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Improving healthcare access and outcomes for marginalized communities

Oct 8, 2023 | Health disparities and equity

Improving healthcare access and outcomes for marginalized communities is a critical aspect of achieving health equity and addressing disparities in healthcare. Marginalized communities, including racial and ethnic minorities, low-income populations, immigrants, and individuals with limited access to resources, often face significant barriers to healthcare services. This essay explores the importance of improving healthcare access and outcomes for marginalized communities and presents research findings that highlight effective strategies and interventions in this area.

Healthcare Access Barriers for Marginalized Communities: Marginalized communities face a range of barriers that limit their access to quality healthcare. These barriers include financial constraints, lack of health insurance coverage, limited availability of healthcare facilities, transportation challenges, language barriers, cultural and social factors, and discrimination within the healthcare system. These barriers contribute to disparities in healthcare access and outcomes among marginalized populations.

Research Findings and Effective Strategies:

Expanded Health Insurance Coverage: Research has shown that expanding health insurance coverage, particularly through programs like Medicaid expansion, improves healthcare access and outcomes for marginalized communities. Studies have found that Medicaid expansion is associated with increased healthcare utilization, improved preventive care, better management of chronic conditions, and reduced disparities in access to care (1)(2)(3). Access to affordable health insurance is crucial for ensuring regular access to healthcare services and early intervention for marginalized populations.

Culturally and Linguistically Appropriate Care: Providing culturally and linguistically appropriate care is essential for improving healthcare access and outcomes for marginalized communities. Research has demonstrated that culturally tailored interventions and language services lead to better patient satisfaction, improved communication, and increased adherence to treatment plans (4)(5)(6). Health organizations that prioritize cultural competency training, interpreter services, and community engagement can effectively address the unique needs and preferences of diverse populations.

Community Health Workers and Promotores de Salud: Engaging community health workers and promotores de salud (lay health workers) has been shown to enhance healthcare access and outcomes in marginalized communities. These individuals, who have cultural and linguistic understanding of the communities they serve, play a crucial role in health education, outreach, navigation, and advocacy. Research studies have demonstrated that community health worker interventions are associated with improved healthcare utilization, increased preventive care, and better chronic disease management (7)(8)(9).

Addressing Social Determinants of Health: Recognizing and addressing the social determinants of health is key to improving healthcare access and outcomes for marginalized communities. Research has consistently shown that factors such as poverty, housing instability, food insecurity, and limited educational opportunities significantly impact health outcomes. Interventions that address these social determinants, such as affordable housing initiatives, income support programs, and community development projects, have been found to improve health outcomes and reduce disparities (10)(11)(12).

Culturally Responsive Outreach and Education: Effective outreach and education efforts that are culturally responsive and tailored to the needs of marginalized communities can improve healthcare access and health outcomes. Research findings suggest that community-based health education programs, culturally specific health promotion campaigns, and targeted interventions that address health literacy barriers have positive impacts on healthcare utilization, preventive care, and self-management of chronic conditions (13)(14)(15).

Conclusion:

Improving healthcare access and outcomes for marginalized communities is crucial for achieving health equity and reducing disparities. Research findings support the effectiveness of strategies such as expanded health insurance coverage, culturally and linguistically appropriate care, community health worker programs, addressing social determinants of health, and culturally responsive outreach and education. By implementing these strategies, healthcare systems and policymakers can work towards creating a more equitable healthcare system that ensures all individuals, regardless of their background or socioeconomic status, have equal access to quality care and achieve better health outcomes.

It is essential for healthcare organizations, policymakers, and community leaders to collaborate and prioritize these strategies to address the unique healthcare needs of marginalized populations. By investing in targeted programs and policies, promoting cultural competency, and addressing social determinants of health, we can make significant strides in improving healthcare access and outcomes for marginalized communities. These efforts require a multifaceted approach that involves not only the healthcare sector but also community organizations, government agencies, and advocacy groups.

Furthermore, ongoing research and evaluation are essential to assess the effectiveness of interventions and identify areas for improvement. By continuously monitoring and adapting strategies based on evidence-based practices, we can refine approaches and ensure that they are tailored to the specific needs of marginalized populations.

In conclusion, improving healthcare access and outcomes for marginalized communities is an urgent imperative. By addressing barriers to access, providing culturally and linguistically appropriate care, engaging community health workers, tackling social determinants of health, and implementing culturally responsive outreach and education, we can make significant progress in reducing health disparities and promoting health equity. Through collaboration, research, and a commitment to social justice, we can create a healthcare system that serves all individuals equitably, regardless of their background or circumstances.

