Summary of the intervention and findings of the selected studies.
\r\n\tGlobalization does not represent a pure and generous process for humanity or other species, but rather it implies social exclusion and also provokes situations of vulnerability in groups of people, forced exclusion, and apartheid: poor job opportunities, lack of access to education, worse socio-sanitary conditions. Specifically, it can be said that social segregation entails the apartheid of social groups of different ages, genders, and ethnicities; these groups live a reality manifested through the deepening of poverty, in terms of increased vulnerability of the poor and groups with little economic, social, cultural, labor and health stability.
\r\n\r\n\tThis book aims to talk about some topics that are neglected in the discourses of academic communities and political elites. The inequality process is deeply rooted among humans and is part of many people's lives in the form of modern apartheid, gender segregation, lack of health access, and cultural gap. All those structural inequality processes are the product of the biopower perpetuated and produced in the macrosystem, exosystem, mesosystem, and microsystem. For many people from the academy, the information-consuming public, and the society in general, it is a problem to talk about these processes, since they have either lost interest or have normalized the structural and social inequity. For this reason, we see it as transcendental to explain how this situation occurs from the most internal fibers to the most evident processes, intending to make it more visible and thus expose the situation for possible solutions.
",isbn:"978-1-83768-406-9",printIsbn:"978-1-83768-405-2",pdfIsbn:"978-1-83768-407-6",doi:null,price:0,priceEur:0,priceUsd:0,slug:null,numberOfPages:0,isOpenForSubmission:!0,isSalesforceBook:!1,isNomenclature:!1,hash:"cefab077e403fd1695fb2946e7914942",bookSignature:"Ph.D. Yaroslava Robles-Bykbaev",publishedDate:null,coverURL:"https://cdn.intechopen.com/books/images_new/11473.jpg",keywords:"Wage Gap, Gender Segregation, Fundamental Human Rights, Health Access, Social Inequity Processes, Modern Apartheid, Resilience, Cultural Gaps, Globalization, Geopolitics of Social Inequality, Public Policies, Social Vulnerability",numberOfDownloads:null,numberOfWosCitations:0,numberOfCrossrefCitations:null,numberOfDimensionsCitations:null,numberOfTotalCitations:null,isAvailableForWebshopOrdering:!0,dateEndFirstStepPublish:"June 15th 2022",dateEndSecondStepPublish:"July 13th 2022",dateEndThirdStepPublish:"September 11th 2022",dateEndFourthStepPublish:"November 30th 2022",dateEndFifthStepPublish:"January 29th 2023",dateConfirmationOfParticipation:null,remainingDaysToSecondStep:"13 days",secondStepPassed:!1,areRegistrationsClosed:!1,currentStepOfPublishingProcess:2,editedByType:null,kuFlag:!1,biosketch:"Dr. Bykbaev is a member of the UNESCO Chair of Politecnica Salesiana University. 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First of all, as hair loss or alopecia is a frequent dermatological disease; second, the treatment options are limited and generate variable rates of success. Last but not least, hair is an important component of human outlook with a strong impact on the overall beauty and attraction of an individual. As several studies have shown, hair plays an interesting part in social and sexual communication.
The chapter addresses several issues: the importance of hair from both personal and social perspective, the structure and chemical composition of hair, hair functions and properties, biology of hair loss and hair regrowth, and consequences of hair loss and treatment options. The authors aim to offer an overview of the hair regrowth
The main reason for hair research on animal models relies on the similarities between human and animal skin biology. New treatments for alopecia with different hair growth-promoting agents and various administration techniques have been tested on animal models to prove efficacy and to minimize possible adverse reactions.
Also known as “fur” in animals, hair is a defining characteristic of mammals. Besides its important thermoregulatory function, it also has a camouflage purpose and offers protection. In animals, hair follicles can modify their type and density during seasonal coat changes [1]. It is noted that in some species, hair provides sensory and defensive functions, while in others it is used for signaling and communication [2, 3].
Although human hair has lost its main thermoregulatory function, on the scalp, it preserves a heat insulation and cooling purpose, by evaporating sweat from soaked hair [4, 5, 6]. It also acts as a sunscreen, offering the skin protection against ultra-violet radiation [7, 8].
Hair is defined as an accessory structure of the integument along with the sebaceous glands, sweat glands, and nails [4]. The shaft of the hair (hard filamentous part that extends above the skin surface) consists of three layers, starting from the outside: the cuticle (having several layers of flat, thin cells, overlapping one another), the cortex (containing the keratin bundles in rod-like cell structures), and the medulla (a disorganized and open area at the fiber’s center) [9, 10].
In the dermis, we find the bulb of the hair, which contains the dermal papilla. It has an important role in hair formation, growth, and hair cycle [11]. Besides maintaining stem cells that regrow the hair after it falls out, it also nourishes the hair follicle (providing nutrients and oxygen to epidermal cells in the lower layer) due to the blood vessels present at the bottom of the dermal papilla [1].
Hair has a complex chemical structure, containing organic substances (glycogen, acidic polysaccharides, lipids and proteins—amino acids). About 90% of the hair structure consists of proteins, out of which keratin (a combination of 18 amino acids) is the essential component, being produced by the skin keratinocytes. The lipids represent 3% of the hair composition and are supplied by the sebaceous glands or produced in the hair bulb from sterols, fatty acids, and ceramides [12, 13].
Hair also contains inorganic substances (carbon 45.2%, oxygen 28%, hydrogen 6.6%, nitrogen 15%, and sulfur 5.2%) and water. Other mineral components of hair consist of iron, copper, calcium, magnesium, zinc, potassium, and lead, all of them of external sources.
The color of hair depends on the type and quantity of melanin inside the cell. The hair follicle pigmentary unit provides the hair shaft color due to the melanin components (eumelanin and pheomelanin) and the interactions between follicular melanocytes, keratinocytes, and fibroblasts (also involved in wound healing) [11, 14]. In the case of the black hair, the pigment is also found in the extracellular compartment.
Hair is flexible and has elastic properties, being able to get longer by 20–50% under controlled traction. Under heat action, the elasticity decreases and hair can break easily. Hair is also hygroscopic, it can absorb water; a fact which decreases hair elasticity and resistance to a third of its normal value [4, 10].
Hair resistance is mostly due to cysteine amino acid, a substance rich in sulphur, which plays an important role in hair cohesion. Hair resistance seems to be increased to physical and biological agents and decreased to chemicals. Excessive light with UV exposure, repetitive hair-dye, and hair perm generate the alteration of the hair elastic properties by the chemical and photochemical degradation of the amino acids from the keratin structure. Hair resistance equals to a force of 60 kg, but it is decreased in children and elderly people. Hair resistance also depends on the hair diameter [4, 6].
Human hair is different from hair grown by mammals due to unsynchronized growth cycles and a sensitive response to androgen.
Human hair exhibits a certain seasonal coordination, but the follicles work independently [15, 16, 17]. Latest research results sustain the idea that hair follicles act like neurons, being able to interconnect and generate hair loss and hair regrowth in a small region of the scalp. Human hair has a mosaic pattern as it consists of hair in different stages: the majority of the hair follicles (90%) being in growing phase (also known as anagen), 1–2% in regression (catagen phase), and 8–9% of the hair follicles are resting (in telogen phase) [18, 19]. The cyclic changes from anagen to telogen via catagen involve rapid remodeling of both the epithelial and dermal components of hair follicles [20, 21].
In both humans and animals, hair cycle is influenced by stimulatory and inhibitory factors, such as hormones, growth factors, cytokines, neuropeptides, and pharmaceutical products [18, 22, 23]. The dermal papilla supports an increased cell division and growth rate and induces the shift between anagen, catagen, and telogen [18, 19]. In telogen phase, the old hair is lost, but the follicle will be regenerated in early anagen, when new hair grows up [24, 25].
Current concepts of hair loss pathogenesis include genetic, genomic, hormonal, and immune contributions. Furthermore, the patient’s behavior influences the hair density and its strength. In recent years, evidence has suggested that hair loss is a multifactorial disease, and the contributing factors include the resistance to insulin, local pathologies (inflammation, hypoxia, and vascular insufficiency), predisposing physiological factors (menopause and aging), association with other diseases (polycystic ovary syndrome, hirsutism, acne, hormonal imbalances, thyroid pathologies, and other autoimmune diseases). Hair loss remains a consequence of the genotype (hereditary information of the organism)-phenotype (morphology, behavior, and development) interaction [25, 26].
The most common form of hair loss is known as “androgenetic alopecia” (AGA), which represents almost 95%. In this case, hair loss is generated by hair cycle abnormalities, such as the shortening of the anagen, within an abnormal hair cycle, and the anagen-telogen rate shifting from 6:1 to 2:1. Also, hair loss can be due to a small-sized dermal papilla. Both situations lead to shortening of hairs, decreasing hair diameter, shaft loss, and an increased number of hairs in telogen phase. In most situations, the changes of hair diameter (hair thinning) are followed by the loss of pigment: final hair (thick and pigmented) can turn back into vellus (thin and white). Studies point out that another cause of hair loss is the fact that the scalp suffers from vasoconstriction and hypoxia [27, 28].
