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We investigated the impact of mindfulness training (MT) on working memory capacity (WMC) and affective experience. WMC is used in managing cognitive demands and regulating emotions. Yet, persistent and intensive demands, such as those experienced during high-stress intervals, may deplete WMC and lead to cognitive failures and emotional disturbances. We hypothesized that MT may mitigate these deleterious effects by bolstering WMC. We recruited 2 military cohorts during the high-stress predeployment interval and provided MT to 1 (MT, n = 31) but not the other group (military control group, MC, n = 17). The MT group attended an 8-week MT course and logged the amount of out-of-class time spent practicing formal MT exercises. The operation span task was used to index WMC at 2 testing sessions before and after the MT course. Although WMC remained stable over time in civilians (n = 12), it degraded in the MC group. In the MT group, WMC decreased over time in those with low MT practice time, but increased in those with high practice time. Higher MT practice time also corresponded to lower levels of negative affect and higher levels of positive affect (indexed by the Positive and Negative Affect Schedule). The relationship between practice time and negative, but not positive, affect was mediated by WMC, indicating that MT-related improvements in WMC may support some but not all of MT's salutary effects. Nonetheless, these findings suggest that sufficient MT practice may protect against functional impairments associated with high-stress contexts.
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We investigated the impact of mindfulness training (MT) on working memory capacity (WMC) and affective experience. WMC is used in managing cognitive demands and regulating emotions. Yet, persistent and intensive demands, such as those experienced during high-stress intervals, may deplete WMC and lead to cognitive failures and emotional disturbances. We hypothesized that MT may mitigate these deleterious effects by bolstering WMC. We recruited 2 military cohorts during the high-stress predeployment interval and provided MT to 1 (MT, n = 31) but not the other group (military control group, MC, n = 17). The MT group attended an 8-week MT course and logged the amount of out-of-class time spent practicing formal MT exercises. The operation span task was used to index WMC at 2 testing sessions before and after the MT course. Although WMC remained stable over time in civilians (n = 12), it degraded in the MC group. In the MT group, WMC decreased over time in those with low MT practice time, but increased in those with high practice time. Higher MT practice time also corresponded to lower levels of negative affect and higher levels of positive affect (indexed by the Positive and Negative Affect Schedule). The relationship between practice time and negative, but not positive, affect was mediated by WMC, indicating that MT-related improvements in WMC may support some but not all of MT's salutary effects. Nonetheless, these findings suggest that sufficient MT practice may protect against functional impairments associated with high-stress contexts.
Abstract Ethnopharmacological relevance Herpetospermum caudigerum Wall. (HCW) is a traditional Tibetan medicine, which has been used to ameliorate liver injuries in the folk. Aim of the study Liver fibrosis has been recognized as a major lesion of the liver that leads to liver cirrhosis/hepatocarcinoma and even to death in the end. This study aims to demonstrate the protective effect of HCW against CCl 4 -induced liver injury in rats and to explore the underlying mechanisms. Materials and methods Hepatic fibrosis was induced by intraperitoneal injection of CCl 4. Liver function markers, fibrosis markers, serum anti-oxidation enzymes as well as elements levels were determined. Serum and liver tissues were subjected to NMR-based metabolomics and multivariate statistical analysis. Results HCW could significantly reduce the elevated levels of fibrosis markers such as hyaluronidase, laminin, Type III procollagen and Type IV collagen in the serum, improve the activities of the antioxidant enzymes, and effectively reverse the abnormal levels of elements in liver fibrosis rats. Correlation network analysis revealed that HCW could treat liver fibrosis by ameliorating oxidative stress, repairing the impaired energy metabolisms and reversing the disturbed amino acids and nucleic acids metabolisms. Conclusion This integrated metabolomics approach confirmed the validity of the traditional use of HCW in the treatment of liber fibrosis, providing new insights into the underlying mechanisms. Graphical abstract fx1 [ABSTRACT FROM AUTHOR]
This study is to establish the fingerprint for Phyllanthus emblica and their tannin parts from different habitats by HPLC for its quality control. The determination was carried out on a Diamonsil C18 (4.6 mm x 250 mm, 5 microm) column, with methanol-0.2% glacial acetic acid as mobile phase with gradient elution at a flow rate of 1 mL x min(-1). The temperature was maintained at 30 degrees C and the detected wavelength is 260 nm, Thirteen chromatographic peaks were extracted as the common peaks of the fingerprint of P. emblica, and eleven as the common peaks of P. emblica tannin parts, and five peaks were identified by comparing with referent samples. The fingerprints of 8 samples were compared and classified by similarity evaluation, cluster analysis and principal component analysis (PCA). The similarity degrees of eight P. emblica were between 0.763 and 0.993, while tannin parts were between 0.903 and 0.991. All the samples of P. emblica and their tannin parts were classified into 3 categories. The method was so highly reproducible, simple and reliable that it could provide basis for quality control and evaluation of P. emblica from different habitats.
