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Alternative and Complementary Medicine Commons™
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Articles 1 - 30 of 31
Full-Text Articles in Alternative and Complementary Medicine
Exercise Therapy For Mood Disorders In Retiring/Former Athletes, Christian Antos
Exercise Therapy For Mood Disorders In Retiring/Former Athletes, Christian Antos
Dissertations
This dissertation examined the potential integration of exercise therapy and psychotherapy as a treatment approach for mood-related difficulties experienced by former elite athletes during the transition out of competitive sport. Retirement from athletics is often associated with significant biopsychosocial challenges, including disruptions in identity, healthy routines, social support, and emotional well-being. Existing literature suggests that exercise may serve as an effective adjunctive intervention for improving mood and overall psychological functioning, though limited research has explored its application among retiring athletes within psychotherapeutic contexts. This literature review synthesized current research related to athletic retirement, neurobiological mechanisms associated with physical activity, and …
Optimizing Interventions For Major Depressive Disorder And Provider Burnout: Self-Speak Exercise Dosing (Sed), Laureen Maloney-Gepfert
Optimizing Interventions For Major Depressive Disorder And Provider Burnout: Self-Speak Exercise Dosing (Sed), Laureen Maloney-Gepfert
Lynchburg Journal of Medical Science
ABSTRACT
Major Depressive Disorder (MDD) is ranked highest among mental illnesses in the United States (US) and significantly contributes to the mental health care crisis. Patients experience resistance to pharmacologic interventions, side effects, co-morbidities, and mental health provider shortages. Subsequently, 33 % of Serious Mental Illnesses (SMIs) are being redirected to Primary Care Providers (PCPs). Concurrently, prescriber mental health is in crisis. Growing workloads for physicians and Advanced Practice Providers (APPs) have increased provider burnout syndrome (BOS). Major Depressive Disorder and BOS are positively affected by exercise, Cognitive Restructuring (CR), and Behavioral Activation (BA). Sports medicine and psychology research shows …
Educating Medical Students In Sleep, Diet, And Exercise To Determine Effects On Their Treatment Plan Development For Future Patients, Paul Jackson, Wyatt Edgekoski, Kaleb Gustavsen, Andrew Payne
Educating Medical Students In Sleep, Diet, And Exercise To Determine Effects On Their Treatment Plan Development For Future Patients, Paul Jackson, Wyatt Edgekoski, Kaleb Gustavsen, Andrew Payne
Annual Research Symposium
No abstract provided.
What Are The Most Effective Non-Pharmacologic Practices For The Management Of Primary Insomnia In Adults?, Alexis Myhre
What Are The Most Effective Non-Pharmacologic Practices For The Management Of Primary Insomnia In Adults?, Alexis Myhre
Theses and Graduate Projects
Objective: Primary insomnia is a mental health condition in which individuals struggle with falling asleep, staying asleep or early morning awakenings. As there are many treatments available that claim to help those with primary insomnia, this review looks specifically at therapy, exercise and acupuncture as management strategies.
Methods: This is a review of 15 peer-reviewed, randomized controlled trials completed in 2018 or later with one additional study completed in 2010. Also, there are four non primary insomnia based studies used to support the efficacy of alternative therapies to cognitive behavioral therapy (CBT). All the studies used in this review come …
Increasing The Efficiency Of Lifestyle Medicine Counseling: A Visual Approach, Kayla A. Hinton, Ryan Smith
Increasing The Efficiency Of Lifestyle Medicine Counseling: A Visual Approach, Kayla A. Hinton, Ryan Smith
HCA Healthcare Journal of Medicine
Too much to counsel on, too little time? We would like to present a unique and innovative perspective on lifestyle medicine counseling through the lens of a homemade flyer, designed to bridge the gap between conventional health care practices and personalized, holistic well-being. In the promising field of health care humanities, the homemade lifestyle medicine flyer serves as a tangible manifestation of individual agency in promoting health and vitality. The flyer encapsulates a diverse range of self-care practices, dietary insights, and mindfulness techniques, emphasizing the inherent connection between mind, body, and spirit in one’s health journey.
