The effects of life review interventions on spiritual well-being, psychological distress, and quality of life in patients with terminal or advanced cancer: A systematic review and meta-analysis of randomized controlled trials.

BACKGROUND: Life review interventions have been used to alleviate psycho-spiritual distress in people near the end of life. However, their effectiveness remains inconclusive. AIM: To evaluate the effects of therapeutic life review on spiritual well-being, psychological distress, and quality of life in patients with terminal or advanced cancer. DESIGN: A systematic review according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses methodology. DATA SOURCES: Five databases were searched from their respective inception through February 2017 for relevant randomized controlled trials. The effects of therapeutic life review were pooled across the trials. Standardized mean differences were calculated for the pooled effects. Heterogeneity was assessed using the I2 test. Study quality was assessed using the Cochrane criteria. RESULTS: Eight randomized controlled trials met the inclusion criteria. The pooled results suggested a desirable effect of therapeutic life review on the meaning of life domain of spiritual well-being (standardized mean difference = 0.33; 95% confidence interval, 0.12 to 0.53), general distress (standardized mean difference = -0.32; 95% confidence interval, -0.55 to -0.09), and overall quality of life (standardized mean difference = 0.35; 95% confidence interval, 0.15 to 0.56) when compared to usual care only. Of the three outcomes examined, only the pooled effect on overall quality of life remained statistically significant at follow-ups up to 3 months after the intervention (standardized mean difference = 0.82; 95% confidence interval, 0.47 to 1.18). CONCLUSIONS: Therapeutic life review is potentially beneficial for people near the end of life. However, the results should be interpreted with caution due to the limited number of randomized controlled trials and associated methodological weaknesses. Further rigorously designed randomized controlled trials are warranted.

Social workers' involvement in advance care planning: a systematic narrative review.

BACKGROUND: Advance care planning is a process of discussion that enables competent adults to express their wishes about end-of-life care through periods of decisional incapacity. Although a number of studies have documented social workers' attitudes toward, knowledge about, and involvement in advance care planning, the information is fragmented. The purpose of this review was to provide a narrative synthesis of evidence on social workers' perspectives and experiences regarding implementation of advance care planning. METHODS: Six databases were searched for peer-reviewed research papers from their respective inception through December 2016. All of the resulting studies relevant to both advance care planning and social worker were examined. The findings of relevant studies were synthesized thematically. RESULTS: Thirty-one articles met the eligibility criteria. Six research themes were identified: social workers' attitudes toward advance care planning; social workers' knowledge, education and training regarding advance care planning; social workers' involvement in advance care planning; social workers' perceptions of their roles; ethical issues relevant to advance care planning; and the effect of social work intervention on advance care planning engagement. The findings suggest that there is a consensus among social workers that advance care planning is their duty and responsibility and that social workers play an important role in promoting and implementing advance care planning through an array of activities. CONCLUSIONS: This study provides useful knowledge for implementing advance care planning through illustrating social workers' perspectives and experiences. Further studies are warranted to understand the complexity inherent in social workers' involvement in advance care planning for different life-limiting illnesses or within different socio-cultural contexts.

HIV/AIDS-related deaths in China, 2000-2012.

This study examined the time trend and pattern of HIV/AIDS-related deaths in China. Data on HIV deaths and AIDS deaths were provided by the Chinese Ministry of Health. Time trend of the overall death rates over the period 2000-2012 was examined using Poisson regression models. Pattern of AIDS deaths was examined for the period 2006-2012, using the age-, gender-, and region-specific death rates. The results indicated that HIV/AIDS-related death rate increased significantly in China over the past decade, with an average annual percentage change of 22.3%. A vast majority of the deaths occurred among those aged between 20 and 65 years, with two age peaks. The death rate was higher for males than females and in rural areas than urban areas. A total of 83% of the deaths occurred among rural residents and 67% among males. The upward trend and distribution pattern of HIV/AIDS-related deaths depicted in the present study not only provides valuable information for additional understanding of the dynamics of the HIV/AIDS epidemic in China, but also has implications for evidence-based public health intervention strategies and policies as well as for further studies.

Application of Volumetric Modulated Arc Therapy and Simultaneous Integrated Boost Techniques to Prepare "Safe Margin" in the Rabbit VX2 Limb Tumor Model.