Ethnopharmacological relevance: Saussurea laniceps Hand.-Mazz. (SL) has long been used under the herbal name Tibetan 'Snow Lotus' for the treatment of rheumatoid arthritis, stomachache and dysmenorrhea in Tibetan folk medicine. Since herbal medicine (HM) is a synergistical system with multiple components, both of the metabolism and pharmacokinetic studies of HM are interdependent. This study aimed to develop an integrated strategy based on the UPLC-DAD-QTOF-MS technique for metabolism and pharmacokinetic studies of HM.Material and methods: SL was used here as a test herb to verify the feasibility of the proposed strategy. SL was administered to rats, then, the blood plasma, urine and feces were analyzed to determine the metabolic profiles. Using our strategy, umbelliferone and scopoletin were evaluated to be the key bioactive components. Their pharmacokinetic parameters were measured and biotransformation pathways were elucidated.Results: After oral administration of SL to rats, 17 components in blood, 10 components in urine and 2 components in feces were identified and characterized using our UPLC-DAD-QTOF-MS method. Umbelliferone, scopoletin and their metabolites were found to be the major components involved in the metabolism process. Literature reports also suggest that umbelliferone and scopoletin are responsible for the therapeutic effects of SL, thus these two components were selected as the active markers for pharmacokinetic study. In the test of validity, the established method presented good linearity with R-2> 0.99. The relative standard deviation value was below 13.9% for precision, and recovery studies for accuracy were found to be within the range 91.8-112.5%.Conclusion: The present strategy offers, simultaneously, precision in quantitative analysis (metabolism study) and accuracy in quantitative analysis (pharmacokinetic study) with greater efficiency and less costs, which is therefore reliably used for integrated metabolism and pharmacokinetic studies of HM. (C) 2014 Elsevier Ireland Ltd. All rights reserved.
<p>The present study was an exploratory investigation of a unique phenomenon: the traditional, Theravadin Buddhist meditation retreat. It is unique in the sense that such meditation retreats involve the constant practice of "concentration" and "insight" meditation techniques during every waking moment for periods of time up to 3 months. The following research questions derived from Buddhist sources and contemporary psychological theory and research, provided the major organizing framework of the study; (1) Are relationship factors, such as idealization, an important component of retreat experience? (2) In a Western, psychoanalytic sense, are the meditators characterized by a healthy sense of "narcissism" or self-love? (3) What is the nature of the meditators' self-concepts? (4) What are the effects of the meditation retreats on the participant's experience of self and world? All subjects were solicited, unpaid, volunteers recruited from the Insight Meditation Society (IMS) during the autumn and winter of 1979-80. The design of the study was naturalistic in the sense that it utilized the natural groupings of the IMS: the 3 month and 2 week meditation retreats. A total of 53 meditators completed the pre and post-retreat test packets: a sample of 20 subjects from the 3 month retreat and a pooled sample of 33 subjects from 3 different 2 week retreats. The self-administering test package included a Semantic Differential with 5 factor scales and 12 concepts, Knapp's Metaphor Scales (MS), and a Who-Are-You (WAY) test in addition to several less important measures. The data analysis was based on the interpretation of sample descriptive statistics, "Matched" T-tests, and analysis of covariance. As reflected by the WAY test, "Abstract" self-concepts predominated over "Role" and "Trait" self-descriptions, suggesting the meditators have an ideological commitment to the "anatta" (no-self) principle of Buddhism. Self-concepts were not significantly effected by either retreat experience. Comparison of the relative magnitude of the profile of semantic factor means for the concepts "Me" and "Your Meditation Instructor" documented that the relationship is an important factor in both types of meditation retreats. Both groups of meditators idealize their teachers, find them reliable and consistent, and experience them as emotionally rewarding. Among the 2 week sample, only, there is evidence that something akin to an "idealizing transference" (or perhaps a more general "positive transference") develops in relation to the teacher. Personality