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Effect of Humor Therapy on Blood Pressure of Patients Undergoing Hemodialysis

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Abstract

One of the problems of the twenty-first century health community is the increasing prevalence of chronic diseases and the side effects of their treatment. Chronic renal failure undergoing hemodialysis is such a disease and controlling its complications through a low-risk approach is of utmost importance. Humor therapy is one of complementary treatment methods which can help these patients. The present study aimed to investigate the effects of humor therapy on blood pressure of patients undergoing hemodialysis in Bu-Ali Sina Hospital of Qazvin in 2010-2011. A total of 26 females and 14 males participated in this pre-and post-intervention clinical trial. The data were collected with a mercury manometer. Humor therapy was performed during hemodialysis using a CD for 30 minutes, 2 sessions per week for 8 weeks. The data were analyzed with SPSS-16. Findings: This study showed that humor therapy is effective on blood pressure of hemodialysis patients (p<0.001). Conclusion: Humor therapy can reduce blood pressure in hemodialysis patients.
Journal of Research in Medical and Dental Science
Volume 5, Issue 6, Page No: 85-88
Copyright CC BY-NC-ND 4.0
Available Online at: www.jrmds.in
eISSN No. 2347-2367: pISSN No. 2347-2545
Journal of Research in Medical and Dental Science | Vol. 5 | Issue 6 | December 2017
85
Effect of Humor Therapy on Blood Pressure of Patients Undergoing
Hemodialysis
Zahra Moshtag Eshg
1
, Jaleh Ezzati
1
, Navideh Nasiri
1
, Raziyeh Ghafouri
2
*
1
Assistant Professor, School of Nursing and Midwifery, Shahid beheshti University of Medical
Sciences, Tehran, Iran
2
PhD Student, Student Research committee, School of Nursing and Midwifery, Iran University of
Medical Sciences, Tehran, Iran
DOI: 10.24896/jrmds.20175615
ABSTRACT
One of the problems of the twenty-first century health community is the increasing prevalence of chronic
diseases and the side effects of their treatment. Chronic renal failure undergoing hemodialysis is such a
disease and controlling its complications through a low-risk approach is of utmost importance. Humor
therapy is one of complementary treatment methods which can help these patients. The present study aimed
to investigate the effects of humor therapy on blood pressure of patients undergoing hemodialysis in Bu-Ali
Sina Hospital of Qazvin in 2010-2011. A total of 26 females and 14 males participated in this pre- and post-
intervention clinical trial. The data were collected with a mercury manometer. Humor therapy was
performed during hemodialysis using a CD for 30 minutes, 2 sessions per week for 8 weeks. The data were
analyzed with SPSS-16. Findings: This study showed that humor therapy is effective on blood pressure of
hemodialysis patients (p<0.001). Conclusion: Humor therapy can reduce blood pressure in hemodialysis
patients.
Keywords: Humor Therapy, Hemodialysis, Blood Pressure
HOW TO CITE THIS ARTICLE:
hra Moshtag Eshg, Jaleh Ezzati
, Nav
ideh Nasiri, Raziyeh Ghafouri
,
Effect of Humor Therapy on
Blood Pressure of Patients Undergoing Hemodialysis, J Res Med Dent Sci, 2017, 5 (6):85-88, DOI: 10.24896/jrmds.20175615
Corresponding author: Raziyeh Ghafouri
e-mailghafouri.r@tak.iums.ac.ir
Received: 15/10/2016
Accepted: 20/03/2017
INTRODUCTION
The increasing prevalence of chronic diseases is
the most prominent problem in human societies
faced with health staff in the twenty-first
century [1]. Advances in the methods of
treatment and health care as well as increased
life expectancy are the causes of the increased
prevalence of chronic diseases [2]. Chronic renal
failure (CRF) is a chronic disease with a growing
prevalence [3]. CRF is referred to irreversible
renal dysfunction which often leads to the end
stage renal disease (ESRD) [4] and the patients
require hemodialysis (peritoneal dialysis) [5, 6].
