Psychological and Physical Well-Being in Women Diagnosed with Breast Cancer: A Comprehensive Study of Anxiety, Depression, Sleep Quality, Physical Activity, and Sociodemographic Factors.

BACKGROUND The psychophysical state of breast cancer patients impacts several outcomes and parameters and can directly affect diagnosis, prehabilitation, and treatment. This questionnaire-based study aimed to compare anxiety levels, depression, physical activity, sleep quality, and sociodemographic features in women with breast cancer and healthy women at a breast cancer unit in Poland. MATERIAL AND METHODS The study enrolled 41 breast cancer patients with no proposed treatment or psychological disorder diagnosis and 50 healthy volunteers. After enrolment, the subjects completed the Spielberger State-Trait Anxiety Inventory (STAI), Beck's Depression Inventory (BDI), International Physical Activity Questionnaire (IPAQ), Pittsburgh Sleep Quality Index (PSQI), and a sociodemographic questionnaire. RESULTS In this study, anxiety levels measured by the STAI anxiety subscale (56.05 [9.18] vs 37.62 [8.35], P<0.001) and BDI-assessed depression levels were higher in the cancer group (12.34 [6.26] vs 6.68 [6.36], P<0.001). PSQI measured quality of sleep (QOS) (5.80 [3.44] vs 3.76 [3.35], p=0.003) and physical activity (PA) levels evaluated by IPAQ were lower for breast cancer patients (1684.62 [2401.19] vs 3473.44 [4756.78], P=0.042). CONCLUSIONS Anxiety, depression, poor quality of sleep, and insufficient PA were common in breast cancer patients. The occurrence of cancer was the main factor causing mental health deterioration in patients with breast cancer. Also, mental state and well-being differed in healthy women compared to breast cancer patients.

Assessment of Stress, Depressive and Anxiety Symptoms in Patients with COPD during In-Hospital Pulmonary Rehabilitation: An Observational Cohort Study.

Background and Objectives: The relationship between physical health and mental health has been considered for years. A number of studies have shown a correlation between depressive states and the progress of somatic diseases. It seems that the proper cooperation of specialists may result in the improvement of the patient's well-being and a positive effect on the course of the rehabilitation process. The aim of this study was to assess the symptoms of depression, anxiety, and stress in patients with chronic obstructive pulmonary disease (COPD) as well as the assessment of the relationship of psychological symptoms with sociodemographic factors and physical condition. Materials and Methods: The study enrolled 51 COPD patients who underwent a three-week pulmonary rehabilitation program. After admission to the rehabilitation department, the subjects were asked to complete the Hospital Anxiety and Depression Scale (HADS) questionnaire, the Perception of Stress Questionnaire (PSQ), and a sociodemographic questionnaire. Results: Anxiety states were diagnosed in 70% of respondents and depressive states were diagnosed in 54% of patients. Some of the respondents (14%) also showed a tendency to experience various grounded stresses. Additionally, there were correlations between the mental state and the results of fitness and respiratory tests. Conclusions: Patients with COPD are at risk for mental disorders, which may adversely affect their general health and significantly limit their physical and respiratory efficiencies. The development of widely available therapeutic solutions to reduce symptoms associated with depression, anxiety, and stress seems to be an important challenge for the management of patients with COPD.

Virtual reality in chemotherapy support for the treatment of physical functions, fear, and quality of life in pediatric cancer patients: A systematic review and meta-analysis.

Background: Appropriately selected complementary therapies, such as virtual reality (VR) and active video games (AVG), provide support to young patients during the process of cancer treatment. Therefore, this systematic review with meta-analysis aimed to analyze the effects of VR and AVG on fear, physical functions, and quality of life. Methods: A systematic search was performed independently in Scopus, PubMed, Embase, Web of Science and Cochrane Library electronic databases for relevant randomized controlled and crossover studies. From a total of 5,963 records, 11 met the inclusion criteria. After full-text screening two publications were excluded, yet six studies were included in the quantitative analysis because three studies had a large discrepancy in their measured outcomes. For methodological quality assessments, the RoB2 software program was used, while RevMan 5.4.1 was used for statistical analysis and meta-analysis. Standard Mean Difference (SMD) outcome measures were used for the analysis. Statistical heterogeneity was assessed using the I2 statistic with a cut-off value of 50% considering intervention and outcome measures. Results: Our systematic review includes six randomized controlled studies and three randomized crossover studies. The participants represented both sexes and were children and adolescents (<18 years old) with a diagnosis of cancer. The analysis of the results allows for a careful conclusion that VR has the potential to become an accessory tool in rehabilitation and oncologic treatment. All of the included studies noted a significant advantage of this intervention. Conclusion: VR has the potential to be an effective and important tool in the oncologic treatment of children. VR immerses the patient, and as a result, produces a distraction that effectively reduces pain associated with standard oncologic care procedures in children. However, this systematic review and meta-analysis highlights the need for more research into the use of VR as support for pediatric oncologic care. Systematic review registration: PROSPERO database (https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=319000), CRD42022319000.