Hair cycle disturbances are mainly caused by an excess of androgens, which alters the production of regulatory factors (soluble paracrine factors and extracellular matrix components) by the dermal papilla cells [13]. Some specific sites of the body (beard, axillary, and pubic hair) react differently than hair from the scalp, as they are androgen-sensitive [4]. Hair miniaturization and thinning, followed by hair fall is most common in the vertex and the crown-frontal area of the scalp [29, 30].
The occipital part of the scalp is an androgen insensitive area that is why in alopecia, hair is still present in this region, and hair follicles are suitable to be used in hair transplants [31, 32]. The androgen effect on hair can be summarized by the metabolization of the testosterone into 5-alpha-dihydrotestosterone by 5-alpha reductase. A good metabolization limits the hair length (in case of the beard, for example) and deficiencies of the 5-alpha reductase generate enlarged hair diameter (thicker hair in the axillary and pubic area) [19, 33, 34, 35].
Another form of alopecia is Alopecia areata (AA), a cell-mediated disease directed against active growing hair follicles. It is a nonscarring alopecia, with limited alopecic patches on the scalp or the body, sometimes affecting also the nails. The pathogenesis of AA includes an autoimmune etiology, linked to human leukocyte antigen (HLA) class II alleles and to the T lymphocytic co-stimulatory cascade [30].
Several studies including recent genome-wide association analyses concluded that a large number of single nucleotide polymorphisms (SNPs) are associated with AGA susceptibility. So far, only some of the genes involved in hair loss have been discovered: genes AR androgen receptor and EDA2R ectodysplasin A2 receptor from chromosome X, region located at 20p1 on chromosome 20, and additional loci associated with early onset baldness in Europeans, such as
Alopecia can be a part of the normal aging process. Still, hair loss represents a great concern for patients. Several studies have shown that it generates anxiety and distress especially in females, affecting couple and social relationships [37, 38, 39].
Hair loss is defined as a stressful experience for both sexes, patients being unable to cope with the progression of the disease [40, 41]. Stress functions not only as a cause, a risk factor, but also as a consequence of hair loss. Alopecia determines a poor quality of life by the physical and psychological sequelae: low self-esteem, depression, distorted social perception, and psychosocial functioning [42, 43, 44, 45].
Up to the present, although many treatments have been tested, hair loss continues to be a frequent dermatological condition [46].
Two FDA-approved hair loss treatment drugs: Finasteride (acting on the hormonal cause of alopecia—the excess of androgens) and Minoxidil (acting on the physical cause—the hypoxia due to vasoconstriction), are commonly used in clinical practice in order to treat androgenetic alopecia, which represents 95% of all hair loss causes [38, 47, 48, 49]. Minoxidil (1 mg per day) is a topical formulation available in 2 and 5% concentration. It stops hair loss and promotes hair growth as it is a vasodilator and potassium channel opener, allowing more oxygen, blood, and nutrients to reach the follicle [50, 51, 52, 53]. It has no therapeutic action on the hormonal and genetic causes of hair loss; therefore, it must be used as a continuous support for the hair follicles, otherwise the hair regrowth will cease and hair loss will begin again in 1–2 months [54, 55, 56, 57]. Finasteride is a dihydrotestosterone-suppressing 5-alpha-reductase inhibitor, recommended for male use only, decreasing the serum levels of dihydrotestosterone, stopping hair fall (in 48% of the cases), and stimulating hair regrowth (in 51% of the cases). Studies have shown that 1 mg of finasteride oral treatment has an efficacy similar to daily topical application of minoxidil [58, 59, 60]. Given the temporary efficacy of finasteride and minoxidil and the limited number of treatments available in alopecia, new therapies are needed to prevent hair loss and enhance hair regrowth [61, 62].
Pharmaceutical hair loss management also includes different substances (arginine, aminexil, caffeine, and taurine), different peptides, B spectrum vitamins, zinc, or different procedures (application of stem cells or plasma-rich platelets and low-level laser therapy), even if clinical studies in this respect are lacking. A large variety of over-the-counter products claim to treat hair loss pathology: hair tonics, hair balms, hair masks, shampoos, leave in conditioners, topical solutions, or foams function as potential anti-hair loss agents [43, 44, 63, 64, 65, 66, 67, 68].
Alternatives to traditional treatment are laser (low-level laser therapy) and platelet-rich plasma (PRP) injections [47, 69].
Gene therapy aims to deliver genetic material (DNA) into the patients’ cells with either a prevention or therapeutic purpose. The therapeutic effect could theoretically be obtained by replacing the mutant gene that causes the disease with a healthy gene, inactivating a mutated gene that causes an imbalance in the organism or introducing a new gene that could fight a particular disease. For the introduction of the gene, a carrier called vector is used, and it usually consists of a modified virus (retrovirus) that will not produce a disease in the organism, but will deliver the gene by integrating the genetic material into the chromosome of a particular cell. The delivery pathway may consist of a direct injection into the tissue or it can be given intravenously, to reach the blood flow [36].
As new evidence shows that 80% of the baldness is genetic, gene therapy could be the solution, although it encounters technical problems that have not been solved up to the present [69]. Most of the hair loss complains in both female and male patients are due to the presence of androgenetic alopecia, caused by hyperandrogenism and sensitivity to dihydrotestosterone (DHT). It has been noticed that people naturally lacking from birth the 5-alpha reductase enzyme (which converts the testosterone to DHT) never develop androgenetic alopecia [50].
Human scalp has DHT-resistant follicles in the occipital area, this location being used to extract the hair follicles for transplant into the vertex or to the fronto-parietal area [53]. Gene therapy may be a solution in this case, if it can trigger the hair follicles with DHT-sensitive cells and change them into DHT-resistant follicles that could regrow hair without being affected by androgen hormones [70]. Another option would consist of the ribonucleic acid (RNA) interference to block the genes responsible for hair loss. Messenger ribonucleic acid (mRNA) represents the carrier of genetic information from the DNA out of the cell nucleus into the cytoplasm, where it is translated into specific proteins, such as receptors, enzymes. Small fragments of nucleic acids, such as small interfering RNAs (siRNAs), can target a specific gene and block the production of any type of protein in a cell. In hair loss, this technology could be used in order to inhibit the androgen receptor (AR) and the 5-alpha reductase enzymes.
Up to the present, an attempt to effectively control delivery of small interfering RNA using biodegradable cationized gelatin microspheres in an animal model of disease was first performed in 2008. Researchers administered local injections of interleukin-4 and neutralizing anti-interferon-γ antibody in C3H/HeJ mice. They concluded that alopecia areata was effectively treated as the treatment suppressed CD8 T cell infiltrates around the hair follicles and repressed enhanced interferon-γ mRNA expression in alopecic skin. Also, restoration of hair shaft elongation occurred due to Th1 transcription factor T-box 21 small interfering RNAs conjugated to cationized gelatin [71]. Another recent study showed that the sonic hedgehog (
Gene therapy is currently available only in research settings. It represents a promising therapeutic option for several diseases (especially those with no cure for the moment), but this procedure needs more research and improvement that need to be considered safe and to prove its effectiveness. So far, scientists have encountered difficulties in finding proper delivery pathways of the genes to the body, targeting them to particular cells, controlling the new gene(s) and their effect after they have been inserted into the body [73].
Human hair follicles as research material for hair loss and regeneration involve ethical problems, an invasive collection method and a limited quantity of follicles available for extraction and testing [60, 61].
The first methods of isolation and maintenance of hair follicles in cell cultures go back to 1990, when several researchers used this method in order to study the biology of the hair cycle [74, 75]. Follicles were usually taken during face lifting surgery, but only a third were suitable for the isolation phase of the hair transplant, due to improper collection procedures. The follicles needed to be isolated from human scalp in a few hours, maintained at 2–6°C, in an Earl medium, combined with phosphate buffered saline solution, with calcium and magnesium added. Only the follicles that seemed intact were used.
Other studies performed in 1990 have shown that transforming growth factor beta 2 (TGF-ß2) promotes anagen to catagen transition. Several inhibitors of hair follicle growth
On the other hand, healthy human dermal papilla cells, isolated from hair follicle, lose the ability to produce hair growth when being outside the body. Also, cycling hair follicles cannot be maintained in culture for any length of time [82].
The data that we now possess about the life and function of the hair follicle in health and disease rely on the successful research performed
Animals and humans are remarkably similar at physiological and anatomical levels. Also, genetically speaking, we share 67% of our DNA with earthworms and 99% with mice. Almost 90% of the veterinary medicines used to treat animals are similar to the ones developed for human use. Animal models can mimic human responses, but the differences in species and even in individual animals must be taken into consideration [83]. By recreating human diseases in animal models, we can study and understand the physiopathological processes involved in the disease and maybe find an efficient cure. The first Nobel Prize was awarded in 1901 and other 94 prizes were directly dependent on animal research [84].
Laboratory animals are used when human testing is not available for practical or ethical reasons. Animals represent good research subjects as they have a shorter life cycle that enables scientists to observe the animal throughout the entire life and across several generations. Also, animal models can be easily influenced by the environment, which is controlled by the researcher as far as the diet, temperature, lighting, and other factors are concerned.