Although hemodialysis can increase life
expectancy, it cannot alter the natural course of
the disease, is not a perfect substitute for full
function of kidneys, results in numerous
complications in patients, and leads to physical,
mental, and social problems for patients and
their families [7]. Hypertension is the first and
earliest sign of renal failure [8] and if left
untreated, results in cardiovascular disease as
the most common cause of death in renal failure
patients [9]. About 80 to 90 percent of patients
with renal failure are hypertensive and if left
untreated, it may result in myocardial disorders
in the form left ventricular hypertrophic
cardiomyopathy [10].
Regarding the use of humor in nurse
interactions, Riley stated that humor is a way of
communication between nurses and patients
and facilities training to patients [11]. humor
can be an important tool in coping with the
disease and reduces its stress. Several studies
have been conducted on negative emotions,
while positive emotions such as happiness and
satisfaction are less studied [12].
Hostler wrote that humor reduces anxiety,
relieves pain, and relaxes muscles [13].
Raziyeh Ghafouri et al J Res Med Dent Sci, 2017, 5 (6):85-88
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Research has shown that humor can reduce
blood pressure [14], acute pain [15], chronic
pain [16], stress hormones, raise self-esteem,
decrease depression [17] increase enkephalin
and endorphin [18] and cardiac output [19], and
improve pulmonary ventilation [20]. Laughter is
effective in preventing hyperglycemia-induced
renal failure [21] and in reducing anxiety in the
first hemodialysis [22]. In this regard, the
present study aimed to determine the effect of
humor therapy on blood pressure of
hemodialysis patients in Bu-Ali Sina Hospital of
Qazvin in 2010-2011.
MATERIALS AND METHOD
A total of 41 patients referred to Bu-Ali Sina
Hospital in Qazvin for hemodialysis were
enrolled in the study based on inclusion criteria
which were chronic renal failure treated with
hemodialysis, willingness to participate in the
research, constant blood pressure (no greater
than 20% fluctuations in blood pressure a
month before starting the study), and using a
method such as venous fistula for dialysis a
month before starting the study. The data were
collected using a demographic questionnaire, a
mercury manometer, and two depression
assessment tools. Exclusion criteria were
fluctuations in blood pressure, changing dialysis
method, and unwillingness to continue the
research. A participant excluded from the study
during the study due to changing the dialysis
method.
The demographic questionnaire included 11
items about demographic information and 14
items about the disease. Mercury manometer
was calibrated and its reliability was assessed
through the intra-rater test giving rise to a
Pearson correlation coefficient of 0.93 after 10
repeats. Reliability of the researcher was
assessed through the inter-rater test and after
10 times measurement of blood pressure by the
researcher and another nurse, the Pearson
correlation coefficient was obtained 0.94.
In the first session of laughter therapy, the mean
blood pressure of participants was measured by
the researcher prior to initiation of dialysis
using the mercury manometer. The CD used in
the research was provided to the Security Office
of Qazvin University of Medical Sciences, the
Cultural Council of Qazvin University of Medical
Sciences, and the Public Relations of Qazvin
University of Medical Sciences and was
approved by the Deputy of Student and Cultural
Affairs. The participants in both groups were
undergone hemodialysis in two groups of 15-20
people and humor therapy was performed 30
minutes after initiation of dialysis therapy using
the approved CD for 30 minutes. Blood pressure
was measured at the end of the first session
after the end of hemodialysis. Humor therapy
and data collection was continued for 8 weeks, 2
sessions per week (totally 16 sessions). Blood
pressure was monitored at all sessions during
the study, and in case of sudden changes (more
than 20% to the previous blood pressure), the
subject was excluded from the study. During this
research, none of the participants had more
than 20% change in blood pressure compared
with the previous measurement. The maximum,
minimum, and mean arterial blood pressures of
the participants were measured at the beginning
and end of hemodialysis in the first and last
sessions of humor therapy and the obtained
data were analyzed with independent t-test and
paired t-test.
RESULTS
A total of 26 women and 14 men with a mean
age of 56 years were participated in this study.
The most common cause of morbidity was
hypertension followed by hyperglycemia. There
was no significant difference between men and
women in the blood pressure (p>0.05). No
significant difference was found between the
cause of renal failure and hypertension
(p>0.05).