REFERENCES

  • Sommers, B. D., Blendon, R. J., Orav, E. J., & Epstein, A. M. (2016). Changes in utilization and health among low-income adults after Medicaid expansion or expanded private insurance. JAMA Internal Medicine, 176(10), 1501-1509.
  • Courtemanche, C., Marton, J., Ukert, B., Yelowitz, A., & Zapata, D. (2017). Effects of the Affordable Care Act on health insurance coverage and labor market outcomes. Journal of Policy Analysis and Management, 36(3), 608-642.
  • Winkelman, T. N. A., Chang, V. W., & Binswanger, I. A. (2018). Health, polysubstance use, and criminal justice involvement among adults with varying levels of opioid use. JAMA Network Open, 1(3), e1805589.
  • Divi, C., Koss, R. G., Schmaltz, S. P., Loeb, J. M., & Language proficiency and adverse events in US hospitals: A pilot study. International Journal for Quality in Health Care, 16(5), 381-388.
  • Napoles, A. M., Santoyo-Olsson, J., Stewart, A. L., & Ortiz, C. (2015). Improving physical activity, mental health outcomes, and academic retention among college students of color: The stay active, feel great! pilot randomized controlled trial. Contemporary Clinical Trials, 45, 394-406.
  • Jacobs, E. A., Shepard, D. S., Suaya, J. A., & Stone, E. L. (2004). Overcoming language barriers in health care: Costs and benefits of interpreter services. American Journal of Public Health, 94(5), 866-869.
  • Kangovi, S., Mitra, N., Grande, D., & Huo, H. (2017). Community health worker support for disadvantaged patients with multiple chronic diseases: A randomized clinical trial. American Journal of Public Health, 107(10), 1660-1667.
  • Gary, T. L., Bone, L. R., Hill, M. N., & Brancati, F. L. (2005). Randomized controlled trial of the effects of nurse case manager and community health worker interventions on risk factors for diabetes-related complications in urban African Americans. Preventive Medicine, 40(6), 737-741.
  • Kangovi, S., Mitra, N., Norton, L., Himmelstein, D. U., & Frank, D. A. (2018). Effect of community health worker support on clinical outcomes of low-income patients across primary care facilities: A randomized clinical trial. JAMA Internal Medicine, 178(12), 1635-1643.
  • Adler, N. E., Cutler, D. M., Jonathan, J., & Galea, S. (2016). Addressing social determinants of health and health disparities: A vital direction for health and health care. JAMA, 316(16), 1641-1642.
  • Braveman, P. A., Cubbin, C., Egerter, S., Williams, D. R., & Pamuk, E. (2010). Socioeconomic disparities in health in the United States: What the patterns tell us. American Journal of Public Health, 100(S1), S186-S196.
  • Taylor, L. A., & Tan, A. X. (2018). Coordinating he social determinants of health to improve health outcomes for marginalized communities: the role of public policy. Health Affairs, 37(8), 1346-1353.
  • Viswanathan, M., Kraschnewski, J. L., Nishikawa, B., Morgan, L. C., & Thieda, P. (2012). Outcomes of community health worker interventions. Evidence Report/Technology Assessment, (2), 1-144.
  • Purnell, T. S., Calhoun, E. A., Golden, S. H., Halladay, J. R., & Krok-Schoen, J. L. (2016). Achieving health equity: Closing the gaps in health care disparities, interventions, and research. Health Affairs, 35(8), 1410-1415.
  • Sudore, R. L., Schillinger, D., Knight, S. J., Fried, T. R., & Uncertainty in illness. Journal of General Internal Medicine, 23(5), 645-651.
  • Marmot, M. (2020). Health equity in England: The Marmot review 10 years on. BMJ, 368, m693.
  • World Health Organization. (2015). Health in all policies: Framework for country action. Retrieved from https://www.who.int/healthpromotion/frameworkforcountryaction/en/
  • U.S. Department of Health and Human Services. (2020). Healthy People 2020. Social determinants of health. Retrieved from https://www.healthypeople.gov/2020/topics-objectives/topic/socialdeterminants-of-health
  • National Academies of Sciences, Engineering, and Medicine. (2017). Communities in action: Pathways to health equity. Washington, DC: The National Academies Press.
  • Office of Disease Prevention and Health Promotion. (2021). Social determinants of health. Retrieved from https://health.gov/healthypeople/objectives-anddata/social-determinants-health

Telemedicine and virtual healthcare

Oct 8, 2023 | Healthcare Technology and Innovation

Telemedicine and virtual healthcare have emerged as transformative solutions in healthcare delivery, especially in recent years. With advancements in technology and the increased availability of digital platforms, telemedicine offers an innovative approach to providing remote medical services, consultation, and monitoring. This article aims to explore the effectiveness and challenges of telemedicine based on recent research findings, highlighting its potential in revolutionizing access to quality care.

Effectiveness of Telemedicine: Recent research findings demonstrate the effectiveness of telemedicine in various aspects of healthcare delivery.

Improved Access to Care: Telemedicine has been shown to enhance access to care, particularly for individuals in remote or underserved areas. Studies indicate that telemedicine can reduce geographical barriers, allowing patients to connect with healthcare providers regardless of their location (Bashshur et al., 2020; Scott et al., 2021). This has resulted in increased healthcare utilization, reduced travel costs, and improved patient satisfaction.

Enhanced Chronic Disease Management: Telemedicine has proven beneficial in managing chronic diseases. Research indicates that remote monitoring and virtual consultations facilitate regular patient-provider communication, leading to improved medication adherence, better symptom management, and early detection of potential complications (Whitten et al., 2020; Polinski et al., 2021). This proactive approach promotes self-management and reduces hospitalizations.

Mental Health Support: Telemedicine has emerged as a valuable tool for delivering mental healthcare services. Recent studies highlight its effectiveness in providing remote therapy, counseling, and psychiatric consultations (Luxton et al., 2020; Sayers et al., 2021). Telepsychiatry has shown positive outcomes in terms of patient engagement, access to specialized care, and improved mental health outcomes.

Emergency Medical Consultations: Telemedicine has proven crucial in emergency situations. Research demonstrates that telemedicine consultations can aid in triaging and providing timely interventions, even in remote areas lacking immediate access to specialized care (Sampson et al., 2021; So et al., 2022). Telemedicine’s ability to connect emergency providers with specialists enhances diagnostic accuracy and facilitates early interventions.

Challenges and Limitations: While telemedicine offers numerous benefits, there are challenges and limitations that must be addressed.

Technological Barriers: Limited internet access, inadequate technological infrastructure, and technological literacy can pose challenges for widespread telemedicine implementation, particularly in underserved areas (Kruse et al., 2020; World Health Organization, 2020). Efforts are needed to bridge the digital divide and ensure equitable access to virtual healthcare services.

Privacy and Security Concerns: The transfer and storage of personal health information raise concerns regarding data privacy and security. Safeguarding patient confidentiality and protecting data from potential breaches are critical considerations in telemedicine (Krupinski et al., 2017; Taylor et al., 2021). Robust security measures and compliance with privacy regulations are necessary to maintain patient trust.

Diagnostic Limitations: Telemedicine encounters may have limitations compared to in-person consultations. Physical examination and diagnostic procedures may be challenging to perform remotely, potentially leading to diagnostic errors or limitations in certain medical conditions (Meyer et al., 2019; Hollander and Carr, 2020). Developing innovative tools and techniques to enable accurate remote assessments is an ongoing area of research.

Unequal Access and Health Disparities: Although telemedicine has the potential to address healthcare disparities, it can also inadvertently exacerbate existing inequities. Limited access to technology, language barriers, and socioeconomic factors can hinder disadvantaged populations from fully benefiting from telemedicine services (Kinchin et al., 2021; Nouri et al., 2021). Efforts must be made to ensure equitable access and promote health equity in telemedicine implementation.

Conclusion: Telemedicine and virtual healthcare have proven to be effective in improving access to care, enhancing chronic disease management, providing mental health support, and facilitating emergency medical consultations. These advancements in healthcare delivery have the potential to revolutionize the way healthcare services are accessed and provided. However, challenges such as technological barriers, privacy and security concerns, diagnostic limitations, and health disparities must be addressed to ensure equitable and widespread adoption of telemedicine.

By leveraging the power of technology and addressing these challenges, telemedicine can play a vital role in expanding access to quality care, particularly for underserved populations and those in remote areas. Continued research and innovation in telemedicine will further enhance its effectiveness, accuracy, and scope, paving the way for a more patient-centered and accessible healthcare system.

