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\"This book introduces novel and groundbreaking theories on social medicine, social medicine therapy and pharmaco-gelotology. Aimed at improving the global health care system in terms of cost-effectiveness and efficiency, the research included in this book represents a paradigm shift from traditional drugs to social medicine. Tracing the history of social medicine, from Natural Healing Power (NHP), Oriental Medicine's vitalism, to Homeostasis (Natural Healing Strength) and Reciprocity (Social Healing Strength), the book first focuses on laying the theoretical foundations. It then highlights how social medicine can be specialized into various social medicine therapies (i.e., aromatherapy, stone therapy, diet therapy, exercise therapy, light therapy, etc.), just like stem cells. This is followed by arguments that 21st century pharmacy should be a harmonious system where the replacement of traditional drug products (i.e., herbal, chemical, and biological products) with new social medicine takes precedence. To that end, the author focuses on the '4+2 system' with 4 representing diet, body, stress, and facial-image control, and 2 representing the complementary and alternative medical methods of evacuation(-) and filling(+). In the context of pharmaco-gelotology, the book then goes on to present findings on theories of laughter and laughter therapy practices, which are systematically examined and described in detail. Finally, it calls for the development of social medicine structures by governments that aim to help local authorities use their resources effectively, and for local governments to establish the long-term planning on social medicine therapy for healthy ageing.\" -- Back cover.

Background Humor trainings have positive effects on mental health and well-being. However, studies investigating the effects of humor trainings in clinical samples are still rare. This study investigated the efficacy and feasibility of a humor training for people suffering from depression, anxiety and adjustment disorders. Methods Based on a diagnostic interview (SCID I and II), 37 people were randomized into a training ( n  = 19) or wait list control group ( n  = 18) and completed questionnaires at pre, post, and 1 month follow-up. After the training group had completed its training and evaluation measures, the wait list control group received the training and the outcomes of the group were additionally evaluated (post2 and follow-up2). Results After training, improvements in humor-related outcomes were observed for the training group, but these were relativized when compared to the wait list control group. Secondary outcomes remained unaffected by the training. In addition, the training group reported interpersonal difficulties. Within-group analyses of the wait list control group after completion of their training showed effects on almost all primary and secondary outcomes and feedback indicated a better atmosphere. Conclusions In summary, the different outcomes of the two groups are surprising and can show potential moderators of efficacy, such as interpersonal and group-specific climate variables. Since moderators of humor trainings in clinical samples have not been investigated at all, future studies should consider integrating them into their design. Trial registration The study was retrospectively registered in the German Clinical Trials Register ( DRKS00012443 ) on May 16, 2017.

AbstractObjectiveTo assess efficacy and safety of laughter exercise in patients with symptomatic dry eye disease.DesignNon-inferiority randomised controlled trial.SettingRecruitment was from clinics and community and the trial took place at Zhongshan Ophthalmic Center, Sun Yat-sen University, the largest ophthalmic centre in China, between 18 June 2020 to 8 January 2021.ParticipantsPeople with symptomatic dry eye disease aged 18-45 years with ocular surface disease index scores ranging from 18 to 80 and tear film break-up time of eight seconds or less.InterventionsParticipants were randomised 1:1 to receive laughter exercise or artificial tears (0.1% sodium hyaluronic acid eyedrop, control group) four times daily for eight weeks. The laughter exercise group viewed an instructional video and participants were requested to vocalise the phrases “Hee hee hee, hah hah hah, cheese cheese cheese, cheek cheek cheek, hah hah hah hah hah hah” 30 times per five minute session. Investigators assessing study outcomes were masked to group assignment but participants were unmasked for practical reasons.Main outcome measuresThe primary outcome was the mean change in the ocular surface disease index (0-100, higher scores indicating worse ocular surface discomfort) from baseline to eight weeks in the per protocol population. The non-inferiority margin was 6 points of this index score. Main secondary outcomes included the proportion of patients with a decrease from baseline in ocular surface disease index score of at least 10 points and changes in dry eye disease signs, for example, non-invasive tear break up time at eight weeks.Results299 participants (mean age 28.9 years; 74% female) were randomly assigned to receive laughter exercise (n=149) or 0.1% sodium hyaluronic acid (n=150). 283 (95%) completed the trial. The mean change in ocular surface disease index score at eight weeks was −10.5 points (95% confidence interval (CI) −13.1 to −7.82) in the laughter exercise group and −8.83 (−11.7 to −6.02) in the control group. The upper boundary of the CI for difference in change between groups was lower than the non-inferiority margin (mean difference −1.45 points (95% CI −5.08 to 2.19); P=0.43), supporting non-inferiority. Among secondary outcomes, the laughter exercise was better in improving non-invasive tear break up time (mean difference 2.30 seconds (95% CI 1.30 to 3.30), P<0.001); other secondary outcomes showed no significant difference. No adverse events were noted in either study group.ConclusionsThe laughter exercise was non-inferior to 0.1% sodium hyaluronic acid in relieving subjective symptoms in patients with dry eye disease with limited corneal staining over eight weeks intervention.Trial registrationClinicalTrials.gov NCT04421300.