Researchers use animal models for short-term objectives (to determine how the animal model responds to a stimuli or a treatment) and long-term purposes (development of a new drug, evaluation of bioavailability or toxicity, genetic study). The animal model should be sensitive, appropriate for the studied condition either by using specific evidence of previous studies or using a new animal model with the risk of generating inaccurate results [69]. Besides the similarity with the human response, other key features of the biomedical research on animal models are specificity to the study purpose, validation of the animal model, and improvement for further research. Animal research has brought many benefits not only to humans but also to animals in disease prevention and treatment [47, 48, 69].
For more than a 100 years, almost all the information obtained in the human and animal health research has been the result of studies performed on animal models. The most common aim of animal models use is the development of new methods for the diagnosis and treatment of diseases, through an understanding of the biology and the physiopathological processes involved [47, 69].
Even though animal models remain a necessity, alternatives consist of computer models, tissue and cell cultures, and other nonanimal-related research methods. In order to minimize the harmful effect of research performed on animal models, scientists tend to reduce the number of animals used to obtain valid results, to refine the experimental technique, or replace it with nonanimal research methods.
A large variety of animals (mice, rats, hamsters, rabbits, sheep, and even stump-tailed macaque) provide useful models for the
Mice represent an excellent model to study the hair cycle for several reasons: the first two cycles of the mouse hair follicle are synchronized; the mouse hair cycle is short, lasting for 3 weeks; hair follicles can be easily harvested and examined at specific time points in the cycle. Most importantly, the stages of the hair cycle have been well characterized in the mouse: anagen being morphologically subdivided into six stages and catagen into eight [22]. The periodic intervals of rodent hair cycles (especially the anagen-growing phase) seem to be less susceptible to iatrogenic influences [90]. The mouse hair cycle does not differ structurally from the human hair follicle cycle, except for the fact that during catagen the hair bulb is remodeled, but the vibrissae follicles do not retract. Scientists have recently discovered that a certain progenitor cell population in mice is analogous to the human cells, encouraging research on this particular animal model.
Besides studying the normal hair cycle on mice, scientists also focussed on the growth waves and hormonal control [91]. Significant differences between species regarding the follicular function and limited androgen-sensitive models were noticed [92]. Spontaneous mutations have been discovered and studied on hairless, nude, and tabby mutants, waved and angora animals, leading to the identification of new genes involved in hair loss and opening the path for transgenic technology research [93, 94].
Transgenic mice, also known as “knockout mice,” are mice with altered genome through the use of genetic engineering. This gene-targeting technique has revolutionized the biomedical research by offering researchers the ability to create a specific animal model for the most common human diseases. In order to select the most appropriate immunodeficient mouse models for research purpose, scientists also take into consideration: background strain, behavior, husbandry, disease susceptibility, life span, breeding performance, radiosensitivity, functionality of various endogenous immune system components, and leakiness (tendency to produce functional B and T cells as they age).
Up to the present, immunodeficient mice (with T and B cells deficiencies) were used as models for autoimmune disease mechanisms and androgenetic alopecia studies. The androgen action upon the hair follicles has been studied on spontaneous and genetically engineered nude mutant mice [95].
The C57BL/6 mouse is the most popular laboratory rodent, widely used and studied, having its entire genome published. Research applications using this particular type of mice include immunology, cancer, neurodegerative disease, age-related hearing loss, bone density, diabetes, obesity, and biomarker studies. This black coat mouse has been used for the skin-free pigment and early visible pigmented tips of new anagen regrowth [88]. C57BL/6 represents one of the most well-characterized models available, with a minimum risk of genetic drift. It is also a convenient model for creating transgenic mice, which are recognized by the mixed coat colors.
The C3H/HeJ mouse model was used in a large range of studies: immunology, cancer (especially mammary tumors), inflammation, sensorineural, and cardiovascular disease. This animal model was the most widely reported for hair growth promotion, most possibly due to the fact that C3H/HeJ mice can spontaneously develop alopecia areata (AA) from 6 to 18 months of age. Also, alopecia areata can be surgically induced by skin-grafting from a donor animal with AA onto an isogenic C3H/HeJ recipient (normal haired mice of the same strain) [90, 96].
In 2010, researchers created the first rodent model of AGA, taking into consideration its relationship to androgen metabolism and androgen signaling, mediated by the androgen receptor (AR). They used transgenic mice overexpressing human AR in the skin under control of the keratin 5 promoter and exposed them to high levels of 5-alpha dihydrotestosterone, which led to delayed hair regeneration, mimicking AGA. The scientists concluded that androgen-mediated hair loss is AR-dependent and suggested that AR and beta-catenin mediate this effect [97].
There are many rat strains raised for research purposes, but the albino Wistar Bratislava rat is the most commonly used. Gene knockout techniques are relatively difficult to be applied and successfully achieved in rats. For hair loss and regeneration experiments, the Wistar rats and the Dundee Experimental Bald Rat (DEBR) strain were commonly used. The latter has the ability to spontaneously develop adult onset alopecia areata (AA) at a higher frequency than in the mouse model [98].
In the research field of hair loss and regeneration two major achievements must be mentioned on the rat animal model: coaxing human stem cells to become dermal papilla and producing new hair follicles when transplanted on rat skin [98]. Also, by inhibiting the rejection of foreign skin, human skin grafts were applied and even rat dermal papillae continued to produce hair after reimplantation
Research performed on a rabbit animal model, added important data to the field, proving that full thickness transplants, made with full pedicle graft (separated from their original nervous and vascular supply) retain their original
The Golden Syrian hamster (
Experimental designs may include one of the depilation methods: shaving, the use of a raisin mixture, or a hair removal cream [91, 103]. The most commonly used is the shaving of a larger skin area (the whole back or body) or of several smaller areas that are denuded for testing. For animal immobilization during procedures, general anesthesia is commonly performed with a combination of ketamine (i.p. 50 mg/kg b.w.) and xylazine (20 mg/kg b.w.) [47, 48, 69].
Some study designs, such as that of Mester et al., required before each successive hair treatment, the shaving of the skin. This procedure can induce mechanic stimulation of hair growth, as previously reported in the literature, and influence the study results. Other experiments done on adult rats point out that after the fur was dyed and shaved, the regrowing hairs formed a system of linear loops that were closely correlated with the shaving process [66, 67].
In order to avoid this effect, it is recommended not to shave the skin of the animal model before each session of therapy. Other factors which influence the hair regrowth are physical factors such as low temperature, which triggers fast regrowth after shaving.
Depilation-induced hair cycle has been studied, and it follows a strict course: nine days after depilation, the hair follicles enter the final stage of the growth cycle (anagen VI). On day 17 after depilation, the follicles enter the regression stage (catagen), while on day 20 follicles get to the resting stage (telogen) [22].
Efficacy of the treatment is screened by observing the presence, rate, and cosmetic acceptability of hair regrowth. More sophisticated assays include determining how the drug induced hair regrowth and exploring the pathogenesis of AA.
Researchers do not possess standardized methods for
Usually, the dorsal part of the animals is used for the testing. After being depilated and treated, the animal skin is observed and photographed at specific time intervals (day 1, 7, 14, and 21) to record the start of the hair regrowth period and the pattern of hair regrowth, compared to controls. Several hair regrowth potential scores are mentioned by literature. The one described by Matsuda et al., for instance, ranges from 0 to 5: 0 = no hair growth, 1 = less than 20% of hair growth, 2 = 20–39% of hair growth, 3 = 40–59% of hair regrowth, 4 = 60–79% of hair regrowth, 5 = 80–100% of hair regrowth [54]. Researchers also use self-designed scales of hair regrowth that consider: Type IV (high hair density, full, thick fur), Type III (moderate hair density with no visible skin area), Type II (low hair density, with the visualization of the skin), Type I (uneven hair growth on the test area, skin easily seen) [47, 69].
The hair regrowth potential scores can be applied for both macroscopic and microscopic assessments (Figures 1 and 2).
Classification of the hair regrowth effect (type I, type II, type III, type IV) for macroscopic and microscopic assessments—personal study performed on Wistar Bratislava rats. The control area is marked with red (left side of the picture), the test area with blue (right side).
Classification of the hair regrowth effect (type 0, type 1, type 2, type 3, type 4, type 5) for macroscopic and microscopic assessments—personal study performed on New Zealand Rabbits.
On the other hand, quantitative methods, such as hair weight determinations, hair density measurements, or histopathological examination offer more accurate results. For hair weight determination, the regrown hair from an area of 1 cm2 of skin is cut and weighed with an analytical balance [48].
In order to analyze the histological features at the end of the treatment period, the animals are sacrificed and a skin biopsy is isolated for histopathological examination. The thickness of the skin and the location of hair follicles in the dermis can be assessed by microscopic photography.
Also the hair cycle can be assessed, as the anagen induction can be calculated with the formula: (number of follicles in hypodermis) × 100/(number of follicles in dermis). Literature data showed an association of increasing skin thickness, follicle count, and macroscopic development of skin pigmentation with anagen induction [18, 23]. The study by Liu et al. found that in the anagen phase the bulb of the hair follicles was enlarged and deeply inserted into the dermis. The research also revealed that the hair follicles in the shaved, bare areas were short, small, and in the phases of telogen, anagen, or catagen [69].
The hair growth cycle, consisting of three phases (anagen, catagen, and telogen) is used by both practitioners and researchers to diagnose the hair growth condition and to decide on the hair growth-promoting agent. In human subjects, digital trichoscopy is available, with automatic assessment of the number of follicles in each hair growth phase.