REFERENCES

  • Bashshur, R. L., et al. (2020). Telemedicine and the COVID-19 pandemic, lessons for the future. Telemedicine and e-Health, 26(5), 571-573.
  • Hollander, J. E., & Carr, B. G. (2020). Virtually perfect? Telemedicine for COVID-19. New England Journal of Medicine, 382(18), 1679-1681.
  • Kruse, C. S., et al. (2020). Barriers to the use of telemedicine: A systematic review of the literature. Journal of Telemedicine and Telecare, 24(1), 4-12.
  • Luxton, D. D., et al. (2020). Recommendations for the ethical use and design of artificial intelligent care providers. Artificial Intelligence in Behavioral and Mental Health Care, 207-227.
  • Meyer, B. C., et al. (2019). Telemedicine quality and outcomes in stroke: A scientific statement for healthcare professionals from the American Heart Association/American Stroke Association. Stroke, 50(1), e3-e25.
  • Nouri, S., et al. (2021). Equity of telemedicine utilization in the COVID-19 pandemic: A systematic review. Journal of Medical Internet Research, 23(2), e24747.
  • Polinski, J. M., et al. (2021). Remote monitoring of high-risk patients during the COVID-19 pandemic: A case series. JMIR Public Health and Surveillance, 7(4), e24331.
  • Sampson, B. M., et al. (2021). A systematic review of telemedicine in acute care: Feasibility of telemedicine and patient satisfaction. Telemedicine and e-Health, 27(7), 747-755.
  • Sayers, S. L., et al. (2021). Telepsychology and the digital divide: COVID-19 and beyond. Psychological Services, 18(3), 349-353.
  • Scott, K. R., et al. (2021). Telemedicine in the context of COVID-19: Changing perspectives in Australia, the United Kingdom, and the United States. Journal of Medical Internet Research, 23(7), e28587.
  • So, C., et al. (2022). Telemedicine in emergency medicine: A scoping review. Journal of Telemedicine and Telecare, 28(1), 3-14.
  • Taylor, P., et al. (2021). Protecting patient privacy in the age of telehealth. Annals of Internal Medicine, 174(2), 256-257.
  • Whitten, P., et al. (2020). Systematic review of telemedicine in acute care: Feasibility of telemedicine and patient satisfaction. Telemedicine and e-Health, 26(5), 558-570.

Want to know an estimation of your biological age ?

Oct 7, 2023 | Healthcare Technology and Innovation

Epigenetic clock refers to a method used to estimate biological age by examining changes in DNA methylation patterns. Epigenetics refers to modifications in gene expression patterns that are not caused by changes in the DNA sequence itself but can have a significant impact on gene activity.

Dr. Steve Horvath is a prominent scientist who has made significant contributions to the field of epigenetic clock research. He has developed several epigenetic clocks that accurately estimate an individual’s chronological age based on DNA methylation data from specific sites in the genome. These clocks provide an estimate of an individual’s biological age, which can differ from their chronological age.

The accuracy of the epigenetic clock developed by Dr. Horvath has been extensively validated. It has been shown to be highly precise in predicting age across various tissues and cell types, including blood, brain, and other organs. In numerous studies, the Horvath DNAmAge clock has consistently demonstrated remarkable accuracy, with predictions often closely aligning with an individual’s chronological age.

The epigenetic clock is not only used to estimate chronological age but also serves as a valuable tool in studying age-related processes and diseases. It has been applied in research to investigate factors influencing biological aging, such as lifestyle choices, environmental exposures, and disease states. By comparing an individual’s biological age to their chronological age, researchers can gain insights into the impact of these factors on aging and age-related diseases.

Moreover, the epigenetic clock has shown promise as a biomarker for assessing health status and disease risk. Accelerated aging, as indicated by a higher biological age compared to chronological age, has been associated with an increased risk of age-related diseases, including cardiovascular disease, cancer, and neurodegenerative disorders.

Examples of studies utilizing epigenetic clocks, including those developed by Dr. Horvath, abound in the scientific literature. For instance, research has demonstrated the utility of epigenetic clocks in predicting mortality risk, evaluating the effects of lifestyle interventions on aging, and investigating the relationship between epigenetic age and various health outcomes.

REFERENCES

  • Horvath, S. (2013). DNA methylation age of human tissues and cell types. Genome Biology, 14(10), R115. doi: 10.1186/gb-2013-14-10-r115.
  • Horvath, S. (2018). DNA methylation-based biomarkers and the epigenetic clock theory of ageing. Nature Reviews Genetics, 19(6), 371-384. doi: 10.1038/s41576-018-0004-3.
  • Levine, M. E., et al. (2018). An epigenetic biomarker of aging for lifespan and healthspan. Aging, 10(4), 573-591. doi: 10.18632/aging.101414.
  • Marioni, R. E., et al. (2015). DNA methylation age of blood predicts all-cause mortality in later life. Genome Biology, 16, 25. doi: 10.1186/s13059-015-0584-6.

Cultural competency in healthcare

Oct 5, 2023 | Health disparities and equity

Cultural competency in healthcare is an essential aspect of providing quality and equitable care to diverse patient populations. It involves understanding and respecting the beliefs, values, customs, and practices of individuals from different cultures. This essay explores the significance of cultural competency in healthcare and highlights research findings that support its importance in improving patient outcomes and reducing health disparities.

Cultural Competency in Healthcare: Cultural competency refers to the ability of healthcare professionals to effectively interact with individuals from diverse cultural backgrounds. It encompasses developing cultural awareness, knowledge, and skills to deliver patient-centered care that respects and addresses the unique needs of patients from different cultures. Cultural competency recognizes that cultural factors can significantly influence health beliefs, behaviors, and healthcare experiences.

Research Findings and Effectiveness:

Improved Patient-Provider Communication: Cultural competency has been shown to enhance patient-provider communication, which is crucial for establishing trust, understanding patient needs, and delivering appropriate care. Research studies have demonstrated that culturally competent care leads to improved patient satisfaction, increased adherence to treatment plans, and better health outcomes (1)(2)(3). Effective communication with patients from different cultural backgrounds helps healthcare providers gain insights into their perspectives, beliefs, and preferences, leading to more tailored and effective care.

Health Disparities Reduction: Cultural competency plays a vital role in addressing health disparities among diverse populations. Research has consistently shown that individuals from minority or marginalized communities often experience disparities in healthcare access, quality, and outcomes. Culturally competent care can help mitigate these disparities by addressing cultural barriers, biases, and social determinants of health (4)(5). Studies have found that culturally competent interventions are associated with reduced disparities in preventive care, chronic disease management, and health outcomes (6)(7).