BACKGROUND: In this study, we aimed to establish the rabbit VX2 limb tumor model, and then prepare a "necrotic zone" as a safe margin by volumetric modulated arc therapy and simultaneous integrated boost (VMAT-SIB) technique applied in the areas where the tumor is located adjacent to the bone (GTVboost area). MATERIAL AND METHODS: Rabbits in the control group (n=10) were not treated, while those in the test group (n=10) were treated with the SIB schedule delivering a dose of 40Gy, 35Gy, 30Gy, and 25Gy to the GTVboost, GTV (gross tumor volume), CTV (clinical target volume), and PTV (planning target volume) in 10 fractions. Magnetic resonance diffusion-weighted imaging (MRDWI), 3-dimensional power Doppler angiography (3D-PDA), and histological changes were observed after radiotherapy. RESULTS: After radiotherapy, the two groups showed a significant difference in the GTVboost area. In the test group, the tumor necrosis showed a significantly low signal in DWI and high signal in apparent diffusion coefficient (ADC) maps. The 3D-PDA observation showed that tumor vascular structures decreased significantly. Histological analysis demonstrated that a necrotic zone could be generated in the GTVboost area, and microscopic examination observed cell necrosis and fibroplasia. CONCLUSIONS: This studies demonstrated the feasibility of using VMAT-SIB technique in the rabbit VX2 limb tumor model. The formation of a necrotic zone can be effectively defined as safe margin in the GTVboost area. showing potential clinical applicability.

End-of-life care research in Hong Kong: A systematic review of peer-reviewed publications.

OBJECTIVE: This systematic review aimed to examine end-of-life (EoL) care research undertaken in an Eastern cultural context--Hong Kong--with the hope of better informing EoL care professionals and policy makers and providing lessons for other countries or areas that share similar EoL care challenges. METHOD: Eight databases were searched from their respective inception through to August of 2014. All of the resulting studies conducted in Hong Kong and relevant to EoL care or palliative care were examined. The included studies were assessed with respect to study design, care settings, participants, research themes, and major findings. RESULTS: Some 107 publications published between 1991 and 2014 were identified. These studies were undertaken at a range of places by different professionals. Of the total, 44 were led by physicians, 36 by nurses, 17 by social workers, and 10 by other professionals. Participants included both inpatients and outpatients with different illnesses, nursing home residents, older community-dwelling adults, deceased individuals, care staff, and informal caregivers. A total of 13 research themes were identified: (1) attitudes to or perceptions of death and dying; (2) utilization of healthcare services, (3) physical symptoms or medical problems; (4) death anxiety or mental health issues; (5) quality of life; (6) advance directives or advance care planning; (7) supportive care needs, (8) decision making; (9) spirituality; (10) cost-effectiveness or utility studies; (11) care professionals' education and training; (12) informal caregivers' perceptions and experience; and (13) scale development or validation. SIGNIFICANCE OF RESULTS: While there has been a wide and diverse range of research activities in Hong Kong, EoL care services at primary care settings should be strengthened. Some priority areas for further research are recommended.

Prevalence and determinants of depression among survivors 8 months after the Wenchuan earthquake.

The current study assessed the estimated rate of depression and associated risk factors among survivors 8 months after the 2008 Wenchuan earthquake in China. A stratified random sample of 1514 participants was recruited from all temporary camp communities in a county town 45 km away from the epicenter. The estimated rate of depression was 35.7%. The severity of depressive symptoms was significantly associated with female sex, perceived livelihood security, loss of a family member, residential house damage or collapse, and not living in an urban area, whereas married status is a protector against depressive symptoms. The results suggest that community-based effective, sustainable, and culturally sensitive interventions and services are warranted and should be directed to the groups at high risk for mental health problems.

Suicide rates in China from 2002 to 2011: an update.