Several studies focused on the validation of Minoxidil 2% treatment on the animal model used, as this topical treatment is thought to be the gold standard treatment for hair loss. This substance affected the normal hair cycle by shortening telogen, causing premature entry of the resting follicles into anagen phase [103, 104].
The limitation of using an animal model while studying hair regeneration can be briefly summarized as follows. First, synchronized hair cycles generate waves of new hair regrowth, which make the interpretation of result a hard task. Second, the lack of independence of the hair follicles, since they have coordinated regrowth pattern on a precise time scale, as described by Muller-Rover et al. [22]. Third, young mice present the drawback of patchy growth after the second wave of hair growth is completed. Lastly, the increased hair density on an animal model leads to difficulties of assessment by densitometry or cross-section trichometer [69].
The results of our hair growth research performed on Wistar rats showed, besides a normal hair growth in the majority of the animal models, a lack of hair regrowth on the tested area. Other studies performed on black-and-white mice reported that no further hair growth was observed on half of the control animals.
We also noticed a diffuse hair regrowth in some study groups, while in others, the hair appeared to make some specific linear loops that were observed macroscopically. Literature date confirmed our findings. In similar situations, researchers experienced a diffuse hair growth in some animals with an uncharacteristic, diagonal strip [66]. Li-Yaun Liu et al. described four main linear hair regrowth patterns noticed on a rat model: the dorsal loop and the lateral dorsal loop (running along the dorsum and hind limb) and the ventral loop and lateral ventral loop (traveling along the thorax, abdomen, and forelimb). These hair-loop-lines create cranio-caudally-oriented waves of regrowth 2–15 mm wide, symmetrically on both sides of the body, running from the head through the torso to the limbs [105]. Li-Yaun Liu et al. concluded that after shaving the skin, the hair follicles from these new hair lines were always in an anagen phase [106].
Also, the behavior of the animals should be taken into consideration, as it can create issues and interfere with the research results [107]. For example, the C57BL/6 mice show barbering behavior, the dominant mouse in a cage selectively removing hair from its subordinate cage mates. Mice that have been barbered have large bald patches on their bodies, especially around the head, snout, and shoulders [108].
Regardless of the shortcomings of either animal model, most of them validate their usefulness for drug efficacy and safety testing for humans.
Although the studies performed on animal models encounter both technical and objective issues, further scientific research is not impeded and continues to remain an intensively explored field. By using proper and well-thought out animal models, we aim to refine our knowledge on human hair diseases and hair regrowth. Hair research provides further insights into the physiopathological pathways and genetic and cell biochemical mechanisms that could promise the cure of hair loss.
Amongst all the mental health disorders, anxiety, depression and stress appear to be the most common ones inflicting the human society. These diseases are disorders of the biochemical and neurophysiological systems which have an impact on not only the release of mood-regulating chemicals such as serotonin, dopamine and noradrenaline, but also on the cortisol and gamma amino-butyric acid (GABA) levels [1]. More than 264 million of people regardless of age, gender or creed suffer from depression [2]. Compared to men, women are more prone to this disorder, but the worrying trend is that depression leads to suicide. Evidence shows that approximately 700,000 people worldwide take their own lives annually, and what is more shocking is that suicide is deemed the fourth cause of death amongst 15 to 19-year-olds [3].
Not only depression, but also anxiety and stress are interrelated with physical well-being. For instance, cardiovascular diseases can lead to depression and vice versa. On a same note, the deadly Covid-19 pandemic which took the entire world by a storm in 2020 has had a significant undesirable impact on mental health. As the pandemic continues to ravage lives of innocent people in every nook and corner of the globe, a wide range of psychological outcomes have been observed at different layers of the society – individual, community, national and international levels. At the individual level, people are still apprehensive of falling ill or experiencing a painful death due the virus or being stigmatized by the society [4]. Health care workers and families with infected patients are completely fatigued. School and college-going students are not only totally demotivated, but also displeased as they have had to switch to virtual learning which in turn has impacted not only their eyesight, but also their physical health due to prolonged hours of being glued to the computer screen, and their social life. Family bread winners in various sectors who have lost jobs, and those in dire need of financial aid are totally dejected and devastated. Findings also reveal that those who have been quarantined or isolated, experienced quite a significant amount of stress, anxiety, mood swings, depression, and insomnia [5, 6, 7]. Frequent exposure to media appears to be another detrimental contributing factor to stress and anxiety [8]. It appears that patients with depression more often than not show symptoms of anxiety disorders, while those with anxiety disorders exhibit signs of depression [9]. Nonetheless, it is evident that both disorders tend to co-exist [10]. There are still so many people out there who are anxious and stressed out that they or their loved ones may contract the disease and not survive.
As anxiety and depression are affiliated with morbidity and mortality, it is imperative that these illnesses be identified and treated. Common treatments for these mental health disorders are available. Besides psychosocial treatments, psychological treatments such as cognitive behavioral therapy and pharmacotherapy such as selective serotonin reuptake inhibitors (SSRIs) and tricyclic antidepressants (TCAs) are usually used as the first line of treatment in moderate to severely depressed individuals [11]. Antidepressants augmented with antipsychotics have shown positive results in treating anxiety. It is noteworthy that some of the drug-based treatments for anxiety have been reported to produce a sharp decline in depressive symptoms [12, 13]; however, the strategy involved in preventing depression by treating anxiety successfully warrants further clinical investigation. Benzodiazepine, a common drug-based medication that enhances the effects of GABA at its receptor, on the other hand, is only effective in treating anxiety and not depression [9].
While treatments are readily available, some of the victims do not seek help because of financial issues, fear of being stigmatized for visiting a mental health counsellor, ignorance or for no rationale at all. Furthermore, there could be concerns about the adverse outcomes and compliance of these drugs [14].
In many parts of the world today, complementary and alternative medicine treatments are gaining popularity by all and sundry. Mindfulness-based interventions such as meditation and yoga are widely used in the therapy of both psychological and also physical ailments as research has shown a link between these practices, and physical and psychological health changes [15]. Findings seem to reveal that the practice of yoga can positively affect the biochemical and neurophysiological systems by regulating the autonomic nervous system and stress response, hence lowering the stress, anxiety and depression levels [16]. There is evidence that patients favour these conventional methods of treatment compared to mainstream approaches such as psychotherapy or psychotropic medications [17].
This chapter will look at the philosophy and benefits of yoga, review some recent research that have been done on the intervention of yoga as an adjunct or stand-alone therapy for stress, anxiety and depression, the effectiveness of this mind-body regime and its implications for the sufferers of the current society.
Yoga, an ancient mind-body movement practice, originated in India more than five millenniums ago. Also commonly referred to as a meditative movement practice, it involves movement, a meditative state of mind, breath focus and deep relaxation for purposes of enhancing or healing the physical, mental and emotional well-being [18].
Yoga appears to be a form of alternative medicine [19], and its philosophy is based on the eight limbs schematised by Maharishi Patanjali, one of the main pillars of classical yoga. These eight limbs comprise yama (universal moral ethics), niyama (internal attitudes for personal discipline), asana (yoga posture), pranayama (expansion of life force), prathyahara (withdrawal of senses), dharana (contemplation of one’s true nature), dhyana (meditation) and samadhi (liberation) [20].
The first three limbs or stages – yama, niyama and asana, are considered the outward quests (bahiranga sadhana). With the practice of yama and niyama, the practitioner works towards keeping his passions and emotions under control, while the asana component, if practised diligently, keeps the body strong and healthy, and in harmony with nature. Breath regulation and mind control take place in the next two stages, that is, pranayama and prathyahara. Since these stages work at the inner level, they are known as inner quests or antaranga sadhana in Sanskrit. The last three stages – dharana, dhyana and samadhi, elevate the practitioner into the deeper recesses of the soul [21].
As yoga is not a religion or a cult, anyone regardless of age, creed or gender can learn and practise it. For the genuine seeker, whose desire is to experience the universal self within, the practice of yoga is an unbroken journey. Nevertheless, this ancient practice can be simplified and performed in a number of ways to suit the practitioner [22].
The practice of yoga is so flexible that the practitioner can simply utilize some, if not all, of the limbs to their own comfort. In a conventional 1 h yoga session, it is not uncommon to have the asanas integrated with practices of pranayama, prathyahara, dharana and dhyana. Having said that, there are many styles of yoga; precision and alignment, asthanga yoga, flow yoga, asana yoga, gentle yoga and hot yoga are some of the common styles [23].
The practice of yoga brings about tremendous benefits to the body and mind. In the past nine decades, empirical research has been carried out on the techniques of yoga to test its credibility. Pioneer experiments conducted by Swami Kuvalayananda in 1924 focused on parameters like heart rate, blood pressure fluctuations, and intra-esophageal air pressure during the performance and also after the practice of asanas and pranayama [24].
Due to promising results, yoga has since been classified by the National Institute of Health as a form of complementary and alternative medicine, and people from all walks of life have incorporated this scientific practice into their lifestyles [25].
