Effects of laughter therapy on quality of life in patients with cancer: An open-label, randomized controlled trial

The Effects of Laughter Therapy on Perceived Stress and Quality of Life in Women With Breast Cancer Receiving Chemotherapy: A Parallel-Group Randomized Controlled Pilot Trial

BACKGROUND

Women with breast cancer experience various symptoms secondary to chemotherapy that reduce their quality of life and increase their stress levels.

OBJECTIVE

To evaluate the effects of laughter therapy on perceived stress levels and quality of life in women with breast cancer receiving chemotherapy using a parallel-group randomized controlled pilot trial.

METHODS

Forty-two women were randomly assigned to intervention and control groups. The intervention group received 40 minutes of laughter therapy twice a week for 8 weeks. The control group received routine treatment. The women in both groups completed the Perceived Stress Scale and SF-12 Health Survey at baseline, week 5, and week 9 after randomization.

RESULTS

There was a significant decrease in the mean Perceived Stress Scale scores in the intervention group compared with those in the control group at weeks 5 and 9 compared with baseline, and the difference between groups by measurement week was significant (P < .001). Women in the intervention group had higher Physical Component Summary-12 and Mental Component Summary-12 scores in weeks 5 and 9 compared with those in the control group, and there was a significant difference between groups in terms of change in the Physical Component Summary-12 and Mental Component Summary-12 mean scores over time (P < .001).

CONCLUSION

Laughter therapy is possible to use as a nursing intervention to reduce the perceived stress levels and increase the quality of life of women receiving chemotherapy for breast cancer.

IMPLICATIONS FOR PRACTICE

Nurses can apply laughter therapy in the symptom management of women receiving chemotherapy.

The Effect of Laughter Yoga Applied to Intensive Care Nurses on Their Perceived Stress, Job Motivation, and Mental Well-being: Randomized Controlled Study

AIM

The aim of this study was to examine the effect of laughter yoga applied to intensive care nurses on perceived stress, job motivation, and mental well-being.

DESIGN

This study was a randomized controlled trial.

METHODS

The study was conducted with nurses working at the university hospital's surgical intensive care and anesthesia intensive care units of the third-level intensive care unit in Turkey. Data obtained from 30 participants in the intervention group and 33 participants in the control group were analyzed. The Nurse Introduction Form, Nurse Job Motivation Scale, Perceived Stress Scale, and Warwick-Edinburgh Mental Well-being Scale were used to collect data. Data obtained from the study were evaluated using the SPSS 22.0 package.

RESULTS

It was determined that there was no statistically significant difference in the average scores of the pretest/posttest 1/posttest 2 of the Perceived Stress Scale (13.70 ± 3.33 to 14.57 ± 4.57, P > .05; 13.50 ± 3.15 to 13.48 ± 4.59, P > .05; and 13.56 ± 3.15 to 13.15 ± 3.49, P > .05, respectively) and Work Motivation Scale (59.70 ± 7.58 to 59.69 ± 7.98, P > .05; 60.30 ± 8.07 to 58.48 ± 8.94, P > .05; and 60.56 ± 7.86 to 57.93 ± 9.54, P > .05, respectively) for both the intervention and control groups of nurses. A statistically significant difference was found in the average scores of the Warwick-Edinburgh Mental Well-Being Scale pretest/posttest 1/posttest 2 for the intervention group of nurses (50.90 ± 7.60, 51.50 ± 7.80, and 53.70 ± 7.08, respectively; F = 3.330, P = .043). However, the difference was found to be insignificant in pairwise comparisons in the further analysis (a = b = c). It was determined that there was no statistically significant difference in the average scores of the Warwick-Edinburgh Mental Well-Being Scale pretest/posttest 1/posttest 2 for the control group of nurses (52.21 ± 9.89, 51.93 ± 10.45, and 51.03 ± 9.63, respectively; P > .05).

CONCLUSIONS

The application of laughter yoga on intensive care nurses did not result in a significant change in perceived stress levels and work motivation. However, statistically significant differences were observed in the average mental well-being scores among the intervention group.