This double-sided document highlights …
The Correlation Of Consistent Exercise With Depressive Symptoms, John Gericke, Tara Pellegrino, Robert Steer
The Correlation Of Consistent Exercise With Depressive Symptoms, John Gericke, Tara Pellegrino, Robert Steer
Rowan-Virtua Research Day
Background: Depression is a major health issue that affects an estimated 350 million people worldwide. Typically, depression is associated with individuals who follow a poor diet and are physically inactive. Exercise is one form of treatment for depression and has been shown to reduce the risk of depression and protect against the onset of depression. The PHQ-9 Depression Score is a tool used to screen individuals for depression on a scale from 0-27. The goal of this study is to identify a relationship between consistent exercise and depression symptoms.
Methods: An original Qualtrics survey was created to be distributed with …
Nutrition And Exercise Resources For Uninsured Patient Populations, Sabrina Marie Paparo, Samantha Plasner, Runi Patel, Wendy Briaguez
Nutrition And Exercise Resources For Uninsured Patient Populations, Sabrina Marie Paparo, Samantha Plasner, Runi Patel, Wendy Briaguez
Rowan-Virtua Research Day
Proper nutrition and exercise is integral for the prevention and management of chronic diseases such as type two diabetes, hypertension, high cholesterol, and cardiovascular disease. However, health care disparities in the United States, such as lack of access to primary health care, has been an ever growing problem. The purpose of this study is to determine if there is a correlation between being uninsured and having worse health outcomes, and to determine if there is a need for accessible nutrition and/or exercise resources for this population. To conduct this research, a survey was distributed at the Cherry Hill Free Clinic …
Health Disparities Among Adults With Disabilities, Kirsten Carlberg, Madison Plone, Chrismely Castro, Nayarith Lopez
Health Disparities Among Adults With Disabilities, Kirsten Carlberg, Madison Plone, Chrismely Castro, Nayarith Lopez
Rowan-Virtua Research Day
Background: According to the Centers for Disease Control (CDC), 27% of adults in the United States (US) live with a disability. These disabilities are often accompanied by poorer health outcomes with adults with disabilities reporting higher rates of obesity, diabetes, and cardiovascular disease. This review aims to characterize rates of disability among young adults in Camden County, New Jersey.
Methods: Data was collected from the CDC and United States Census and analyzed using Microsoft Excel 365.
Results: In 2022, 9.7% of residents of Camden County aged 18-34 were reported as disabled while the rate was 8.3% of US residents nationwide. …
Academic Stress And Anxiety In Nursing Students: An Aerobic Exercise Intervention, Mariko Danielle Aka
Academic Stress And Anxiety In Nursing Students: An Aerobic Exercise Intervention, Mariko Danielle Aka
DNP Research Projects
Abstract
Background: The demands of rigorous nursing education programs often cause students to experience high levels of stress and anxiety during their schooling. Moderate to high academic stress and anxiety levels impact nursing students around the world. This is significant as academic stress and anxiety contribute to decreased academic success, program completion, and student health.
Local Problem: Students at Kettering College and Southern Adventist University were found to have moderate academic stress and anxiety using the SNSI and GAD-7.
Intervention: Participants (N = 24) engaged in a 4-week aerobic-exercise intervention. They were required to complete a minimum of 80 …
Physical Activity As A Means Of Improving Quality Of Life In Individuals With Chronic Pain, Tracy Tauro
Physical Activity As A Means Of Improving Quality Of Life In Individuals With Chronic Pain, Tracy Tauro
Rowan-Virtua Research Day
Pharmacologic management of chronic pain has variable results, sometimes resorting to ineffective and dangerous opioids that can potentiate substance abuse in a vulnerable population.
Exercise is unique in its ability to positively impact both the molecular and psychological aspects of chronic pain. Its role in decreasing inflammation as well as improving mental health make it an excellent option for improving quality of life.
Physicians should work with their patients to develop a patient-centered exercise plan to manage chronic pain.
