Integrating mindfulness and the expressive arts for meaning making in cancer care: A grounded theory of the processes, facilitators, and challenges.

PURPOSE: There is a growing interest in mindfulness-based expressive arts interventions in oncology, to help patients process their experiences, learn how to live with cancer, and ameliorate psychological distress. Our research purpose was to explore how patients with cancer experience a mindfulness-based expressive arts group intervention, and to articulate individual and contextual factors influencing their experiences. METHODS: We conducted a constructivist grounded theory study and recruited 32 participants who experienced a 10-week mindfulness-based expressive arts group intervention at a tertiary cancer center in mid-Western Canada. We gathered socio-demographic data and descriptions of their experiences through semi-structured interviews. Participants brought art they had created to facilitate art elicitation. Socio-demographic data were analyzed with descriptive statistics and all other data with grounded theory methods. RESULTS: Our findings revealed how entering the group and meaning making processes through mindfulness enabled participants to let go of their ruminations and calm their minds so they could fully engage in arts activities. Participants found inspiration for their artistic expressions in mindfulness meditation which allowed them to express themselves in new ways. Although this work was challenging, combining mindfulness and the arts created a unique healing space in which individual work was nested within group processes. There were notable personal factors and perspectives that influenced participants' experiences, as well as factors related to the group design and facilitator. CONCLUSIONS: Our findings provide insight into how and when this intervention was meaningful for patients, and have important implications to guide ongoing intervention development, implementation, and evaluation.

Perspective: Call for Re-evaluation of the Tolerable Upper Intake Level for Magnesium Supplementation in Adults.

In 1997, the US Institute of Medicine (IOM) dietary reference intakes (DRI) Committee established a magnesium (Mg) tolerable upper intake level (UL) for adults of 350 mg/d from supplemental intake alone. Diarrhea was the limiting factor. The safety of oral Mg dietary supplements exceeding the UL is currently in debate. Increasing the UL may result in more Mg supplementation, decreasing the prevalence of undernutrition for this nutrient and thus providing additional protection against numerous chronic diseases. This perspective aims to show that more recent and comprehensive evidence-based data on the occurrence of diarrhea indicate that the Mg UL for adults should be re-evaluated. To update the literature base to re-evaluate setting the Mg UL, a PubMed search was conducted to identify intervention studies published between 1997 and 2022 that used single-ingredient Mg products reporting a priori diarrhea adverse events among adults. The Food and Drug Administration Center for Food Safety and Adverse Event Reporting System (CAERS) was also searched for adverse events caused by Mg supplementation. The PubMed search identified 10 studies, including 5 meta-analyses and 5 randomized controlled trials, that met the search criteria. Seven studies (Mg intakes of 128-1200 mg/d) found no significant differences in diarrhea occurrence between the intervention and control groups. One meta-analysis found only minor differences in gastrointestinal disturbances between groups given placebo versus 520 mg Mg/d, but withdrawals were not significantly different between groups. Another meta-analysis found that 3 of 13 studies (120-973 mg/d) reported diarrhea that led to study withdrawal, but the treatment arm was not specified in 2 studies. The CAERS search, when limited to single-ingredient suspect Mg products, found only 40 attributable cases of gastrointestinal adverse events. Only one-third of these 40 cases noted a complaint of diarrhea. These updated data indicate that doses above the current UL for Mg supplements can be consumed without adverse events.

Mindfulness-based arts interventions for cancer care: A systematic review of the effects on wellbeing and fatigue.