Unlike other forms of exercise, yoga focuses on being present in the moment. Hence, the practitioner needs to be mindful regardless of whether they have assumed a static position while holding an asana for a couple of breaths, or in motion especially during the performance of an asana. Preliminary research has advocated that yoga may increase levels of mindfulness in the practitioner [26, 27]. The asanas when performed steadily and joyfully, are useful in preventing and correcting structural imbalances in the body [28].
As this ancient science also appears to be a form of moving meditation, there have been suggestions that practitioners are more likely to be engaged in the movement aspect of yoga as it stimulates the cognitive processes related to mindfulness [29]. In addition, the meditative movement, which coordinates each movement with the breath systematically, increases physical endurance in the practitioner over time. As the muscles recurrently contract with more force while performing a particular movement, their strength eventually increases. An example would be in the classical cobra pose (bhujangasana). In this pose, the practitioner starts of by lying flat facing downward on the mat. As the upper torso and head are lifted of the mat upon inhalation, the back extensors are engaged and contracted strongly. Hence, if the position is held long enough (while breathing normally), and if the movement is repeated a couple of times in each practice, the back muscles will be strengthened [30].
Muscles and connective tissues are stretched in asanas to increase flexibility. Regardless of whether the stretch is with or against gravity, the body will experience a stretch, thus increasing flexibility [30]. Unfortunately, in the current situation today where many, who work from home, pay little attention to their sitting position, the structural alignment is greatly compromised. Certain sporting activities like tennis and football, which require strenuous use of one side of the body, are equally to be blamed too. Asanas taught in yoga have been known to prevent and correct structural misalignments in the body.
Having said that, existing research unveils that the benefits of yoga are not limited to only correcting structural misalignments, enhancing stretching and improving flexibility; yoga also enhances emotional and psychosocial health and brings about an increase in proprioceptive and interoceptive awareness [31, 32]. There have been propositions that if yoga is practised consistently, it has the ability to induce neuroplasticity i.e., changes in the neural pathways of the brain, thus improving psychological skills [33]. This augurs well for the yoga practitioner as it suggests that the brain can be rewired just like a muscle in the physical body.
Yoga as therapy or therapeutic yoga has been defined as application of yoga postures and practice to the treatment of health conditions [34]. Evidence from a growing body of research supports the notion that yoga may bring about positive effects not only in one’s physical but also mental health through the downregulation of the hypothalamo–pituitary adrenal (HPA) axis and the sympathetic nervous system (SNS) [35].
Since the aim of this review is to look into the impact of yoga specifically on stress, anxiety and depression in this contemporary society, only findings from articles that were published from 2014 to 2021 were reviewed and included. A combination of databases including PubMed, MEDLINE and PsychInfo were used to identify these articles with the help of keywords and phrases such as “intervention of yoga,” “anxiety,” “stress,” and “depression.” The search was streamlined to include only studies that were conducted with adults as participants, irrespective of gender or creed. Those that were conducted with children or teenagers below the age of 18 were excluded completely. In addition, studies that included adults suffering from multiple diseases and/or mental health issues, such as psychosis, obsessive – compulsive disorder and health-related aspects of physical fitness were not included in the discussion here. Studies that included pregnant and post-partum participants were also omitted as it is not unusual for this category of participants to undergo depression and anxiety during that period. In terms of the intervention, only studies that integrated classical yoga were included. Hence, the discussion is substantiated with findings from nine studies conducted between 2014 and 2021.
The design of all the studies varied considerably from pre-test/post-test to quasi-experimental and randomised controlled trials (RCTs). One of the RCTs was a stratified-randomised controlled with repeated measures [36]. The sample size incorporated in all these studies was relatively small, ranging from 18 [37] to a maximum of 226 [38]. While this review is not limited to qualitative and quantitative studies, the instruments used in each study varied rather significantly. In all these studies, the intervention of yoga was heterogeneous. Studies that had incorporated transcendental meditation or mindfulness meditation (or any other forms of meditation) or pranayama as stand-alone practices are not included in this discussion.
Only studies that assimilated aspects of classical hatha yoga specifically asana, pranayama, prathyahara, dharana and dhyana were included, though the duration of each class and frequency of sessions varied considerably. One study had administered Kundalini yoga; however, it had incorporated all the aspects of classical hatha yoga, hence the findings of that study were included in this review [38]. It is interesting to note that another study had incorporated chanting as part of the intervention [39].
On a positive note, most of the studies reviewed (2014–2021), if not all, exhibited appreciable outcomes; intervention of yoga, with or without pharmacotherapy, appeared to be effectual in reducing the symptoms of these mental health disorders [36, 37, 38, 39, 40, 41, 42, 43, 44]. A summary of the intervention and findings is provided in Table 1. Even though the duration of each and every study reviewed in this chapter varied considerably, that is, from 4 weeks to 6 months, there are implications that the practice of yoga advocates changes in the neural pathways of the human brain, resulting in favorable effects to the brain activity. Evidence has shown that, when compared to controls, there is less activation in the dorsolateral prefrontal cortex of yoga practitioners [45]. It appears that if there is consistency in the practice of yoga, the alpha, beta and theta brainwaves are activated; these have been linked to improvement in not only memory, but also mood and anxiety.
Authors | Description of Intervention | Findings |
Kinser et al. [40] | RCT; YG: 75 min of hatha yoga (asanas, breathing techniques, relaxation, guided meditation) per week over 8 weeks; CG: health education activities (lectures, videos, discussions) Both groups continued with prescribed medication and maintained their lifestyle activities. | YG experienced multiple benefits of yoga including a boost of confidence; Gained new skills to be used in daily life to manage depression and stress; |
Doria et al. [39] | Pre-test post-test; Grp 1: medication+SKY+self-help group weekly; Grp 2: SKY+self-help group weekly but no medication 6 months prior to study Intervention: 10 sessions of 2 h SKY in 2 weeks followed by weekly SKY for 6 months (asanas, pranayama, chanting, prathyhara, dharana) | A reduction in anxiety and depression levels in both groups No significant differences in scores between both groups |
Falsafi and Leopard [37] | Quasi-experimental (repeated measures with one group); Intervention: 90 min yoga per week for 8 weeks (asanas, pranayama and mindfulness practice) | Significant decrease ( |
De Manincor et al. [41] | RCT; YG: A 6 week yoga program; 30 min of vini yoga practice (asanas, pranayama, relaxation, mindfulness, meditation) for 4.8 days per week + TAU; CG: TAU – yoga was given after waitlist period. | A significant reduction in depression and anxiety scores; YG showed greater reduction compared to CG. |
Falsafi [36] | RCT (stratified- randomised controlled repeated measures); YG: 8 weeks hatha yoga; 75 min session once a week; 20 min daily home practice. CG: absence of yoga MIG: mindfulness practice | YG and MIG showed significant reduction in depression, stress and anxiety compared to CG; no significant change in CG; No difference between YG and MIG, but self-compassion scores significant in MIG. |
Prathikanti et al. [42] | RCT (stratified-randomised controlled); YG: A 8 week yoga program (asana, pranayama, dharana, prathyahara); 90 min per session, two sessions a week; props used; TAU. CG: 90 min of Yoga history workshop twice a week for 8 weeks, TAU. No medication for both groups. | YG showed a significant decrease in depression compared to CG ( YG more likely to achieve remission. YG requested for more sessions per week and also permission to attend yoga history workshop. |
Uebelacker et al. [44] | RCT (stratified-randomised controlled); YG: A 10 week yoga program (asana, pranayama, dharana, dhyana, prathyahara); 80 min per session; one or two sessions per week; TAU. CG: A 10 week healthy-living workshop; 60 min per session; one or two sessions per week; TAU. | Insignificant difference between YG and CG; YG demonstrated lower levels of depressive symptoms, better social and role functioning, and general health perceptions when compared to CG. |
Shohani et al. [43] | Quasi-experimental (pre/post -test); YG: 60–70 min hatha yoga, three times a week for 4 weeks | A significant, decrease in depression, stress and anxiety in the YG ( |
Simon et al. [38] | RCT (three-arm controlled single blind); YG: A 12 week program (asana, pranayama, dharana, prathyahara dharana, dhyana) 120 min per session CBT: evidence-based GAD protocol CG: stress education | YG and CBT showed efficacy for treatment of GAD; CBT remains first-line treatment. |
Summary of the intervention and findings of the selected studies.
CG: control group; CBT: cognitive behavioral therapy; GAD: generalized anxiety disorder; MIG: mindfulness intervention group; RCT: randomized controlled trial; TAU: treatment as usual; and YG: yoga group.
All the studies reviewed in this chapter incorporated the fundamental limbs of Patanjali yoga, that is, asanas, pranayama, prathyahara, dharana and dhyana. The first two limbs in yoga, that is, yama and niyama, are therapeutic in nature as both entail code of ethics that work at not only intrapersonal (yama), but also interpersonal (niyama) levels [46]. Yama includes practices such as ahimsa (non-violence), satya (non-stealing), asteya (non-lying), brahmacharya (non-excessiveness) and aparigraha (non-greediness). Niyama, on the other hand, encompasses traits such as saucha (cleanliness), santosha (contentment), tapas (sacrifice), swadyaya (self-study) and Ishwara pranidana (surrendering to the higher power). It is imperative to note that while none of these studies reported the inclusion of yamas and niyamas as part of the intervention, it is believed that these two limbs may have been interleaved into the yoga sessions in an informal manner [47].