change among the meditators may be as much due to the relationship with the teacher as it is to the practice of meditation, per se. Judged in relation to 3 Western variables, derived from modern clinical theory, both samples appeared to have a healthy sense of "narcissism". These clinical variables seemed unaffected by the meditation retreats. However, important changes in the experience of self and world did occur among the 3 month sample. These results were consistent with Theravadin Buddhist theory. The self was perceived as more "non-reactive", suggesting an increased mastery of the "insight meditation" technique of "bare attention". The connotations of death changed, suggesting an increased appreciation of "anicca" (impermanence) and acceptance of the theory of reincarnation. The 3 month meditators come to reject a Western, romantic, interpersonal definition of love in favor of the Buddhist emphasis on an internally generated and maintained feeling state and stance of selfless, altruistic, "non-reactive", non-selective, compassion for the world. Finally, the 3 month retreat seemed to increase the participants' emotional detachment from and devaluation of Western attitudes concerning work and material strivings. Additional, but less important findings are reported in the body of the study.</p>
Zotero Collections:
- Buddhist Contemplation by Applied Subject,
- Contemplation by Applied Subject,
- Contemplation by Tradition,
- Meditation Retreats,
- Psychology and Buddhist Contemplation,
- Science and Buddhist Contemplation,
- Community and Buddhist Contemplation,
- Practices of Buddhist Contemplation,
- Psychology and Contemplation,
- Science and Contemplation,
- Buddhist Contemplation
BACKGROUND:Research suggests that an 8-week mindfulness-based cognitive therapy (MBCT) course may be effective for generalised anxiety disorder (GAD).
AIMS:
To compare changes in anxiety levels among participants with GAD randomly assigned to MBCT, cognitive-behavioural therapy-based psychoeducation and usual care.
METHOD:
In total, 182 participants with GAD were recruited (trial registration number: CUHK_CCT00267) and assigned to the three groups and followed for 5 months after baseline assessment with the two intervention groups followed for an additional 6 months. Primary outcomes were anxiety and worry levels.
RESULTS:
Linear mixed models demonstrated significant group × time interaction (F(4,148) = 5.10, P = 0.001) effects for decreased anxiety for both the intervention groups relative to usual care. Significant group × time interaction effects were observed for worry and depressive symptoms and mental health-related quality of life for the psychoeducation group only.
CONCLUSIONS:
These results suggest that both of the interventions appear to be superior to usual care for the reduction of anxiety symptoms.
The grief of bereavement is recognized as a severe psychosocial stressor that can trigger a variety of mental and physical disorders, and the long-lasting unresolved grief has a detrimental effect on brain functionality. Literature has documented mindfulness-based cognitive therapy (MBCT) as an efficient treatment for improving well-being, specifically related to the mood and cognition, in a variety of populations. However, little attention has been devoted to neural mechanisms with regard to bereaved individuals' cognition after MBCT intervention. In this study, we recruited 23 bereaved participants who lost a significant relative within 6 months to 4 years to attend 8-week MBCT course. We used self-reporting questionnaires to measure emotion regulation and functional magnetic resonance imaging (fMRI) with the numerical Stroop task to evaluate the MBCT effect on executive control among the bereaved participants. The self-reported questionnaires showed improvements on mindfulness and reductions in grief, difficulties in emotion regulation, anxiety, and depression after the MBCT intervention. The fMRI analysis demonstrated two scenarios: (1) the activity of the fronto-parietal network slightly declined accompanied with significant improvements in the reaction time of incongruent trials; (2) the activities in the posterior cingulate cortex and thalamus were positively associated with the Texas Revised Inventory of Grief, implying emotional interferences on cognitive functions. Results indicated that MBCT facilitated the executive control function by alleviating the emotional interferences over the cognitive functions and suggested that the 8-week MBCT intervention significantly improved both executive control and emotion regulation in bereaved individuals.