The Impact Of Participation In A Mentored Cycling Program, Dana Bolduc
The Impact Of Participation In A Mentored Cycling Program, Dana Bolduc
Doctor of Nursing Practice Scholarly Projects
Physical activity (PA) has the potential to have a positive impact on mental health conditions such as anxiety, depression and self-esteem. In particular, this project focused on self-esteem because low self-esteem can lead to increased risk of developing anxiety or depression. In contrast, high self-esteem can have a protective effect against anxiety and depression. Group PA programs combined with mentorship have been shown to build relationships and enhance self-esteem. The purpose of this DNP project was to determine the impact of participation in a rural midwestern, mentored cycling program on self-esteem in an at-risk adolescent population. Self-esteem was measured using …
The Effect Of Nutrition And Exercise On Mental Health, Rebekah Owen
The Effect Of Nutrition And Exercise On Mental Health, Rebekah Owen
Senior Honors Theses
Research has shown nutrition and exercise are especially effective in helping relieve mental illness. Mental health can be aided through dietary alterations such as increasing intake of omega-3 fatty acids, fermented foods, certain vitamins, minerals, and amino acids. Proper nutritional patterns help regulate neurotransmitters and assist in the betterment of brain functioning, offering protection from and maintenance of mental illness. Furthermore, the Mediterranean diet provides to be most beneficial for mental health compared to the standard American diet which contains additives harmful to the human brain. Physical exercise also provides to be a possible therapy for those suffering from mental …
Exercise To Improve Cancer-Related Fatigue, Jennifer Watson
Exercise To Improve Cancer-Related Fatigue, Jennifer Watson
MSN Capstone Projects
For the average patient, medical professionals typically recommend exercise to enhance the health of their patients in multiple ways. Oncology patients, however, often have different issues that the treating physicians are more concerned about, so physical activity gets placed on the back burner. The need for exercise in oncology patients is certainly a decision that should be part of an individualized treatment plan, but it is reasonable to believe that most of these patients will benefit from participating in an exercise program. With the high demanding need to decrease chemotherapy side effects and improve lives of those undergoing it, this …
An Investigation Of Treatments For The Prevention Of Metabolic Complications For Women Suffering From Polycystic Ovarian Syndrome: Diet, Exercise, Weight Reduction And Herbal Remedies, Brenda Martinez-Puente
An Investigation Of Treatments For The Prevention Of Metabolic Complications For Women Suffering From Polycystic Ovarian Syndrome: Diet, Exercise, Weight Reduction And Herbal Remedies, Brenda Martinez-Puente
Nursing | Senior Theses
The purpose of this research study is to compare the views of traditional versus alternative treatments available to women with Polycystic Ovarian Syndrome (PCOS) suffering from metabolic complications. Alternative treatments include diet, exercise, herbal remedies, or any combination of the three. Pharmacological interventions for the conditions associated with PCOS such as metformin, used to control glucose levels, and clomiphene, used to treat infertility. Through the literature review, articles show herbs and plant products to have similar mechanisms of actions as the pharmacological interventions, but with less side effects. For example, cinnamon was shown to increase insulin sensitivity and pomegranate juice …
Dancing During Labor: Social Media Trend Or Future Practice?, Caroline P. Toberna, Drew Horter, Kayla Heslin, Marie M. Forgie, Emily Malloy, Jessica J. F. Kram
Dancing During Labor: Social Media Trend Or Future Practice?, Caroline P. Toberna, Drew Horter, Kayla Heslin, Marie M. Forgie, Emily Malloy, Jessica J. F. Kram
Journal of Patient-Centered Research and Reviews
Over the past 30 years, medical interventions in pregnancy and childbirth have increased. Some pregnant women seek less invasive and nonpharmacological options to manage discomforts during labor. While exercise during pregnancy is recommended, less is known about exercise, specifically dancing, during labor. While anecdotal evidence is supportive, little is known about the implications of exercise and dance during the first stage of labor for pain reduction and labor progression. Some movements common in dance, such as expanding hip circles that loosen and relax muscles of the pelvic floor, may be beneficial to women during labor. Available evidence suggests that dancing …
The Implementation Of Exercise For Chronic Kidney Disease And Dialysis Patients, Syed Ahmad Rizvi
The Implementation Of Exercise For Chronic Kidney Disease And Dialysis Patients, Syed Ahmad Rizvi
Honors College Theses