It is common to prompt students in a timely manner specifically during the asana session to practise ahimsa, for example. While mindfully challenging oneself to perform a strenuous or a dynamic pose is encouraged, using unwarranted force recklessly to get into the pose is not. For obvious reasons, just like in any sporting activities, adding excessive pressure at certain joints in the body can and will bring about unforeseen injury to the practitioner. More importantly, while the pose is being held (being in the pose), students are persistently reminded to bring their awareness to the deep joy and pleasurable feelings that they are experiencing at that moment regardless of whether they are in the full pose or in a modified version. This act of experiencing joy while being in a particular position brings us to one of the niyamas, that is santosha. Hence, in this manner, the other yamas and niyamas are introduced and expounded during a yoga session at the academy where classes are conducted.
In the studies that have been reviewed in this chapter, the instructors assigned to the yoga sessions may have implicitly incorporated the yamas and niyamas but may have inadvertently failed to report the minutiae and hence, the details of the latter were not highlighted in the papers published. Just like in any study, implicit details are imperative for informed choices to be made. If the specifics of the yoga intervention for each study had been reported, it would have been instrumental not only to the researcher and the reader, but also to the participant who may be keen on exploring the philosophical roots of the yogic practice [47].
It is noteworthy that despite the insignificant sample size, heterogeneity in the sample population, varied duration of the intervention and wide-ranging styles of yoga taught, all studies reviewed demonstrated positive results in reducing the scores in depression, anxiety, and also stress.
In one study, where both the yoga group (YG) and the control group (CG) underwent pharmacotherapy during the intervention, the YG not only experienced a significant decrease in ruminations, but also found solace in the practice; participants used yoga as a strategy to help cope with ill-thoughts and other symptoms of depression in daily life [40]. This could be due to the impact of one of the components in the yoga practice, i.e., yoga nidra (guided meditation) that may have enhanced the self-regulatory capacities in the participants. On the hindsight, participants of this study acknowledged that the practice of yoga had intensified their confidence and that the practice had become an internal motivator for continued participation.
Similar results were seen in another study that engaged sudharshan kriya yoga (SKY) [39]. There was hardly any difference in the scores between the two groups (one group did SKY with pharmacotherapy, while the other group did SKY sans pharmacotherapy), purely suggesting that SKY may be effective not only as a stand-alone therapy, but also as an adjunct therapy for patients undergoing medical treatment. This study was exceptional as it had incorporated chanting in the yoga session. Chanting appears to have a healing effect not only on the physical and emotional, but also on the mental and spiritual body. It provides the drifting mind with a focal point. Though the chanting aspect was brief in this study, previous research has revealed that chanting has the potential to bring about deactivation in the amygdala, parahippocampal and hippocampal brain regions [46]. By stimulating the auricular branches of the vagal nerves, chanting creates vibrations at the cellular level. It is these vibrations that create neuro-linguistic effects which induce tranquility in the body and mind. Those suffering from depression tend to have a noisy mind – one that is cluttered with heaps of unnecessary thoughts. It is believed that the sounds of the mantra have the ability to mask the negative voices in the brain. Only when these ruinous thoughts are eradicated, can the mind have room for positive contemplations.
Similarly, the eight-week yoga intervention study which was conducted on 18 patients diagnosed with anxiety in the US showed a significant reduction in depressive symptoms (
In a study conducted amongst a subsyndromal population in Australia, a six-week yoga intervention was found to be effective in reducing depressive and anxiety symptoms in both groups of participants, the YG and the CG [41]. There was reduction in psychological stress and rumination, an increase in resilience, and an improvement in mental well-being. It is interesting to note that findings of this study revealed that the yoga participants, on their own accord, had reduced medication dosage and frequency of visiting the counsellor. Though the reasons for these actions are indistinct and warrants deeper investigation, the yoga intervention mode appeared effective in managing the issue at hand of these participants. Pharmacological interventions for depression and anxiety usually produce a delay of approximately 4 weeks before exerting significant mood effects over placebo; it may take up to 12 weeks to achieve full anti-depression effects with medication [48]. Hence, time is definitely a parameter for consideration in yoga intervention. However, in this Australian study, it was suggested that a 30 min yoga practice over 5 days per week should suffice for all and sundry.
Similar positive outcomes of practicing yoga were observed in a depressive and withdrawn community who participated in a randomized controlled trial in San Francisco [42]. Unlike other studies, participants in the YG in this study not only asked for more yoga sessions, but also sought permission to attend the theoretical sessions on yoga history that were specifically held for the CG. It appears that these participants were definitely eager to do yoga for the benefit of their own mind-body health, but at the same time, interested in understanding the physiology behind this ancient science. Specific asanas such as dhanurasana (bow pose), ardhakati chakrasana (half waist wheel pose), ardha chakrasana (half wheel pose), Bhujangasana (cobra pose), setu bandhasana (bridge pose), sarvangasana (shoulder stand) and matsyasana (fish pose) employed in this study were found to be effectual in helping the participants manage their depressive moods and anxiety. It is interesting to note that most of these asanas are heart/chest openers. It appears that in the process of expanding the chest and rib cage to oxygenate the lungs efficiently, these asanas have helped in managing symptoms of depression such as grief, anger and frustration.
The findings from an Iranian study which was carried amongst 52 women suffering from some form of mental health disorders albeit free from pharmacotherapy, was equally positive; the intervention of yoga as a stand-alone therapy brought upon a reduction in anxiety, depression and also stress levels (p = 0.001) in the participants who did 12 sessions of yoga over a four-week period [43].
While most studies showed promising outcomes, one study hardly showed any significant statistical difference between the YG and the CG even though there was evidence of a reduction in depressive symptoms and better social functioning in the YG [44]. These positive effects could have been merely an after effect due to the relaxation techniques included in the yogic regime. Relaxation techniques in yoga are known to downplay the sympathetic activity and balance the autonomic nervous system responses.
Finally, in one recent three-arm controlled single blind clinical trial, where participants were randomized over a period of 12 weeks to either the kundalini yoga (KY) or cognitive behavioral therapy (CBT) while the CG was subjected to stress education, it was found that the KY group and the CBT group had shown significant reduction in generalized anxiety disorder symptoms. That said, the findings also revealed that CBT appears to be more effective than yoga, and it was concluded that the former shall remain the first line of treatment for anxiety disorders [38].
However, in most, if not all, of the studies reviewed in this chapter, they were subjected to limitations. For example, a few of the studies were predominantly a female sample [40, 43]. While there is a greater tendency for women to suffer from depression compared to men [49], the sample size in these studies was disproportionately represented. Also, most of the studies were limited by the insignificant sample population and heterogeneity. Due to the absence of controls in certain studies, it was challenging to establish whether the results obtained were due intervention of yoga or another factor. RCTs are known to be intervention research of high standards, but most of the studies reviewed here were challenged due to several reasons. Either the randomization was inappropriate, yoga styles in terms of postures, breathing and meditative techniques were too varied and/or incongruence in teaching methods.
Despite the limitations, it appears that participants who have benefitted from these yoga sessions may now have an extra tool at hand to help them manage stress, anxiety and depression. Since there were no adverse effects reported in any of the studies, yoga appears to be a safe practice.
All studies that have been reviewed in this chapter incorporated the fundamental limbs of Patanjali yoga that is, asanas, pranayama, prathyahara, dharana and dhyana. Despite the limitations such as heterogeneity in the sample population, insignificant sample size, varied durations of intervention and styles of yoga taught, most studies, if not all, demonstrated substantial positive outcomes in reducing the scores in depression, anxiety and stress. Previous studies have shown that the practice of asana, pranayama, dharana and dhyana have the ability to still not only the mind, but also the body, thus lowering anxiety levels, and these effects were seen in the studies reviewed in this chapter.
Having said that, another factor to delve into is the time (duration) required for participants to master the yoga asanas, especially for those whose flexibility is compromised, and the breathing techniques. The duration for the psycho-physiological factors mediating specific mood benefits of yoga to develop and exert a quantifiable effect in the participant is equally important. While factors such as duration of a yoga session, frequency and duration of each limb in a yoga session warrant further investigation, selection of asanas in a yoga intervention should not be neglected.
At the Malaysian Yoga Academy, students, regardless of their mental or physical health conditions, are encouraged to practise yoga daily for at least 45 min. This is not only to ensure there is sufficient time to practise most, if not all the limbs, but also to sustain a healthy mind and body, and keep diseases at bay; this step is crucial as studies have indicated that many people suffer from some form of anxiety and/or mood disorder at some point in their life.
Here are some simple postures (asanas) and breathing practices one can do two to three times daily. All practices should be done on an empty stomach. A suggestion would be to practice before sunrise, and/or at sunset and/or before bedtime. If food has been consumed, allow 2 h for digestion before the practice. It is imperative to note that these practices do not replace any form of prescribed medication. They are merely suggested complementary practices towards better mental and physical health, and tools that can be used to manage a sudden onslaught of stress, anxiety and/or a depressive mood.
All these postures and breathing techniques induce relaxation for the body and mind. One may practice all the postures and breathing techniques given here at any one sitting; alternatively, one may practice a few.
The author is grateful to Malaysian Association of Yoga Instructors (MAYI) Yoga Academy and the Malaysian Yoga Society for all the trainings and certifications she has received over the years.