Medical students in Malaysia face enormous amount of stress that can compromise their medical training. A brief group Mindfulness-based Cognitive Therapy (b-MBCT)/Mindful-Gym) programme has been developed to help medical students cope more effectively with stress. The intervention was found to be effective for reducing stress and increasing subjective well-being among medical students in University Putra Malaysia (UPM). One of the training methodologies used in the programme, ‘Mindful-S.T.O.P.,’ was particularly popular among the students. The aim of this paper is to describe the concept and application of this mindfulness-based psychological tool (Mindful-S.T.O.P.) for stress reduction in medical students.
A new iridoid named (1R,6S,8R,9R) -1 -ethoxy-8-methyl-1,5,6,7,8,9-hexahydrocyclopenta[c] pyran-4-carbaldehyde (1) was isolated from the Tibetan folk medicine Incarvillea younghusbandii Sprague. Its structure was elucidated by spectral methods,e, g. ID and 2D NMR and HRMS.
Oxyfadichalcones A and B, two unprecedented chalcone dimers fused through a cyclobutane ring by head-to-tail [2+2] cycloaddition of two chalcones that had never been found previously in nature, along with oxyfadichalcone C, a new head-to-head [2+2] cyclized chalcone dimer, were simultaneously obtained from Oxytropis falcata. Structural elucidation was succeeded by spectroscopic and single-crystal synchrotron radiation analysis. Additionally, the photosynthesis of the chalcone dimers was performed and the plausible biosynthesis was discussed. (C) 2013 Elsevier Ltd. All rights reserved.
Study Design. Multicentered randomized controlled trial with quality of life and resource use data collected. Objective. The objective of this study was to evaluate the cost-effectiveness of yoga intervention plus usual care compared with usual care alone for chronic or recurrent low back pain. Summary of Background Data. Yoga has been shown as an effective intervention for treating chronic or recurrent low back pain. However, there is little evidence on its cost-effectiveness. The data are extracted from a pragmatic, multicentered, randomized controlled trial that has been conducted to evaluate the effectiveness and cost-effectiveness of a 12-week progressive program of yoga plus usual care in patients with chronic or recurrent low back pain. Methods. With this trial data, a cost-effectiveness analysis during the time period of 12 months from both perspectives of the UK National Health Service and the societal is presented. Main outcome measure is an incremental cost per quality-adjusted life-year (QALY). Results. From the perspective of the UK National Health Service, yoga intervention yields an incremental cost-effectiveness ratio of 13,606 pound per QALY. Given a willingness to pay for an additional QALY of 20,000 pound, the probability of yoga intervention being cost-effective is 72%. From the perspective of the society, yoga intervention is a dominant treatment compared with usual care alone. This result is surrounded by fewer uncertainties-the probability of yoga being cost-effective reaches 95% at a willingness to pay for an additional QALY of 20,000 pound. Sensitive analyses suggest the same results that yoga intervention is likely to be cost-effective in both perspectives. Conclusion. On the basis of this trial, 12 weekly group classes of specialized yoga are likely to be a cost-effective intervention for treating patients with chronic or recurrent low back pain.
To predict the suitable distribution patterns of Lycium ruthenicum in the present and future under the background of climate change, and provide reference for the resources sustainable utilization and GAP standardized planting. The software of Maxent and ArcGis was used to predict the potential suitable regions and grades of L. ruthenicum in China based on the 149 distribution information, climate data of contemporary (1950-2000) and future (20-80 decade of 21 century), and considering of three greenhouse gaseous emission scenario. The results showed that：the suitable distribution regions of L. ruthenicum are mainly concentrated in Xinjiang, Qinghai, Gansu, Neimenggu, and Ningxia province in present. In addition, Shaanxi, Shanxi and Xizang are also distribution regions.The suitable distribution area of L. ruthenicum is 284.506 949×104 km2, accounted for 29.6% of the land area of China.The relatively stable area of the suitable regions accounted for 25.2% of the total suitable region area.Under the background of climate change, compared with contemporary, the total area of suitable region is reducing and moderately suitable area is increasing at different degree at the 20, 30, 40, 50, 60, 70, 80 decade of 21 century. Climate change both can change the total area of suitable regions and habitat suitability of L. ruthenicum. It could provide a strategic guidance for protection, development and utilization of L. ruthenicum though the prediction of potential suitable regions distribution of L. ruthenicum based on the mainly factor of climate change.