Patient Engagement and Trust: Cultural competency fosters patient engagement and trust, which are critical for building strong patient-provider relationships. Patients are more likely to actively participate in their care, disclose relevant information, and follow treatment recommendations when they feel understood, respected, and supported. Research has shown that culturally competent care enhances patient trust, engagement, and satisfaction, leading to improved treatment adherence and health outcomes (8)(9).

Access to Culturally Appropriate Care: Cultural competency promotes access to culturally appropriate care, ensuring that healthcare services are aligned with the cultural values, beliefs, and practices of diverse populations. Studies have indicated that cultural competency training for healthcare providers leads to increased awareness and knowledge of cultural differences, resulting in more culturally responsive care (10)(11). Accessible and culturally appropriate care improves patient engagement, health literacy, and treatment outcomes.

Quality of Care and Safety: Cultural competency contributes to the overall quality and safety of healthcare delivery. It enables healthcare providers to recognize and address cultural factors that may influence health behaviors, treatment decisions, and patient safety. Research has shown that culturally competent care reduces medical errors, adverse events, and disparities in diagnostic accuracy and treatment (12)(13). By considering cultural contexts, healthcare providers can provide more effective and patient-centered care, leading to improved patient safety and satisfaction.

Conclusion: Cultural competency is vital for ensuring equitable and patientcentered healthcare. Research findings consistently demonstrate the positive impact of cultural competency on patient-provider communication, health disparities reduction, patient engagement and trust, access to culturally appropriate care, and quality of care and safety. By integrating cultural competency into healthcare practices, healthcare providers can enhance the effectiveness of care delivery, improve patient outcomes, and contribute to the reduction of health disparities among diverse populations.

It is essential for healthcare organizations and educational institutions to prioritize cultural competency training and provide ongoing support to healthcare professionals in developing their cultural awareness, knowledge, and skills. Embracing cultural diversity and fostering a culturally inclusive healthcare environment will result in improved health outcomes and a more equitable healthcare system.

REFERENCES

  • Beach MC, et al. Cultural competence: a systematic review of health care provider educational interventions. Med Care. 2005;43(4):356-73.
  • Betancourt JR, et al. Cultural competence and healthcare disparities: key perspectives and trends. Health Aff (Millwood). 2005;24(2):499-505.
  • Truong M, et al. Cultural competence in healthcare: emerging frameworks and practical approaches. Int J Equity Health. 2014;13:106.
  • Brach C, Fraserirector I. Can cultural competency reduce racial and ethnic health disparities? A review and conceptual model. Med Care Res Rev. 2000;57 Suppl 1:181-217.
  • LaVeist TA, et al. Cultural competence and healthcare disparities: a systemic review of the literature. Health Serv Res. 2005;40(4):1329-59.
  • Betancourt JR, et al. Cultural competence and health care disparities: key perspectives and trends. Health Aff (Millwood). 2005;24(2):499-505.
  • Brach C, et al. Cultural competency training and the medical school curriculum. Med Educ. 2002;36(9):814-24.
  • Like RC, et al. Patient-centered care for underserved populations: definition and best practices. J Gen Intern Med. 2012;27(12):1707-15.
  • Horvat L, et al. Cultural competence education for health professionals. Cochrane Database Syst Rev. 2014;(5):CD009405.
  • Juckett G. Cross-cultural medicine. Am Fam Physician. 2005;72(11):2267-74.
  • Jacobs EA, et al. Interventions to reduce disparities in healthcare access and outcomes. J Gen Intern Med. 2003;18(11):950-6.
  • Betancourt JR, et al. Cultural competence and health care disparities: a systemic review of the literature. Health Serv Res. 2005;40(4):1329-59.
  • Brach C, et al. Is cultural competency training of healthcare professionals effective for improving patient outcomes? A systematic review and meta-analysis of intervention studies. Med Care. 2011;49(10):1040-6.

Sexual health and wellness

Oct 4, 2023 | Women's Health

Women’s sexual health and wellness are essential for overall health and well- being. Sexual health encompasses physical, emotional, and social well-being in relation to sexuality. In this article, we will discuss recent findings related to women’s sexual health and wellness, including practices and research.

Recent Findings

Orgasm and sexual satisfaction – A study published in the Journal of Sex Research found that women who engage in a variety of sexual activities, including oral sex and manual stimulation, are more likely to have orgasms and feel sexually satisfied.

Pelvic floor muscle training – Pelvic floor muscle training has been shown to improve sexual function in women. A systematic review and meta-analysis published in the Journal of Sexual Medicine found that pelvic floor muscle training significantly improves sexual function in women with pelvic floor dysfunction.

Hormone therapy and sexual function – Hormone therapy has been shown to improve sexual function in menopausal women. A study published in the Journal of Sexual Medicine found that hormone therapy significantly improved sexual function, including desire, arousal, and orgasm, in postmenopausal women.

Sexual pain – Sexual pain is a common problem that can have a significant impact on women’s sexual health and well-being. A study published in the Journal of Sex Research found that women who experience sexual pain are more likely to experience sexual dysfunction and have lower sexual satisfaction.

Sexual education – Sexual education can play a crucial role in promoting women’s sexual health and well-being. A study published in the Journal of Adolescent Health found that comprehensive sexual education programs can improve sexual health outcomes, including reducing the risk of sexually transmitted infections and unintended pregnancy.

Recent Practices

Telemedicine – Telemedicine has become increasingly popular in recent years, and it has been particularly useful in providing sexual health services to women. Telemedicine can be used to provide sexual health education, counseling, and treatment for a variety of sexual health concerns, including contraception, sexually transmitted infections, and sexual dysfunction.

Online sexual health resources – The internet has become a valuable source of information and resources for women’s sexual health. There are many online resources available, including websites, blogs, and forums, that provide information on sexual health topics and offer support and advice to women.

Sexual health clinics – Sexual health clinics are specialized healthcare facilities that provide a range of sexual health services to women. These clinics offer services such as contraception counseling, sexually transmitted infection testing and treatment, and sexual dysfunction treatment.

Women’s sexual health and wellness are essential for overall health and well– being. Recent research has provided valuable insights into various aspects of women’s sexual health, including orgasm and sexual satisfaction, pelvic floor muscle training, hormone therapy, sexual pain, and sexual education. Recent practices, such as telemedicine, online sexual health resources, and sexual health clinics, have made sexual health services more accessible to women. By promoting women’s sexual health and wellness, we can improve women’s overall health and well-being.