While commonly known to be the organ that helps with urine production within the human body, the kidney plays one of the most crucial roles in maintaining homeostasis. When establishing all of the roles the kidney has on keeping humans healthy, there is the question of how does the body cope when a patient is diagnosed with kidney failure. One of the more common treatment options that allows the body to continue to function without a kidney is by beginning a patient on a form of dialysis. However, as with any treatment, there will always be a list of side …
The Impact Of Lifestyle Medicine On Nonalcoholic Fatty Liver Disease, Kelli L. Noble
The Impact Of Lifestyle Medicine On Nonalcoholic Fatty Liver Disease, Kelli L. Noble
DNP Research Projects
Nonalcoholic fatty liver disease (NAFLD) is the most common liver disease worldwide. The main risk factor for the development of NAFLD is metabolic syndrome. Women are at greatest risk, typically in their 5th to 6th decade of life. The more aggressive form of NAFLD is nonalcoholic steatohepatitis (NASH) which is characterized by inflammation associated with NAFLD. NASH has the greatest tendency to progress into cirrhosis. However, lifestyle intervention has been shown to effectively treat, and even reverse NAFLD. The purpose of this quantitative, quasi-experimental study was to lend additional research and demonstrate improvement in NAFLD through lifestyle intervention with 1) …
Effectiveness Of Physical Exercise In Treating Depression Versus Conventional Treatments: A Systematic Review, Julianne Ferrie, Coleby Charlier
Effectiveness Of Physical Exercise In Treating Depression Versus Conventional Treatments: A Systematic Review, Julianne Ferrie, Coleby Charlier
Student Research Poster Presentations 2020
Purpose: This systematic review was done to compare the effects of physical exercise on depression versus the standard treatments most patients who are diagnosed with depression receive, which includes antidepressant medication and cognitive behavioral therapy. There is not currently a collective source that summarizes the various studies on this topic within the physical therapy world. Our article compiles relevant information that supports physical exercise as an alternative treatment for individuals who have been diagnosed with depression. We sampled randomized control studies and prospective cohort studies for data and results, and systematic reviews for supporting information. Our research will be a …
Modulation Of Parasympathetic Reactivation Post-Exercise Via Slow Breathing, Brent Burg
Modulation Of Parasympathetic Reactivation Post-Exercise Via Slow Breathing, Brent Burg
CSB and SJU Distinguished Thesis
During exercise sympathetic nervous activity increases and parasympathetic nervous activity decreases to fuel energy demands. Heart rate variability (HRV) indicates activity of the autonomic nervous system and the balance of its two branches. Slow breathing (SB) (6 breaths/minute) increases parasympathetic activity both spontaneously during practice and at rest after long-term practice. Thus, SB may increase parasympathetic activity after exercise. PURPOSE: This study aimed to determine whether post-exercise SB increases parasympathetic activity as measured by HRV. METHODS: Ten recreationally active college aged males (21 +/-1 years old) completed the study. A VO2max test was used to determine 70% of VO2max for …
A Qualitative Investigation Into The Influence Of A Mental Health Physical Activity Intervention On University Students, Heather M. Tunks
A Qualitative Investigation Into The Influence Of A Mental Health Physical Activity Intervention On University Students, Heather M. Tunks
Theses and Dissertations (Comprehensive)
Objective
Among the university student population, mental illnesses are highly prevalent. Adults aged 20-30 years have the highest rates of mood and anxiety disorders than any other age group, with approximately 12.0% diagnosed with an anxiety disorder and 7.0 to 9.0% experiencing clinical depression (Nunes et al., 2014; Pedrelli, Nyer, Yeung, Zulauf, & Wilens, 2015). Reducing or preventing the effects of mental illness among this population may have lifelong implications including improvements in coping and management of mental illness throughout the lifespan(Jaworska, DeSomma, Fonseka, Heck, & MacQueen, 2016). This research examines the lived experiences of volunteers and participants in a …
Prescribing Exercise For Chronic Pain Management, Katie Hettinger
Prescribing Exercise For Chronic Pain Management, Katie Hettinger
BU Well
In light of the opioid crisis, practitioners are looking for alternative ways to effectively treat pain. Utilizing exercise modalities as a method of pain management is becoming increasingly popular and more research is being done in this area than ever before. This article analyzes different research regarding exercise therapy for pain management, as well as what type of exercise has been found to be most beneficial for patients in pain.