BackgroundResearch suggests that an eight-week Mindfulness-Based Cognitive Therapy (MBCT) program may be effective in the treatment of generalized anxiety disorders. Our objective is to compare the clinical effectiveness of the MBCT program with a psycho-education programme and usual care in reducing anxiety symptoms in people suffering from generalized anxiety disorder.
Methods
A three armed randomized, controlled clinical trial including 9-month post-treatment follow-up is proposed. Participants screened positive using the Structure Clinical Interview for DSM-IV (SCID) for general anxiety disorder will be recruited from community-based clinics. 228 participants will be randomly allocated to the MBCT program plus usual care, psycho-education program plus usual care or the usual care group. Validated Chinese version of instruments measuring anxiety and worry symptoms, depression, quality of life and health service utilization will be used. Our primary end point is the change of anxiety and worry score (Beck Anxiety Inventory and Penn State Worry Scale) from baseline to the end of intervention. For primary analyses, treatment outcomes will be assessed by ANCOVA, with change in anxiety score as the baseline variable, while the baseline anxiety score and other baseline characteristics that significantly differ between groups will serve as covariates.
Conclusions
This is a first randomized controlled trial that compare the effectiveness of MBCT with an active control, findings will advance current knowledge in the management of GAD and the way that group intervention can be delivered and inform future research.
BACKGROUND:Research suggests that an eight-week Mindfulness-Based Cognitive Therapy (MBCT) program may be effective in the treatment of generalized anxiety disorders. Our objective is to compare the clinical effectiveness of the MBCT program with a psycho-education programme and usual care in reducing anxiety symptoms in people suffering from generalized anxiety disorder.
METHODS:
A three armed randomized, controlled clinical trial including 9-month post-treatment follow-up is proposed. Participants screened positive using the Structure Clinical Interview for DSM-IV (SCID) for general anxiety disorder will be recruited from community-based clinics. 228 participants will be randomly allocated to the MBCT program plus usual care, psycho-education program plus usual care or the usual care group. Validated Chinese version of instruments measuring anxiety and worry symptoms, depression, quality of life and health service utilization will be used. Our primary end point is the change of anxiety and worry score (Beck Anxiety Inventory and Penn State Worry Scale) from baseline to the end of intervention. For primary analyses, treatment outcomes will be assessed by ANCOVA, with change in anxiety score as the baseline variable, while the baseline anxiety score and other baseline characteristics that significantly differ between groups will serve as covariates.
CONCLUSIONS:
This is a first randomized controlled trial that compare the effectiveness of MBCT with an active control, findings will advance current knowledge in the management of GAD and the way that group intervention can be delivered and inform future research.
Purpose: Chronic insomnia is a prevalent health problem in primary care associated with morbidity and health service utilization. Mindfulness Based Cognitive Therapy (MBCT) is a therapeutic approach developed over the last few decades although only few large randomized control trials have been conducted in those with primary insomnia. This study aimed to evaluate the effectiveness of MBCT in treating primary chronic insomnia in primary care by comparing with a psycho-education control (PEC) group in the community.Methods: This was a single-blinded, randomised, controlled clinical trial. Eligible participants were Chinese adults (18 years of age or above) with diagnosed chronic insomnia at baseline assessment. Subjects were randomly assigned into MBCT group (intervention) and PEC group (control), were followed up for six months. Primary outcome was changes in the score of a validated Chinese version of 7-item Insomnia Severity Index (ISI). Paired t-test was used to examine between-group differences. Analysis was performed by intention-to-treat.
Results: We recruited 216 subjects with an average age of 56.05 (SD 9.39), where 77.0% [116/216] were female. At baseline, there was no significant differences between MBCT group [N=110] and PEC group [N=106] in terms of age (p=0.450), gender (p=0.250), ISI scores (17.67, SD 3.70 for PEC; 17.94, SD 3.70 for MBCT; p=0.623). At eight-week (follow-up rate 93.6% [88/94] for MBCT group, 93.5% [87/93] for PEC group), there was a significant decrease in ISI scores in MBCT group (-4.26, SD 3.87) when compared to that of PEC group (-2.81, SD 4.08) (p=0.041).
Conclusion: Results demonstrated that MBCT programme may significantly reduce the insomnia severity among Chinese subjects with chronic insomnia when compared to PEC group in the primary care group. The study suggested that MBCT programme may be an evidence-based treatment options for subjects with chronic insomnia in primary care although longer follow-up is needed to evaluate the sustainability of the effects.