OBJECTIVE: Upon receiving a cancer diagnosis, life irrevocably changes and complex experiences of emotional distress often occur. There is a growing interest in mindfulness-based arts interventions (MBAIs) to ameliorate the distress many patients experience. Our review objective was to synthesize the evidence on the effectiveness of MBAIs on psychological wellbeing and fatigue. METHOD: Relevant quantitative articles were identified through a systematic search of the grey literature and online databases including MEDLINE, CINAHL, Cochrane CENTRAL, Art Full Text, ART bibliographies Modern, PsycINFO, Scopus, and EMBASE. Two independent reviewers screened titles/abstracts against predetermined inclusion criteria, read full-text articles for eligibility, conducted quality appraisals of included articles, and extracted pertinent data with a standardized data extraction form. The heterogeneity of the included studies precluded a meta-analysis and a narrative synthesis of study outcomes was conducted. RESULTS: Our systematic search retrieved 4241 titles/abstracts, and 13 studies met our inclusion criteria (eight randomized controlled trials and five quasi-experiments). Most of the studies focused on patients with cancer (92.3%). There is a growing interest in MBAIs over time and significant heterogeneity in the types of interventions. A significant effect was found on several outcomes that are important in psychosocial oncology: quality of life, psychological state, spiritual wellbeing, and mindfulness. The effect on fatigue was equivocal. CONCLUSIONS: This novel intervention demonstrates promise for the psychosocial care of patients with cancer. These findings are an essential antecedent to the continued implementation, development, and evaluation of MBAIs in oncology.

Effectiveness of mindfulness-based arts interventions on psychological wellbeing and fatigue in adults with a physical illness: a systematic review protocol.

REVIEW QUESTION/OBJECTIVE: The objective of this review is to synthesize evidence on the effectiveness of mindfulness-based arts interventions on psychological wellbeing and fatigue in adults with a physical illness.

Existential anxiety and growth: an exploration of computerized drawings and perspectives of children and adolescents with cancer.

BACKGROUND: Until now, most existentially focused cancer research has been conducted within adult populations. Only a handful of qualitative investigations have captured the experiences of children with cancer relative to themes such as existential fear and finitude, meaning/meaninglessness, uncertainty, authenticity, and inauthenticity. OBJECTIVE: This article aimed to provide a deeper understanding of the existential challenges faced by children living with cancer. METHODS: An interpretive, descriptive qualitative research approach was used. Thirteen children (8-17 years) undergoing treatment for cancer participated. Children participated in individual open-ended interviews and also had the opportunity to journal their experiences in a computerized drawing tool. RESULTS: The 4 main themes that emerged in relation to the existential challenges experienced by children with cancer included (1) existential worry, (2) existential vacuum, (3) existential longing, and (4) existential growth. The drawing tool within the computer diary was found to be particularly beneficial in assisting children to express the existential challenges that they had previously been unable to articulate in words. CONCLUSION: Children moved between existential anxiety and existential growth within the cancer world. The expressive means of drawing pictures gave children a therapeutic space to explore and work at understanding the existential challenges experienced. IMPLICATIONS FOR PRACTICE: This research provides evidence that the active engagement of children's imaginations through the use of a computer-drawing tool may have significant therapeutic value for children with cancer. As well, the findings support the importance of nurses "being there" for young patients with cancer in their time of despair.

Vitamin D deficiency at the Arctic Circle - a study in food-allergic adolescents and controls.

AIM: At the extremes of latitude, UVB intensity is insufficient for adequate vitamin D synthesis in winter. Fatty fish, vitamin D enriched milk, margarine and eggs are main dietary sources of vitamin D. Their elimination may increase the risk of vitamin D deficiency. The aim was to assess vitamin D status in food-allergic adolescents eliminating milk, egg and/or fish compared with adolescents on normal diets. METHODS: In winter, vitamin D intake was assessed by a food frequency questionnaire in 20 food-allergic adolescents and 42 controls in the population-based Obstructive Lung Disease In Northern Sweden (OLIN) cohort studies. Vitamin D supplementation was queried. Serum 25-hydroxyvitamin D [S-25(OH)D] and S-parathormone (S-PTH) levels were determined. RESULTS: Mean (SD) dietary vitamin D intake was 7.9 (3.6) µg/day in allergic adolescents and 7.8 (3.4) in controls (p > 0.05). Mean (SD) S-25(OH)D levels in supplement consumers were 44 (18) nmol/L compared with 35 (10) in non-consumers (p = 0.03). S-25(OH)D and S-PTH levels were similar in food-allergic adolescents and controls (p > 0.05). Eighty-two percentage had deficient S-25(OH)D levels <50 nmol/L, and none reached levels >75 nmol/L. CONCLUSION: Vitamin D deficiency was as common in food-allergic adolescents as in controls although the vitamin D intake met national recommendations. Large-scale studies on the prevalence of vitamin D deficiency in this region are needed.