Feasibility And Preliminary Efficacy Of A 10-Week Resistance And Aerobic Exercise Intervention During Neoadjuvant Chemoradiation Treatment In Rectal Cancer Patients, Favil Singh, Daniel A. Galvão, Robert Newton, Nigel A. Spry, Michael K. Baker, Dennis Taaffe
Feasibility And Preliminary Efficacy Of A 10-Week Resistance And Aerobic Exercise Intervention During Neoadjuvant Chemoradiation Treatment In Rectal Cancer Patients, Favil Singh, Daniel A. Galvão, Robert Newton, Nigel A. Spry, Michael K. Baker, Dennis Taaffe
Research outputs 2014 to 2021
Background:
Neoadjuvant chemoradiation treatment (CRT) in rectal cancer patients is associated with a reduction in physical capacity, lean mass and increased fatigue. As a countermeasure to these treatment-related adverse effects, we examined the feasibility and preliminary efficacy of a 10-week exercise program during CRT.
Methods:
Ten rectal cancer patients (7 men, aged 27-70 years, body mass index = 26.4 ± 3.8 kg/m2) receiving CRT undertook supervised resistance and aerobic exercise twice weekly. Assessments were undertaken pre- and post-intervention for upper and lower body muscle strength by 1-RM, muscle endurance, physical performance tests, body composition by dual X-ray absorptiometry, quality of …
Mind And Body Training To Improve Functioning And Coping With Chronic Pain: A Pilot Study, Olga Valieva, Leah M. Welsh, Betty Amuzu, Niraj Nijhawan, Jessica J.F. Kram
Mind And Body Training To Improve Functioning And Coping With Chronic Pain: A Pilot Study, Olga Valieva, Leah M. Welsh, Betty Amuzu, Niraj Nijhawan, Jessica J.F. Kram
Journal of Patient-Centered Research and Reviews
Background: Patients with chronic pain are often crippled by psychological distress, depression and fear. These patients also can develop altered pain perception, with enhanced brain activity in pain-responsive regions and those associated with anxiety/depression. Exercise and meditation can impact pain-reducing brain areas and positively influence pain characteristics.
Purpose: To alter pain center activity by reducing the activation of the higher brain and deactivation of the lower brain with somatocognitive and meditative practices, with secondary aim of reducing anxiety/depression and improve overall quality of life.
Methods: We conducted a pilot study on mentally competent adult women with stable chronic pain who …
The Effect Of An 8-Minute Yoga Breathing Program On Fitness, Weight Loss And Breathing Capacity, Jerrold S. Petrofsky, Michael S. Laymon, Iman Akef Khowailed, Haneul Lee, Allie Petrofsky
The Effect Of An 8-Minute Yoga Breathing Program On Fitness, Weight Loss And Breathing Capacity, Jerrold S. Petrofsky, Michael S. Laymon, Iman Akef Khowailed, Haneul Lee, Allie Petrofsky
College of Health & Human Services (TUN) Publications and Research
This was a single blinded randomized study with an intervention group and a control group to examine a modification in lifestyle and an 8-minute exercise session each day to lose weight. Fifty-seven female subjects participated. Subjects underwent girth measurements at the umbilicus, hips, thigh and upper arm; weight, height (for BMI), body fat, heart rate, blood pressure, abdominal strength, leg strength, arm strength, sedentary O2 saturation, treadmill challenged O2 saturation, resting metabolism (which includes fat metabolism), and lung capacity. Measures were repeated at baseline and the end of the 6-week period. During the 6-week period, they followed a healthy recommended …
The Effect Of Run Sprint Interval Training On Diabetic Metabolic Markers In Prediabetic Adults, Kathryn L. Hilovsky
The Effect Of Run Sprint Interval Training On Diabetic Metabolic Markers In Prediabetic Adults, Kathryn L. Hilovsky
Masters Theses, 2010-2019
Abstract
Purpose: The primary purpose of this study was to compare the effects of an 8-week run-sprint interval training (R-SIT) and continuous moderate-intensity training (MIT) on fasting blood glucose, HbA1c, insulin sensitivity, and β-cell function in sedentary, prediabetic adults. Secondary outcomes of the study included anthropometric, body composition variables, and aerobic capacity.