Development of an Artificial Intelligence-Based Tailored Mobile Intervention for Nurse Burnout: Single-Arm Trial

BACKGROUND

Nurse burnout leads to an increase in turnover, which is a serious problem in the health care system. Although there is ample evidence of nurse burnout, interventions developed in previous studies were general and did not consider specific burnout dimensions and individual characteristics.

OBJECTIVE

The objectives of this study were to develop and optimize the first tailored mobile intervention for nurse burnout, which recommends programs based on artificial intelligence (AI) algorithms, and to test its usability, effectiveness, and satisfaction.

METHODS

In this study, an AI-based mobile intervention, Nurse Healing Space, was developed to provide tailored programs for nurse burnout. The 4-week program included mindfulness meditation, laughter therapy, storytelling, reflective writing, and acceptance and commitment therapy. The AI algorithm recommended one of these programs to participants by calculating similarity through a pretest consisting of participants' demographics, research variables, and burnout dimension scores measured with the Copenhagen Burnout Inventory. After completing a 4-week program, burnout, job stress, stress response using the Stress Response Inventory Modified Form, the usability of the app, coping strategy by the coping strategy indicator, and program satisfaction (1: very dissatisfied; 5: very satisfied) were measured. The AI recognized the recommended program as effective if the user's burnout score reduced after the 2-week program and updated the algorithm accordingly. After a pilot test (n=10), AI optimization was performed (n=300). A paired 2-tailed t test, ANOVA, and the Spearman correlation were used to test the effect of the intervention and algorithm optimization.

RESULTS

Nurse Healing Space was implemented as a mobile app equipped with a system that recommended 1 program out of 4 based on similarity between users through AI. The AI algorithm worked well in matching the program recommended to participants who were most similar using valid data. Users were satisfied with the convenience and visual quality but were dissatisfied with the absence of notifications and inability to customize the program. The overall usability score of the app was 3.4 out of 5 points. Nurses' burnout scores decreased significantly after the completion of the first 2-week program (t=7.012; P<.001) and reduced further after the second 2-week program (t=2.811; P=.01). After completing the Nurse Healing Space program, job stress (t=6.765; P<.001) and stress responses (t=5.864; P<.001) decreased significantly. During the second 2-week program, the burnout level reduced in the order of participation (r=-0.138; P=.04). User satisfaction increased for both the first (F=3.493; P=.03) and second programs (F=3.911; P=.02).

CONCLUSIONS

This program effectively reduced burnout, job stress, and stress responses. Nurse managers were able to prevent nurses from resigning and maintain the quality of medical services using this AI-based program to provide tailored interventions for nurse burnout. Thus, this app could improve qualitative health care, increase employee satisfaction, reduce costs, and ultimately improve the efficiency of the health care system.

How Should Therapists Treat Patients who are so Altruistic They Regularly Harm Themselves for the Sake of Others?

Mental health providers sometimes encounter patients who are exceptionally altruistic toward others and, at the same time, are willing to ignore their own needs and even significantly harm themselves to best achieve these ends for others. Traditionally, therapists have seen it to be their role to discern patients' negative symptoms, then seek to reduce them. This article reviews gains based on positive psychology that highlight the importance of therapists giving priority to supporting patients' strengths, particularly the sources of meaning they have in their lives. As is consistent with this view, it is suggested that therapists working with this group of self-harming, altruistic patients not only support their altruism, but particularly consider and remain cautious as to whether or not they should explore unconscious factors with the patient that might fuel their altruism. It is suggested that the discovery of such factors might be harmful because it could risk decreasing the degree to which these patients continue to show and personally value their altruism, thus potentially decreasing the meaning they derive from their altruism.