PURPOSES: The aims of this study were: (1) to present the time trend of suicide rate among people aged 15 or above in China over the period 2002-2011 and (2) to examine the current profile of completed suicides during 2009-2011. METHODS: Data on suicide rate in 2002-2011 were provided by the Chinese Ministry of Health (MOH). The trends of region-, gender-, and age-specific suicide rates were examined using Poisson regression models. The mean number of completed suicides for each cohort during 2009-2011 was calculated and a mean national suicide rate was estimated. FINDINGS: The overall suicide rate decreased significantly over the past decade, but rates in young males and rural older adults did not reduce and in fact increased among older adults in both urban and rural areas towards the end of the study period. For 2009-2011, 44 % of all suicides occurred among those aged 65 or above and 79 % among rural residents. The estimated mean national suicide rate was 9.8 per 100,000 and was slightly higher for males than females. CONCLUSION: The benefits of economic growth, such as higher employment and more educational opportunities for the rural population in particular, may have contributed to the reduced suicide rate in China. However, the recent rapid changes in socioeconomic conditions could have increased stress levels and resulted in more suicides, especially among the elderly. Despite the significant reduction reported here, the latest figures suggest the declining trend is reversing. It will be important to continue monitoring the situation and to examine how urbanization and economic changes affect the well-being of 1.3 billion Chinese.

Managing stress and anxiety through qigong exercise in healthy adults: a systematic review and meta-analysis of randomized controlled trials.

BACKGROUND: An increasing number of studies have documented the effectiveness of qigong exercise in helping people reduce psychological stress and anxiety, but there is a scarcity of systematic reviews evaluating evidence from randomized controlled trials (RCTs) conducted among healthy subjects. METHODS: Thirteen databases were searched for RCTs from their inception through June 2013. Effects of qigong exercise were pooled across trials. Standardized mean differences (SMDs) were calculated for the pooled effects. Heterogeneity was assessed using the I2 test. The risk of bias was assessed using the Cochrane criteria. RESULTS: Seven RCTs met the inclusion criteria. Two RCTs suggested that qigong exercise immediately relieved anxiety among healthy adults, compared to lecture attendance and structured movements only. Four RCTs suggested qigong exercise relieved anxiety (pooled SMD = -0.75; 95% CI, -1.11 to -0.40), and three RCTs suggested that qigong exercise reduced stress (pooled SMD = -0.88; 95% CI, -1.22 to -0.55) among healthy subjects following one to three months of qigong practice, compared to wait-list controls. CONCLUSIONS: The available evidence suggests that qigong exercise reduces stress and anxiety in healthy adults. However, given the limited number of RCTs and their methodological flaws, further rigorously designed RCTs are needed.

Prevalence and correlates of video and internet gaming addiction among Hong Kong adolescents: a pilot study.

This pilot study investigated the patterns of video and internet gaming habits and the prevalence and correlates of gaming addiction in Hong Kong adolescents. A total of 503 students were recruited from two secondary schools. Addictive behaviors of video and internet gaming were assessed using the Game Addiction Scale. Risk factors for gaming addiction were examined using logistical regression. An overwhelming majority of the subjects (94%) reported using video or internet games, with one in six (15.6%) identified as having a gaming addiction. The risk for gaming addiction was significantly higher among boys, those with poor academic performance, and those who preferred multiplayer online games. Gaming addiction was significantly associated with the average time spent gaming per week, frequency of spending money on gaming, period of spending money on gaming, perceived family disharmony, and having more close friends. These results suggest that effective educational and preventative programs or strategies are needed.

Prevalence and trajectory of psychopathology among child and adolescent survivors of disasters: a systematic review of epidemiological studies across 1987-2011.

AIMS: The goal of this paper was to systematically review evidence on (1) the potential magnitude of the psychopathological impacts of community-wide disasters on child and adolescent survivors, and (2) the long-term course or trajectory of disaster-induced psychopathology among children and adolescents. METHODS: The PubMed/MEDLINE and PsycINFO databases were searched from their respective inception through December 2011. All of the resulting epidemiological studies of child and adolescent survivors following community-wide disasters were examined. RESULTS: Sixty cross-sectional studies and 25 longitudinal or long-term follow-up studies were identified. The estimated rates of posttraumatic stress disorder (PTSD) and depression among child and adolescent survivors varied greatly across the included studies, ranging from 1.0 to 95 % and 1.6 to 81 %, respectively, while the reported rates of diagnosable PTSD according to the DSM-IV criteria and diagnosable depression ranged from 1.0 to 60 % and 1.6 to 33 %, respectively. The long-term courses of psychopathology among youthful survivors were summarized. Methodological issues with those studies were discussed. CONCLUSIONS: The empirical findings summarized in this review highlight the importance of psychosocial intervention at early postdisaster stages for child and adolescent survivors. The methodological flaws revealed by this review indicate the need for continued attempts to better understand the epidemiology and trajectory of psychopathological problems among youthful survivors.