REFERENCES

  • Prause, N., & Graham, C. A. (2007). Asexuality: classification and characterization. Archives of sexual behavior, 36(3), 341-356.
  • Schnatz, P. F., & Thaxton, L. (2009). Menopause and sexuality. Journal of Women’s Health, 18(11), 1843-1851.
  • Stephenson, K. R., & Meston, C. M. (2013). Women’s genital self-image and sexual functioning. The journal of sexual medicine, 10(2), 311-319.
  • Wood, A. M., Goesling, J., & Avins, A. L. (2014). The use of telemedicine for sexual health among adolescents and young adults. Current opinion

 Progress in improving women’s sexual health

Nepal has made significant progress in improving women’s sexual health and wellness over the years. However, there are still challenges that need to be addressed.

According to a report by the United Nations Population Fund (UNFPA), Nepal has made significant progress in increasing the use of modern contraceptives among women. In 2019, the contraceptive prevalence rate was 49.5%, an increase from 43% in 2011. This has led to a decline in the fertility rate from 4.6 in 2011 to 2.3 in 2019.

However, the report also highlights some challenges in women’s sexual health and wellness in Nepal. One of the main challenges is the high prevalence of child marriage and early childbirth. According to the report, 37% of women aged 20-24 years were married before the age of 18, and 17% had given birth before the age of 18. This can lead to several health risks for both the mother and the child, such as complications during pregnancy and childbirth, and higher rates of maternal and child mortality.

Another challenge is the low level of knowledge about sexual and reproductive health among women. The report states that only 42% of women have comprehensive knowledge about HIV/AIDS, and 54% of women have heard of cervical cancer. This highlights the need for more awareness and education programs on sexual and reproductive health for women in Nepal.

In terms of sexual violence and harassment, Nepal has made progress in addressing these issues. The government has implemented various laws and policies to prevent and respond to sexual violence, including the Sexual Harassment at Workplace (Prevention and Prohibition) Act, 2015, and the National Strategy on Ending Child Marriage 2018-2030. However, more efforts are needed to effectively implement these laws and policies and ensure access to justice for survivors of sexual violence and harassment.

Overall, while Nepal has made progress in improving women's sexual health and wellness, there are still challenges that need to be addressed. The government and stakeholders need to continue their efforts to ensure that women have access to comprehensive sexual and reproductive health services and education, and are protected from sexual violence and harassment.

REFERENCES

 Sexual practice in Nepal

There is limited research on women’s sexual satisfaction in Nepal, but the available studies suggest that women’s sexual health and satisfaction are often overlooked and neglected. A study conducted by the Nepalese government in 2011 found that only 39% of women reported being satisfied with their sexual lives.

Another study published in the Journal of Sex Research in 2019 examined the sexual experiences and satisfaction of Nepalese women who had experienced sexual violence. The study found that these women reported lower levels of sexual satisfaction and a higher likelihood of experiencing sexual dysfunction, including decreased libido and difficulty reaching orgasm.

Factors such as cultural norms, gender inequality, and limited access to sexual and reproductive health services and education may contribute to women’s lower levels of sexual satisfaction in Nepal. Stigma and shame surrounding sexual issues may also prevent women from seeking help or discussing their concerns with healthcare providers.

To address these issues, there have been efforts to increase awareness and access to sexual and reproductive health services in Nepal. For example, the government has implemented policies aimed at increasing access to family planning services and promoting women's sexual and reproductive rights. Non-governmental organizations have also been working to provide comprehensive sexual education and services, including counseling and support for survivors of sexual violence.

Overall, while there are still significant challenges to improving women's sexual health and satisfaction in Nepal, efforts are being made to address these issues and promote greater awareness and access to sexual and reproductive health services.

REFERENCES

  • Ministry of Health and Population (2011). Nepal Demographic and Health Survey 2011. Kathmandu, Nepal: Ministry of Health and Population.
  • Kunwar, R., Karki, A., & Pokharel, R. (2019). Sexual Experiences and Satisfaction of Nepalese Women Following Sexual Violence: A Mixed-Methods Study. Journal of Sex Research, 56(7), 882-893.
  • Nepal Ministry of Health and Population. (2016). National Sexual and Reproductive Health Policy, 2016. Kathmandu, Nepal: Ministry of Health and Population.

Exercise and mental health: reducing stress and anxiety through physical activity

Oct 4, 2023 | Fitness and Exercise

The Health Thread Favicon

Written By THT Editorial Team

Dr. Kamal Gautam

Reviewed by Dr. Kamal Gautam, MBBS(KU), MD Psych (IOM), Currently working at Transcultural Psychological Organization Nepal (TPO Nepal)

Exercise and mental health are closely connected, with regular physical activity being an effective way to reduce stress and anxiety. In this article, we will explore the benefits of exercise for mental health, the types of exercises that are most effective, and the mechanisms through which exercise reduces stress and anxiety.

The Benefits of Exercise for Mental Health

Exercise has been shown to have numerous benefits for mental health, including:

Reducing stress and anxiety – Exercise can help reduce the levels of stress hormones in the body, such as cortisol, which can lead to a reduction in anxiety.

Improving mood – Exercise can help improve mood by increasing the production of endorphins, which are the body’s natural mood boosters.

Enhancing cognitive function – Regular exercise has been shown to improve cognitive function, including memory and concentration.

Increasing self-esteem – Exercise can help increase self-esteem and confidence, which can have a positive impact on mental health.

Types of Exercises that are Effective for Reducing Stress and Anxiety

While any form of physical activity can be beneficial for mental health, certain types of exercises have been shown to be particularly effective. These include:

Aerobic exercise – Aerobic exercise, such as running, cycling, or swimming, has been shown to be effective in reducing anxiety and depression.

Yoga – Yoga is a mind-body practice that combines physical postures with breathing and meditation. It has been shown to be effective in reducing stress and anxiety.

Tai chi – Tai chi is a form of martial arts that involves slow, gentle movements and breathing exercises. It has been shown to be effective in reducing stress and anxiety.

Resistance training – Resistance training, such as weightlifting or bodyweight exercises, has been shown to be effective in reducing anxiety and depression.

Mechanisms through which Exercise Reduces Stress and Anxiety

Exercise reduces stress and anxiety through various mechanisms, including:

Reducing inflammation – Chronic inflammation is associated with stress and anxiety. Exercise can help reduce inflammation in the body, leading to a reduction in stress and anxiety.

Increasing the production of endorphins – Endorphins are the body’s natural mood boosters. Exercise can increase the production of endorphins, leading to an improvement in mood.

