Psychological interventions for women with non-metastatic breast cancer.

BACKGROUND: Breast cancer is the most common cancer affecting women worldwide. It is a distressing diagnosis and, as a result, considerable research has examined the psychological sequelae of being diagnosed and treated for breast cancer. Breast cancer is associated with increased rates of depression and anxiety and reduced quality of life. As a consequence, multiple studies have explored the impact of psychological interventions on the psychological distress experienced after a diagnosis of breast cancer. This review is an update of a Cochrane Review first published in 2015. OBJECTIVES: To assess the effect of psychological interventions on psychological morbidities and quality of life among women with non-metastatic breast cancer.  SEARCH METHODS: We searched the Cochrane Breast Cancer Group Specialised Register, CENTRAL, MEDLINE, Embase, CINAHL, PsycINFO, the World Health Organization International Clinical Trials Registry Platform (WHO ICTRP) and ClinicalTrials.gov up to 16 March 2021. We also scanned the reference lists of relevant articles. SELECTION CRITERIA: Randomised controlled trials that assessed the effectiveness of psychological interventions for women with non-metastatic breast cancer. DATA COLLECTION AND ANALYSIS: Two review authors independently appraised, extracted data from eligible trials, and assessed risk of bias and certainty of the evidence using the GRADE approach. Any disagreement was resolved by discussion. Extracted data included information about participants, methods, the intervention and outcomes. MAIN RESULTS: We included 60 randomised controlled trials comprising 7998 participants. The most frequent reasons for exclusion were non-randomised trials and the inclusion of women with metastatic disease. The updated review included 7998 randomised women; the original review included 3940 women. A wide range of interventions was evaluated. Most interventions were cognitive- or mindfulness-based, supportive-expressive, and educational. The interventions were mainly delivered face-to-face (56 studies) and in groups (50 studies) rather than individually (10 studies). Most intervention sessions were delivered on a weekly basis with an average duration of 14 hours. Follow-up time ranged from two weeks to 24 months.  Pooled standardised mean differences (SMD) from baseline indicated that the intervention may reduce depression (SMD -0.27, 95% confidence interval (CI) -0.52 to -0.02; P = 0.04; 27 studies, 3321 participants, I2 = 91%, low-certainty evidence); anxiety (SMD -0.43, 95% CI -0.68 to -0.17; P = 0.0009; 22 studies, 2702 participants, I2 = 89%, low-certainty evidence); mood disturbance in the intervention group (SMD -0.18, 95% CI -0.31 to -0.04; P = 0.009; 13 studies, 2276 participants, I2 = 56%, low-certainty evidence); and stress (SMD -0.34, 95% (CI) -0.55 to -0.12; P = 0.002; 8 studies, 564 participants, I2 = 31%, low-certainty evidence). The intervention is likely to improve quality of life in the intervention group (SMD 0.78, 95% (CI) 0.32 to 1.24; P = 0.0008; 20 studies, 1747 participants, I2 = 95%, low-certainty evidence). Adverse events were not reported in any of the included studies. AUTHORS' CONCLUSIONS: Based on the available evidence, psychological intervention may have produced favourable effects on psychological outcomes, in particular depression, anxiety, mood disturbance and stress. There was also an improvement in quality of life in the psychological intervention group compared to control group. Overall, there was substantial variation across the studies in the range of psychological interventions used, control conditions, measures of the same outcome and timing of follow-up.

Characteristics of Patients with SARS-CoV-2 Positive Cerebrospinal Fluid: A Systematic Review.

BACKGROUND: The coronavirus disease 2019 (COVID-19) has been shown to affect several systems, notably the respiratory system. However, there has been considerable evidence implicating the nervous system in COVID-19 infection. This study aims to investigate the clinical characteristics of patients whose cerebrospinal fluid (CSF) tested positive for SARS-CoV-2. METHODS: A comprehensive search of PubMed, EMBASE, Scopus, WHO Coronavirus database, bioRxiv, medRxiv, and Web of Science databases was carried out in August 2020. Original studies involving patients who tested positive for SARS-COV-2 in their CSF were included. Key search terms encompassed all variations of "COVID-19" AND "Cerebrospinal Fluid". RESULTS: A total of 525 studies were identified. Fifty-six full-text articles were assessed, of which 14 were included. In total, 14 patients tested positive for SARS-CoV-2 in their CSF. 21.4% (3/14) of patients had negative nasopharyngeal (NP) swabs despite a positive CSF sample. About 14.2% (2/14) of patients who initially had positive NP swabs developed neurological deterioration after a supposed recovery as indicated by their negative NP swabs, but their CSF still tested positive for SARS-CoV-2. Common symptoms were headache (42.8%; 6/14), fever (35.6%; 5/14), vomiting (28.6%; 4/14), cough (28.6; 4/14), visual disturbances (28.6%; 4/14), diarrhea (21.4%; 3/14), and seizures (21.4%; 3/14). Four patients (28.6%) were admitted to ICU, one (7.14%) was admitted to a rehabilitation facility, and two (14.3%) died. CONCLUSION: Physicians should be familiar with the presenting neurological features of COVID-19, and be aware that they can occur despite a negative NP swab. The results of this study are intended to aid in the development of informed guidelines to diagnose and treat COVID-19 patients with neurological manifestations.