Bibliometric Analysis of Randomized Controlled Trials on Yoga Interventions for Cancer Patients: A Decade in Review

This literature review presents a bibliometric analysis of the randomized controlled trials conducted between 2014 and 2023 on the potential benefits of yoga as a complementary therapy for cancer patients. To conduct this analysis, we searched medical and scientific databases, such as Scopus, Cochrane, and PubMed, using relevant keywords. Our search yielded 58 clinical trials involving 4,762 patients, which indicates a growing trend in this field of research. The studies we reviewed mainly focused on breast cancer patients and demonstrated the adaptability and versatility of yoga, offering a ray of hope and optimism. Among the various styles of yoga, Hatha yoga was the most frequently practiced style in these clinical trials. The analysis we conducted reveals that yoga interventions have a promising role in cancer care and can be a valuable complementary therapy for cancer patients. However, significant gaps and limitations still need to be addressed in this area of research. For instance, more rigorous and diverse investigations are needed to further establish the potential benefits of yoga interventions for cancer patients. Additionally, the standardization of yoga interventions is crucial to optimize therapeutic benefits. By addressing these gaps and limitations, we can further enhance the potential of yoga as a complementary therapy for cancer patients.

Efficacy and Safety of Laughter Yoga in Cancer Patients: A Scoping Review of Randomized Controlled Trials

The use of laughter yoga as a complementary and alternative medicine (CAM) strategy has recently gained interest as a potential supportive intervention for cancer patients. In this review, we aimed to assess the impact of laughter yoga on the quality of life of cancer patients, with a focus on evidence from randomized controlled trials (RCTs). Our analysis indicates that laughter yoga can significantly improve the quality of life of cancer patients by improving emotional and physical functioning and reducing symptoms of depression and stress. These findings suggest that laughter yoga is a promising CAM practice for enhancing cancer patients' psychological and physical health. Future research should aim to extend these studies to more extensive and more diverse populations to validate and expand upon these findings.

A structured laughter yoga therapy program on patients with chemotherapy-induced nausea and vomiting: A randomized clinical trial

Objetive

Chemotherapy is a prevalent cancer treatment, often accompanied by debilitating side effects such as nausea and vomiting. This study explores the potential effectiveness of laughter yoga, a combination of exercise and voluntary laughter, in alleviating chemotherapy-induced nausea and vomiting.

Methods

This two-group randomized clinical trial was conducted on 69 cancer patients undergoing chemotherapy at the Reza Chemotherapy and Oncology Center, Mashhad, Iran, in 2018. Patients were randomly divided into intervention and control groups. Both groups received routine self-care training, with the addition of four 20-min to 30-min laughter yoga sessions held immediately before one of their chemotherapy appointments for the intervention group only. Nausea and vomiting were assessed using the Morrow Assessment of Nausea and Emesis questionnaire at two stages, before and after the intervention. Data were analyzed with Chi-square, Independent-t, Mann-Whitney, Wilcoxon, and McNemar tests using Statistical Package for the Social Sciences (SPSS).

Results

The mean age of patients in the intervention group was 49.0 ± 9.6 years, while in the control group, it was 45.2 ± 12.6 years. The intragroup comparison showed a statistically significant decrease in the severity and duration of nausea in the intervention group and a statistically significant increase in the severity and duration of nausea in the control group from pre-test to post-test (P < 0.05). The intergroup comparison showed no statistically significant difference between the two groups in terms of vomiting conditions.

Conclusions

Laughter yoga demonstrates promise in improving chemotherapy-induced nausea, suggesting its potential recommendation for managing this distressing side effect. Further research is warranted to explore its broader application in cancer care.

Trial registration

This study (No. IRCT20180429039463N1) was registered in the Iranian Registry of Clinical Trials on 21/08/2018.

Effect of Laughter Therapy on Mood Disturbances, Pain, and Burnout in Terminally Ill Cancer Patients and Family Caregivers

BACKGROUND

Humor has been commonly used in palliative care and identified as a coping strategy of palliative care patients and family caregivers. However, the use of humor or laughter in palliative care settings is still limited.

OBJECTIVE

The aim of this study was to examine the effect of laughter therapy involving spontaneous laughter on mood disturbances and pain in terminally ill patients with cancer and mood disturbances and the levels of burnout in family caregivers.

METHODS

This quasi-experimental study used a nonequivalent control group pretest-posttest design. The laughter therapy developed was provided for 20 to 30 minutes a day for 5 consecutive days. Twenty-six pairs of terminally ill cancer patients and family caregivers in the intervention group and 23 pairs in the comparison group from the hospice ward of a tertiary teaching hospital participated in this study. The data were collected using structured questionnaires and analyzed using descriptive statistics and 2-way repeated-measures analysis of variance.