According to paired t-test, a significant
difference existed between blood pressure in
the first and last sessions of humor therapyat all
times of investigation (beginning of
hemodialysis, an hour after the initiation of
dialysis, and at the end of humor), which shows
that humor therapy is effective on blood
pressure in patients undergoing hemodialysis
(p>0.001). Unilateral evaluation of the effect of
humor therapy also showed that humor therapy
can decrease blood pressure of patients
undergoing hemodialysis (p>0.001).
Raziyeh Ghafouri et al J Res Med Dent Sci, 2017, 5 (6):85-88
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Journal of Research in Medical and Dental Science | Vol. 5 | Issue 6 | December 2017
87
Table 1: Result of blood pressure comparison in first and last sessions of hemodialysis
DISCUSSION
In this study, 65% of the participants were
female and 35% were male. The most common
cause of renal failure in the present study was
hypertension followed by hyperglycemia.
According to Andreoli et al., the most common
cause of renal failure was hyperglycemia and
then hypertension [23]. Their finding was same
as this study.
This study showed that humor can reduce blood
patient undergoing heamodialysis. Jalali et al.
demonstrated that humor therapy is effective in
reducing blood pressure [14]. Humor reduces
blood pressure by influencing vessel wall
performance through two ways:
1. Activation of nitric oxide secretion [20].
2. Effect on the activity of vasoconstrictors
receptors and reducing their activity and
number [24].
Further research is needed regarding the
therapeutic effect of laughter on blood pressure
to explicitly claim that downregulation of blood
pressure with humor therapy is whether
through activating the secretion of nitric oxide
in blood vessels and reduction of
catecholamines (stress hormones) or through
regulation of vessel wall receptors and affecting
neurotransmitters receptors of the endocrine
system in two directions and regulation of blood
pressure within normal limits [24]. In a study by
Wolter et al., no significant difference existed
between drug therapy and drug therapy plus
humor therapy; the reason of which was
attributed to the existence of drug therapy in
both groups of intervention and control [25].
On the other hand, Martin confirmed the
therapeutic effect of humor on the psychologic
and refused its physical effects [26]. Cutdif and
McKenna did not confirm the physiological
effects of laughter therapy; this was attributed
to the lack of research on positive emotions and
their performance in small statistical societies.
They suggested more research in this field in
order to demonstrate the physical effects of
humor [12].
CONCLUSION
According to the findings of this research,
humor therapy is effective in reducing blood
pressure in patients undergoing hemodialysis.
Acknowledgement
The author would like to thank the nurses and
staffs of the dialysis ward of Bu-Ali Sina
Educational Hospital of Qazvin University of
Medical Sciences that helped us in conducting
this study.
REFERENCES
1. Bahram neghad, N, Social and psychological
stress factors of patient undergoing
hemodialysis, Journal of Qazvin University
of medical science,2000; 14(2):90-95.
2. Bezerra KV, Santos JLF. Daily life of patients
with chronic renal failure receiving
hemodialysis treatment. Revista latino-
americana de enfermagem. 2008;
16(4):686-91.
3. Thomas D, Joseph J, Francis B, Mohanta GP.
(2009), Effect of patient counseling on
quality of life of hemodialysis patients in
India. Pharm Pract.2009; 7(3):181-4.
4. Marcovitch H. Black's medical dictionary,
London, A&G Black Co. 2005; 41
st
edition.
5. Brunner LS, Smeltzer SCC, Bare BG, Hinkle
JL, Cheever K ) , Brunner & Suddarth's
textbook of medical-surgical nursing:
Lippincott Williams & Wilkins. 2010
6. Sommers MS, Fannin E. Diseases and
disorders: A nursing therapeutics manual:
FA Davis. 2014
7. Rahimi, A, et al, Effect of continuous care
method on self esteem of patient
undergoing hemodialysis, The Scientific
Time
First
session
Last
session
P
value
Mean
SD
Mean
SD
The beginning of hemedialysis
Systolic BP
141.8
20.7
125.4
13.5
p
>0.001
Diastolic BP
81.3
605
76.0
8.7
p
>0.001
Mean Arterial pressure (MAP)
100.9
10.4
91.8
10.6
p
>0.001
The end of humor
Systol
ic BP
136.5
18.6
119
18.8
p
>0.001
Diastolic BP
80.8
7.3
74.3
7.8
p
>0.001
Mean Arterial pressure (MAP)
97.7
10.8
88.2
10.1
p
>0.001
The end of hemodialysis
Systolic BP
136.5
9.22
118
14.6
p
>0.001
Diastolic BP
80.3
6.6
75.5
7.8
p
>0.001
Mean Arterial
pressure (MAP)
98.1
10.2
89.2
9.38
p
>0.001
Raziyeh Ghafouri et al J Res Med Dent Sci, 2017, 5 (6):85-88
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Journal Of Zanjan University Of Medical
Science, 2006;13(53):16-21.