Effects of a Short-Term Slackline Training Program on Energy Expenditure and Balance in Healthy Young Adults: A Preliminary Report of a Randomized Controlled Trial.

The development of technology and a fast-paced lifestyle has caused a significant decrease in physical activity, especially among young people. These worrying trends can be countered by the use of attractive forms of physical recreation, including the increasingly popular slackline. The aim of this study was to evaluate energy expenditure during slackline training and to analyze changes in dynamic and static balance parameters after supervised slackline training sessions. The study enrolled 28 healthy volunteers (14 men and 14 women aged 21−25) who were randomly divided into two groups: experimental and passive control. The energy expenditure level was the primary outcome and was assessed using the SenseWear Armband. Each participant underwent an initial and final balance assessment using two selected protocols on the Balance Master platform. The intervention lasted 5 days, with 15 min of supervised training per day. The average energy expenditure expressed in MET was 6.0 (±0.7) MET per training session. An analysis of the results regarding static and dynamic balance showed that the group participating in slackline training significantly improved stability on foam surfaces with their eyes open (p < 0.003), as well as tandem walk speeds (p < 0.05), both with small effect sizes. The results suggested that slackline training has the potential to produce significant positive effects on general health statuses following the World Health Organization's (WHO) recommendations on physical activity. The significant improvement in task-specific balance suggests that slackline training could become an important element of the prevention and rehabilitation of many injuries.

Effectiveness of an Inpatient Virtual Reality-Based Pulmonary Rehabilitation Program among COVID-19 Patients on Symptoms of Anxiety, Depression and Quality of Life: Preliminary Results from a Randomized Controlled Trial.

Forms of rehabilitation for patients after COVID-19 are gaining interest. The purpose of this study was to investigate and compare an innovative in-hospital pulmonary rehabilitation programs augmented with training elements performed in virtual reality. This randomized controlled study included 32 patients enrolled in post-COVID-19 rehabilitation at a Public Hospital in Poland. The rehabilitation models included exercise capacity training on a cycle ergometer, breathing and general fitness workout, resistance training, and relaxation. The forms of training and relaxation differed between the groups: the experimental group employed virtual reality, and the control group used a traditional form of therapy. Exercise tolerance was assessed using a 6 min walk test (6 MWT), while psychological parameters were evaluated using the Hospital Anxiety and Depression Scale (HADS) and the brief World Health Organization Quality of Life Scale (WHOQOL-BRIEF). The analysis of the post-rehabilitation results showed a statistically significant improvement in both groups regarding depression (VR: 6.9 (3.9) vs. 4.7 (3.5), p = 0.008; CG: 7.64 (4.5) vs. 6.6 (4.8), p = 0.017) and anxiety (VR: 8.6 (4.6) vs. 5.6 (3.3), p < 0.001; CG: 9.57 (6.0) vs. 8 (4.8), p = 0.003). No statistically significant improvements in quality of life were noted in both groups. Moreover, the analysis showed a statistically significant improvement in the exercise capacity in both groups after completion of the rehabilitation program, expressed as a distance in the 6 MWT, as well as a statistically significant improvement in dyspnea in the VR group. To conclude, the analysis of the preliminary data revealed that a 3-week hospital-based pulmonary rehabilitation program for COVID-19 patients led to an improvement in exercise tolerance as well as a reduction in the symptoms of anxiety and depression. The virtual reality-based form of training delivery, despite its attractiveness, did not significantly affect patients' performance.

Virtual reality intervention as a support method during wound care and rehabilitation after burns: A systematic review and meta-analysis.

