Psychosocial stress and cardiovascular disease Part 2: effectiveness of the Transcendental Meditation program in treatment and prevention

Psychosocial stress is a nontraditional risk factor for cardiovascular morbidity and mortality that may respond to behavioral or psychosocial interventions. To date, studies applying such interventions have reported a wide range of success rates in treatment or prevention of cardiovascular disease (CVD). The authors focus on a natural medicine approach that research indicates reduces both psychosocial and traditional risk factors for cardiovascular disease-the Transcendental Meditation (TM) program. Randomized controlled trials, meta-analyses, and other controlled studies indicate this meditation technique reduces risk factors and can slow or reverse the progression of pathophysiological changes underlying cardiovascular disease. Studies with this technique have revealed reductions in blood pressure, carotid artery intima-media thickness, myocardial ischemia, left ventricular hypertrophy, mortality, and other relevant outcomes. The magnitudes of these effects compare favorably with those of conventional interventions for secondary prevention.     

Psychosocial Stress and Cardiovascular Disease Part 2: Effectiveness of the Transcendental Meditation Program in Treatment and Prevention

Abstract

Psychosocial stress is a nontraditional risk factor for cardiovascular morbidity and mortality that may respond to behavioral or psychosocial interventions. To date, studies applying such interventions have reported a wide range of success rates in treatment or prevention of cardiovascular disease (CVD). The authors focus on a natural medicine approach that research indicates reduces both psychosocial and traditional risk factors for cardiovascular disease—the Transcendental Meditation (TM) program. Randomized controlled trials, meta-analyses, and other controlled studies indicate this meditation technique reduces risk factors and can slow or reverse the progression of pathophysiological changes underlying cardiovascular disease. Studies with this technique have revealed reductions in blood pressure, carotid artery intimamedia thickness, myocardial ischemia, left ventricular hypertrophy, mortality, and other relevant outcomes. The magnitudes of these effects compare favorably with those of conventional interventions for secondary prevention.     

Evidence that the Transcendental Meditation program prevents or decreases diseases of the nervous system and is specifically beneficial for epilepsy

Although meditation has been practiced worldwide for centuries, there are no reports that it causes epilepsy or increases the predisposition to it. Medical care utilization statistics and clinical studies indicate that individuals who regularly practice the Transcendental Meditation technique have fewer problems of the nervous system and specifically show decreased symptoms of epilepsy. The frequency, amplitude, areas of activation, and effects of the EEG during the Transcendental Meditation technique are completely different from those of epilepsy. There is no evidence that the Transcendental Meditation technique increases glutamate, which has been associated with epilepsy. With regard to serotonin, the relationship of serotonin to epilepsy has to be viewed in the context of the abnormal brain tissue that causes epilepsy. The serotonin increases that may occur through meditation have been associated with only beneficial effects.     

Medical care utilization and the transcendental meditation program

This field study compared 5 years of medical insurance utilization statistics of approximately 2000 regular participants in the Transcendental Meditation (TM) program with a normative data base of approximately 600,000 members of the same insurance carrier. The benefits, deductible, coinsurance terms, and distribution by gender of the TM group were very similar to the norm, yet the TM group had lower medical utilization rates in all categories. Inpatient days per 1000 by age category were 50.2% fewer than the norm for children (0-18), 50.1% fewer for young adults (19-39), and 69.4% fewer for older adults (40+). Outpatient visits per 1000 for the same age categories were, respectively, 46.8%, 54.7%, and 73.7% fewer. When compared with five other health insurance groups of similar size and professional membership, the TM group had 53.3% fewer inpatient admissions per 1000 and 44.4% fewer outpatient visits per 1000. Admissions per 1000 were lower for the TM group than the norm for all of 17 major medical treatment categories, including -55.4% for benign and malignant tumors -87.3% for heart disease, -30.4% for all infectious diseases, -30.6% for all mental disorders, and -87.3% for diseases of the nervous system. However, the TM group's admission rates for childbirth were similar to the norm. The issue of self-selection is addressed in terms of previous medical research in this area.     

Transcendental mediatation: a psychological interpretation.

The authors suggest that Transcendental Meditation offers a great deal of promise for use in helping relationships. They also suggest that the technique might receive wider acceptance if it could be explained in other than a purely philosophical or mystical way. For that reason, in their article they offer a psychological interpretation of the TM process.     

Behavioral treatment of hypertensive heart disease in African Americans: rationale and design of a randomized controlled trial.