Community-acquired pneumonia (CAP) is a leading cause of hospitalization in children. The hospitalization duration depends on factors as child’s well-being, vital signs, need for parenteral treatments, and development of complications. Medical clowns (MCs) are known to assist in reducing pain and alleviating anxiety and have been integrated into many aspects of hospital treatment routines. Our aim was to evaluate the effect of MC intervention on length of hospitalization in children admitted with CAP. A prospective quasi-randomized controlled trial allocated 51 children (2–18 years) hospitalized for CAP to receive standard care (control group, n  = 25) or standard care plus 15-minute MC visits twice daily during the first 48 h of hospitalization (intervention group, n  = 26). The primary outcome was hospitalization duration. Both groups were comparable in all demographic and clinical characteristics at admission with a mean age of 4.4 ± 3.6 years. The intervention group had significantly shorter duration of hospitalization (43.5 vs. 70 h, p  = 0.03) and IV antibiotic treatment duration (48 vs. 72 h, p  < 0.01) compared to controls. When comparing day 1 to day 2 in each group, significant decreases in respiratory rate, heart rate, white blood cell count, and absolute neutrophil count were noted in the study group. No significant differences were observed between the two groups in changes in patient well-being. The integration of MC into the pediatric CAP care-team reduced length of hospitalization and need for IV antibiotics. This can improve the quality of care as well as the burden and cost endured by hospitalization with CAP. Future larger studies are warranted to support these positive effects of MC. Trial registration ClinicalTrials.gov Identifier NCT06750029, 27/12/2024.

To explore the effectiveness of family participatory clown therapy in venipuncture in hospitalized children. We recruited 104 children aged 3 to 6 years for a non-randomized controlled trial from March to December 2022. All participants required peripheral venepuncture infusions for treatment. The children were assigned to either the control group (n = 52) or the experimental group (n = 52).Standard care was utilized in the control group. In the experimental group, two clown nurses and a parent provided family participatory clown therapy for 35-45 minutes per child before, during, and after venipuncture. We assessed children's pain (FLACC and W-B FPS), anxiety (VAS-A), medical fear (CFS), crying incidence, compliance, parental anxiety (S-AI), and parental satisfaction. At venipuncture, the FLACC score was lower in the experimental group (4.46±2.053) compared to the control group (5.96±2.441), the W-B FPS score was also lower in the experimental group (4.96±2.392) than in the control group (6.35±2.266), with a statistically significant difference (P<0.05).The children in the experimental group had lower levels of anxiety, medical fear, crying, and parental anxiety than the control group. In addition, child compliance and parent satisfaction were higher in the experimental group than in the control group, with statistically significant differences (P<0.05). Family participatory clown therapy can reduce pain, anxiety, medical fear, and crying during venipuncture in children. It can also improve venipuncture compliance, reduce parental anxiety, and increase parental satisfaction.