Emirati Women's Knowledge about the Menopause and Menopausal Hormone Therapy.

The aim of this study was to investigate the knowledge of Emirati women aged 30-64 about menopause, menopausal hormone therapy (MHT), and their associated health risks, and additionally, to determine the relationships between Emirati women's knowledge about menopause and their sociodemographic and reproductive characteristics. A community-based cross-sectional study was conducted of 497 Emirati women visiting five primary healthcare centers in Dubai. Data were collected using a questionnaire composed of sociodemographic and reproductive characteristics, menopause knowledge scale (MKS), and menopause symptoms knowledge and MHT practice. The mean menopause symptoms knowledge percentage was 41%, with a standard deviation of 21%. There were significant differences in the mean knowledge percentage among categories of education level (p < 0.001) and employment (p = 0.003). No significant differences in the knowledge percentages were found among categories of menopausal status. "Pregnancy cannot occur after menopause" was the statement with the highest knowledge percentage (83.3%), while the lowest knowledge percentages were "risk of cardiovascular diseases increases with menopause'' (23.1%), "MHT increases risk of breast cancer'' (22.1%), and "MHT decreases risk of colon cancer'' (13.9%). The knowledge of Emirati women about menopause, MHT, and related heart diseases was very low; therefore, an education campaign about menopause and MHT risks is needed to improve their knowledge for better coping with the symptoms.

Attitudes and barriers towards conducting research amongst primary care physicians in Bahrain: a cross-sectional study.

BACKGROUND: Research in primary care is essential for disease diagnosis, management and prevention in relation to the individuals, families and the community. This research aims to study the attitude of primary care physicians towards conducting research in Bahrain and to identify the main barriers encountered during research. METHODS: A cross-sectional study was conducted amongst 200 randomly selected primary care physicians registered in Ministry of Health affiliated primary healthcare centers in Bahrain. A self-administered validated questionnaire was adopted and used for data collection. Research data was analyzed using the Statistical Package for Social Sciences (SPSS) version 23. RESULTS: Primary care physicians had a positive attitude towards conducting research with a total mean score (SD) of 4.47(0.65) (on a scale from 1 to 5 with higher scores indicating more positive attitudes). The total mean score (SD) for barriers encountered by physicians during research was 3.34 (0.80). Insufficient research allotted time (76.5%), insufficient financial support (63%), lack of financial incentives (51%) and lack of statistical support (50%) were major barriers. Physicians designation and board certificate were significantly associated with attitudes and barriers towards research (P-value < 0.05). CONCLUSION: The majority or primary care physicians had positive attitudes towards conducting research. The major difficulties faced by physicians in conducting research are: Insufficient research allotted time, lack of financial incentives and inadequate statistical support. The study addressed a gap in building research capacity which should be embraced by many institutions through partnership and collaboration.

The lifestyle habits and wellbeing of physicians in Bahrain: a cross-sectional study.

BACKGROUND: Lifestyle habits of physicians are of paramount importance both because they influence the physician's own health and because these habits have been shown to affect patients' care. There is limited information on physician health and lifestyle habits in Bahrain. METHODS: In a cross-sectional study design, an anonymous self-administered questionnaire that assesses wellbeing and lifestyle habits was distributed to a random sample of 175 out of 320 primary health care physicians in Bahrain. Descriptive analyses were performed, and the variables were cross-tabulated using SPSS version 20.0. RESULTS: 152 physicians agreed to participate in the study. Respondents were 67.1% female with a mean age of 45 (SD = 10). The majority were of Bahraini nationality. The most prevalent reported health conditions were hyperlipidaemia (25.5%), hypertension (20.3%), and diabetes (11.0%). Only 29.6% of physicians reported performing ≥ 30 min of exercise in a usual week. Of physicians exercising ≥ 30 min weekly, only 13% exercised ≥ 5 days weekly. 98.0% report never drinking, 1.3% report previously drinking, and 0.7% report drinking less than once weekly. The average body mass index (BMI) was 27.8 (SD = 5), with 39% of physicians being overweight and 33% obese. BMI was directly associated with sleep time (P0.027, r(2) = 0.034), age (P < 0.01, r(2) = 0.179), male gender (P = 0.031, r(2) = 0.054), and a known diagnosis of hypertension (P = 0.007, r(2) = 0.079) or hyperlipidaemia (P = 0.008, r(2) = 0.088). CONCLUSIONS: There is a clear pattern of unfavourable lifestyle habits and obesity among primary health care physicians in Bahrain. We encourage institutions and public health sectors to be more proactive in assisting physicians to attain healthier lifestyles.

