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Yeoh JPS, Spence C. Background Music's Impact on Patients Waiting in Surgery and Radiology Clinics. HERD-HEALTH ENVIRONMENTS RESEARCH & DESIGN JOURNAL 2023; 16:278-290. [PMID: 37016842 DOI: 10.1177/19375867231161094] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/06/2023]
Abstract
OBJECTIVES To assess the impact of different types of background music on patients' anxiety and perceptions in a healthcare setting. BACKGROUND An overwhelming number of studies in the West have been conducted on the use of background music in reducing patients' anxiety and their perception of hospitals. Despite the optimism for Western classical music in such settings, evidence documenting the successful use of this genre of music in waiting rooms across other people groups has, thus far, been inconclusive. METHOD A single-blind randomized study in which a total of 303 participants were recruited from both surgery and radiology clinics using a between-groups experimental design. Patients were seated in the waiting room for at least 20 min while music (Western classical, lo-fi) or no music was playing in the background. Participants were then required to complete a questionnaire that consisted of a shortened 6-item State Trait Anxiety Inventory (STAI-6), and eight questions relating to overall perceptions of the hospital. RESULTS The results from both clinics revealed that patients in the no music condition rated themselves as feeling significantly less anxious than those in either of the two music conditions. Patients' perceptions of the hospital's overall service and expectations were higher in the no music condition. CONCLUSIONS Firstly, the choice of background music should match the differing pace of the day; for example, a more upbeat song would better fit the mood of a busy clinic, leading to a more "congruent" atmosphere. Secondly, playing background music in a "task-oriented" and highly charged/anxious environment may increase arousal levels, which in turn could result in negative perceptions of the hospital and an increase in anxiety among patients. Finally, music is a cultural product and music that primes certain beliefs in one culture may not have similar effects among other people groups. Hence, specific curated playlists are necessary to convey "intentions" to different people groups.
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Affiliation(s)
- Joanne Pei Sze Yeoh
- Music Department, Faculty of Human Ecology, University Putra Malaysia, Serdang, Malaysia
| | - Charles Spence
- Department of Experimental Psychology, University of Oxford, United Kingdom
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2
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Ugras GA, Kanat C, Yaman Z, Yilmaz M, Turkmenoglu MO. The Effects of Virtual Reality on Preoperative Anxiety in Patients Undergoing Colorectal and Abdominal Wall Surgery: A Randomized Controlled Trial. J Perianesth Nurs 2023; 38:277-283. [PMID: 36319521 DOI: 10.1016/j.jopan.2022.07.005] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2022] [Revised: 06/24/2022] [Accepted: 07/13/2022] [Indexed: 11/06/2022]
Abstract
PURPOSE The purpose of this study was to investigate the effects of a virtual reality (VR) application on preoperative anxiety (PA) in patients undergoing colorectal and abdominal wall surgery. DESIGN A prospective, parallel two-armed, randomized controlled trial. METHODS Eighty six patients were divided into the control group (n = 43) and in the experimental group (n = 43). The experimental group received a preoperative VR application for 10 minutes. The routine preoperative procedure used at the clinic was used for the patients in the control group. The anxiety level was assessed using the Anxiety Specific to Surgery Questionnaire (ASSQ) and measured with physiological responses to anxiety, such as changes in systolic blood pressure (SBP), diastolic blood pressure (DBP), heart rate (HR), respiratory rate (RR), and peripheral oxygen saturation (SpO2), before and after the VR application. FINDINGS The VR application reduced PA levels in the experimental group (P < .001) and changes in the SBP (P < .001), DBP (P < .001), HR (P < .001), RR (P = .041) and SpO2(P = .019) values) compared to the levels in the control group. CONCLUSIONS VR applications can reduce psychological and physiological responses to PA in patients undergoing colorectal and abdominal wall surgery.
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Affiliation(s)
- Gülay Altun Ugras
- Department of Surgical Nursing, Mersin University, Nursing Faculty, Mersin, Turkey.
| | - Canan Kanat
- Department of Surgical Nursing, Mersin University, Nursing Faculty, Mersin, Turkey
| | - Zeliha Yaman
- Department of Mental Health Nursing, Mersin University, Nursing Faculty, Mersin, Turkey
| | - Mualla Yilmaz
- Department of Mental Health Nursing, Mersin University, Nursing Faculty, Mersin, Turkey
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3
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Quan X. Improving Ambulatory Surgery Environments: The Effects on Patient Preoperative Anxiety, Perception, and Noise. HERD-HEALTH ENVIRONMENTS RESEARCH & DESIGN JOURNAL 2023; 16:73-88. [PMID: 36740908 DOI: 10.1177/19375867221149990] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
OBJECTIVES The study aimed to comparatively evaluate three types of preoperative care environment in terms of patient experience outcomes including patient preoperative anxiety, perceived environmental qualities, and noise level. BACKGROUND Preoperative anxiety is a major healthcare problem causing delays, complications, dissatisfaction, and rising healthcare costs. The design of preoperative spaces may play an important role in reducing preoperative anxiety and improving outcomes. METHODS Anonymous questionnaire surveys were conducted with 228 patients in the three types of preoperative bays that varied in terms of bay size and the amount of hard-wall partitions between bays to compare patient self-reported anxiety and perceived environmental qualities. Sound level measurements were conducted throughout the three preoperative care units. RESULTS Female patients in the preoperative unit with largest bays and full hard-wall partitions between bays reported significantly lower levels of subjective anxiety (p's = .002, <.001) and higher levels of perceived environmental qualities on privacy, cleanliness, noise, and pleasantness (p's from <.001 to .017) than patients in the units with smaller bays and no or partial hard-wall partitions. Similar but less clear pattern was found among male patients. The lowest average noise levels were recorded in the unit with largest bays and full hard-wall partitions between bays (2.3-6.1 decibels lower than the other units). CONCLUSIONS The design of preoperative care environment may contribute to the better management of preoperative anxiety. Further efforts in research and design are needed to maximize the benefits in clinical, experiential, and financial outcomes.