8. Hall JE. Guyton and Hall textbook of medical
physiology: Elsevier Health Sciences; 11
th
edition.2015
9. Libby, P, et al, Braunwald’s Heart Disease,
Elsevier Saunders Co; 2008;8
th
edition.
10. Shiri, H, Nikravan monfared, M, (2005),
Principle Of Intensive Care, CCU, ICU,
Dialysis, Nordanesh.
11. Riley, J, B, Communication in Nursing,
Philadelphia, Mosby Co. 2004; 5
th
edition.
12. CutDiffe JR, McKenna HP. (2005), The
Essential Concept of Nursing. 5
ed
.
Philadelphia: Elsevier Saunders Co .
13. Hostetler J. Humor, spirituality, and well-
being. Perspectives on Science and Christian
Faith. 2002; 54(2): 108-13.
14. Jalali S, Kheirkhah F, Ahmadi H, Seifi Zarei B.
Effect of Laughter Therapy on Blood
Pressure Patients with Essential
Hypertension. Journal of Babol University of
Medical Sciences.2008;10(5):35-40 ,
15. Matz A, Brown S T. Humour and pain
management. Journal of Holistic Nursing.
1998;16(1):68-75.
16. [Adams P. Humour and love: the origination
of clown therapy. Postgraduate Medical
Journal.2002; 78(922):447-8.
17. Bennett HJ. (2003), Humor in medicine.
Southern Medical Journal-Birmingham
Alabama-.2003; 96(12):1257-61.
18. Weisenberg M, Tepper I, Schwarzwald J.
(1995), Humor as a cognitive technique for
increasing pain tolerance. Pain.
1995;63(2):207-12.
19. Brutsche MH, Grossman P, Muller R, Pello J,
Baty F, Ruch W. (2008), Impact of laughter
on air trapping in severe chronic
obstructive lung disease. International
journal of chronic obstructive pulmonary
disease. 2008; 3(1):185.
20. Miller M, Mangano C, Park Y, Goel R,
Plotnick G, Vogel R. Impact of cinematic
viewing on endothelial function. Heart.
2006; 92(2):261-2.
21. Hayashi T, Urayama O, Hori M, Sakamoto S,
Nasir UM, Iwanaga S, et al. Laughter
modulates prorenin receptor gene
expression in patients with type 2 diabetes.
Journal of psychosomatic research.2007;
62(6):703-6.
22. Leibovitz Z. Humour and dialysis.
EDTNA/ERCA journal (English ed).
1997;24(4):17-8 , (abstract).
23. Andreoli T. Andreoli and Carpenter's Cecil
essentials of medicine. Philadelphia, PA:
Saunders. Elsevier; 7
th
edition 2010.
24. Miller M, Fry WF. The effect of mirthful
laughter on the human cardiovascular
system. Medical hypotheses. 2009;
73(5):636-9.
25. Walter M, Hänni B, Haug M, Amrhein I,
Krebs-Roubicek E, Müller-Spahn F, et al.
(2007), Humour therapy in patients with
late-life depression or Alzheimer's disease:
a pilot study. International journal of
geriatric psychiatry. 2007; 22(1):77-83.
26. Martin RA. Sense of humor. Positive
psychological assessment: A handbook of
models and measures. Availlable on:
http://humoursummerschool.org/01/articl
esNhandouts/PosPsych.pdf:2003; 313-26.
... The five articles selected and included in this SLR were published between 2015 and 2019: one article from 2015 (Bennett, et al.,2015), one from 2016 (Heo, Kim, Park, & Kil, 2016), one from 2017 (Eshg, Ezzati, Nasiri, & Ghafouri, 2017) and two from 2019 (Sousa et al., 2019a;Sousa, et al., 2019b. Articles vary by country of origin: one study was conducted in Australia (Bennett, et al., 2015), one in Iran (Eshg et al., 2017) ( Eshg et al., 2017;Bennett et al., 2015). ...