The author declares no conflict of interest.
As a yoga instructor and therapist, the author has shared lots of personal experiences and provided home practice for the benefit of those who need it. Thank you.
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It has many different shapes as well as many various effects, both on the economy and the society at large. Among the most common causes of corruption are the political and economic environment, professional ethics and morality and, of course, habits, customs, tradition and demography. Its effects on the economy (and also on the wider society) are well researched, yet still not completely. Corruption thus inhibits economic growth and affects business operations, employment and investments. It also reduces tax revenue and the effectiveness of various financial assistance programs. The wider society is influenced by a high degree of corruption in terms of lowering of trust in the law and the rule of law, education and consequently the quality of life (access to infrastructure, health care). There also does not exist an unambiguous answer as to how to deal with corruption. Something that works in one country or in one region will not necessarily be successful in another. This chapter tries to answer at least a few questions about corruption and the causes for it, its consequences and how to deal with it successfully.",book:{id:"6487",slug:"trade-and-global-market",title:"Trade and Global Market",fullTitle:"Trade and Global Market"},signatures:"Štefan Šumah",authors:[{id:"228073",title:"Mr.",name:"Stefan",middleName:null,surname:"Sumah",slug:"stefan-sumah",fullName:"Stefan Sumah"}]},{id:"55499",title:"Human Resources Management in Nonprofit Organizations: A Case Study of Istanbul Foundation for Culture and Arts",slug:"human-resources-management-in-nonprofit-organizations-a-case-study-of-istanbul-foundation-for-cultur",totalDownloads:2294,totalCrossrefCites:0,totalDimensionsCites:0,abstract:"The aim of this study is to investigate the efficiency and importance of human resources management in nonprofit organizations. The understanding was included to the literature as personnel management at the beginning of the twentieth century and it turned into an approach as human resources management in the 1980s. It could be observed that many organizations, which deem the human as the most critical stakeholder, adopt a traditional way of personnel management in operating human resources. The employees play a key role in the success of an organization. For this reason, subjects such as recruitment, training, development, career management, performance appraisal, occupational health, and safety are the fundamental functions of human resources management. The study examines to what extent these roles are evaluated through a case study. The subject matter of the study is the most powerful culture and art foundation in Turkey. Compared to many other nonprofit organizations, the foundation actively performs a variety of services within a year worldwide. The fact that the total number of employees might rise up to 800, including the field personnel, indicates the need of a good functioning human resources management. The human resources practices of the foundation are examined and evaluated within that scope.",book:{id:"5826",slug:"issues-of-human-resource-management",title:"Issues of Human Resource Management",fullTitle:"Issues of Human Resource Management"},signatures:"Beste Gökçe Parsehyan",authors:[{id:"189113",title:"Dr.",name:"Beste",middleName:null,surname:"Gokce Parsehyan",slug:"beste-gokce-parsehyan",fullName:"Beste Gokce Parsehyan"}]},{id:"59152",title:"Marketing Strategies for the Social Good",slug:"marketing-strategies-for-the-social-good",totalDownloads:1594,totalCrossrefCites:1,totalDimensionsCites:1,abstract:"Social network sites (SNS) have proven to be a good environment to promote and sell goods and services, but marketing is more than creating commercial strategies. Social marketing strategies can also be used to promote behavioral change and help individuals transform their lives, achieve well-being, and adopt prosocial behaviors. In this chapter, we seek to analyze with a netnographic study, how SNS are being employed by nonprofits and nongovernment organizations (NGOs) to enable citizens and consumers to participate in different programs and activities that promote social transformation and well-being. A particular interest is to identify how organizations are using behavioral economic tactics to nudge individuals and motivate them to engage in prosocial actions. By providing an understanding on how SNS can provide an adequate environment for the design of social marketing strategies, we believe our work has practical implications both for academicians and marketers who want to contribute in the transformation of consumer behavior and the achievement of well-being and social change.",book:{id:"6583",slug:"marketing",title:"Marketing",fullTitle:"Marketing"},signatures:"Alicia De La Pena",authors:[{id:"196878",title:"Dr.",name:"Alicia",middleName:null,surname:"De La Pena",slug:"alicia-de-la-pena",fullName:"Alicia De La Pena"}]},{id:"37593",title:"Standard Operating Procedures (What Are They Good For ?)",slug:"standard-operating-procedures-what-are-they-good-for-",totalDownloads:26482,totalCrossrefCites:6,totalDimensionsCites:8,abstract:null,book:{id:"3276",slug:"latest-research-into-quality-control",title:"Latest Research into Quality Control",fullTitle:"Latest Research into Quality Control"},signatures:"Isin Akyar",authors:[{id:"36323",title:"Dr.",name:"Isin",middleName:null,surname:"Akyar",slug:"isin-akyar",fullName:"Isin Akyar"}]},{id:"38348",title:"Globalization and Culture: The Three H Scenarios",slug:"globalization-and-culture-the-three-h-scenarios",totalDownloads:16772,totalCrossrefCites:4,totalDimensionsCites:11,abstract:null,book:{id:"3009",slug:"globalization-approaches-to-diversity",title:"Globalization",fullTitle:"Globalization - Approaches to Diversity"},signatures:"Abderrahman Hassi and Giovanna Storti",authors:[{id:"148330",title:"Dr.",name:"Abderrahman",middleName:null,surname:"Hassi",slug:"abderrahman-hassi",fullName:"Abderrahman Hassi"},{id:"152537",title:"Prof.",name:"Giovanna",middleName:null,surname:"Storti",slug:"giovanna-storti",fullName:"Giovanna Storti"}]}],onlineFirstChaptersFilter:{topicId:"7",limit:6,offset:0},onlineFirstChaptersCollection:[{id:"82425",title:"Financial Reporting and Analysis of Tesla Green Technology in the United States Market",slug:"financial-reporting-and-analysis-of-tesla-green-technology-in-the-united-states-market",totalDownloads:2,totalDimensionsCites:0,doi:"10.5772/intechopen.105065",abstract:"This study aims to discuss and analyze the financial position and performance of the US Tesla green technology company in the United States. This study uses a case study approach, financial data, and website methodologies to collect and analyze the research data. The case study is Tesla, Inc., which is a US electric vehicle and clean energy company based in Austin, Texas. Tesla is a green technology company that produces and designs electric cars, battery energy storage from home to grid-scale, solar roof tiles and solar panels, and related products and services. Tesla is growing fastly by introducing new green products, and it is now one of the world’s most valuable enterprises. It has a high market capitalization of almost US$1 trillion to become the world’s most valuable automaker. This study concludes that Tesla has changed their strategy to become the most worldwide sales of purely battery electric vehicles, capturing 23% of the market and 16% of the plug-in electric battery in the market for 2020. It has also developed a significant installer of photovoltaic systems through its subsidiary Tesla Energy in the United States. One of the largest global battery energy-storage systems suppliers is Tesla Energy, with 3.99 gigawatt-hours installed in 2021.",book:{id:"11251",title:"Banking and Accounting",coverURL:"https://cdn.intechopen.com/books/images_new/11251.jpg"},signatures:"Nizar Mohammad Alsharari"},{id:"82427",title:"Our Globalization Era among Success, Obstacles and Doubts",slug:"our-globalization-era-among-success-obstacles-and-doubts",totalDownloads:5,totalDimensionsCites:0,doi:"10.5772/intechopen.105545",abstract:"In the last decades, the never-ending and unlimited expanding of both international economies and operations became globalization. Among its main features, one could recall the enormous increase of world macro-economic quantities (Gross World Product, Inter-continental Trade, FDI), as well as financial values (public debts and currency printing). The chapter tries to quantify them, by a statistical analysis of historical data (Section 1). Section 2 is dedicated to the strategic problems of firms, in particular the threats and opportunities for (inter) national firms willing to become global, and obstacles are included in Section 3. This given, it deals with the behavior of countries from the political and juridical points of view, and those ones passed form initial perplexities, distaste, or even hostility to a favorable behavior. Conclusions (Section 4) recall both the problematic alternative for globalized companies between “the world as our next door” and their social responsibilities and the similar problem for host countries, between socioeconomic advantages and protection of local workers, resources, and environment.",book:{id:"11476",title:"Globalization and Sustainability - Recent Advances, New Perspectives and Emerging Issues",coverURL:"https://cdn.intechopen.com/books/images_new/11476.jpg"},signatures:"Arnaldo Canziani, Annalisa Baldissera and Ahmad Kahwaji"},{id:"82289",title:"Consumer Culture and Abundance of Choices: Having More, Feeling Blue",slug:"consumer-culture-and-abundance-of-choices-having-more-feeling-blue",totalDownloads:1,totalDimensionsCites:0,doi:"10.5772/intechopen.105607",abstract:"The defining feature of contemporary consumer culture is