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Affiliation(s)
- Xiaobo Quan
- Christopher C. Gibbs College of Architecture, University of Oklahoma, Norman, OK, USA
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Impact of Music in Males and Females for Relief from Neurodegenerative Disorder Stress. CONTRAST MEDIA & MOLECULAR IMAGING 2022; 2022:3080437. [PMID: 35494208 PMCID: PMC9019444 DOI: 10.1155/2022/3080437] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/21/2022] [Accepted: 03/05/2022] [Indexed: 11/21/2022]
Abstract
Neurological imbalance sometimes resulted in stress, which is experienced by the number of people at some moment in their life. A considerable measurement scheme can quantify the stress level in an individual, in which music has always been considered as the best therapy for stress relief in healthy human being as well in severe medical conditions. In this work, the impact of four types of music interventions with the lyrics of Hindi music and varying spectral centroid has been studied for an analysis of stress relief in males and females. The self-reported data for stress using state-trait anxiety (STA) and electroencephalography (EEG) signals for 14 channels in response to music interventions have been considered. Features such as Hjorth (activity, mobility, and complexity), variance, standard deviation, skew, kurtosis, and mean have been extracted from five bands (delta, theta, alpha, beta, and gamma) of each channel of the recorded EEG signals from 9 males and 9 females of the age category between 18 and 25 years. The support vector machine classifier has been used to classify three subsets: (i) male and female, (ii) baseline and female, and (iii) baseline and male. The noteworthy accuracy of 100% was found at the delta band for the first subset, beta and gamma bands for the second subset, and beta, gamma, and delta bands for the third subset. STA score has shown more deviation in the male category than in female, which gives a clear insight into the impact of music intervention with varying spectral centroid that has a higher impact to relieve stress in the male category than the female category.
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The Effects of Listening to Music on Anxiety, Pain, Vital Signs, and Patient Satisfaction in Intravitreal Injection. ANADOLU KLINIĞI TIP BILIMLERI DERGISI 2022. [DOI: 10.21673/anadoluklin.1049397] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
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Yoo GE, Hong SJ, Chong HJ. Nighttime Walking with Music: Does Music Mediate the Influence of Personal Distress on Perceived Safety? INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph19031383. [PMID: 35162401 PMCID: PMC8835712 DOI: 10.3390/ijerph19031383] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/02/2021] [Revised: 01/22/2022] [Accepted: 01/24/2022] [Indexed: 02/04/2023]
Abstract
There is growing interest in identifying the environmental factors that contribute to individuals’ perceptions of safety and sense of well-being in public spaces. As such, this study examined how music listening during nighttime walking influenced female university students’ psychological state and perceptions of their campus. A total of 178 female university students with a mean age of 23.0 years participated in this study. One group of 78 students listened to prerecorded music while walking across their campus at night, while the other 100 students did not listen to music during nighttime walking. Immediately following their nighttime walking, participants were asked to rate their psychological state, perceptions on the safety of their campus, and the music (only for the music-listening group). For the non-music-listening group, significant correlations were found between the perceived safety of the campus and psychological states (both anxiety and psychological distress); the correlations were not significant in the music-listening group. The results indicate that music can mediate psychological states, supporting the proactive use of music as a psychological resource for coping with their perceptions of adverse environments. Given the limitations of this preliminary study, further studies with controlled music listening conditions, type of music, and environmental issues are suggested.
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Affiliation(s)
- Ga Eul Yoo
- Department of Music Therapy, Graduate School, Ewha Womans University, Seoul 03760, Korea;
| | - Sung Jin Hong
- KU Program in Urban Regeneration, Graduate School, Korea University, Seoul 02841, Korea;
- Strategic Sales HQ Consulting Group, S-1 Corporation, Seoul 04511, Korea
| | - Hyun Ju Chong
- Department of Music Therapy, Graduate School, Ewha Womans University, Seoul 03760, Korea;
- Correspondence:
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Abstract
OBJECTIVE We aim to review existing literature on the effects of background music in waiting rooms on patients. Furthermore, we examine existing neurobiological research for potential mechanisms by which music may affect patients. BACKGROUND Music has been studied in healthcare in various forms, from formal interventions such as music therapy to passive listening as therapy. However, music is also present in the healthcare environment in the form of background music in waiting rooms. There has been interest in whether background music in such a setting may have beneficial effects on patient anxiety in order to potentially inform healthcare workers whether and what type of music may be suitable for waiting rooms. METHODS We reviewed existing literature on music in healthcare waiting rooms and the neurobiological mechanisms by which music affects anxiety. RESULTS We located several small studies performed in a range of settings, including physician office waiting rooms and preoperative waiting areas. The studies generally reported that most patients viewed music in these areas positively; some, but not all, studies showed positive effects on patient anxiety. A variety of theories by which music may impact patient anxiety was noted. CONCLUSIONS We conclude that there exists some evidence to support an anxiety-reducing effect of background music on patients, though studies vary widely in methodology and music selection. A small amount of neurobiological research into the pertinent mechanisms has been conducted, but further research will be required to elucidate the exact mechanisms by which this intervention may reduce anxiety.