African Americans experience higher morbidity and mortality than Whites do as a result of hypertension and associated cardiovascular disease. Chronic psychosocial stress has been considered an important contributing factor to these high rates. The authors describe the rationale and design for a planned randomized controlled trial comparing Transcendental Meditation, a stress-reduction technique, with lifestyle education in the treatment of hypertension and hypertensive heart disease in urban African Americans. They pretested 170 men and women aged 20 to 70 years over a 3-session baseline period, with posttests at 6 months. Outcomes included clinic and ambulatory blood pressure, quality of life, left ventricular mass measured by M-mode echocardiography, left ventricular diastolic function measured by Doppler, and carotid atherosclerosis measured by beta-mode ultrasound. This trial was designed to evaluate the hypothesis that a selected stress reduction technique is effective in reducing hypertension and hypertensive heart disease in African Americans.     

Long-term endocrinologic changes in subjects practicing the Transcendental Meditation and TM-Sidhi program

The Transcendental Meditation (TM) and a more advanced program, the TM-Sidhi program, have been reported to produce a number of acute and long-term metabolic and electrophysiologic changes. To investigate the possibility that the practice of these techniques may be associated with long-term endocrinologic changes, we prospectively evaluated 11 male subjects before and over a 3-year period after starting the TM-Sidhi program. A progressive decrease in serum TSH, growth hormone, and prolactin levels occurred over the 3 years while no consistent change in cortisol, T4, or T3 levels was observed. These results suggest that the long-term practice of the TM and TM-Sidhi program may have effects on neuroendocrine function. Further studies using 24-hr monitoring with frequent blood sampling will, however, be needed to fully assess the significance of the simultaneous decline of the anterior pituitary hormones with maintenance of levels of hormones from peripheral endocrine glands.     

Problems of transition from tax-based system of health care finance to mandatory health insurance model in Russia

This article examines three problems burdening the Russian system of health care finance in transition period: (a) unrealistic government promise to cover health care coverage too wide to be achieved with available resources; (b) inefficient management of health care delivery systems; and (c) lack in evidence of actual positive changes effected by the new players: mandatory health insurance carriers and funds. Radical reshaping of the health benefits promised by the government and introduction of patient co-payments are considered as a way to normalize public health sector finance and operations. Two alternative approaches to the reform of the existing eclectic system of health care management are available. Institutional preconditions for operational effectiveness of third-party purchasers of health services in public-financed health sector are defined.     

The TM-Sidhi programme, age, and brief tests of perceptual-motor speed and nonverbal intelligence

Three brief tests that assess perceptual-motor speed and two that assess nonverbal intelligence were administered to individuals who were practicing the Transcendental Meditation and TM-Sidhi programme. Multiple regression analyses showed that when motivation (measured on a 5-point self-rating scale), age, sex, education, and duration of practice of the Transcendental Meditation technique were held constant, number of months of practice of the TM-Sidhi programme significantly predicted higher performance on two of the perceptual-motor speed tests and both tests of intelligence. Age predicted lower scores on the same tests.     

Impact of management change and an intervention program on health care personnel

BACKGROUND: There has been a major shift in the organization and responsibility for the provision of geriatric care in Sweden. This was believed to be stressful. We therefore decided to launch a controlled intervention program on health care personnel aimed at enhancing their adaptation and ability to cope. The purpose of this study was to assess the impact of management change on psychosocial parameters of health care personnel and the effects, if any, of a structured intervention program. METHODS: Two separate wards were randomly allocated to be either intervention (I) or control (C) ward. The I-ward personnel were subjected to a psychologist's structured 10-session intervention program for 20 weeks. The program consisted of an initial educational part followed by a practical problem-solving discussion part. A structured questionnaire on psychosocial issues was answered by the participants before (0 weeks), immediately after (20 weeks), and 10 weeks after the intervention (30 weeks). RESULTS: There were no significant changes in the psychosocial parameters of the C-ward personnel. In the I-ward, however, there was a significant increase in work demand as well as in positive feelings about work, as compared to the C-ward at the 30-week follow-up. There was also significantly better work comfort in the I-ward. CONCLUSIONS: We did not find any anticipated negative psychosocial effects on health care personnel undergoing an organizational change. However, by offering a structured intervention program to one group of health care personnel, we found some positive psychosocial effects. Future research is needed to pinpoint which factor or factors in the intervention program were the most crucial for the effects to occur.     