... The five articles selected and included in this SLR were published between 2015 and 2019: one article from 2015 (Bennett, et al.,2015), one from 2016 (Heo, Kim, Park, & Kil, 2016), one from 2017 (Eshg, Ezzati, Nasiri, & Ghafouri, 2017) and two from 2019 (Sousa et al., 2019a;Sousa, et al., 2019b. Articles vary by country of origin: one study was conducted in Australia (Bennett, et al., 2015), one in Iran (Eshg et al., 2017) ( Eshg et al., 2017;Bennett et al., 2015). The study sample ranges from 17 (Bennet et al., 2015) to 70 (Sousa et al., 2019a;Sousa et al., 2019b) people with CKD undergoing haemodialysis. ...
... The five articles selected and included in this SLR were published between 2015 and 2019: one article from 2015 (Bennett, et al.,2015), one from 2016 (Heo, Kim, Park, & Kil, 2016), one from 2017 (Eshg, Ezzati, Nasiri, & Ghafouri, 2017) and two from 2019 (Sousa et al., 2019a;Sousa, et al., 2019b. Articles vary by country of origin: one study was conducted in Australia (Bennett, et al., 2015), one in Iran (Eshg et al., 2017) ( Eshg et al., 2017;Bennett et al., 2015). The study sample ranges from 17 (Bennet et al., 2015) to 70 (Sousa et al., 2019a;Sousa et al., 2019b) people with CKD undergoing haemodialysis. ...
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Full-text available
Objective: To know the health and welfare benefits of Laughter-inducing and humor nursing interventions in people with CKD undergoing haemodialysis. Methods: Systematic Review of Literature (RSL). The research was conducted between November 2018 and May 2019. Articles were selected through the Biblioteca Virtual em Saúde (BVS) and EBSCOhost databases, whose research was complemented by Google Scholar. Articles published between 2014 and 2019 were searched and articles published with the Portuguese, English and Spanish language were used as criteria for inclusion, articles available with full text, referring to elderly / elderly people undergoing haemodialysis, which included primary experimental studies and quasi-experimental and that use as intervention humor, laughter-inducing therapy. Results: Five articles were selected, with quasi-experimental studies showing the control and reduction of blood pressure, the quality of life, the promotion of well-being (happiness and satisfaction with life in general), the reduction of depression, stress and anxiety and increased sense of humor are the main benefits of laughter-inducing and humor nursing interventions. Conclusion: Laughter-inducing and humor nursing interventions have benefits in the health and well-being of people undergoing haemodialysis and help them cope with disease and treatment.
... On psychosocial therapy, there is a useful meditation to relieve stress and have an effect on reducing blood pressure (Astin, 1997), (Schneider & Reangsing, 2016), (Márquez, Soler & vila et al., 2019). There is laughter therapy (Eshg, & Ghafouri, 2017), and SEFT therapy (Karmiyati & Sari, 2018), both of which exert an influence on stress for people with hypertension. Then there is aromatherapy therapy (Nesami, et al, 2018), music listening therapy (Knight & Richard, 2001), and getting closer to religion (Lev et al., 2007& & Fernando et al., 2019. ...
... A comunicação deve ser facilitada ao longo do tratamento dialítico, no sentido de permitir à pessoa e sua família lidarem com a vulnerabilidade inerente à situação que vivem e envolver-se no seu processo de cuidados (FREITAS et al., 2018). A visualização de filmes de humor, como atividade da intervenção humor, assim como a intervenção do yoga do riso em pessoas com DRC, não provocou alterações na PAS e PAD, assim como na FC, o que pressupõe tratar-se de uma intervenção segura, acessível e de baixa intensidade, que pode ser facilmente utilizada durante as sessões de hemodiálise(BENNETT et al., 2015a), sendo também efetiva no controlo da pressão arterial(ESHG et al., 2017;GHAFOURI, 2015).No final da intervenção as pessoas com DRC não apresentaram alterações hemodinâmicas, demonstrando-se a segurança da mesma e que esta não necessita de muitos recursos. Cabe ao enfermeiro fazer uma avaliação, selecionar e motivar a pessoa para a visualização de filmes humorísticos. ...