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Affiliation(s)
- James C-Y Lai
- Michael G. DeGroote School of Medicine, McMaster University, Hamilton, Ontario, Canada
| | - Noel Amaladoss
- Department of Psychiatry and Behavioural Neurosciences, McMaster University, Hamilton, Ontario, Canada
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Application of Music Therapy in General Surgical Treatment. BIOMED RESEARCH INTERNATIONAL 2021; 2021:6169183. [PMID: 34621896 PMCID: PMC8492240 DOI: 10.1155/2021/6169183] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 06/25/2021] [Revised: 09/06/2021] [Accepted: 09/07/2021] [Indexed: 11/23/2022]
Abstract
With the increasing application of music therapy in clinical practice, the effectiveness of music therapy in improving the negative emotions of patients, relieving pain, and adjusting the physiological state has also been receiving increasing recognization. Moreover, music therapy as adjuvant therapy for conventional treatment can achieve a better improvement in patient satisfaction and facilitate the acceptance of make music therapy by the medical industry. In addition to inevitable trauma, general surgery is criticized for its long treatment cycles and postoperative pain. With the continuous development of fast-track surgery (FTS), music therapy has received more attention in general surgical treatment. This study reviews the development history and prospects of music therapy in general surgery.
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Dingle GA, Sharman LS, Bauer Z, Beckman E, Broughton M, Bunzli E, Davidson R, Draper G, Fairley S, Farrell C, Flynn LM, Gomersall S, Hong M, Larwood J, Lee C, Lee J, Nitschinsk L, Peluso N, Reedman SE, Vidas D, Walter ZC, Wright ORL. How Do Music Activities Affect Health and Well-Being? A Scoping Review of Studies Examining Psychosocial Mechanisms. Front Psychol 2021; 12:713818. [PMID: 34566791 PMCID: PMC8455907 DOI: 10.3389/fpsyg.2021.713818] [Citation(s) in RCA: 31] [Impact Index Per Article: 10.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2021] [Accepted: 08/03/2021] [Indexed: 11/13/2022] Open
Abstract
Background: This scoping review analyzed research about how music activities may affect participants' health and well-being. Primary outcomes were measures of health (including symptoms and health behaviors) and well-being. Secondary measures included a range of psychosocial processes such as arousal, mood, social connection, physical activation or relaxation, cognitive functions, and identity. Diverse music activities were considered: receptive and intentional music listening; sharing music; instrument playing; group singing; lyrics and rapping; movement and dance; and songwriting, composition, and improvisation. Methods: Nine databases were searched with terms related to the eight music activities and the psychosocial variables of interest. Sixty-three papers met selection criteria, representing 6,975 participants of all ages, nationalities, and contexts. Results: Receptive and intentional music listening were found to reduce pain through changes in physiological arousal in some studies but not others. Shared music listening (e.g., concerts or radio programs) enhanced social connections and mood in older adults and in hospital patients. Music listening and carer singing decreased agitation and improved posture, movement, and well-being of people with dementia. Group singing supported cognitive health and well-being of older adults and those with mental health problems, lung disease, stroke, and dementia through its effects on cognitive functions, mood, and social connections. Playing a musical instrument was associated with improved cognitive health and well-being in school students, older adults, and people with mild brain injuries via effects on motor, cognitive and social processes. Dance and movement with music programs were associated with improved health and well-being in people with dementia, women with postnatal depression, and sedentary women with obesity through various cognitive, physical, and social processes. Rapping, songwriting, and composition helped the well-being of marginalized people through effects on social and cultural inclusion and connection, self-esteem and empowerment. Discussion: Music activities offer a rich and underutilized resource for health and well-being to participants of diverse ages, backgrounds, and settings. The review provides preliminary evidence that particular music activities may be recommended for specific psychosocial purposes and for specific health conditions.
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Affiliation(s)
- Genevieve A Dingle
- UQ Music, Dance and Health Research Group, The University of Queensland, Brisbane, QLD, Australia.,School of Psychology, The University of Queensland, St Lucia, QLD, Australia
| | - Leah S Sharman
- UQ Music, Dance and Health Research Group, The University of Queensland, Brisbane, QLD, Australia.,School of Psychology, The University of Queensland, St Lucia, QLD, Australia
| | - Zoe Bauer
- UQ Music, Dance and Health Research Group, The University of Queensland, Brisbane, QLD, Australia.,School of Human Movement and Nutrition Sciences, University of Queensland, Brisbane, QLD, Australia
| | - Emma Beckman
- UQ Music, Dance and Health Research Group, The University of Queensland, Brisbane, QLD, Australia.,School of Human Movement and Nutrition Sciences, University of Queensland, Brisbane, QLD, Australia
| | - Mary Broughton
- UQ Music, Dance and Health Research Group, The University of Queensland, Brisbane, QLD, Australia.,School of Music, The University of Queensland, Brisbane, QLD, Australia
| | - Emma Bunzli
- UQ Music, Dance and Health Research Group, The University of Queensland, Brisbane, QLD, Australia.,School of Psychology, The University of Queensland, St Lucia, QLD, Australia
| | - Robert Davidson
- UQ Music, Dance and Health Research Group, The University of Queensland, Brisbane, QLD, Australia.,School of Music, The University of Queensland, Brisbane, QLD, Australia
| | - Grace Draper
- UQ Music, Dance and Health Research Group, The University of Queensland, Brisbane, QLD, Australia.,School of Psychology, The University of Queensland, St Lucia, QLD, Australia
| | - Sheranne Fairley