Little research has examined ways in which mindfulness is associated with affect dynamics, referring to patterns of affect fluctuations in daily life. Using ecological momentary assessment (EMA), the present study examined the associations between trait mindfulness and several types of affect dynamics, namely affect variability, affect inertia, affect switch, and affect instability. Three hundred ninety undergraduate students from Singapore reported their current emotions and coping styles up to 19 times per day across 2 days. Results showed that trait mindfulness correlated negatively with variability, instability, and inertia of negative affect and positively with negative-to-positive affect switch. These relationships were independent of openness, habitual reappraisal, habitual suppression, depression, and self-esteem. Importantly, lower maladaptive coping was found to mediate these relationships. The study suggests that trait mindfulness independently promotes adaptive patterns of affective experiences in daily life by inhibiting maladaptive coping styles. (PsycINFO Database Record (c) 2016 APA, all rights reserved)
Chronic inflammation is associated with various chronic illnesses including immunity disorders, cancer, neurodegeneration, and vascular diseases. Iridoids are compounds with anti-inflammatory properties. However their anti-inflammatory mechanism remains unclear. Here, we report that scropolioside B, isolated from a Tibetan medicine (Scrophularia dentata Royle ex Benth.), blocked expressions of TNF, IL-1, and IL-32 through NF-κB pathway. Scropolioside B inhibited NF-κB activity in a dose-dependent manner with IC50 values of 1.02 μmol/L. However, catalpol, similar to scropolioside B, was not effective in inhibiting NF-κB activity. Interestingly, scropolioside B and catalpol decreased the expression of NLRP3 and cardiolipin synthetase at both the mRNA and protein level. Our results showed that scropolioside B is superior in inhibiting the expression, maturation, and secretion of IL-1β compared to catalpol. These observations provide further understanding of the anti-inflammatory effects of iridoids and highlight scropolioside B as a potential drug for the treatment of rheumatoid arthritis and atherosclerosis.
Chronic inflammation is associated with various chronic illnesses including immunity disorders, cancer, neurodegeneration, and vascular diseases. Iridoids are compounds with anti-inflammatory properties. However their anti-inflammatory mechanism remains unclear. Here, we report that scropolioside B, isolated from a Tibetan medicine (Scrophularia dentata Royle ex Benth.), blocked expressions of TNF, IL-1, and IL-32 through NF-κB pathway. Scropolioside B inhibited NF-κB activity in a dose-dependent manner with IC50 values of 1.02 μmol/L. However, catalpol, similar to scropolioside B, was not effective in inhibiting NF-κB activity. Interestingly, scropolioside B and catalpol decreased the expression of NLRP3 and cardiolipin synthetase at both the mRNA and protein level. Our results showed that scropolioside B is superior in inhibiting the expression, maturation, and secretion of IL-1β compared to catalpol. These observations provide further understanding of the anti-inflammatory effects of iridoids and highlight scropolioside B as a potential drug for the treatment of rheumatoid arthritis and atherosclerosis.
Chronic inflammation is associated with various chronic illnesses including immunity disorders, cancer, neurodegeneration, and vascular diseases. Iridoids are compounds with anti-inflammatory properties. However their anti-inflammatory mechanism remains unclear. Here, we report that scropolioside B, isolated from a Tibetan medicine (Scrophularia dentata Royle ex Benth.), blocked expressions of TNF, IL-1, and IL-32 through NF-κB pathway. Scropolioside B inhibited NF-κB activity in a dose-dependent manner with IC50 values of 1.02 μmol/L. However, catalpol, similar to scropolioside B, was not effective in inhibiting NF-κB activity. Interestingly, scropolioside B and catalpol decreased the expression of NLRP3 and cardiolipin synthetase at both the mRNA and protein level. Our results showed that scropolioside B is superior in inhibiting the expression, maturation, and secretion of IL-1β compared to catalpol. These observations provide further understanding of the anti-inflammatory effects of iridoids and highlight scropolioside B as a potential drug for the treatment of rheumatoid arthritis and atherosclerosis.