A randomized controlled trial of qigong exercise on fatigue symptoms, functioning, and telomerase activity in persons with chronic fatigue or chronic fatigue syndrome.

BACKGROUND: Chronic fatigue is common in the general population. Complementary therapies are often used by patients with chronic fatigue or chronic fatigue syndrome to manage their symptoms. PURPOSE: This study aimed to assess the effect of a 4-month qigong intervention program among patients with chronic fatigue or chronic fatigue syndrome. METHODS: Sixty-four participants were randomly assigned to either an intervention group or a wait list control group. Outcome measures included fatigue symptoms, physical functioning, mental functioning, and telomerase activity. RESULTS: Fatigue symptoms and mental functioning were significantly improved in the qigong group compared to controls. Telomerase activity increased in the qigong group from 0.102 to 0.178 arbitrary units (p < 0.05). The change was statistically significant when compared to the control group (p < 0.05). CONCLUSION: Qigong exercise may be used as an alternative and complementary therapy or rehabilitative program for chronic fatigue and chronic fatigue syndrome.

A systematic review of the effectiveness of qigong exercise in supportive cancer care.

PURPOSE: Qigong as a complementary and alternative modality of traditional Chinese medicine is often used by cancer patients to manage their symptoms. The aim of this systematic review is to critically evaluate the effectiveness of qigong exercise in cancer care. METHODS: Thirteen databases were searched from their inceptions through November 2010. All controlled clinical trials of qigong exercise among cancer patients were included. The strength of the evidence was evaluated for all included studies using the Oxford Centre for Evidence-based Medicine Levels of Evidence. The validity of randomized controlled trials (RCTs) was also evaluated using the Jadad Scale. RESULTS: Twenty-three studies including eight RCTs and fifteen non-randomized controlled clinical trials (CCTs) were identified. The effects of qigong on physical and psychosocial outcomes were examined in 14 studies and the effects on biomedical outcomes were examined in 15 studies. For physical and psychosocial outcomes, it is difficult to draw a conclusion due to heterogeneity of outcome measures and variability of the results in the included studies. Among reviewed studies on biomedical outcomes, a consistent tendency appears to emerge which suggests that the patients treated with qigong exercise in combination with conventional methods had significant improvement in immune function than the patients treated with conventional methods alone. CONCLUSIONS: Due to high risk of bias and methodological problems in the majority of included studies, it is still too early to draw conclusive statements. Further vigorously designed large-scale RCTs with validated outcome measures are needed.

Tai chi exercise for patients with heart disease: a systematic review of controlled clinical trials.

CONTEXT: To summarize and evaluate the available evidence from controlled clinical trials of tai chi (TC) exercise for patients with heart disease. SEARCH METHODS: Fourteen databases were searched up to November 2010 with the terms tai chi, taichi, tai ji, taiji, taijichuan, cardiac, heart, coronary, myocardial, and atrial fibrillation in the title, abstract, or key words. No language restrictions were imposed. The quality and validity of randomized clinical trials (RCTs) were evaluated using the Jadad Scale. The strength of the evidence for all included studies was evaluated using the Oxford Centre for Evidence-based Medicine Levels of Evidence. RESULTS: Nine studies including 5 RCTs and 4 nonrandomized controlled clinical trials met the inclusion criteria. Three studies examined the effectiveness of TC exercise for patients with chronic heart failure (CHF), and 6 studies examined the effectiveness of TC exercise among patients with coronary heart disease (CHD). Overall, these studies demonstrated favorable effects of TC exercise for the patients with heart disease. CONCLUSIONS: The existing evidence suggests that TC exercise is a good option for heart patients with very limited exercise tolerance and can be an adjunct to rehabilitation programs for patients with CHD or CHF.