- UQ Music, Dance and Health Research Group, The University of Queensland, Brisbane, QLD, Australia.,University of Queensland Business School, Brisbane, QLD, Australia
| | - Callyn Farrell
- UQ Music, Dance and Health Research Group, The University of Queensland, Brisbane, QLD, Australia.,School of Psychology, The University of Queensland, St Lucia, QLD, Australia
| | - Libby Maree Flynn
- UQ Music, Dance and Health Research Group, The University of Queensland, Brisbane, QLD, Australia.,School of Music, The University of Queensland, Brisbane, QLD, Australia
| | - Sjaan Gomersall
- UQ Music, Dance and Health Research Group, The University of Queensland, Brisbane, QLD, Australia.,School of Health and Rehabilitation Sciences, University of Queensland, St Lucia, QLD, Australia
| | - Mengxun Hong
- UQ Music, Dance and Health Research Group, The University of Queensland, Brisbane, QLD, Australia.,School of Psychology, The University of Queensland, St Lucia, QLD, Australia
| | - Joel Larwood
- UQ Music, Dance and Health Research Group, The University of Queensland, Brisbane, QLD, Australia.,School of Psychology, The University of Queensland, St Lucia, QLD, Australia
| | - Chiying Lee
- UQ Music, Dance and Health Research Group, The University of Queensland, Brisbane, QLD, Australia.,School of Psychology, The University of Queensland, St Lucia, QLD, Australia
| | - Jennifer Lee
- UQ Music, Dance and Health Research Group, The University of Queensland, Brisbane, QLD, Australia.,School of Health and Rehabilitation Sciences, University of Queensland, St Lucia, QLD, Australia
| | - Lewis Nitschinsk
- UQ Music, Dance and Health Research Group, The University of Queensland, Brisbane, QLD, Australia.,School of Psychology, The University of Queensland, St Lucia, QLD, Australia
| | - Natalie Peluso
- UQ Music, Dance and Health Research Group, The University of Queensland, Brisbane, QLD, Australia.,School of Psychology, The University of Queensland, St Lucia, QLD, Australia
| | - Sarah Elizabeth Reedman
- UQ Music, Dance and Health Research Group, The University of Queensland, Brisbane, QLD, Australia.,Child Health Research Centre, University of Queensland, Brisbane, QLD, Australia
| | - Dianna Vidas
- UQ Music, Dance and Health Research Group, The University of Queensland, Brisbane, QLD, Australia.,School of Psychology, The University of Queensland, St Lucia, QLD, Australia
| | - Zoe C Walter
- UQ Music, Dance and Health Research Group, The University of Queensland, Brisbane, QLD, Australia.,School of Psychology, The University of Queensland, St Lucia, QLD, Australia
| | - Olivia Renee Louise Wright
- UQ Music, Dance and Health Research Group, The University of Queensland, Brisbane, QLD, Australia.,School of Human Movement and Nutrition Sciences, University of Queensland, Brisbane, QLD, Australia
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Nees LK, Grozinger P, Orthmann N, Deutsch TM, Hennigs A, Domschke C, Wallwiener M, Rom J, Riedel F. Evaluating the influence of music at different sound pressure levels on medical students' performance of standardized laparoscopic box training exercises. BMC MEDICAL EDUCATION 2021; 21:209. [PMID: 33849503 PMCID: PMC8042978 DOI: 10.1186/s12909-021-02627-6] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 12/08/2020] [Accepted: 03/22/2021] [Indexed: 06/12/2023]
Abstract
BACKGROUND The influence of music on the performance of surgical procedures such as laparoscopy is controversial and methodologically difficult to quantify. Here, outcome measurements using laparoscopic box training tools under standardized conditions might offer a feasible approach. To date, the effect of music exposure at different sound pressure levels (SPL) on outcome has not been evaluated systematically for laparoscopic novices. METHODS Between May 2017 and October 2018, n = 87 students (49 males, 38 females) from Heidelberg University Medical School performed three different laparoscopy exercises using the "Luebecker Toolbox" that were repeated twice under standardized conditions. Time was recorded for each run. All students were randomly assigned to four groups exposed to the same music compilation but at different SPLs (50-80 dB), an acoustically shielded (earplug) group, or a control group (no intervention). RESULTS Best absolute performance was shown under exposure to 70 dB in all three exercises (a, b, c) with mean performance time of 121, 142, and 115 s (p < 0.05 for a and c). For the control group mean performance times were 157, 144, and 150 s, respectively. In the earplug group, no significant difference in performance was found compared to the control group (p > 0.05) except for exercise (a) (p = 0.011). CONCLUSION Music exposure seems to have beneficial effects on training performance. In comparison to the control group, significantly better results were reached at 70 dB SPL, while exposure to lower (50 or 60 dB) or higher (80 dB) SPL as well as under acoustic shielding did not influence performance.
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Affiliation(s)
- Lisa Katharina Nees
- Department of Gynecology and Obstetrics, Heidelberg University Hospital, Im Neuenheimer Feld 440, D-69120, Heidelberg, Germany
| | - Philipp Grozinger
- Department of Gynecology and Obstetrics, Heidelberg University Hospital, Im Neuenheimer Feld 440, D-69120, Heidelberg, Germany
| | - Natalie Orthmann
- Asklepios Klinik Hamburg-Altona, Department of Gynecology and Obstetric, Hamburg, Germany
| | - Thomas Maximilian Deutsch
- Department of Gynecology and Obstetrics, Heidelberg University Hospital, Im Neuenheimer Feld 440, D-69120, Heidelberg, Germany
| | - André Hennigs
- Department of Gynecology and Obstetrics, Heidelberg University Hospital, Im Neuenheimer Feld 440, D-69120, Heidelberg, Germany
| | - Christoph Domschke
- Department of Gynecology and Obstetrics, Heidelberg University Hospital, Im Neuenheimer Feld 440, D-69120, Heidelberg, Germany
| | - Markus Wallwiener
- Department of Gynecology and Obstetrics, Heidelberg University Hospital, Im Neuenheimer Feld 440, D-69120, Heidelberg, Germany
| | - Joachim Rom
- Klinikum Frankfurt-Hoechst, Department of Gynecology and Obstetrics, Frankfurt, Germany
| | - Fabian Riedel
- Department of Gynecology and Obstetrics, Heidelberg University Hospital, Im Neuenheimer Feld 440, D-69120, Heidelberg, Germany.