Behavioral Treatment of Hypertensive Heart Disease in African Americans: Rationale and Design of a Randomized Controlled Trial

Abstract

African Americans experience higher morbidity and mortality than Whites do as a result of hypertension and associated cardiovascular disease. Chronic psychosocial stress has been considered an important contributing factor to these high rates. The authors describe the rationale and design for a planned randomized controlled trial comparing Transcendental Meditation, a stress-reduction technique, with lifestyle education in the treatment of hypertension and hypertensive heart disease in urban African Americans. They pretested 170 men and women aged 20 to 70 years over a 3-session baseline period, with posttests at 6 months. Outcomes included clinic and ambulatory blood pressure, quality of life, left ventricular mass measured by M-mode echocardiography, left ventricular diastolic function measured by Doppler, and carotid atherosclerosis measured by β-mode ultrasound. This trial was designed to evaluate the hypothesis that a selected stress reduction technique is effective in reducing hypertension and hypertensive heart disease in African Americans.     

A psychosocial risk assessment model (PRAM) for use with pregnant and postpartum women in primary care settings

Recognition of high rates of mental health morbidity and mortality that affect women during the perinatal period has prompted the development of psychosocial risk assessment programs. Designed to identify women, at risk, during routine health checks and delivered by primary care health service providers, these fit within a primary prevention and early intervention strategic approach to the reduction of perinatal mental illness and reflect an integrated approach to perinatal health services delivery. This paper describes the development and use of the psychosocial risk assessment model (PRAM) at the Royal Hospital for Women in Sydney, Australia. Data is presented on 2,142 women who attended the Antenatal Midwives Clinic between 2002 and 2005. The PRAM guides primary care staff to quickly identify women experiencing emotional distress and/or psychosocial problems during pregnancy or postnatal checks. Measures used in pregnancy are the symptom-based Edinburgh Depression Scale and the psychosocial risk-based Antenatal Risk Questionnaire. In postnatal setting the Postnatal Risk Questionnaire is used. Scores can be used to compute a Psychosocial Risk Index (PRI) to guide individualized care planning, define needs for referral and classify groups for clinical and research purposes. Based on the PRI, among 2,142 women assessed in pregnancy 70.6% were classified as low/no risk (no interventions indicated currently), 24.1% as medium risk (in need of monitoring), and 5.3% as high risk (complex). The PRAM offers a conceptual framework, methods and measures for brief psychosocial assessment with clinical and research applications. Postpartum follow up studies of women assessed during pregnancy have commenced. Randomized controlled trials and cross-cultural studies are now indicated to strengthen the evidence base for the model.     

Prevention and treatment of depression in pregnancy and the postpartum period – summary of a maternal depression roundtable: a U.S. perspective

Summary This article summarizes the proceedings of a roundtable sponsored by the National Institute of Mental Health on January 31, 2001. The objective of this meeting was to discuss the current status and future directions of research on the prevention and treatment of depression in pregnancy and the postpartum period from multidisciplinary and public health perspectives. The major foci included current U.S. federal initiatives, nosology/diagnosis, approaches to assessment, psychosocial and pharmacological interventions, prevention approaches, and service delivery systems. This summary presents the pertinent topics of discussion from the group of experts and identifies key areas for future research and public health directives.     

Getting the word out: Teaching middle-school children about cardiovascular disease

Cardiovascular disease (CVD) has roots in childhood. Because CVD begins early, a clear strong case for early education focused on CVD primary prevention exists. Scientists are not traditionally involved in disseminating health knowledge into public education. Similarly, public school teachers typically do not have access to biomedical research that may increase their students' health science literacy. One way to bridge the “cultural” gap between researchers and school teachers is to form science–education partnerships. For such partnerships to be successful, teams of scientists and teachers must “translate” biomedical research into plain language appropriate for students. In this work, we briefly review the need for improving health literacy, especially through school-based programs, and describe work with one model scientist–teacher partnership, the Teacher Enrichment Initiatives. Examples of cardiovascular research “translated” into plain language lessons for middle-school students are provided and practical considerations for researchers pursuing a science–education partnership are delineated.     

The Puerto Rican and Cuban public health systems: a comparison.

This article compares the Puerto Rican and Cuban public health and mental health systems and the respective health profiles, emphasizing the role of psychosocial stressors. The Cuban health system was found to be better organized and more capable of providing equitable health care and encouraging community participation in health care delivery. However, the Puerto Rican public health system is in crisis and in the process of turning over the administration of its facilities to the private medical sector. Although both countries share health profiles similar to those of developed nations, differences in morbidity and mortality patterns, and the seemingly epidemic incidence of mental disorders in Puerto Rico suggest dissimilarities between their respective psychosocial stressors. Differences in the quality of public health care and in the health profiles seem mostly attributable to the divergent political and economic organization and priorities of both countries.     