Posttraumatic stress disorder symptoms among adult survivors of the 2008 Sichuan earthquake in China.

This study examined the estimated prevalence rate of posttraumatic stress disorder (PTSD) symptoms and associated risk factors among Chinese adult survivors 7 to 8 months after the 2008 Sichuan earthquake. The sample was recruited from 2 areas close to the epicenter but of different distances. The estimated rate of PTSD symptoms was 55.6% and 26.4% respectively in the two areas. Loss of a child was a strong predictive factor for PTSD symptoms for the parents. Other predictive factors included female gender, loss of a parent, loss of friends or neighbors, residential house damage or collapse, and proximity to the epicenter. Effective and sustainable mental health services are needed and should be directed particularly to bereaved survivors.

Examination of Chinese gambling problems through a socio-historical-cultural perspective.

The aim of this review is to highlight emerging trends about Chinese people and gambling addiction over the last 15 years, and to provide a discourse on the potential link between gambling and Chinese culture and history. The authors reported on the phenomenon of gambling among Chinese people using relevant research studies and reports and traditional Chinese literature. Chinese people have elevated levels of gambling addiction compared to their Western counterparts. These elevated rates are coupled with the rapid expansion of gambling venues within the Pan-Pacific region. While there is an accumulated body of research on Chinese and gambling, a systematic cultural analysis of Chinese gambling is still under development. We undertook a brief comparison between two ancient civilizations, China and Rome, in order to gain better understanding about gambling among Chinese people. To effectively deal with gambling addictions among Chinese people, it is imperative to develop culturally responsive interventions.

Psychosocial adaptation status and health-related quality of life among older Chinese adults with visual disorders.

PURPOSE: To examine the association of psychosocial adaptation status with vision-specific health-related quality of life (HRQOL) and the role of psychosocial adaptation in the linkage between visual impairment and vision-specific HRQOL outcomes among older adults with visual disorders. DESIGN AND METHODS: In this cross-sectional study, older urban adults with visual problems (N = 167) were interviewed using a structured questionnaire to assess their self-reported visual function, general health, psychosocial adaptation status, and vision-specific HRQOL. Performance-based measure of visual function marked by distance visual acuity was clinically conducted by ophthalmologists. RESULTS: It was found in the study that psychosocial adaptation status was significantly associated with vision-specific HRQOL, including the domains of mental health symptoms due to vision and dependency on others due to vision. The results also showed that psychosocial adaptation status could buffer the effect of visual impairment on vision-specific HRQOL, including the domains of social function, mental health, and dependency. CONCLUSION: Psychosocial adaptation status is significantly associated with multiple domains of vision-specific HRQOL. The findings have significant implications for health education and psychosocial intervention for older adults with age-related vision loss.

Psychometric properties of the Chinese version of the 25-item National Eye Institute Visual Function Questionnaire.

PURPOSE: The goal of this study was to present the psychometric properties of the Chinese version of the short-form National Eye Institute Visual Function Questionnaire (NEI-VFQ-25) in older adults with age-related ocular disorders. METHODS: The NEI-VFQ-25 was translated and adapted into the Chinese version and then was administered to a sample of 167 older adults with age-related visual problems. All participants were also administered with a Medical Outcomes study 12-item Short-Form Health Survey, and received a detailed eye examination by an ophthalmologist. The sample was divided into two groups--a group with mild visual problems, and a moderately or severely visually impaired group--based on visual acuity in the better eye. The psychometric properties of the questionnaire were examined by both traditional validation methods and Rasch analysis. RESULTS: Results of traditional validation analyses showed that the Chinese version of NEI-VFQ-25 obtained satisfactory validity and reliability, and was able to discriminate among older adults with different severities of visual impairment. Cronbach alpha coefficients for multi-item subscales were all above 0.70 for the whole sample. Results of Rasch analysis revealed significant misfits of some items to the Rasch model. CONCLUSIONS: These results suggest that both the conventional psychometric properties and potential weakness of the Chinese version of NEI-VFQ-25 are similar to those of the English version. The significant limitations of the questionnaire may limit the application of the whole questionnaire in the future.

Social networks and health-related quality of life among Chinese older adults with vision impairment.