BACKGROUND: This review aims to rate the quality of evidence and the strength of recommendations in high-quality systematic reviews of non-drug therapies. Hypertensive patients who are resistant or non-adherent to antihypertensive drugs may be easier to manage if they choose alternative non-drug therapies for hypertension, based on this review.METHODS: P: Adults (>18 years), except pregnant women, with essential hypertension. I: Cupping, moxibustion, acupuncture, acupoint stimulation, yoga, meditation, tai chi, Qi gong, Chinese massage, massage, spinal manipulation, biofeedback, device-guided breathing therapy, aromatherapy, music therapy, and relaxation approaches. C: 1. No treatment. 2. Sham therapy. 3. Conventional treatment, including antihypertensive drugs and lifestyle modification (e.g., exercise). O: 1. Change in the incidence of cardiovascular death. 2. Change in the incidence of myocardial infarction. 3. Change in the incidence of stroke. 4. Change in blood pressure (BP). 5. Efficacy rate of BP lowering. 6. Adverse effects (review specific). S: Systematic reviews of randomized controlled trials, including meta-analyses and assessments of the methodological quality/risk of bias.
INFORMATION SOURCES: Cochrane Database of Systematic Reviews, Database of Abstracts of Reviews of Effects, Cochrane library, PubMed, Web of Science, China National Knowledge Infrastructure, and Chinese Scientific Journal Database were searched. The bibliographies of the included articles were also searched for relevant systematic reviews. GRADE criteria were used to rate the quality of evidence in systematic reviews considering 6 factors, including risk of bias.
RESULTS: This review ultimately included 13 systematic reviews of 14 non-drug therapies (acupuncture, wet cupping, Baduanjin, blood letting, auricular acupuncture, music, massage, Qi gong, moxibustion, relaxation therapies, biofeedback, device-guided breathing, yoga and tai chi) based on the inclusion criteria. The quality of evidence was generally low, and weak recommendations were given for most therapies except massage and acupuncture plus antihypertensive drug. Based on the analyzed evidence, massage and acupuncture plus antihypertensive drug could benefit people who want to lower their BP and do not have contraindications for massage and acupuncture plus antihypertensive drug.
DISCUSSION/STRENGTH: The GRADE approach makes this review a unique reference for people who are considering the grade of quality of evidence in systematic reviews, the balance of desirable and undesirable consequences and the strength of recommendations to decide which intervention should be used to reduce BP.
LIMITATIONS: Many non-drug therapies were excluded due to the low methodological quality of their systematic reviews, and only 14 therapies were evaluated in this review. As no patient-important outcomes were reviewed, surrogate outcomes were used to rate the strength of recommendations. This approach may cause a decrease in evidence quality according to GRADE, but we argue that this is appropriate in the context of this review.
Education in Singapore strives to foster the holistic development of its youth. To attain this goal, social and emotional learning (SEL) has been an integral part of the academic curricula at the different levels of schooling. The SEL Framework, which was formally introduced by the Ministry of Education in 2005 (see Ministry of Education 2008) and then further formulated to be the Framework for Twenty First Century Competencies and Student Outcomes (Ministry of Education 2014), provides an organizing structure to conceptualize, design, implement, evaluate, and refine school-based programs seeking to facilitate the development of social and emotional competencies (SECs) of Singaporean youth. Although the five key SECs emphasized in the Framework (Ministry of Education 2008; Ministry of Education 2014) are aligned with those in the widely adopted prototypical model of SECs formulated by the Collaborative for Academic, Social, and Emotional Learning (CASEL), the Framework differs in its emphasis on the cultivation of core moral values (respect, responsibility, integrity, care, resilience, and harmony) as guiding principles for the application of SECs. The SECs under the Framework are also the basis of the broader twenty first century skills and competencies (civic literacy, global awareness and cross-cultural skills, critical and inventive thinking, and communication, collaboration and information skills). Importantly, the Framework also takes the view that the promotion of SECs in schools is part of the concerted effort in attaining desired outcomes of education: nurturing young Singaporeans who are confident, self-directed in learning, actively contributing to collective efforts, and concerned about the well-being of others, community, and society. The present chapter not only examines key components of the Framework for Twenty First Century Competencies and Student Outcomes (Ministry of Education 2014), it also discusses its pedagogical principles and approaches to school-wide implementation of SEL. Recent SEL studies in Singapore are reviewed, and future directions for SEL application and research in Singapore are proposed.
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