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As intervenções terapêuticas baseadas no humor e no riso parecem ser um importante fator na promoção da saúde dos indivíduos em programas de hemodiálise por ser benéfico a sua utilização em situações como ansiedade, stress e insónia, assim como na melhoria de sintomatologia física. Na realidade, é evidente o caráter protetor da visualização de filmes de humor sobre a componente física da qualidade de vida, constatando-se diminuições significativas dos valores da pressão arterial sistólica e pressão arterial diastólica no grupo de intervenção. Por esse motivo os enfermeiros devem prescrever a visualização de filmes humorístiscos durante a sessão de hemodiálise dado que esta, além de ser um meio de distração, melhora a qualidade de vida de pessoas submetidas a hemodiálise. Esta componente da intervenção de enfermagem Humor é segura, poderá ser recomendada como estratégia de melhoria de qualidade de vida no grupo estudado.
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Substantial research has demonstrated that cognitive psychological techniques including distraction can increase pain tolerance. In recent years, there also have been claims that humor and laughter possess unique characteristics for coping with pain and stress. Theoretically, explanations include the release of endorphins, the lowering of tension, as well as the distraction that results from humor. The question is whether humor is more effective than simple distraction. For this purpose humor was contrasted with a repulsive stimulus and a neutral stimulus controlled for interest level, that would also have distraction capabilities but not the unique aspects of humor. Pain tolerance was tested using cold pressor stimulation. Four groups (20 subjects in each) were tested. Three groups were shown a film: (1) a humorous film, (2) a repulsive film, (3) a neutral film. Group 4 was not shown any film. Results indicated that both the humor and repulsive groups showed a significant increase in pain tolerance as compared to the other groups. The repulsive group yielded the largest increase in pain tolerance although not different from the humor group. Except for sex differences, pain ratings did not show any group effects. Discussion focused on the type of distraction that would be meaningful for increasing pain tolerance and on the place of humor in pain control.
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There are many articles on the connection between the spirit and the body and the influence of a good mood on the way people deal with physical problems. This paper will demonstrate that the use of humour is a way of influencing our patients' spirit in order to help them deal with problems relating to their illness. In our every day experience with renal patients, we have noticed that humour helps us reduce patients' anxiety, before the first dialysis, before using the dialysis needles, or before performing painful procedures. Humour also helps us to offset the anger patients often express during treatment. Humour brings about a better atmosphere and the possibility of creating positive communication with the patients in a more relaxed environment and in a much more effective way. Our findings are similar to those in the literature and conclude that humour is an aid for dealing with patients' problems.
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Compassion, joy, love, and humour are essential to build healthy and peaceful societies The events of terror in the United States on 11 September 2001 have provoked many reactions and the traditional revenge/fear action. The casual, quick acceptance of this response globally, instead of outrage over more senseless carnage, is symptomatic, in medical jargon, of a massive malignant cancer in human society. Also symptomatic is that, on the same day, over 30 000 children died of starvation and there was no noise heard. As I explore the health of the human society, with the same tender, thoughtful compassion I have explored individual patients, I find the “patient” in critical condition, needing global universal attention. Why do we revere our diversions, and neglect our collective health? We live in a country where athletes and actresses are multimillionaires. Though school teachers are second only to mothers in supporting a healthy human society, in the US, 60% have to hold second jobs to support a family. Mechanisms need to be found to help midwife a human society that never needs war again; where all are cared for (and all of nature too), and life is a celebration. At this point in human history these goals can no longer be considered idealistic or naive. They are thoughtful imperatives if we want to get humans off the endangered species list. I know, after September 11th, everywhere I travelled I heard the nation echoing our president's immediate call to war. I started to ask my audiences if any of them had wondered what “love strategy” could effectively respond to terror? I've never heard any nation or people discuss a love strategy in the face of violence. We have to be the pioneers. First, we declare the intention to be peaceful and loving and, being present in …
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Humor and laughter have been a focus of attention in the popular media and in the medical literature. Despite statements about the health benefits of humor, current research is insufficient to validate such claims. There is support in the literature for the role of humor and laughter in other areas, including patient-physician communication, psychological aspects of patient care, medical education, and as a means of reducing stress in medical professionals.