Background Laughter yoga is a non-pharmacological and non-invasive therapeutic approach that integrates voluntary laughter with controlled breathing exercises. This systematic review aimed to evaluate research investigating the impact of laughter yoga on children’s health outcomes. Methods This systematic review included studies with randomized controlled trial (RCT) and quasi-experimental designs, adhering to the PRISMA guidelines. This systematic review, conducted between December 18, 2023, and October 31, 2024, was guided by the PRISMA guidelines and a predefined protocol based on the PICOS-based protocol. Eligible studies included randomized controlled trials (RCTs) and quasi-experimental designs. A comprehensive literature search was conducted in Google Scholar, Medline/PubMed, Cochrane Library, Science Direct, CINAHL Complete, and OVID databases. Study selection was based on the PICOS framework, and methodological quality was assessed using the Joanna Briggs Institute-Meta Analysis Statistical Assessment and Review Instrument (JBI-MAStARI). Based on the inclusion criteria, six studies were incorporated into the review. Results The total sample across the included studies was 305 participants, with 66% of the studies involving at least 50 participants. Findings indicated that laughter yoga contributed to a reduction in anxiety and stress levels in children ( p  < 0.05), while no statistically significant effect was observed on depression scores ( p  > 0.05). Although no substantial improvement in self-esteem was reported, positive changes in self-concept were noted. Furthermore, laughter yoga was associated with an increase in salivary IgA levels ( p  < 0.01), whereas no significant influence on cortisol levels was found ( p  > 0.05). Additionally, the intervention was reported to alleviate pain, fatigue, and burnout while enhancing hope and overall happiness. Conclusions Study results showed that laughter yoga promoted the increase in happiness and self-concept in children and improved their ability to cope with stress. It also provided a physiological improvement by positively affecting pain and fatigue. In light of these results, it is recommended that laughter yoga be used more widely in children’s daily lives and clinical practices.

To evaluate the effectiveness of laughter-based interventions across psychological, physiological and educational outcomes in nursing students. Nursing education may involve educational, emotional and clinical demands that could impact students' well-being and academic success. Laughter-based interventions may help to reduce these challenges. Systematic review and meta-analysis. A comprehensive search was conducted between March 1–15, 2025, using seven international and two national databases. Randomized controlled and controlled studies comparing laughter-based interventions with control groups were included. Data extraction was performed independently by two reviewers and risk of bias was assessed using the Cochrane RoB tool. Meta-analyses and subgroup analyses based on intervention timing (regular term vs. special or transitional periods) were performed using RevMan (version 5.4). Eighteen studies with 1366 participants were included. Laughter-based interventions significantly reduced stress (SMD = –1.26, 95 % CI [–1.83, –0.69], p < 0.0001), anxiety (SMD = –1.19, 95 % CI [–1.87, –0.50], p = 0.0007) and salivary cortisol levels (SMD = –0.86, 95 % CI [–1.23, –0.48], p < 0.00001). Improvements were also observed in well-being, happiness and sleep quality. Subgroup analyses showed benefits in both regular and transitional periods, though effects did not consistently differ by timing. No significant effects were found for depression, pulse rate, or academic self-efficacy. Laughter-based interventions appears to be a promising complementary approach to promote psychological well-being and physiological stress regulation in nursing students. Further high-quality research is needed to clarify academic effects and guide implementation.