Meditation training and essential hypertension: A methodological study

Meditation training appears to be a promising psychological approach to the control of hypertension. However, most studies to date have had serious deficiencies. This study attempted to correct many of these deficiencies. Forty-one unmedicated hypertensives referred by general practitioners were randomly allocated to three groups. The treatment group (SRELAX) underwent training procedures based on Transcendental Meditation; a placebo control group (NSRELAX) underwent identical training but without a mantra. Both procedures were compared with a no-treatment control group. The results showed modest reductions in blood pressure in both SRELAX and NSRELAX groups, compared with the no-treatment controls, with diastolic percentage reductions reaching significance (p<0.05). There was considerable subject variation in response, with overall a mean decline in diastolic blood pressure of 8–10% on 3-month follow-up. Possible indicators to predict the response of subjects are considered and reasons for the similarity in the effectiveness of the SRELAX and NSRELAX conditions are discussed.This research was funded by a grant from the Auckland Medical Research Foundation.     

New options for health care policy and health status insurance: citizens as customers

Health education and health literacy programs have implications on health care policy and health care status insurance. There are many benefits of a transition from disease management to a health care system, which includes priorities in prediction, prevention, and health education. Health care and disease management could best be implemented by multiple-tier, market-oriented models of universal coverage allowing for competition among health status insurers and educational, pharmaceutical, nursing, and other health service providers. Promotion of health literacy will allow citizens to become educated customers and consumers of health care services. Internationally, health literacy might narrow the gap between economically richer and poorer countries.     

Treatment of functional impairment in severe somatoform pain disorder: a case example

OBJECTIVE: To describe the assessment and treatment of severe functional impairment in a young female adolescent with somatoform pain disorder. METHODS: Treatment included an inpatient hospital admission using a rehabilitation approach and behavior modification program. Standardized assessment of functional impairment and health-related quality of life was performed at baseline and follow-up. Diagnostic evaluation and treatment costs were computed using insurance and hospital billing data. RESULTS: Pre-/postintervention measures of functional disability indicated significant improvement in physical and psychosocial functioning in everyday activities. Although costly, the inpatient admission decreased frequent health care use over the short term. CONCLUSIONS: Delay in diagnosis of somatoform disorders may seriously extend children's disability and require more intensive treatment. Functional disability is a critical measure of treatment outcome in children with severe somatoform disorder. Future research concerning interventions for children with a broad range of recurrent and chronic pain symptoms can be strengthened through a focus on reducing functional disability.     

Adverse health events and health hazards reflections of epidemiologists and environmentalists

In this article we present management of water resources in Croatia as a model of integral approach in public health interventions. The links between provision of clean water, sanitation and good health are so strong that today management and water protection are deeply integrated in primary health care. This article is a follow up on topics presented on 2nd Croatian congress on preventive medicine and health promotion which gave us "state of art" in Croatian public health. We strongly believe that every system has its own advantages and downsides, and only by knowing the system well and continuous improvement we can protect ourselves in time of health, social or economic crisis. The model of water protection showed that to prevent and overcome the variety of water-related health risks, implementation of various activities that include general environmental protection, development of water management system, permanent water quality monitoring and control, and improvement of standards and legislative is needed. On the other hand if there is no holistic approach, to the public health problems, all the efforts in just one field will not result in health indicators improvement. Constant monitoring and uniform analysis of data could help to identify possible risks of adverse effects of various environmental factors and possible burden of disease as a consequence. That information could be a point of arguing with local governments and communities for public health interventions. It is important that epidemiological and environmental data do not remain in the domain of academic discussion or statistics, and never reach primary health care which could use them in direct health care providing. Information exchange in real time is important for the real time public health intervention. Primary health care is the front line in communication with patients and diagnostics of disease as well as prevention, and they need to have access to all relevant data.     

The privatization of treatment services for alcohol abusers: effect on the black community

This article discusses the "new wave" of privatization of treatment services for alcohol abusers. Despite the prevalence of alcohol abuse among ethnic minorities, the problem is still only marginally accepted as a focus for public health services. Instead of a consolidated effort or an integrated network, there are territorial fights among providers, a mistargeting of audiences, and a lack of any effort directed toward preventive health care. Recent research indicates that 68.5% of private sector employees are now covered by alcohol abuse treatment benefits as compared with only 36.2% in 1982. The growing number of employee assistance programs also has addressed the financial problems associated with long-term treatment in the work environment. Unfortunately these efforts are only directed at those in the society who are employed. As minority employment is much lower than that of the majority, minorities have not received the benefits of employer-financed treatment. This article assesses the growing privatization of treatment services and the failure of public alcohol prevention and rehabilitation programs to provide needed treatment for American minorities.