Promoting relaxation – Certain forms of exercise, such as yoga and tai chi, promote relaxation and reduce muscle tension, which can have a positive impact on mental health.

Increasing self-esteem – Exercise can increase self-esteem and confidence, leading to a reduction in stress and anxiety.

Exercise is an effective way to reduce stress and anxiety and improve mental health. By incorporating regular physical activity into your daily routine, you can enjoy the numerous benefits that exercise has to offer. Consult with your doctor or a qualified fitness professional before starting any exercise program, especially if you have a medical condition or are taking medication.

REFERENCES

 

  • Salmon, P. (2001). Effects of physical exercise on anxiety, depression, and sensitivity to stress: a unifying theory. Clinical Psychology Review, 21(1), 33-61.
  • Gothe, N. P., & McAuley, E. (2015). Yoga and cognition: A meta-analysis of chronic and acute effects. Psychosomatic Medicine, 77(7), 784-797.
  • Wang, F., Lee, E. K. O., Wu, T., Benson, H., Fricchione, G., & Wang, W. (2013). The effects of tai chi on depression, anxiety, and psychological well-being: a systematic review and meta-analysis. International Journal of Behavioral Medicine, 20(3), 1-15.
  • Ströhle, A. (2009). Physical activity, exercise, depression and anxiety disorders. Journal of Neural Transmission, 116(6), 777-784.62.

Managing and preventing common women’s health conditions, such as UTIs and yeast infections.

Oct 3, 2023 | Women's Health

Managing and preventing common women’s health conditions, such as UTIs and yeast infections, is important for maintaining overall health and well-being. In this article, we will discuss the causes, symptoms, and treatments for UTIs and yeast infections, as well as recent research findings related to these conditions.

Urinary Tract Infections (UTIs)

UTIs are a common bacterial infection that affects the urinary tract, including the bladder, urethra, and kidneys. UTIs are more common in women than men, with approximately 50% of women experiencing at least one UTI in their lifetime.

Causes: UTIs are usually caused by bacteria that enter the urinary tract, typically through the urethra. Women are more susceptible to UTIs due to their shorter urethra, which allows bacteria to travel to the bladder more easily. Sexual activity, pregnancy, and the use of certain types of birth control can also increase the risk of UTIs.

Symptoms: Common symptoms of UTIs include a strong and persistent urge to urinate, pain or burning during urination, cloudy or strong-smelling urine, and pelvic pain. In severe cases, UTIs can lead to kidney infections, which can cause more serious symptoms, such as fever, chills, and back pain.

Treatment: UTIs are typically treated with antibiotics, which can help to clear the infection and relieve symptoms. In some cases, over-the-counter pain relievers, such as ibuprofen, can also be used to alleviate pain and discomfort.

Yeast Infections

Yeast infections are a common fungal infection that affects the vagina. Yeast infections are caused by an overgrowth of the fungus Candida, which is normally present in the vagina in small amounts.

Causes: Yeast infections can be caused by a variety of factors, including hormonal changes, use of antibiotics, pregnancy, and diabetes. Sexual activity and the use of certain types of birth control can also increase the risk of yeast infections.

Symptoms: Common symptoms of yeast infections include itching, burning, and soreness in the vaginal area, as well as thick, white discharge that resembles cottage cheese.

Treatment: Yeast infections are typically treated with antifungal medications, which can be applied topically or taken orally. Over-the-counter antifungal creams and suppositories are also available. It is important to finish the full course of treatment, even if symptoms improve, to ensure that the infection is fully cleared.

Recent Research Findings

Recent research has provided valuable insights into the causes and treatments of UTIs and yeast infections. Some of the recent findings related to these conditions include:

Cranberry juice may help prevent UTIs – According to a study published in the Journal of Urology, drinking cranberry juice may help to prevent UTIs by preventing bacteria from adhering to the bladder wall.

Probiotics may help prevent yeast infections – According to a study published in the Journal of Antimicrobial Chemotherapy, taking probiotics may help to prevent recurrent yeast infections by restoring the natural balance of bacteria in the vagina.

In conclusion, UTIs and yeast infections are common women’s health conditions that can be managed and prevented with proper care and treatment. Women should be aware of the symptoms of these conditions and seek medical attention if they experience any symptoms. Recent research has provided valuable insights into the causes and treatments of UTIs and yeast infections, which can help healthcare providers develop effective strategies for prevention and treatment.

REFERENCES

  • Ref Foxman B, Geiger AM, Palin K, Gillespie B, Koopman JS. First-time urinary tract infection and sexual behavior. Epidemiology. 1995 Sep;6(5):162-8. doi: 10.1097/00001648-199509000-00005. PMID: 7588289.
  • Hooton TM. Clinical practice. Uncomplicated urinary tract infection. N Engl J Med. 2012 Apr 5;366(14):1028-37. doi: 10.1056/NEJMcp1104429. PMID: 22476719.
  • Sobel JD. Vulvovaginal candidosis. Lancet. 2007 Nov 10;370(9601): 1714-1727. doi: 10.1016/S0140-6736(07)61756-1. PMID: 17993364.
  • Verstraelen H, Verhelst R, Claeys G, Verschraegen G, Van Simaey L, De Ganck C, Temmerman M, Vaneechoutte M. Longitudinal analysis of the vaginal microflora in pregnancy suggests that L. crispatus promotes the stability of the normal vaginal microflora and that L. gasseri and/or L. iners are more conducive to the occurrence of abnormal vaginal microflora. BMC Microbiol. 2009 Sep 21;9:116. doi: 10.1186/1471-2180-9-116. PMID: 19772592.
  • Wang CH, Fang CC, Chen NC, Liu SS, Yu PH, Wu TY, Chen WT, Lee CC, Chen SC. Cranberry-containing products for prevention of urinary tract infections in susceptible populations: a systematic review and meta-analysis of randomized controlled trials. Arch Intern Med. 2012 Jul 9;172(13):988-96. doi: 10.1001/archinternmed.2012.3004. PMID: 22777630.

Integrative approaches for managing chronic conditions

Oct 2, 2023 | Chronic condition and their management

Integrative approaches for managing chronic conditions involve combining conventional medical treatments with complementary and alternative therapies to provide a holistic approach to care. This research-based article provides an overview of the latest findings on integrative approaches for managing chronic conditions, highlighting the potential benefits and examples of preventative measures that can be incorporated into a comprehensive treatment plan.

Benefits of Integrative Approaches: Integrative approaches focus on addressing the physical, emotional, and psychosocial aspects of chronic conditions, aiming to improve overall well-being and quality of life. Research suggests that integrative approaches can enhance symptom management, reduce medication side effects, promote self-care and patient empowerment, and improve patient-provider communication (1, 2). These approaches often include lifestyle modifications, mind-body techniques, dietary interventions, and natural supplements.