Introduction Cancer is a major cause of death worldwide and laughter therapy is used as a complementary therapy for cancer treatment. This study aimed to investigate the effects of laughter therapy on psychological symptoms (stress, anxiety, and depression) and physical symptoms (pain, fatigue, and sleep quality) among cancer patients. Methods Eight databases were searched, with the search period was limited to April 2024. Quality assessment of the included randomized controlled trials was performed according to the criteria for evaluating randomized controlled trials in the Cochrane Handbook for Systematic Reviews of Interventions. The RevMan 5.4 software was used for the data analysis. Results Nine randomized controlled trials were included in this systematic review and meta-analysis. The quality of the included studies was relatively high. The results showed that laughter therapy can effectively improve cancer patients’ stress, anxiety, depression, pain, and fatigue, but has no effect on sleep quality. Conclusions Laughter therapy is a low-cost, easy-to-implement intervention that may have potential benefits in improving psychological symptoms (stress, anxiety, and depression) and physical symptoms (pain and fatigue) among cancer patients. Laughter therapy has the characteristics of high safety, strong interaction, and strong feasibility. It may promote communication between patients and between patients and medical healthcare, enhance the trust relationship between medical staff, and potentially improve the quality of life for cancer patients. Healthcare professionals should consider laughter therapy as a potential adjunctive therapy, but its implementation should be tailored to individual patient needs and supported by robust evidence.

Background Clowning has been used in many hospitals, particularly for children. Studies suggest the effectiveness of this methodology, but more evidence is needed. The aim of this study was to evaluate the impact of a humour therapy intervention on biological markers, pain and anxiety levels in paediatric patients. Methods Three different clinical contexts were chosen to assess the effect of clowning interventions: patients who were subjected to venepuncture (group 1), patients undergoing general anesthesia for any cause (group 2)and patients hospitalized in the pediatric ward without distinction of their disease (group 3). Groups 1 and 2 were divided into control (C) and intervention (I) subgroups. A saliva sample was taken from all the children to measure oxytocin and cortisol levels by ELISAs. Validated scales and crying time were used to determine pain, stress, and anxiety levels. Children in group 3 were assessed before and after the intervention, employing the same methods. Results A total of 272 patients were included. The children in group 1 ( n  = 125) were 7.7 ± 3.2 years old, and 53.6% were females. 48% were in the I group, which showed decreased cortisol levels and increased oxytocin levels. The I group exhibited a decrease in perceived pain and crying time. The children in group 2 ( n  = 69) were aged 7.1 ± 3.5 years, and 36% were females. 51% were in the I group, which showed increased oxytocin levels and decreased cortisol levels, acute stress levels, perceived pain, and crying time. The children in group 3 ( n  = 78) were 8.6 ± 3.3 years old, and 54% of the children were females. There was an increase in oxytocin levels and a decrease in cortisol levels, stress levels and perceived pain following the intervention. Conclusions This study suggested that an intervention based on clowning is an effective strategy for decreasing pain, stress, and anxiety levels in paediatric patients in different clinical contexts. These findings support the implementation of humour therapy programs in paediatric units.

The aim of the study is to investigate if the presence of medical clowns during painful procedures in the emergency department (ED) affects children’s anxiety and pain. Forty children (4–11 years) admitted to the ED with the need of painful procedures were prospectively enrolled. They were randomly assigned to the clown group, where children interacted with clowns or to the control group in which they were entertained by parents and ED nurses. The children’s anxiety was assessed by the Children’s Anxiety and Pain Scales; pain was evaluated with the Numerical Rating Scale and Wong-Backer Scale, according to the children’s age. Staff and clown’s opinions were evaluated by means of dedicated questionnaires. Children’s anxiety levels in the clown group were significantly lower than those compared with the control group, while children’s pain levels did not change between the two groups. Conclusion : The presence of clowns in the ED before and during painful procedures was effective in reducing children’s anxiety. What is Known: • Anxiety and fear caused by medical procedures exacerbate children’s pain and may interfere with the procedure. • To reduce anxiety, fear, and pain and to facilitate patient’s evaluation, different non-pharmacological approaches have been proposed and positive effects of laughter and humor have been reported. What is New: • The presence of clowns in the waiting room and in the ED during medical evaluation and painful procedures helps to reduce children’s anxiety.