OBJECTIVE: This systematic review and meta-analysis aimed to analyze and synthesize the evidence on the effectiveness of virtual reality (VR) interventions in the prevention of pain, fear and anxiety during burn wound care procedures. METHODS: In September and October 2021, PubMed, Scopus, Cochrane Library and Web of Science were searched for relevant randomized controlled and crossover studies. Two independent authors described the following inclusion criteria for the search: patients undergoing burn wound care with applied VR treatment compared to any other or non-VR intervention. From a total of 1171 records, 25 met the inclusion criteria. After full-text screening, seven publications were excluded. The risk of bias was assessed for 18 studies by two independent authors. RevMan 5.4 was used for the statistical analysis, meta-analysis and visual presentation of the results. RESULTS: The meta-analysis showed a significant difference between VR treatment and standard care when analyzing pain outcome during wound care procedures (SMD = -0.49; 95% CI [-0.78, -0.15]; I2 = 41%) and in subgroup analysis when immersive VR was incorporated (SMD = -0.71; 95% CI [-1.07, -0.36]; I2 = 0%). No significant differences were found between VR treatment and standard care for range of motion outcome (SMD = 0.44; 95% CI [-0.23, 1.11]; I2 = 50%). CONCLUSIONS: VR seems to be an effective therapeutic support in burn wound care procedures for reducing pain. However, this systematic review and meta-analysis highlights the need for more research into the use of VR as a distraction method. Studies on larger groups using similar conditions can provide unequivocal evidence of the effectiveness of VR and enable the inclusion of such intervention in standard medical procedures.

Virtual Therapy Complementary Prehabilitation of Women Diagnosed with Breast Cancer-A Pilot Study.

Breast cancer is becoming an important issue due to its various consequences and epidemiology. Studies are showing that it extremely impacts the mental health as well as the physical activity of the patients. In addition to the most common symptom, which is fatigue, patients also have problems with the quality of sleep. Therefore, this study aimed to evaluate the effectiveness of virtual reality (VR) therapy in improving the mental state and quality of sleep, as well as increasing the physical activity (PA) of patients diagnosed with breast cancer. The study was conducted in a hospital's Breast Unit and included patients at the time of diagnosis of malignant breast cancer. A total of 16 subjects randomly divided into experimental (n = 9), and control (n = 7) groups were measured with the Beck Depression Scale, Mental Adjustment to Cancer Scale, International Physical Activity Questionnaire, and Pittsburgh Sleep Quality Index at two timepoints. The experimental intervention consisted of a 2-week (8 sessions) Virtual Therapeutic Garden (VRTierOne) procedure performed daily for about 15 min. Significant differences were identified between groups in the interactions between the main factors seen in the destructive style of the Mini-Mac scale: F(1.14) = 4.82, p = 0.04, and between multiple experiments: F(1.14)= 5.54, p = 0.03 showing a significant reduction in the destructive style of coping with the disease in the study group after therapy (32.44 vs. 28.33, p = 0.003). The level of main effects [study] for the constructive style is F(1.14) = 3.93, p = 0.06 with a significant increase in constructive style in the study group (43.33 vs. 45.33, p = 0.044). Significant differences in levels of depression between multiple experiments: F(1.14) = 5.04, p = 0.04, show a significant reduction in the severity of depressive symptoms was found in the experimental group after therapy (13.33 vs. 8.11, p = 0.02). However, the analysis did not show significant differences between group analyses (p = 0.25). It seems that VR reduces the severity of depressive symptoms and reduces the destructive style and can be an effective option in improving the mental state of patients diagnosed with breast cancer.

Virtual Reality Interventions for Needle-Related Procedural Pain, Fear and Anxiety-A Systematic Review and Meta-Analysis.

Needle-related procedures are often a source of pain, anxiety and fear in young patients. This systematic review aimed to investigate the effectiveness of virtual reality (VR) on reducing pain, fear and anxiety in pediatric patients undergoing needle-related procedures. Pain, anxiety, fear, changes in blood pressure and heart rate as well as satisfaction were evaluated as outcomes during needle-related procedures in VR compared with standard care conditions. A meta-analysis was performed, taking into account online databases. Two authors independently conducted literature searches in December 2020. The last search was conducted in March 2021 from a total of 106 records, 7 met our inclusion criteria. One study was excluded from the meta-analysis due to insufficient data. VR was applied as a distractor during venous access. Statistically significant benefits of using VR were shown in children's pain scores, where VR significantly decreased symptoms (n = 3204 patients, MD = -2.85; 95% CI -3.57, -2.14, for the Wong-Baker Faces Pain Rating Scale and n = 2240 patients, MD = -0.19; 95% CI -0.58, 0.20, for the Faces Pain Scale-Revised). The analysis of fear, anxiety and satisfaction scores revealed no significant differences between the conditions, as the studies were too heterogeneous to be pooled. Distraction using virtual reality may be an effective intervention for reducing pain in children undergoing needle-related medical procedures. However, further research in the implementation of VR as a distractor for children and adolescents is required, due to the limited research into this field.

Virtual reality as a chemotherapy support in treatment of anxiety and fatigue in patients with cancer: A systematic review and meta-analysis and future research directions.