RESULTS

There were significant decreases in mood disturbances in the patients ( P < .001) and family caregivers ( P < .001), pain in the patients ( P < .001), and levels of burnout in the caregivers ( P < .001) in the intervention group.

CONCLUSION

Laughter therapy can be an alternative intervention to support both terminally ill patients with cancer and their family caregivers experiencing multidimensional distress in palliative care settings.

IMPLICATIONS FOR PRACTICE

The appropriate use of laughter or humor therapy needs to be encouraged as a support tool in palliative care. Palliative care teams must be properly trained to provide spontaneous laughter therapy or planned humor therapy.

A pilot randomized controlled trial of distance laughter therapy for mothers' level of depression, anxiety, and parental stress during the COVID-19 pandemic

The COVID-19 pandemic has led to substantial lifestyle changes worldwide, contributing to heightened psychological stressors such as depression and anxiety. The demands of parental care have also intensified, increasing the risk of caregiver burnout and potential child maltreatment. This study aimed to evaluate the efficacy and feasibility of implementing distance laughter therapy for mothers caring for young children during the pandemic, with a focus on mitigating depression, anxiety, and parental stress. Utilizing a pilot randomized controlled design, 22 participants were divided into two groups-experimental and control groups-and underwent four virtual sessions over two weeks. The experimental group engaged in distance laughter therapy, a technique designed to stimulate self-induced laughter, while the control group viewed a 50-minute entertainment TV show. Both groups experienced a significant decrease in depression and anxiety; however, only the experimental group experienced a significant reduction in parental stress. Nonetheless, the differences in outcomes between the groups were not statistically significant. Participants who engaged in distance laughter therapy reported positive changes across physical, emotional, social, self-perception, and stress-coping domains in exit interviews. Therefore, laughter therapy has an additional benefit of reducing parental stress, which may be particularly useful for mothers primarily responsible for childcare during the pandemic. Future research should investigate the effects of laughter on broader populations and settings and quantify the actual amount of laughter generated.

Effect of Laughter Yoga on Sleep and Quality of Life in Individuals With Fecal Ostomies: A Randomized Controlled Trial

PURPOSE

The aim of this study was to evaluate the effect of laughter yoga on the quality of life and sleep quality in individuals with fecal ostomies.

DESIGN

This was randomized controlled trial.

SUBJECTS AND SETTING

The sample comprised 55 individuals with an ostomy who received care at Ankara University's I˙bni Sina Hospital Stoma Therapy Unit in Ankara, Turkey. Data were collected over a 2-month period (January and February 2020).

METHODS

Participants were allocated into an intervention group (n = 27) who received a yoga therapy intervention and a control group (n = 28) who received no intervention via simple randomization. Demographic and pertinent clinical variables were obtained during a baseline visit in both groups, along with the Pittsburgh Sleep Quality Index (PSQI) and Stoma-Quality of Life (Stoma-QOL) instruments. The intervention group received laughter yoga weekly over a period of 8 weeks.

RESULTS

Mean scores on the PSQI and the Stoma-QOL at baseline were compared. Participants in the intervention had a significant decline in mean PSQI scores (6.85 vs 5.48, P = .044) indicating improvement in sleep quality following the intervention. Analysis revealed no significant difference in mean Stoma-QOL scores (P = .077). Control group participants had no significant difference in either mean PSQI or Stoma-QOL scores following data collection at the end of 8 weeks.

CONCLUSIONS

Laughter yoga had a positive effect on the sleep quality in individuals with fecal ostomies. Further research is recommended to evaluate the effect of the number of laughter yoga sessions on the sleep quality and quality of life in individuals with ostomies.