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Kavak Akelma F, Altınsoy S, Arslan MT, Ergil J. Effect of favorite music on postoperative anxiety and pain. Anaesthesist 2020; 69:198-204. [DOI: 10.1007/s00101-020-00731-8] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2019] [Revised: 12/22/2019] [Accepted: 12/28/2019] [Indexed: 10/25/2022]
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12
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Lee M, Song CB, Shin GH, Lee SW. Possible Effect of Binaural Beat Combined With Autonomous Sensory Meridian Response for Inducing Sleep. Front Hum Neurosci 2019; 13:425. [PMID: 31849629 PMCID: PMC6900908 DOI: 10.3389/fnhum.2019.00425] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2019] [Accepted: 11/15/2019] [Indexed: 12/22/2022] Open
Abstract
Sleep is important to maintain physical and cognitive functions in everyday life. However, the prevalence of sleep disorders is on the rise. One existing solution to this problem is to induce sleep using an auditory stimulus. When we listen to acoustic beats of two tones in each ear simultaneously, a binaural beat is generated which induces brain signals at a specific desired frequency. However, this auditory stimulus is uncomfortable for users to listen to induce sleep. To overcome this difficulty, we can exploit the feelings of calmness and relaxation that are induced by the perceptual phenomenon of autonomous sensory meridian response (ASMR). In this study, we proposed a novel auditory stimulus for inducing sleep. Specifically, we used a 6 Hz binaural beat corresponding to the center of the theta band (4-8 Hz), which is the frequency at which brain activity is entrained during non-rapid eye movement (NREM) in sleep stage 1. In addition, the "ASMR triggers" that cause ASMR were presented from natural sound as the sensory stimuli. In session 1, we combined two auditory stimuli (the 6 Hz binaural beat and ASMR triggers) at three-decibel ratios to find the optimal combination ratio. As a result, we determined that the combination of a 30:60 dB ratio of binaural beat to ASMR trigger is most effective for inducing theta power and psychological stability. In session 2, the effects of these combined stimuli (CS) were compared with an only binaural beat, only the ASMR trigger, or a sham condition. The combination stimulus retained the advantages of the binaural beat and resolved its shortcomings with the ASMR triggers, including psychological self-reports. Our findings indicate that the proposed auditory stimulus could induce the brain signals required for sleep, while simultaneously keeping the user in a psychologically comfortable state. This technology provides an important opportunity to develop a novel method for increasing the quality of sleep.
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Affiliation(s)
- Minji Lee
- Department of Brain and Cognitive Engineering, Korea University, Seoul, South Korea
| | - Chae-Bin Song
- Department of Brain and Cognitive Engineering, Korea University, Seoul, South Korea
| | - Gi-Hwan Shin
- Department of Brain and Cognitive Engineering, Korea University, Seoul, South Korea
| | - Seong-Whan Lee
- Department of Brain and Cognitive Engineering, Korea University, Seoul, South Korea
- Department of Artificial Intelligence, Korea University, Seoul, South Korea
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13
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Ciğerci Y, Kısacık ÖG, Özyürek P, Çevik C. Nursing music intervention: A systematic mapping study. Complement Ther Clin Pract 2019; 35:109-120. [DOI: 10.1016/j.ctcp.2019.02.007] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2018] [Revised: 02/04/2019] [Accepted: 02/06/2019] [Indexed: 01/09/2023]
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14
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Felix MMDS, Ferreira MBG, Oliveira LFD, Barichello E, Pires PDS, Barbosa MH. Guided imagery relaxation therapy on preoperative anxiety: a randomized clinical trial. Rev Lat Am Enfermagem 2018; 26:e3101. [PMID: 30517586 PMCID: PMC6280172 DOI: 10.1590/1518-8345.2850.3101] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2018] [Accepted: 10/08/2018] [Indexed: 12/15/2022] Open
Abstract
Objective to evaluate the effect of relaxation therapy with guided imagery on state
anxiety and cortisol in the immediate preoperative period in patients
submitted to bariatric surgery by videolaparoscopy. Method a randomized, triple-blind clinical trial in a large teaching hospital in
the interior of Minas Gerais. Twenty-four patients who would undergo
video-laparoscopic bariatric surgery were randomly allocated in two groups,
namely 12 in the control group and 12 in the experimental group. State
anxiety was assessed by the State-Trait Anxiety Inventory, and blood
cortisol levels were measured before and after the intervention or standard
care. Descriptive analyzes were used for the quantitative variables and
Student’s t-test for independent samples, in the analysis of the differences
between the state anxiety scores and cortisol levels. Results the experimental group presented a statistically significant reduction of
the state anxiety scores (p = 0.005) as well as of cortisol levels (p
<0.001) after the intervention. Conclusion guided imagery relaxation therapy is an effective nursing intervention for
the reduction of state anxiety and blood cortisol levels in the preoperative
period in patients undergoing video-laparoscopic bariatric surgery.
Brazilian Registry of Clinical Trials: RBR-5qywrf.
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Affiliation(s)
- Márcia Marques Dos Santos Felix
- Universidade Federal do Triângulo Mineiro, Departamento Didático Científico de Enfermagem na Assistência Hospitalar, Uberaba, MG, Brasil
| | - Maria Beatriz Guimarães Ferreira
- Universidade Federal do Triângulo Mineiro, Departamento Didático Científico de Enfermagem na Assistência Hospitalar, Uberaba, MG, Brasil
| | | | - Elizabeth Barichello
- Universidade Federal do Triângulo Mineiro, Departamento Didático Científico de Enfermagem na Assistência Hospitalar, Uberaba, MG, Brasil
| | - Patricia da Silva Pires
- Universidade Federal da Bahia, Instituto Multidisciplinar em Saúde, Vitória da Conquista, BA, Brasil
| | - Maria Helena Barbosa
- Universidade Federal do Triângulo Mineiro, Departamento Didático Científico de Enfermagem na Assistência Hospitalar, Uberaba, MG, Brasil
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15
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Boyce M, Bungay H, Munn-Giddings C, Wilson C. The impact of the arts in healthcare on patients and service users: A critical review. HEALTH & SOCIAL CARE IN THE COMMUNITY 2018; 26:458-473. [PMID: 28940775 DOI: 10.1111/hsc.12502] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 08/30/2017] [Indexed: 05/06/2023]
Abstract
This review provides an updated evaluation of the emerging body of literature on the value of the arts in healthcare settings. Internationally, there is growing interest in the use of the arts in the healthcare context supported by the number of research studies reported in the nursing and medical literature. There is evidence that arts interventions have positive effects on psychological and physiological outcomes on patients in a hospital environment. A critical review of the literature between 2011 and 2016 was undertaken. The following databases were searched: MedLine, CINAHL, AMED, Web of Science and ASSIA. Searches included words from three categories: cultural activities, outcomes and healthcare settings. Initial searches identified 131 potentially relevant articles. Following screening and review by the research team, a total of 69 studies were included in the final review. The majority of studies examined the effect of music listening on patients/service users (76.8%). These studies were primarily quantitative focusing on the measurable effects of music listening in a surgical context. Overall, the studies in the review support the growing evidence base on the value of the arts in a variety of healthcare settings for patients/service users. The review findings suggest that now is the time for different voices and art forms to be considered and represented in the research on arts in healthcare. Further research is also required to strengthen the existing evidence base.