OBJECTIVE: This study examines the associations between social networks and vision-specific health-related quality of life (HRQOL) among Chinese older adults. METHOD: Urban older adults with visual problems (N = 167) were interviewed using a structured questionnaire to assess self-reported visual functioning, general health, social networks, and vision-specific HRQOL. Objective visual function was clinically measured by ophthalmologists in terms of distance visual acuity. RESULTS: Findings indicate that age-related vision loss is significantly associated with older adults' social networks. Multiple regression analyses show that social networks are mildly related to vision-specific HRQOL even after controlling for other variables, and that friendship network was a significant predictor, independent of family network, of vision-specific HRQOL. DISCUSSION: Previous studies have emphasized the importance of family network, whereas this study finds that friendship network correlates more strongly with HRQOL measures among Chinese visually impaired older adults. This suggests a need to expand intervention beyond the family system.

Endoscopic management of gastrointestinal smooth muscle tumor.

AIM: To systematically evaluate the efficacy and safety of endoscopic resection of gastrointestinal smooth muscle tumors (SMTs, including leiomyoma and leiomyosarcoma) and to review our preliminary experiences on endoscopic diagnosis of gastrointestinal SMTs. METHODS: A total of 69 patients with gastrointestinal SMT underwent routine endoscopy in our department. Endoscopic ultrasonography (EUS) was also performed in 9 cases of gastrointestinal SMT. The sessile submucosal gastrointestinal SMTs with the base smaller than 2 cm in diameter were resected by "pushing" technique or "grasping and pushing" technique while the pedunculated SMTs were resected by polypectomy. For those SMTs originating from muscularis propria or with the base size >or= 2 cm, ordinary biopsy technique was performed in tumors with ulcers while the "Digging" technique was performed in those without ulcers. RESULTS: 54 cases of leiomyoma and 15 cases of leiomyosarcoma were identified. In them, 19 cases of submucosal leiomyoma were resected by "pushing" technique and 10 cases were removed by "grasping and pushing" technique. Three cases pedunculated submucosal leiomyoma were resected by polypectomy. No severe complications developed during or after the procedure. No recurrence was observed. The diagnostic accuracy of ordinary and the "Digging" biopsy technique was 90.0% and 94.1%, respectively. CONCLUSION: Endoscopic resection is a safe and effective treatment for leiomyomas with the base size

[Anti-Helicobacter pylori effect and regulation of T helper response of chitosan].

OBJECTIVE: To study the anti-Helicobacter pylori (Hp) effect and the regulation of T helper (Th) response of chitosan. METHODS: Hp infected grade one female BALB/c mice model was established by inoculating Hp Sydney strain 1 and the mice were randomly divided into eight groups and administrated with (1) Arabia glue solution (control group), (2) omeprazole, (3) amoxicillin, (4) amoxicillin plus omeprazole, (5) chitosan, (6) chitosan plus omeprazole, (7) chitosan plus amoxicillin, (8) chitosan plus amoxicillin plus omeprazole respectively twice daily for 14 consecutive days. Four weeks after the last administration, these mice were all killed and samples of gastric mucosa were embedded in paraffin, sectioned and assayed with Giemsa stain. The remaining gastric mucosa was used to quantitatively culture Hp. An quantitative ELISA was used to detect IL-2, IFNgamma, IL-12, IL-4, IL-10 content in gastric mucosa. RESULTS: The eradication rate of Hp was 0, 0, 41.7%, 58.3%, 58.3%, 66.7%, 83.3% and 91.7% respectively among these eight groups (P < 0.01). The Hp colony density in the (1) group and (2) group was significantly higher than that in the other six groups (P < 0.05). The Hp colony density in (3) group was significantly higher than that in (6) group, (7) group and (8) group (P < 0.05) and that in (4) group was significantly higher than that in (8) group (P < 0.05). There was no difference in the content of IL-2 in the gastric mucosa among these eight groups (P > 0.05). The content of IFNgamma, IL-12, IL-4 and IL-10 in the gastric mucosa in groups with chitosan was significantly higher than that in groups without chitosan (P < 0.05). CONCLUSIONS: Chitosan has anti-Hp effect and synergism with amoxicillin in vivo. Chitosan can up-regulate Th1 and Th2 response.