Effects of laughter yoga on health-related quality of life in cancer patients undergoing chemotherapy: a randomized clinical trial

BACKGROUND

Chemotherapy is associated with a wide range of physical and psychological side effects, so complementary and alternative therapies may be practiced as an independent treatment or combined with the standard ones to improve health-related quality of life of cancer patients. Laughter yoga has predominantly been used as a complementary therapy to enhance health and wellbeing of ordinary people and patients with chronic diseases. However, to date, few studies have evaluated the effects of this modern exercise on cancer patients undergoing chemotherapy in clinical settings, to the best of the authors' knowledge. the present study aimed to investigate the effects of Laughter Yoga on the health-related quality of life of cancer patients undergoing chemotherapy.

METHODS

This study was a two-group randomized clinical trial on 69 cancer patients undergoing chemotherapy at Reza Radiotherapy and Oncology Center, Iran in 2018. Patients were randomly divided into intervention and control groups. The intervention group received laughter yoga for four sessions at one-week intervals. Each session consists of one part and lasts for 20-30 min. Patients' health-related quality of life was assessed before and after the laughter yoga sessions using Quality of Life Questionnaire European Organization for Research and Treatment of Cancer (EORTC QLQ-C30) version 3.0. SPSS Statistics (v.20 software was used to conduct Chi-square, independent t-test, Mann-Whitney, Wilcoxon and paired t-tests analyses of the data.

RESULTS

The number of participants in intervention and control groups were 34 and 35, there was no significant difference of demographic and disease related characteristics and pre-intervention HRQOL between two groups. In the intervention group, there is significant difference between pre- and post-intervention scores (Mean ± Standard Deviation) of emotional functioning (12.99 ± 10.49), physical functioning (0.78 ± 6.08), role functioning (3.43 ± 7.97), fatigue (-8.82 ± 22.01), pain (-8.33 ± 11.78), sleep disturbance (-15.68 ± 18.77), and global health and quality of life (6.37 ± 5.04) (p < 0.05). There was no significant change in the control group. Participants reported no adverse events.

CONCLUSIONS

A structured laughter yoga intervention in a hospital setting effectively improved health-related quality of life for cancer patients undergoing chemotherapy. Benefits to many patients could be expected if this would become a part of routine care.

TRIAL REGISTRATION

This study was registered in the Iranian Registry of Clinical Trials (no. IRCT20180429039463N1) on 21/08/2018.

The Effects of Laughter Yoga on Perceived Stress, Positive Psychological Capital, and Exercise Capacity in Lung Cancer Chemotherapy Patients: A Pilot Randomized Trial

BACKGROUND

Lung cancer is the malignant tumor with the highest morbidity and mortality rate in China. Although chemotherapy is effective in improving clinical symptoms, it causes a variety of acute and chronic side effects, seriously aggravating the psychological stress of patients. Laughter Yoga as a new type of aerobic exercise can effectively reduce stress levels and increase positive mood in patients. This study aimed to examine the effects of laughter yoga on perceived stress, positive psychological capital, and exercise capacity in lung cancer patients.

METHODS

This study was a randomized, single-blind, parallel-group trial. The study enrolled 84 lung cancer chemotherapy patients from a general hospital in central China. These patients were randomly allocated to control and intervention groups (n = 42 per group) after baseline assessments. Patients in the control group received routine care and those in the intervention group received laughter yoga intervention. Perceived stress, positive psychological capital, and exercise capacity were assessed at baseline, immediately post-intervention.

RESULTS

During the implementation of the study, there were 2 dropouts in each of the intervention and control groups. Ultimately, 80 patients in the control and intervention groups completed the trial. Patients who received laughter yoga intervention had significantly higher scores in positive psychological capital (P < .01, Cohen's d = 0.692) and exercise capacity (P < .01, Cohen's d = 0.659). Discernible differences were also observed in perceived stress (P < .01, Cohen's d = 1.087) between the 2 groups.

CONCLUSIONS

The results of this study suggest that laughter yoga is an effective way and may produce beneficial effects on perceived stress, positive psychological capital and exercise capacity.

Are yoga and physical activity determinants of quality of life in Polish adults? a cross-sectional study

OBJECTIVES

Yoga is an ancient form of physical activity (PA) that encompasses meditation, stretching and breathing techniques. Although the benefits of PA and associated lifestyle interventions are clear, we here addressed the paucity of evidence regarding the specific relationship between yoga and quality of life (QOL) in adults in Poland. We hypothesised that participation in PA and yoga could result in a positive impact on QOL.

