longer than their counterparts did during the 14 years after the baseline assessment, even when controlling for other markers of psychological and affective well-being. Moreover, these longevity benefits did not appear to be conditional on the participants’ age, how long they lived during the follow-up period, or whether they had retired from the workforce. In other words, having a purpose in life appears to widely buffer against mortality risk across the adult years.

McGrady A., Moss D.

Ekman I., Swedberg K., Taft C., Lindseth A., Norberg A., Brink E., Carlsson J., Dahlin-Ivanoff S., Johansson I., Kjellgren K., Lidén E., Öhlén J., Olsson L., Rosén H., Rydmark M., et. al.

Long-term diseases are today the leading cause of mortality worldwide and are estimated to be the leading cause of disability by 2020. Person-centered care (PCC) has been shown to advance concordance between care provider and patient on treatment plans, improve health outcomes and increase patient satisfaction. Yet, despite these and other documented benefits, there are a variety of significant challenges to putting PCC into clinical practice. Although care providers today broadly acknowledge PCC to be an important part of care, in our experience we must establish routines that initiate, integrate, and safeguard PCC in daily clinical practice to ensure that PCC is systematically and consistently practiced, i.e. not just when we feel we have time for it. In this paper, we propose a few simple routines to facilitate and safeguard the transition to PCC. We believe that if conscientiously and systematically applied, they will help to make PCC the focus and mainstay of care in long-term illness.

Starfield B.

George S.R., Thomas S.P.

This paper is a report of a study conducted to elucidate experiences and perceptions of self-management of diabetes as narrated by older people diagnosed with insulin-dependent diabetes living in a rural area.Older people worldwide are disproportionately affected by diabetes and are more likely to have co-morbidities and disabilities. Guidelines for management, developed by the American Diabetes Association, are not targeted for this population. A plethora of quantitative research has investigated self-management issues, with little change to outcomes. This pleads for consideration of a new diabetes education model, which includes consideration of experiences within clients' worldviews.Unstructured interviews starting with an open question were conducted from a purposive sample in 2005. Interviews were transcribed and analysed according to the tenets of existential phenomenology, a process which began with bracketing the researcher's biases. Findings. Living with poorly controlled diabetes led participants to introspection and existential questioning. Four connected themes were identified: 'Your Body Will Let You Know'; 'I Thought I Was Fine, But I Wasn't'; 'The Only Way Out is to Die'; and 'You Just Go On'.Currently designed from a medical perspective, diabetes education should be based on a nursing model incorporating the client's insights and experiences. When managing diabetes is viewed from a client's perspective, the focus becomes solving problems that arise in self-regulation of one's own regimen rather than in complying with doctor's orders. Nurses need to reframe the problem by excluding the compliance/noncompliance model and developing a conceptual perspective on self-management that is grounded in world and body.

Umberson D., Karas Montez J.

Social relationships—both quantity and quality—affect mental health, health behavior, physical health, and mortality risk. Sociologists have played a central role in establishing the link between social relationships and health outcomes, identifying explanations for this link, and discovering social variation (e.g., by gender and race) at the population level. Studies show that social relationships have short- and long-term effects on health, for better and for worse, and that these effects emerge in childhood and cascade throughout life to foster cumulative advantage or disadvantage in health. This article describes key research themes in the study of social relationships and health, and it highlights policy implications suggested by this research.

Hall J.A., Horgan T.G., Stein T.S., Roter D.L.

Patients and physicians in established relationships (261 patients and their 44 physicians) were asked after a medical visit how much they liked each other and how much they felt liked, along with questions concerning patient health, physician and patient satisfaction, and the patient’s affective state. Patients were re-contacted 1 year later and asked about their satisfaction with the same physician and whether they had considered changing physicians during the year. Patients’ and physicians’ ratings indicated mutuality of liking, as well as accuracy of estimating the other’s liking for the self. The physician’s liking for the patient was positively associated with the following variables: better patient health, more positive patient affective state after the visit, more favorable patient ratings of the physician’s behavior, greater patient satisfaction with the visit, and greater physician satisfaction with the visit. The patient’s liking for the physician was positively associated with better self-reported health, a more positive affective state after the visit, more favorable ratings of the physician’s behavior, and greater visit satisfaction. Both the physician’s liking for the patient and the patient’s liking for the physician positively predicted the patient’s satisfaction 1 year later and were associated with a lower likelihood that the patient considered changing physicians during the year. Female physicians reported liking their patients more than male physicians did, and patients’ ratings of how much they felt liked corroborated this difference. Patients also reported liking female physicians more than male physicians. A number of these results remained significant even after controlling for the patient’s overall satisfaction with the medical visit.

Surwit R.S., van Tilburg M.A., Zucker N., McCaskill C.C., Parekh P., Feinglos M.N., Edwards C.L., Williams P., Lane J.D.

OBJECTIVE—There is conflicting evidence regarding the utility of stress management training in the treatment of diabetes. The few studies that have shown a therapeutic effect of stress management have used time-intensive individual therapy. Unfortunately, widespread use of such interventions is not practical. The aim of the present investigation is to determine whether a cost-effective, group-based stress management training program can improve glucose metabolism in patients with type 2 diabetes and to determine whether a particular subset of patients is more likely to get positive results. RESEARCH DESIGN AND METHODS—Patients with type 2 diabetes were randomized to undergo a five-session group diabetes education program with or without stress management training. Participants (n = 108) were followed for 1 year, during which HbA1c tests and questionnaires assessing perceived stress, anxiety, and psychological health were administered at regular intervals to evaluate treatment effects. RESULTS—Stress management training was associated with a small (0.5%) but significant reduction in HbA1c. Compliance with the treatment regimen decreased over time but was similar to that seen in patients receiving stress management for other reasons in the clinic. Trait anxiety (a measure of stable individual differences in anxiety proneness) did not predict response to treatment, showing that highly anxious patients did not derive more benefit from training. CONCLUSIONS—The current results indicate that a cost-effective, group stress management program in a “real-world” setting can result in clinically significant benefits for patients with type 2 diabetes.

Engel G.L.

Gallo L.M., Giampietro V., Zunszain P.A., Tan K.S.

A worldwidemental health crisis is expected, as millions worldwide fear death and disease while being forced into repeated isolation. Thus, there is a need for new proactive approaches to improve mental resilience and prevent mental health conditions. Since the 1990s, art has emerged as an alternative mental health therapy in the United States and Europe, becoming part of the social care agenda. This article focuses on how visual esthetic experiences can create similar patterns of neuronal activity as those observed when the reward system is activated. The activation of the reward structures could have a stress buffering effect, given the interdependence observed between the reward and stress systems. Therefore, could visual esthetic experiences stimulate mental resilience? And if this were the case, could art-based interventions be offered for mental health in the context of COVID-19 and beyond?