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Affiliation(s)
- Melanie Boyce
- Faculty of Health, Social Care and Education, Anglia Ruskin University, Chelmsford, UK
| | - Hilary Bungay
- Faculty of Medical Science, Anglia Ruskin University, Chelmsford, UK
| | - Carol Munn-Giddings
- Faculty of Health, Social Care and Education, Anglia Ruskin University, Chelmsford, UK
| | - Ceri Wilson
- Faculty of Health, Social Care and Education, Anglia Ruskin University, Chelmsford, UK
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16
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Najafi Ghezeljeh T, Mohaddes Ardebili F. Comparing the effect of patients preferred music and Swedish massage on anticipatory anxiety in patients with burn injury: Randomized controlled clinical trial. Complement Ther Clin Pract 2018; 32:55-60. [PMID: 30057058 DOI: 10.1016/j.ctcp.2018.05.002] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2017] [Revised: 04/11/2018] [Accepted: 05/03/2018] [Indexed: 11/17/2022]
Abstract
BACKGROUND Effective strategies should be considered for reducing pain and anxiety and improving burn patients' well-being. This study was aimed to compare the effect of preferred music and Swedish massage on pain anticipatory anxiety in burn patients. METHODS In this randomized controlled clinical trial 240 hospitalized burn patients were selected and assigned to Swedish massage, preferred music, combination of Swedish massage and preferred music and control groups through fixed blocking randomization. Interventions was offered before wound care one time for 20 min on patients' bedside. Patients in the control group only received routine care. The Persian version of Burn Specific Pain Anxiety Scale were used for data gathering. Data was analyzed using SPSS-PC (V.16.0). RESULTS There was a statistically significant difference between groups regarding mean changes of anticipatory anxiety (P < 0.001). The results indicated that patients in the group of combination of both interventions reported significantly lower anticipatory anxiety as compared to the preferred music (P = 0.015), Swedish massage (P = 0.002) and control (P < 0.001) groups. The mean changes of anticipatory anxiety score in the Swedish massage and preferred music groups had a statistically significant difference with the control group (P < 0.001). There was no difference between the mean changes of anticipatory anxiety in preferred music and Swedish massage groups. CONCLUSIONS According to the results, combining both Swedish massage and preferred music was more effective in reducing anticipatory anxiety in burn patients. Health care providers, particularly, nurses can provide these two noninvasive and economical interventions simultaneously and benefits the synergistic effect of them in burn patients.
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Affiliation(s)
- Tahereh Najafi Ghezeljeh
- Department of Critical Care Nursing, School of Nursing and Midwifery, Iran University of Medical Sciences, Rashid Yasemi St., Valiasr St., Tehran, Iran.
| | - Fatemeh Mohaddes Ardebili
- Department of Medical-Surgical Nursing, Faculty of Nursing and Midwifery, Iran University of Medical Sciences, Rashid Yasemi St., Valiasr St., Tehran, Iran.
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17
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The effect of different types of music on patients' preoperative anxiety: A randomized controlled trial. Complement Ther Clin Pract 2018; 31:158-163. [DOI: 10.1016/j.ctcp.2018.02.012] [Citation(s) in RCA: 31] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2018] [Accepted: 02/13/2018] [Indexed: 11/22/2022]
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18
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Nielsen E, Wåhlin I, Frisman GH. Evaluating Pictures of Nature and Soft Music on Anxiety and Well-Being During Elective Surgery. Open Nurs J 2018; 12:58-66. [PMID: 29755608 PMCID: PMC5925859 DOI: 10.2174/1874434601812010058] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2017] [Revised: 03/07/2018] [Accepted: 03/28/2018] [Indexed: 12/16/2022] Open
Abstract
Background: Patients going through surgery being awake often have a sense of anxiety and need support to relax. Objective: The aim of this study was to investigate whether looking at pictures of natural scenery could reduce anxiety and pain and increase relaxation and well-being being awake during the elective surgery. Methods: This three-arm, randomized intervention study consisted of one group viewing pictures of natural scenery, one group listening to soft instrumental music, and one control group without distraction, all adult patients (n=174). The State Trait Anxiety Inventory short form and a visual analogue scale on well-being were used as well as sedation treatment if necessary. Results: No differences related to anxiety after surgery were found among the three groups. When controlling for the effect of sedative treatment, however, patients without sedation had a lower degree of anxiety postoperatively (p=0.014). Younger patients had a higher degree of anxiety and lower degree of postoperative relaxation and well-being.
Conclusion:
Viewing pictures of natural scenery while being awake during elective surgery is as relaxing as listening to soft instrumental music. Offering nature scenery pictures for patients to view could be relaxing during the elective surgery.