DESIGN

Cross-sectional, self-administered questionnaire-based survey. Both the quantitative and qualitative variables were statistically compared. Multivariate analyses were performed using linear regression. Results were determined based on age, sex and education level; a p<0.05 was considered significant.

SETTING

Questionnaires were delivered to participants online, at high schools and universities, and in elderly communities in Poland.

PARTICIPANTS

714 polish citizens aged over 18 participated in the study; there are no specific entry and exclusion criteria besides age.

RESULTS

Statistically significant differences (p<0.05) were observed between the QOL of the physically active group (PAG) and non-PAG (N-PAG). Meanwhile, yoga practice was revealed to have a significant effect on QOL; QOL was found to be statistically higher (p<0.001) in the PAG with yoga (PAG-Y) (4.29±0.66) than in the N-PAG (3.83±0.92) and PAG without yoga (4.07±0.68).

CONCLUSIONS

The study shows that both regular PA and yoga practices could improve QOL; however, PAG-Y produced higher QOL scores than PA of other types. This outcome may be explained by the impact of physiological and psychological aspects within yoga practice. These results suggest that this unique combination impacts health more positively than other kinds of PA alone.

Effects of Simulated Laughter Therapy Using a Breathing Exercise: A Study on Hospitalized Pulmonary Tuberculosis Patients

This study evaluated the effects of simulated laughter therapy on physical symptoms, pulmonary function, depression, and health-related quality of life (HRQOL) among pulmonary tuberculosis patients. This quasi-experimental study assigned tuberculosis patients of hospital A to a laughter group (n = 26) and those of hospital B to a control group (n = 26). The eight-week laughter therapy, held twice a week in a 60-min group session, included laughter, entertainment, music-related chorusing, breathing exercises, and meditation. The values of physical symptoms, pulmonary function, depression, and HRQOL from before and after the therapy were analyzed using the paired t-test and the Mann−Whitney U-test. To verify group differences between the experiment and control group, the Wilcoxon signed-rank test and the analysis of covariance (ANCOVA) were employed. Unlike the control group, laughter therapy decreased physical symptoms (t = 7.30, p < 0.01) and increased pulmonary function (t = −3.77, p < 0.01). Psychological health also improved, including depression (t = 10.46, p < 0.01) and HRQOL (t = −9.31, p < 0.01) in the experimental group but not in the control group. Group differences of changes in physical symptoms, pulmonary function, depression, and HRQOL were also significant. Simulated laughter therapy can help moderate depression and physical symptoms and enhance pulmonary function among tuberculosis patients.

Are mind-body therapies effective for relieving cancer-related pain in adults? A systematic review and meta-analysis

OBJECTIVE

To assess whether mind-body therapies are effective for relieving cancer-related pain in adults, since at least one-third of adults with cancer are affected by moderate or severe pain.

METHODS

We searched for all randomized or quasi-randomized controlled trials that included adults (≥18 years) with cancer-related pain who were treated with mind-body therapies (mindfulness, hypnosis, yoga, guided imagery, and progressive muscle relaxation) in MEDLINE, Embase, CINAHL, Cochrane Central Register of Controlled Trials (CENTRAL), Science Citation Index, Web of Science, trials registers, and reference lists. The primary outcome was pain intensity. We calculated the standardized mean differences and 95% confidence intervals (CIs) and assessed the risk of bias.

RESULTS

We identified 40 primary studies involving a total of 3569 participants. The meta-analysis included 24 studies (2404 participants) and showed a significant effect of -0.39 (95% CI -0.62 to -0.16) with considerable heterogeneity (I²  = 86.3%, p < 0.001). After we excluded four "outlier" studies in sensitivity analyses, the effect size remained significant but weaker. There was a high risk of bias in all studies, for example, performance bias due to lack of participant blinding. Patients in multiple settings were included but many studies were of low quality.

CONCLUSIONS

Mind-body therapies may be effective in improving cancer pain, but the quality of the evidence is low. There is a need for further high-quality clinical trials.