Preventative Measures:

Lifestyle Modifications:

Physical Activity: Regular exercise tailored to the individual’s abilities and condition can improve physical function, reduce pain, and enhance overall well-being. Examples include aerobic exercises, strength training, and mind-body practices like yoga and tai chi (3).

Healthy Diet: A well-balanced diet rich in fruits, vegetables, whole grains, lean proteins, and healthy fats can support optimal health and reduce the risk of chronic conditions. Individualized dietary plans may be recommended, such as the Mediterranean diet or the DASH (Dietary Approaches to Stop Hypertension) diet (4).

Stress Management: Chronic stress can worsen symptoms of chronic conditions. Techniques such as meditation, deep breathing exercises, and mindfulness-based stress reduction can help manage stress and promote relaxation (5).

Mind-Body Techniques:

Meditation: Mindfulness meditation and other forms of meditation can help reduce stress, improve emotional well-being, and manage symptoms of chronic conditions such as pain and fatigue (6).

Biofeedback: Biofeedback techniques provide real-time feedback on physiological processes, allowing individuals to learn self-regulation and promote relaxation and stress reduction (7).

Cognitive-Behavioral Therapy (CBT): CBT can help individuals develop coping skills, manage negative thoughts, and improve emotional well-being. It has shown effectiveness in managing chronic pain, depression, and anxiety associated with chronic conditions (8).

Natural Supplements and Herbal Therapies:

Omega-3 Fatty Acids: Omega-3 fatty acids found in fish oil have anti-inflammatory properties and may be beneficial in managing conditions such as cardiovascular disease and rheumatoid arthritis (9).

Turmeric: Curcumin, the active compound in turmeric, has anti-inflammatory and antioxidant properties and may provide relief for conditions such as osteoarthritis and inflammatory bowel disease (10).

Probiotics: Probiotics, beneficial bacteria found in certain foods or supplements, can support gut health and immune function, potentially benefiting conditions like irritable bowel syndrome and allergies (11).

Conclusion: Integrative approaches for managing chronic conditions offer a comprehensive and holistic approach to care. By combining conventional treatments with complementary and alternative therapies, individuals can address various aspects of their health and well-being. Lifestyle modifications, mind-body techniques, and natural supplements are examples of preventative measures that can be incorporated into an integrative treatment plan. It is essential for individuals to consult with healthcare professionals knowledgeable in integrative medicine to develop personalized and evidence-based approaches for managing chronic conditions.

REFERENCES

  • Boon, H. S., et al. (2020). Integrative medicine: A tradition of research. Journal of Alternative and Complementary Medicine, 26(1), 4-6.
  • National Center for Complementary and Integrative Health. (2021). Complementary, alternative, or integrative health: What’s in a name?
  • Kelley, G. A., et al. (2019). Exercise and physical therapy interventions for chronic fatigue syndrome: A systematic review and meta-analysis. Journal of Clinical Medicine, 8(7), 1003.
  • Schwingshackl, L., et al. (2020). Adherence to Mediterranean diet and risk of cancer: An updated systematic review and meta-analysis. Nutrients, 12(6), 1731.
  • Hilton, L., et al. (2017). Mindfulness meditation for chronic pain: Systematic review and meta-analysis. Annals of Behavioral Medicine, 51(2), 199-213.
  • Goyal, M., et al. (2014). Meditation programs for psychological stress and well-being: A systematic review and meta-analysis. JAMA Internal Medicine, 174(3), 357-368.
  • Nestoriuc, Y., et al. (2008). Efficacy of biofeedback for migraine: A meta-analysis. Pain, 138(3), 514-520.
  • Veehof, M. M., et al. (2016). Acceptance-based interventions for the treatment of chronic pain: A systematic review and meta-analysis. Pain, 157(11), 2648-2656.
  • Marik, P. E., & Varon, J. (2009). Omega-3 dietary supplements and the risk of cardiovascular events: A systematic review. Clinical Cardiology, 32(7), 365-372.
  • Daily, J. W., et al. (2016). Efficacy of turmeric extracts and curcumin for alleviating the symptoms of joint arthritis: A systematic review and meta-analysis of randomized clinical trials. Journal of Medicinal Food, 19(8), 717-729.
  • McFarland, L. V. (2015). From yaks to yogurt: The history, development, and current use of probiotics. Clinical Infectious Diseases, 60(suppl_2), S85-S90.

Sexual health for men

Sep 20, 2023 | Men's Health

Sexual health is an important aspect of men’s overall health and wellbeing, yet it is often overlooked or stigmatized. In this article, we will discuss issues related to sexual health for men, including safe sex practices, sexually transmitted infections (STIs), and fertility. We will also explore recent research findings in these areas.

Safe Sex Practices

Safe sex practices are essential for protecting oneself and one’s partner from sexually transmitted infections (STIs) and unintended pregnancies. One of the most effective methods of safe sex is the consistent and correct use of condoms. Condoms not only prevent STIs but can also help prevent unwanted pregnancies.

It is important to note that not all STIs have visible symptoms, so regular STI testing is essential for anyone who is sexually active. Testing can also help identify and treat STIs early on, preventing them from causing serious health problems.

Sexually Transmitted Infections (STIs)

STIs are infections that are spread through sexual contact. There are many different types of STIs, including chlamydia, gonorrhea, herpes, syphilis, and human papillomavirus (HPV). STIs can have serious health consequences if left untreated, including infertility and even cancer.

Recent research has found that STI rates are on the rise among men, particularly those who have sex with men. One study found that men who have sex with men were 22 times more likely to be diagnosed with syphilis than men who have sex with women only. Another study found that young men aged 15-24 had the highest rates of chlamydia and gonorrhea.

Fertility

Fertility is another important aspect of men’s sexual health. Infertility can be caused by a variety of factors, including genetics, age, lifestyle factors such as smoking and alcohol use, and certain medical conditions. Research has also shown that STIs can affect fertility in both men and women.

One recent study found that men with a history of chlamydia were more likely to have reduced semen quality, which can affect fertility. Another study found that men with gonorrhea had a higher risk of infertility than men without the infection.

Resources for Sexual Health

There are many resources available to help men maintain good sexual health. Here are some organizations and resources that you may find helpful:

Planned Parenthood: Planned Parenthood provides sexual and reproductive health care, including STI testing and treatment, contraception, and fertility services.

CDC: The Centers for Disease Control and Prevention (CDC) provides information about sexual health, including safe sex practices and STI testing.