OBJECTIVE: The aim of this systematic review was to analyse the effectiveness of virtual reality intervention as an aid for treatment-related anxiety and fatigue in cancer patients undergoing chemotherapy. The term chemotherapy was assumed without distinction regarding type. METHODS: The inclusion criteria were (1) randomised controlled trials or crossover studies, (2) adult cancer patients undergoing chemotherapy, (3) treatment with VR scenarios providing distraction during chemotherapy, and (4) with pain, anxiety, fatigue, fear, or symptom distress as the measured outcomes. Articles in English, Polish, and Italian were sought. For the methodological quality assessment of risk of bias, likewise statistical analysis and meta-analysis the RevMan version 5.4 software and the Cochrane Risk of Bias Tool were used. Two authors independently analysed the following databases for relevant research articles: PubMed, Scopus, Cochrane Library, Web of Science, and Embase. RESULTS: From a total of 2543 records, 6 studies met the inclusion criteria for qualitative analysis. At the end of the process, 3 studies remained for quantitative analysis. The systematic review includes three randomised, controlled studies and three crossover studies with an overall sample size of 453 patients. The analysis of the primary outcomes chosen for each study revealed no significant differences between the control and experimental conditions. Moreover, an important factor influencing the results of the review and meta-analysis was the poor quality of the publications available on the topic of distraction during chemotherapy. CONCLUSION: Due to the low research standards, the results do not provide an unambiguous answer to the research question. The most important limitations result from the small number of trials, the generally small sample sizes, and the differences in study design.

Short-Term Changes in Quality of Life in Patients with Advanced Lung Cancer during In-Hospital Exercise Training and Chemotherapy Treatment: A Randomized Controlled Trial.

The aim of this study was to assess the impact of exercise training on the quality of life (QoL) of patients diagnosed with stage IIIB and stage IV non-small cell lung cancer (NSCLC) compared to a passive control group (CG). The exercise-trained group (ETG) consisted of 18 patients, and the CG consisted of 8 patients. The training program in the ETG consisted of two 2-week running cycles interspersed with consecutive rounds of chemotherapy with cytostatic drugs. A comparison of the changes in the Short Form (36) Health Survey (SF-36), St. George's Respiratory Questionnaire (SGRQ), and the Functional Assessment of Cancer Therapy-Lung (FACT-L) was the primary outcome. Analysis of the results of the SGRQ and the SF-36 questionnaire did not reveal any statistically significant differences in the assessment of QoL between the examined groups. The analysis of FACT-L questionnaires showed statistically significant changes, indicating deterioration of QoL in domains describing physical well-being in the CG. Therefore, the analysis of the results of the QoL assessment did not show any significant improvements in the group of patients undergoing comprehensive exercise training, although deterioration of QoL was noted in the CG.

Exploiting Substrate Promiscuity of Ectoine Hydroxylase for Regio- and Stereoselective Modification of Homoectoine.

Extant enzymes are not only highly efficient biocatalysts for a single, or a group of chemically closely related substrates but often have retained, as a mark of their evolutionary history, a certain degree of substrate ambiguity. We have exploited the substrate ambiguity of the ectoine hydroxylase (EctD), a member of the non-heme Fe(II)-containing and 2-oxoglutarate-dependent dioxygenase superfamily, for such a task. Naturally, the EctD enzyme performs a precise regio- and stereoselective hydroxylation of the ubiquitous stress protectant and chemical chaperone ectoine (possessing a six-membered pyrimidine ring structure) to yield trans-5-hydroxyectoine. Using a synthetic ectoine derivative, homoectoine, which possesses an expanded seven-membered diazepine ring structure, we were able to selectively generate, both in vitro and in vivo, trans-5-hydroxyhomoectoine. For this transformation, we specifically used the EctD enzyme from Pseudomonas stutzeri in a whole cell biocatalyst approach, as this enzyme exhibits high catalytic efficiency not only for its natural substrate ectoine but also for homoectoine. Molecular docking approaches with the crystal structure of the Sphingopyxis alaskensis EctD protein predicted the formation of trans-5-hydroxyhomoectoine, a stereochemical configuration that we experimentally verified by nuclear-magnetic resonance spectroscopy. An Escherichia coli cell factory expressing the P. stutzeri ectD gene from a synthetic promoter imported homoectoine via the ProU and ProP compatible solute transporters, hydroxylated it, and secreted the formed trans-5-hydroxyhomoectoine, independent from all currently known mechanosensitive channels, into the growth medium from which it could be purified by high-pressure liquid chromatography.