Methods: Sedentary, physician diagnosed prediabetic individuals were randomized into R-SIT (n=7, BMI 36.76 ± 9.79) or MIT (n=8, BMI 40.59 ± 12.49) interventions. Subjects participated in supervised exercise three times a week and attended a Diabetes Prevention Program course, once weekly. R-SIT participants performed 4-6 x 30-second …
Recipe For Life - Health Awareness, Courtney Thrower
Recipe For Life - Health Awareness, Courtney Thrower
Collection of Engaged Learning
The design of this project was two-fold; the research component included examination of data from a previous investigation and compared it with data collected in a community service project. In each, the aim was to assess the health habits of underserved Spanish communities and provide information and opportunity for engagement with health education. Data were collected from voluntary participants in Panama and West Dallas. The purpose of the investigation was to learn more about perceptions of health habits and provide hands-on learning regarding what it means to be healthy and practice a wellness lifestyle. Specifically, to help participants in underserved …
Yoga For The Pelvic Floor, Sandi Tenfelde, Rich Logan, Melinda Abernethy
Yoga For The Pelvic Floor, Sandi Tenfelde, Rich Logan, Melinda Abernethy
Nursing: School of Nursing Faculty Publications and Other Works
A detailed, instructional guide to yoga that helps strengthen the pelvic floor.
A Pilot Study On The Effects Of Exercise On Depression Symptoms Using Levels Of Neurotransmitters And Eeg As Markers, Timothy H. Barclay, Scott Richards, James Schoffstall, Chad Magnuson, Christine Mcphee, Josh Price, Stephen Aita, Audrey Anderson, Dan Johnson, Jerry Price
A Pilot Study On The Effects Of Exercise On Depression Symptoms Using Levels Of Neurotransmitters And Eeg As Markers, Timothy H. Barclay, Scott Richards, James Schoffstall, Chad Magnuson, Christine Mcphee, Josh Price, Stephen Aita, Audrey Anderson, Dan Johnson, Jerry Price
Faculty Publications and Presentations
Context: The prescribing of exercise by physicians has become a popular practice, yet the effectiveness of exercise on symptoms of depression is difficult to determine due to a lack of randomized controlled trials with clinical populations. Reports also indicate that only a small percentage of physicians advise their patients regarding exercise and confusion still exists as to how much and what types are best. Aims: To understand the mechanisms that make exercise a viable treatment in depression. Settings and Design: This study employed a six‑week, two group, single‑level trial, pre‑ and posttest design using self‑report of symptoms, blood …
The Influence Of Exercise Environment And Gender On Mood And Exertion, Thomas G. Plante, Marily A. Opezzo, L. Aislinn Diaz, Selena Pistoresi, Michael Santos, Jacqueline E. Fahey, Elizabeth Kay, Briana Britton, Suheel Khan
The Influence Of Exercise Environment And Gender On Mood And Exertion, Thomas G. Plante, Marily A. Opezzo, L. Aislinn Diaz, Selena Pistoresi, Michael Santos, Jacqueline E. Fahey, Elizabeth Kay, Briana Britton, Suheel Khan
Psychology
This study examined the influence of exercise environment and gender on post-exercise mood and exertion. College student participants (55 females, 49 males) were instructed to pedal a stationary bike at a moderate pace for 20 minutes. Participants were randomly assigned to one of three laboratory conditions: (1) exercising in front of a mirror and posters showing ideal fit body types (i.e., celebrity male and female personal trainers), (2) exercising in front of a mirror only, or (3) a control condition in which participants exercised without a mirror or posters. The Activation- Deactivation Adjective Check List (AD-ACL), measuring exercise-induced mood states, …
Characteristics And Quality Of Life Of Patients Presenting To Cancer Support Centres: Patient Rated Outcomes And Use Of Complementary Therapies, Bonnie J. Furzer, Kemi E. Wright, Anna S. Petterson, Karen E. Wallman, Timothy R. Ackland, David Jl Joske
Characteristics And Quality Of Life Of Patients Presenting To Cancer Support Centres: Patient Rated Outcomes And Use Of Complementary Therapies, Bonnie J. Furzer, Kemi E. Wright, Anna S. Petterson, Karen E. Wallman, Timothy R. Ackland, David Jl Joske
Research outputs 2013
Background: In order to effectively target and provide individualised patient support strategies it is crucial to have a comprehensive picture of those presenting for services. The purpose of this study was to determine the characteristics and patient rated outcomes of individuals presenting to SolarisCare cancer support centres and their choices regarding complementary and integrated therapies (CIT).Methods: A cohort with a current or previous cancer diagnosis aged 18 - 87 years presenting to a SolarisCare centre during a 5-day period completed a questionnaire. Four SolarisCare centres participated in the trial including regional and metropolitan locations. Outcomes included medical and demographic characteristics, …