Psychological interventions for women with non-metastatic breast cancer.

BACKGROUND: Breast cancer is the most common cancer affecting women worldwide. It is a distressing diagnosis and, as a result, considerable research has examined the psychological sequelae of being diagnosed and treated for breast cancer. Breast cancer is associated with increased rates of depression and anxiety and reduced quality of life. As a consequence, multiple studies have explored the impact of psychological interventions on the psychological distress experienced after a diagnosis of breast cancer. OBJECTIVES: To assess the effects of psychological interventions on psychological morbidities, quality of life and survival among women with non-metastatic breast cancer. SEARCH METHODS: We searched the following databases up to 16 May 2013: the Cochrane Breast Cancer Group Specialised Register, CENTRAL, MEDLINE, EMBASE, CINAHL and PsycINFO; and reference lists of articles. We also searched the World Health Organization International Clinical Trials Registry Platform (WHO ICTRP) search portal and ClinicalTrials.gov for ongoing trials in addition to handsearching. SELECTION CRITERIA: Randomised controlled trials that assessed the effectiveness of psychological interventions for non-metastatic breast cancer in women. DATA COLLECTION AND ANALYSIS: Two review authors independently appraised and extracted data from eligible trials. Any disagreement was resolved by discussion. Extracted data included information about participants, methods, the intervention and outcome. MAIN RESULTS: Twenty-eight randomised controlled trials comprising 3940 participants were included. The most frequent reasons for exclusion were non-randomised trials and the inclusion of women with metastatic disease. A wide range of interventions were evaluated, with 24 trials investigating a cognitive behavioural therapy and four trials investigating psychotherapy compared to control. Pooled standardised mean differences (SMD) from baseline indicated less depression (SMD -1.01, 95% confidence interval (CI) -1.83 to -0.18; P = 0.02; 7 studies, 637 participants, I(2) = 95%, low quality evidence), anxiety (SMD -0.48, 95% CI -0.76 to -0.21; P = 0.0006; 8 studies, 776 participants, I(2) = 64%, low quality evidence) and mood disturbance (SMD -0.28, 95% CI -0.43 to -0.13; P = 0.0003; 8 studies, 1536 participants, I(2) = 47%, moderate quality evidence) for the cognitive behavioural therapy group than the control group. For quality of life, only an individually-delivered cognitive behavioural intervention showed significantly better quality of life than the control with an SMD of 0.65 (95% CI 0.07 to 1.23; P = 0.03; 3 studies, 141 participants, I(2) = 41%, very low quality evidence). Pooled data from two group-delivered studies showed a non-significant overall survival benefit favouring cognitive behavioural therapy compared to control (pooled hazard ratio (HR) 0.76, 95% CI 0.25 to 2.32; P = 0.63; 530 participants, I(2) = 84%, low quality evidence). Four studies compared psychotherapy to control with one to two studies reporting on each outcome. The four studies were assessed as high risk of bias and provided limited evidence of the efficacy of psychotherapy. Adverse events were not reported in any of the included studies. AUTHORS' CONCLUSIONS: A psychological intervention, namely cognitive behavioural therapy, produced favourable effects on some psychological outcomes, in particular anxiety, depression and mood disturbance. However, the evidence for survival improvement is still lacking. These findings are open to criticism because of the notable heterogeneity across the included studies and the shortcomings of the included studies.

Understanding the experiences and quality of life issues of Bahraini women with breast cancer.

We explored the experiences of Bahraini women who have survived breast cancer and their perception of quality of life after diagnosis. We conducted in depth, semi-structured face-to-face interviews with twelve women diagnosed with breast cancer. A qualitative method using semi-structured interviews on a purposive sample of 12 Bahraini women with breast cancer was conducted. Similarities and differences in women's experience were identified through thematic analysis of interview transcripts using a constant comparative approach. The themes identified were meaning of cancer and quality of life, spirituality and beliefs about causes of breast cancer, coping mechanisms, impact of illness and change in relationships. Quality of life was framed in terms of the ability to perform daily duties with emphasis on the physical component of quality of life. Themes that differed from previous western studies included a heavy emphasis on spiritual practices for comfort; the use of traditional clothing (hijab and abaya) to hide hair and body changes; the important role played by the family and husband in treatment decisions and concerns regarding satisfying the sexual needs of the husband, which were related to a fear of losing the husband to a second wife. Evil eye, stress and God's punishment were believed to be fundamental causes of the disease. The emotional shock of the initial diagnosis, concerns about whether to reveal the diagnosis and a desire to live a normal life were consistent with previous studies. However, cultural and religious issues such as role of the husband and impact of prayers were also important here. These themes are important to healthcare professionals for ensuring an individualized approach to the treatment of women with breast cancer.

Strategies for managing hot flashes.

Hormone therapy--at the lowest possible dose for the shortest period of time--remains the best option for menopausal women with moderate to severe vasomotor symptoms.