the escalation of consumption opportunities and the expanding space for choice. An unbridled and unrestricted range of products is part of material prosperity, rising living standards, and emancipation of human freedoms. The growing demands for constant consumer decision-making in an increasingly opaque environment of potential targets of choice exposes consumers to the risk of procrastination, passivity, and resignation, as well as psychological discomfort. The goal here is to contribute to theories of consumer behavior in the context of the psychological experience of choice under the conditions of the accelerated quantity of consumption volumes against the backdrop of the COVID-19 pandemic. While conventional offline shopping was drastically curtailed during the coronavirus crisis, freedom of consumer choice was maintained despite many proclamations to the contrary. I seek to provide support to the claim that freedom of consumer choice was maintained and often amplified during the pandemic in the online virtual environment of digital commerce formats. Freedom of consumer choice has merely been transformed into a horizontal level of application by the relatively rapid and fluid conversion of market activities into the cyberspace of a growing number of e-stores and online supermarkets, unconstrained by the physical space of shelves and counters.",book:{id:"11581",title:"A New Era of Consumer Behavior - Beyond the Pandemic",coverURL:"https://cdn.intechopen.com/books/images_new/11581.jpg"},signatures:"Ondřej Roubal"},{id:"82405",title:"Does Board Structure Matter in CSR Spending of Commercial Banks? Empirical Evidence from an Emerging Economy",slug:"does-board-structure-matter-in-csr-spending-of-commercial-banks-empirical-evidence-from-an-emerging-",totalDownloads:6,totalDimensionsCites:0,doi:"10.5772/intechopen.105589",abstract:"This chapter examines the impact of board elements on CSR spending by private commercial banks in an emerging economy, considering Bangladesh as a case. In doing so, we collected necessary data from the annual reports of 30 commercial banks listed on the Dhaka Stock Exchange, covering the period 2007–2020. In addition, we reviewed the patterns of CSR spending by commercial banks to understand the CSR universe in Bangladesh. We adopted the OLS model with two-way clustering to measure the effects of board elements on CSR spending. Our results confirm that factors, such as independent directors and board size, have a significant and positive relationship with CSR expenditures, while board gender deters the same. Also, board meetings do not have any significant connection with CSR spending. For control variables, factors, such as firm size and leverage, tend to promote the CSR spending of commercial banks, while profitability has no such relationship. As for the sectoral distribution of CSR funds, we found that although the absolute amount of CSR expenditures by banks has increased substantially over the years, they are primarily limited to health, education, natural disasters, and humanitarian activities. These findings are expected to have significant policy implications.",book:{id:"11602",title:"Corporate Social Responsibility",coverURL:"https://cdn.intechopen.com/books/images_new/11602.jpg"},signatures:"Bishnu Kumar Adhikary and Ranjan Kumar Mitra"},{id:"82395",title:"Toward a Better Understanding of Green Human Resource Management’s Impact on Green Competitive Advantage: A Conceptual Model",slug:"toward-a-better-understanding-of-green-human-resource-management-s-impact-on-green-competitive-advan",totalDownloads:9,totalDimensionsCites:0,doi:"10.5772/intechopen.105528",abstract:"Today, green human resource management (GHRM) has become a key business strategy where HRM plays an active role in the ongoing green movement. Thus, the topic of GHRM is of growing interest among management scholars. However, despite the theoretically important role of GHRM, relatively small number of research has been discovered so far about how GHRM, in companies striving to achieve environmental sustainability, could help them gain a green competitive advantage (GCA). Thus, based on the resource-based view (RBV) arguments, the main objective of this paper is to develop a conceptual model of the relationship between GHRM and green competitive advantage through green knowledge, green values, and green commitment. This model is expected to provide a strategic map that could be utilized by the practitioners and managers so that GHRM implementation can be more effective in contributing to green competitive advantage. Overall, the present article extends knowledge on the resource-based view by contributing to the literature on GHRM and its interactions with the main assets that lead to green competitive advantage.",book:{id:"11602",title:"Corporate Social Responsibility",coverURL:"https://cdn.intechopen.com/books/images_new/11602.jpg"},signatures:"Hosna Hossari and Kaoutar Elfahli"},{id:"82248",title:"Sustainability and Excellence: Pillars for Business Survival",slug:"sustainability-and-excellence-pillars-for-business-survival",totalDownloads:5,totalDimensionsCites:0,doi:"10.5772/intechopen.105420",abstract:"The chapter presents an overview of management models starting with self-assessment (ISO 9004) and continuing with the European Foundation for Quality Management (EFQM) Excellence Model. Stakeholders’ analysis and their needs and expectations diagnostic are the baseline for building sustainable businesses. Sustainability and excellence are connected, and particular details of these approaches’ implementation are presented. Partnership development appears a key principle in the EFQM model. Based on companies’ strategies analysis, a simplified model may be proposed in order to support business survival in changing environments. Some guidelines to allow assessment of excellence fundamentals implementation are given. Based on experience and without seeing as exhaustive, a summary sheet of possible approaches and deployments is given. This may be used as a practical tool to connect actions implemented in organizations with the excellence model enablers, so as to facilitate assessment to explore the performance maturity level. The same sequence of Plan-Do-Check-Act relates approaches stated by ISO 26000 and sustainability initiatives. Embedding excellence and sustainability into business strategic objectives allows the management to define the framework for competitive continuous improvement.",book:{id:"11476",title:"Globalization and Sustainability - Recent Advances, New Perspectives and Emerging Issues",coverURL:"https://cdn.intechopen.com/books/images_new/11476.jpg"},signatures:"Irina Severin, Maria Cristina Dijmarescu and Mihai Caramihai"}],onlineFirstChaptersTotal:75},preDownload:{success:null,errors:{}},subscriptionForm:{success:null,errors:{}},aboutIntechopen:{},privacyPolicy:{},peerReviewing:{},howOpenAccessPublishingWithIntechopenWorks:{},sponsorshipBooks:{sponsorshipBooks:[],offset:8,limit:8,total:0},allSeries:{pteSeriesList:[{id:"14",title:"Artificial Intelligence",numberOfPublishedBooks:9,numberOfPublishedChapters:89,numberOfOpenTopics:6,numberOfUpcomingTopics:0,issn:"2633-1403",doi:"10.5772/intechopen.79920",isOpenForSubmission:!0},{id:"7",title:"Biomedical Engineering",numberOfPublishedBooks:12,numberOfPublishedChapters:104,numberOfOpenTopics:3,numberOfUpcomingTopics:0,issn:"2631-5343",doi:"10.5772/intechopen.71985",isOpenForSubmission:!0}],lsSeriesList:[{id:"11",title:"Biochemistry",numberOfPublishedBooks:32,numberOfPublishedChapters:318,numberOfOpenTopics:4,numberOfUpcomingTopics:0,issn:"2632-0983",doi:"10.5772/intechopen.72877",isOpenForSubmission:!0},{id:"25",title:"Environmental Sciences",numberOfPublishedBooks:1,numberOfPublishedChapters:12,numberOfOpenTopics:4,numberOfUpcomingTopics:0,issn:"2754-6713",doi:"10.5772/intechopen.100362",isOpenForSubmission:!0},{id:"10",title:"Physiology",numberOfPublishedBooks:11,numberOfPublishedChapters:141,numberOfOpenTopics:4,numberOfUpcomingTopics:0,issn:"2631-8261",doi:"10.5772/intechopen.72796",isOpenForSubmission:!0}],hsSeriesList:[{id:"3",title:"Dentistry",numberOfPublishedBooks:8,numberOfPublishedChapters:129,numberOfOpenTopics:2,numberOfUpcomingTopics:0,issn:"2631-6218",doi:"10.5772/intechopen.71199",isOpenForSubmission:!0},{id:"6",title:"Infectious Diseases",numberOfPublishedBooks:13,numberOfPublishedChapters:113,numberOfOpenTopics:3,numberOfUpcomingTopics:1,issn:"2631-6188",doi:"10.5772/intechopen.71852",isOpenForSubmission:!0},{id:"13",title:"Veterinary Medicine and Science",numberOfPublishedBooks:11,numberOfPublishedChapters:105,numberOfOpenTopics:3,numberOfUpcomingTopics:0,issn:"2632-0517",doi:"10.5772/intechopen.73681",isOpenForSubmission:!0}],sshSeriesList:[{id:"22",title:"Business, Management and Economics",numberOfPublishedBooks:1,numberOfPublishedChapters:19,numberOfOpenTopics:2,numberOfUpcomingTopics:1,issn:"2753-894X",doi:"10.5772/intechopen.100359",isOpenForSubmission:!0},{id:"23",title:"Education and Human Development",numberOfPublishedBooks:0,numberOfPublishedChapters:5,numberOfOpenTopics:1,numberOfUpcomingTopics:1,issn:null,doi:"10.5772/intechopen.100360",isOpenForSubmission:!0},{id:"24",title:"Sustainable Development",numberOfPublishedBooks:0,numberOfPublishedChapters:15,numberOfOpenTopics:5,numberOfUpcomingTopics:0,issn:null,doi:"10.5772/intechopen.100361",isOpenForSubmission:!0}],testimonialsList:[{id:"6",text:"It is great to work with the IntechOpen to produce a worthwhile collection of research that also becomes a great educational resource and guide for future research endeavors.",author:{id:"259298",name:"Edward",surname:"Narayan",institutionString:null,profilePictureURL:"https://mts.intechopen.com/storage/users/259298/images/system/259298.jpeg",slug:"edward-narayan",institution:{id:"3",name:"University of Queensland",country:{id:null,name:"Australia"}}}},{id:"13",text:"The collaboration with and support of the technical staff of IntechOpen is fantastic. 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