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Affiliation(s)
- Elinor Nielsen
- Department of Anesthesiology and Intensive Care, Vrinnevi Hospital Norrköping, Norrköping, Sweden
| | - Ingrid Wåhlin
- Research Section, Kalmar County Council, S-391 85 Kalmar, Sweden and Linnaeus University, Faculty of Health and life Sciences, Växjö, Kalmar, Sweden
| | - Gunilla Hollman Frisman
- Department of Anesthetics, Operations and Speciality Surgery Center and Medical and Health Sciences, Division of Nursing Sciences. Linköping University, 581 85 Linköping, Sweden
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19
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Kühlmann AYR, de Rooij A, Kroese LF, van Dijk M, Hunink MGM, Jeekel J. Meta-analysis evaluating music interventions for anxiety and pain in surgery. Br J Surg 2018; 105:773-783. [PMID: 29665028 PMCID: PMC6175460 DOI: 10.1002/bjs.10853] [Citation(s) in RCA: 162] [Impact Index Per Article: 27.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2017] [Revised: 12/08/2017] [Accepted: 02/09/2018] [Indexed: 01/01/2023]
Abstract
BACKGROUND This study aimed to evaluate anxiety and pain following perioperative music interventions compared with control conditions in adult patients. METHODS Eleven electronic databases were searched for full-text publications of RCTs investigating the effect of music interventions on anxiety and pain during invasive surgery published between 1 January 1980 and 20 October 2016. Results and data were double-screened and extracted independently. Random-effects meta-analysis was used to calculate effect sizes as standardized mean differences (MDs). Heterogeneity was investigated in subgroup analyses and metaregression analyses. The review was registered in the PROSPERO database as CRD42016024921. RESULTS Ninety-two RCTs (7385 patients) were included in the systematic review, of which 81 were included in the meta-analysis. Music interventions significantly decreased anxiety (MD -0·69, 95 per cent c.i. -0·88 to -0·50; P < 0·001) and pain (MD -0·50, -0·66 to -0·34; P < 0·001) compared with controls, equivalent to a decrease of 21 mm for anxiety and 10 mm for pain on a 100-mm visual analogue scale. Changes in outcome corrected for baseline were even larger: MD -1·41 (-1·89 to -0·94; P < 0·001) for anxiety and -0·54 (-0·93 to -0·15; P = 0·006) for pain. Music interventions provided during general anaesthesia significantly decreased pain compared with that in controls (MD -0·41, -0·64 to -0·18; P < 0·001). Metaregression analysis found no significant association between the effect of music interventions and age, sex, choice and timing of music, and type of anaesthesia. Risk of bias in the studies was moderate to high. CONCLUSION Music interventions significantly reduce anxiety and pain in adult surgical patients.
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Affiliation(s)
- A Y R Kühlmann
- Department of Paediatric Surgery, Erasmus Medical Centre-Sophia Children's Hospital, Rotterdam, The Netherlands
| | - A de Rooij
- Department of Neuroscience, Erasmus Medical Centre, Rotterdam, The Netherlands
| | - L F Kroese
- Department of Surgery, Erasmus Medical Centre, Rotterdam, The Netherlands
| | - M van Dijk
- Department of Paediatric Surgery, Erasmus Medical Centre-Sophia Children's Hospital, Rotterdam, The Netherlands.,Department of Internal Medicine, Erasmus Medical Centre, Rotterdam, The Netherlands
| | - M G M Hunink
- Department of Epidemiology, Erasmus Medical Centre, Rotterdam, The Netherlands.,Department of Radiology, Erasmus Medical Centre, Rotterdam, The Netherlands.,Department of Health Policy and Management, Harvard T. H. Chan School of Public Health, Boston, Massachusetts, USA
| | - J Jeekel
- Department of Neuroscience, Erasmus Medical Centre, Rotterdam, The Netherlands
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20
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Williams C, Hine T. An investigation into the use of recorded music as a surgical intervention: A systematic, critical review of methodologies used in recent adult controlled trials. Complement Ther Med 2018; 37:110-126. [PMID: 29609922 DOI: 10.1016/j.ctim.2018.02.002] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2017] [Revised: 02/01/2018] [Accepted: 02/12/2018] [Indexed: 01/20/2023] Open
Abstract
CONTEXT While music is being increasingly used as a surgical intervention, the types of music used and the reasons underlying their selection remain inconsistent. Empirical research into the efficacy of such musical interventions is therefore problematic. OBJECTIVE To provide clear guidelines for musical selection and employment in surgical interventions, created through a synthesis of the literature. The aim is to examine how music is implemented in surgical situations, and to provide guidance for the selection and composition of music for future interventions. METHODS English language quantitative surgical intervention studies from Science Direct, ProQuest, and Sage Journals Online, all published within the last 10 years and featuring recorded music, were systematically reviewed. Variables investigated included: the time the intervention was performed, the intervention length, the outcomes targeted, music description (general and specific), theoretical frameworks underlying the selection of the music, whether or not a musical expert was involved, participant music history, and the participants' feedback on the chosen music. RESULTS Several aspects contribute to the lack of scientific rigour regarding music selection in this field, including the lack of a theoretical framework or frameworks, no involvement of musical experts, failure to list the music tracks used, and the use of vague and subjective terms in general music descriptions. Patients are frequently allowed to select music (risking both choosing music that has an adverse effect and making study replication difficult), and patient music history and listening habits are rarely considered. Crucially, five primary theoretical frameworks underlying the effectiveness of music arose in the literature (distraction, relaxation, emotional shift, entrainment, and endogenous analgesia), however music was rarely selected to enhance any of these mechanisms. CONCLUSIONS Further research needs to be conducted to ensure that music is selected according to a theoretical framework and more rigorous and replicable methodology. Music interventions can be made more effective at improving psychological states and reducing physiological arousal by selecting music conducive to specific mechanisms, and also by considering at what point during the surgical experience the music would be most effective. Greater involvement of music experts in interventions would help to ensure that the most appropriate music was chosen, and that it is clearly and precisely described.