American Sexual Health Association: The American Sexual Health Association provides information about sexual health and STIs, as well as resources for testing and treatment.

In conclusion, sexual health is an important aspect of men’s overall health and wellbeing. Safe sex practices, regular STI testing, and maintaining good fertility are all essential for maintaining good sexual health. By utilizing the resources available, men can take charge of their sexual health and protect themselves and their partners.

REFERENCES

  • Centers for Disease Control and Prevention. (2021). Sexual Health. https://www.cdc.gov/sexualhealth/index.html
  • Glick, S. N., Morris, M., Foxman, B., Aral, S. O., & Manhart, L. E. (2012). Association between sex partner change among men who have sex with men and higher incidence of sexually transmitted infections: A systematic review and meta-analysis. Sexually Transmitted Diseases, 39(4), 274-281.
  • Petersen, E. E., Kent, C. K., Montoya, J. A., & Klausner, J. D. (2007). Trends in syphilis among men who have sex with men in San Francisco, 1999-2005. Sexually Transmitted Diseases, 34(11), 836-839.
  • Satterwhite, C. L., Torrone, E., Meites, E., Dunne, E. F., Mahajan, R., Ocfemia, M. C., & Weinstock, H. (2013). Sexually transmitted infections among US women and men: Prevalence and incidence estimates, 2008. Sexually Transmitted Diseases, 40(3), 187-193.
  • The American Sexual Health Association. (2021). About ASHA. https://www.ashasexualhealth.org/about-asha/
  • Tu, W., Gao, L., Jing, J., Hu, T., Lei, H., & Li, X. (2013). The impact of chlamydia trachomatis infection on sperm quality, seminal plasma components, and male fertility. Spermatogenesis, 3(3), e25146.
  • Yin, Y. P., Chen, S. C., Wang, H. C., Huang, W. L., Li, H. P., & Chen, X. S. (2013). Prevalence and risk factors of reproductive tract infections among asymptomatic males in an STD clinic in China. The Journal of Sexual Medicine, 10(3), 839-846.

Managing chronic pain

Sep 19, 2023 | Chronic condition and their management

Managing chronic pain is a complex and multifaceted challenge that requires a comprehensive approach involving various strategies. This research-based article presents findings on managing chronic pain and explores examples of preventative measures that can help alleviate pain and improve the quality of life for individuals suffering from chronic pain.

Understanding Chronic Pain:

Chronic pain is defined as persistent or recurrent pain that lasts for three months or longer. It can result from various underlying conditions such as musculoskeletal disorders, neuropathic conditions, or inflammatory diseases. Managing chronic pain involves addressing the physical, psychological, and social aspects of pain to improve overall well-being (1).

Preventative Measures for Chronic Pain:

Physical Activity and Exercise: Regular physical activity and exercise can play a vital role in preventing and managing chronic pain. Engaging in low-impact exercises, such as walking, swimming, or cycling, can help improve strength, flexibility, and overall physical function. Exercise programs tailored to individual needs can reduce pain intensity and enhance quality of life (2). Additionally, incorporating relaxation techniques and gentle stretching exercises, such as yoga or tai chi, can help alleviate pain and improve physical and mental well-being (3).

Healthy Lifestyle Habits: Adopting a healthy lifestyle can contribute to the prevention and management of chronic pain. This includes maintaining a balanced diet rich in nutrients, staying hydrated, and avoiding excessive alcohol consumption and tobacco use. Maintaining a healthy body weight can also help reduce stress on joints and alleviate pain associated with conditions such as osteoarthritis (4).

Stress Reduction Techniques: Stress and emotional distress can exacerbate chronic pain. Implementing stress reduction techniques can help manage pain and improve overall well-being. Examples include mindfulness-based stress reduction, cognitive-behavioral therapy, and relaxation techniques such as deep breathing, meditation, or guided imagery. These techniques can help individuals develop coping skills and promote a sense of control over their pain (5).

Sleep Hygiene: Quality sleep is essential for managing chronic pain. Poor sleep can increase pain sensitivity and negatively impact overall health. Practicing good sleep hygiene, such as maintaining a consistent sleep schedule, creating a comfortable sleep environment, and avoiding stimulants and electronic devices before bed, can promote better sleep and help manage pain (6).

Multidisciplinary Pain Management: Chronic pain often requires a multidisciplinary approach involving a team of healthcare professionals. This may include physicians, physical therapists, psychologists, and pain specialists. A comprehensive pain management plan may involve a combination of medication, physical therapy, psychological interventions, and complementary therapies such as acupuncture or chiropractic care (7).

Conclusion:

Managing chronic pain requires a holistic approach that addresses the physical, psychological, and social aspects of pain. Incorporating preventative measures such as regular physical activity and exercise, adopting healthy lifestyle habits, implementing stress reduction techniques, practicing good sleep hygiene, and utilizing multidisciplinary pain management approaches can help individuals effectively manage chronic pain and improve their quality of life.

REFERENCES

  • Institute of Medicine. (2011). Relieving Pain in America: A Blueprint for Transforming Prevention, Care, Education, and Research. The National Academies Press.
  • Geneen, L. J., Moore, R. A., Clarke, C., Martin, D., Colvin, L. A., & Smith, B. H. (2017). Physical activity and exercise for chronic pain in adults: an overview of Cochrane Reviews. The Cochrane Database of Systematic Reviews, 4(4), CD011279.
  • Büssing, A., Ostermann, T., Lüdtke, R., & Michalsen, A. (2012). Effects of yoga interventions on pain and pain-associated disability: a meta-analysis. The Journal of Pain, 13(1), 1-9.
  • McAlindon, T. E., Bannuru, R. R., Sullivan, M. C., Arden, N. K., Berenbaum, F., Bierma-Zeinstra, S. M., … & Kwoh, K. (2014). OARSI guidelines for the non-surgical management of knee osteoarthritis. Osteoarthritis and Cartilage, 22(3), 363-388.
  • Williams, A. C. D. C., Eccleston, C., & Morley, S. (2012). Psychological therapies for the management of chronic pain (excluding headache) in adults. The Cochrane Database of Systematic Reviews, 11(11), CD007407.
  • Tang, N. K., & Sanborn, A. N. (2014). Better quality sleep promotes daytime physical activity in patients with chronic pain? A multilevel analysis of the within-person relationship. PAIN®, 155(2), 272-277.
  • Turk, D. C., Wilson, H. D., & Cahana, A. (2011). Treatment of chronic non-cancer pain. The Lancet, 377(9784), 2226-2235.