Effects of laughter therapy on the stress response of married immigrant women in South Korea: A randomized controlled trial

The authors aimed to investigate the effects of a laughter therapy (LT) program on the acculturative stress, anxiety, depression, salivary cortisol, and salivary IgA of married immigrant women in South Korea. A randomized waiting-list control design was utilized. The 19 experimental group participants were given LT twice a week for 2 weeks, whereas the 22 participants in the waiting-list control group received no treatment during the same period but received it afterward. Outcomes were measured right after the completion of the intervention and 2 weeks later. The experimental group showed significantly decreased levels of acculturative stress, anxiety, depression, and salivary cortisol compared to the control group. As for salivary IgA, however, the experimental group showed no statistically significant decrease compared to the control group. An LT program can be a good option for married immigrant women undergoing acculturation experiences in consideration of its effectiveness.

CLARIFY 2021: explanation and elaboration of the Delphi-based guidelines for the reporting of yoga research

BACKGROUND

Reporting of yoga research often lacks the detail required for clinical application, study replication, summary research and comparative effectiveness studies.

METHODS

To improve the transparency of reporting yoga interventions, and building on the development of previous reporting guidelines, a group of international yoga research stakeholders developed the consensus-based CheckList stAndardising the Reporting of Interventions For Yoga (CLARIFY) guidelines.

RESULTS

The 21-item CLARIFY checklist outlines the minimum details considered necessary for high-quality reporting of yoga research. This paper provides a detailed explanation of each of the 21 items of the CLARIFY checklist, together with model examples of how to integrate each item into publications of yoga research. The CLARIFY guideline serves as an extension for existing research reporting guidelines, and is flexible for use across all study designs.

CONCLUSION

We strongly encourage the uptake of these reporting guidelines by researchers and journals, to facilitate improvements in the transparency and utility of yoga research.

Mental Health Consequences of the Three Mile Island, Chernobyl, and Fukushima Nuclear Disasters: A Scoping Review

Many individuals who were affected by the Great East Japan earthquake and tsunami and the subsequent Fukushima Daiichi Nuclear Power Plant accident continue to face a challenging recovery. We reviewed the long-term mental health consequences of three major nuclear power plant accidents: the Three Mile Island (TMI, 1979), Chernobyl (1986), and Fukushima (2011) nuclear disasters. We examined the relevant prospective cohort studies and before-and-after studies that covered more than two timepoints, searching four databases (PubMed, Ichushi, PsyArticles, and PTSDPub). We identified a total of 35 studies: TMI, n = 11; Chernobyl, n = 6; and Fukushima, n = 18. The smaller numbers of early-phase studies (within 6 months) of the Chernobyl and Fukushima disasters may also indicate the chaotic situation at those timepoints, as large-scale interviews were conducted in the early phase after the TMI disaster. Although the patterns of effects on mental health outcomes were diverse, more than half of the participants in the studies we evaluated were categorized into low or under-threshold symptom groups in all three disasters. Across the three disasters, the radiation exposure level estimated by the proximity and stigma were the common risk factors for mental health outcomes. Our findings will contribute to a comprehensive understanding of the impact of the worst nuclear accidents in history on the affected individuals' mental health, and our results illustrate the longitudinal consequences of such disasters.

Effects of laughter yoga on hemodialysis patients' plasma-beta endorphin levels, pain levels and sleep quality: A randomized controlled trial

This study evaluates the effects of "laughter yoga" on the plasma beta-endorphin levels, pain levels and sleep quality of hemodialysis patients. It is a randomized controlled trial. The study was carried out between July and October 2018. A total of 68 patients receiving hemodialysis treatment at two different dialysis centers were included in the study. The duration of the laughter yoga was 30 min, and a total of 16 sessions were performed on a twice-weekly basis. The data were collected by using a socio-demographic information form, the Visual Analog Scale and the Pittsburgh Sleep Quality Index, and blood samples were collected to determine beta-endorphin levels. Following the laughter yoga implementation, the pain level of the intervention group patients significantly decreased, and their sleep quality significantly improved. No significant change occurred in the patients' beta-endorphin levels. Laughter yoga was effective in reducing pain and increasing sleep quality.