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Affiliation(s)
- Courtney Williams
- Queensland Conservatorium Research Centre, Griffith University, South Brisbane, QLD, Australia.
| | - Trevor Hine
- Menzies Health Institute Queensland, Australia; School of Applied Psychology, Griffith University, Mt Gravatt, QLD, Australia.
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21
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van Aken M, Oosterman J, van Rijn T, Ferdek M, Ruigt G, Kozicz T, Braat D, Peeters A, Nap A. Hair cortisol and the relationship with chronic pain and quality of life in endometriosis patients. Psychoneuroendocrinology 2018; 89:216-222. [PMID: 29414035 DOI: 10.1016/j.psyneuen.2018.01.001] [Citation(s) in RCA: 31] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/21/2017] [Revised: 12/15/2017] [Accepted: 01/02/2018] [Indexed: 12/30/2022]
Abstract
Endometriosis is a chronic estrogen-dependent disease in which pelvic pain is the dominant symptom. The negative effects of endometriosis on the life of women with this disease can be a cause of stress. Stress levels can be measured in different ways, mostly reflecting acute stress responses. Hair cortisol measurements are a reflection of long-term systematic cortisol levels. In this study a first attempt is made to measure cortisol levels in hair of endometriosis patients in comparison with healthy controls. Moreover, it is explored whether chronic pain symptoms as well as different aspects of Health Related Quality of Life (HRQoL) are associated with hair cortisol levels in women with endometriosis. Results show that the mean hair cortisol level is significantly higher in women with endometriosis compared to healthy controls (p = 0.018). There is a positive correlation between hair cortisol level and HRQoL in patients but not in controls (Rho 0.426). The level of hair cortisol does not correlate with the reported pain intensity in patients (Rho -0.082). These results are indicative of an altered HPA-axis function in endometriosis patients, possibly caused by higher chronic stress level in these patients. Moreover, a potential explanation for the positive correlation of cortisol with the HRQoL in these patients is that patients with a high HRQoL have an adequate stress response by increasing their cortisol levels as a response to physical and emotional stress induced by the endometriosis.
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Affiliation(s)
- Mieke van Aken
- Department of Anatomy, Radboud University Medical Centre, Nijmegen, The Netherlands; Department of Gynaecology and Obstetrics, Rijnstate, Arnhem, The Netherlands.
| | - Joukje Oosterman
- Radboud University, Donders Institute for Brain, Cognition and Behaviour, Nijmegen, The Netherlands
| | - Tineke van Rijn
- Radboud University, Donders Institute for Brain, Cognition and Behaviour, Nijmegen, The Netherlands
| | - Magdalena Ferdek
- Radboud University, Donders Institute for Brain, Cognition and Behaviour, Nijmegen, The Netherlands; Psychology Laboratory, Institute of Psychology, Jagiellonian University, Krakow, Poland
| | - Gé Ruigt
- Clinical Consultancy for Neuroscience Drug Development BV, Oss, The Netherlands
| | - Tamas Kozicz
- Department of Anatomy, Radboud University Medical Centre, Nijmegen, The Netherlands
| | - Didi Braat
- Department of Obstetrics and Gynaecology, Radboud University Medical Centre Nijmegen, The Netherlands
| | - Ard Peeters
- Department of Anatomy, Radboud University Medical Centre, Nijmegen, The Netherlands
| | - Annemiek Nap
- Department of Gynaecology and Obstetrics, Rijnstate, Arnhem, The Netherlands
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22
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Amiri MJ, Sadeghi T, Negahban Bonabi T. The effect of natural sounds on the anxiety of patients undergoing coronary artery bypass graft surgery. Perioper Med (Lond) 2017; 6:17. [PMID: 29167742 PMCID: PMC5688625 DOI: 10.1186/s13741-017-0074-3] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2017] [Accepted: 10/27/2017] [Indexed: 11/10/2022] Open
Abstract
Background This study aims to investigate the effect of natural sounds on the anxiety of patients undergoing coronary artery bypass graft surgery (CABG). Methods In this clinical trial, 90 patients, who were candidates for CABG in an urban area of Iran, were selected and randomly assigned to intervention and control groups by the minimization method. In the intervention group, natural sounds were broadcast through headphones for 30 min. In the control group, headphones connected to a silent device were used. The research instruments were a demographic questionnaire and the Spielberger State-Trait Anxiety Inventory (STAI). These were used before the intervention, 30 min after the music, and before the surgery in the waiting room for both groups. Data was analyzed using SPSS software. Results The mean anxiety level of the intervention group has been found to be significantly lower than that of the control group half an hour after the intervention as well as in the waiting room in the preoperative period (p = 0.001). Moreover, the mean anxiety of the intervention group decreases, while it increases for the control group over time (p < 0.001). Conclusion Natural sounds can be used as a non-pharmacological way to reduce the anxiety of patients undergoing CABG. Trial registration IRCT2017011723190N3, Registered 1 March 2017.
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Affiliation(s)
- Mohammad Javad Amiri
- School of Nursing and Midwifery, Rafsanjan University of Medical Sciences, Rafsanjan, Iran
| | - Tabandeh Sadeghi
- Non-Communicable Diseases Research Center, Rafsanjan University of Medical Sciences, Rafsanjan, Iran.,Department of Pediatric Nursing, School of Nursing and Midwifery, Rafsanjan University of Medical Sciences, Jomhori St., Rafsanjan, 7718796755 Iran
| | - Tayebeh Negahban Bonabi
- Social Determinants of Health Research Center, Rafsanjan University of Medical Sciences, Rafsanjan, Iran.,Deparment of Community Health Nursing, School of Nursing and Midwifery, Rafsanjan University of Medical Sciences, Rafsanjan, Iran
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