Associations between maternal antioxidant intakes in pregnancy and infant allergic outcomes.

Antioxidant intakes in pregnancy may influence fetal immune programming and the risk of allergic disease. We investigated associations between maternal intakes of ß-carotene, vitamin C, vitamin E, copper and zinc, and infant allergic outcomes. Antioxidant intakes of pregnant women (n = 420) assessed prospectively by a food frequency questionnaire, were examined in relation to allergic outcomes at 1 year of age (n = 300). The main relationships with allergic outcomes were seen with dietary vitamin C and copper. Specifically, higher maternal dietary vitamin C intake was associated with a reduced risk of any diagnosed infant allergic disease and wheeze. After adjustment for potential confounders the relationship with wheeze remained statistically significant. There was also an inverse linear relationship between vitamin C and food allergy. Higher dietary copper intake was associated with reduced risk of eczema, wheeze and any allergic disease. The relationship with wheeze and any allergic disease remained statistically significant in multivariate analysis, and there was also an inverse linear relationship between copper and food allergy. However, these relationships were only seen for nutrients present in food. There were no relationships between ß-carotene, vitamin E or zinc and any allergic outcomes. In summary, this study suggests that maternal diet of fresh foods rich in vitamin C is associated with reduced risk of infant wheeze, and that copper intake is associated with reduced risk of several allergic outcomes.

Probiotics during weaning reduce the incidence of eczema.

A reduced microbial load early in life has been suggested to be linked to the increasing prevalence of allergic diseases in the industrialized world. Some studies have indicated that probiotics may be effective in the prevention of eczema. In vitro studies indicate that probiotics have immunomodulatory effects. In the present study, we evaluated the effects of feeding Lactobacillus F19 during weaning on the incidence of eczema and Th1/Th2 balance. In a double-blind, placebo-controlled randomized intervention trial, infants were fed cereals with (n = 89) or without Lactobacillus F19 (n = 90) from 4 to 13 months of age. We assessed the cumulative incidence of eczema at 13 months of age. The ratio of interferon-gamma (IFN-gamma) to interleukin 4 (IL4) mRNA expression levels in polyclonally stimulated peripheral blood T cells was used as a proxy for immune balance. Total and specific IgE serum levels were also assessed. The cumulative incidence of eczema at 13 months was 11% (4-17%, 95% CI) and 22% (13-31%, 95% CI) in the probiotic and placebo groups, respectively (p < 0.05). The number needed to treat was 9 (6.5-11.5, 95% CI). At 13 months of age, the IFN-gamma/IL4 mRNA ratio was higher in the probiotic compared with the placebo group (p < 0.05). In contrast, there were no differences between groups in serum concentrations of IgE. In summary, feeding Lactobacillus F19 during weaning could be an effective tool in the prevention of early manifestation of allergy, e.g., eczema. The higher Th1/Th2 ratio in the probiotic compared with the placebo group suggests enhancing effects of Lactobacillus F19 on the T cell-mediated immune response.

Processed infant cereals as vehicles of functional components.

Cereals are the most common complementary foods all over the world and there is now a novel possibility to add functional components to target health problems that are not caused by a simple nutritional deficiency. So far there have been very few published trials on the addition of functional components to infant cereals. A single trial has suggested that infant cereals containing a combination of probiotics, prebiotics and zinc are an effective adjunct to oral rehydration solution in the treatment of acute gastroenteritis. Up to now there has been no evidence that infant cereals supplemented with probiotics or prebiotics have a preventive effect on diarrhea but a recent study has suggested that a milk fat globule membrane (MFGM) protein fraction added to an infant cereal reduces the risk of diarrhea in a developing country. There are some promising results suggesting that infant cereals supplemented with probiotics or prebiotics may prevent atopic eczema. The addition of prebiotic oligosaccharides to infant cereals may lead to softer stools, likely to benefit those infants who are suffering from constipation. More studies are needed to verify these results and to assess the effects of other functional components - especially probiotics, prebiotics, nucleotides, novel protein fractions and recombinant human milk proteins - added to infant cereals.