Anti-inflammatory mouthwashes for the prevention of oral mucositis in cancer therapy: an integrative review and meta-analysis.

PURPOSE: Mucositis is severely painful and often reported as one of the most distressing adverse effects of cancer therapy; it is a significant threat to quality of life as well as life itself. Anti-inflammatory agents may modulate physiologic mechanisms that perpetuate mucositis and be useful in prevention efforts. Because systemic anti-inflammatory agents are not appropriate for many patients, locally acting agents (mouthwashes) may be more feasible for use. This review and meta-analysis evaluates the role that anti-inflammatory mouthwashes have in preventing or reducing oral mucositis associated with chemotherapy and radiation therapy. METHODS: A systematic literature review was conducted to identify studies evaluating the efficacy of anti-inflammatory mouthwashes to prevent therapy-associated mucositis. Meta-analysis was conducted to determine efficacy in preventing any mucositis and dose-limiting mucositis. RESULTS: Eight peer-reviewed publications were identified; corticosteroid and nonsteroidal anti-inflammatory mouthwashes are effective in reducing overall incidence of mucositis and are associated with lower severity of mucositis. Meta-analysis reveals significant reduction in symptomatic mucositis incidence (OR 6.00, 95% CI 4.39-8.20, p < 0.0001) and reduction of dose-limiting mucositis (OR 2.12, 95% CI 1.07-4.28, p = 0.032). CONCLUSION: Mouthwashes containing anti-inflammatory agents are a potential effective means to prevent or reduce mucositis associated with cancer therapy. There are limited adverse effects from these agents, and adherence is high, indicating safety and feasibility of use. Anti-inflammatory mouthwashes should be considered for supportive care in persons at risk for mucositis and must be further evaluated to investigate efficacy across multiple chemotherapy agents, adverse effects, and impacts on symptoms, pain, and quality of life.

Trauma informed interventions: A systematic review.

BACKGROUND: Health inequities remain a public health concern. Chronic adversity such as discrimination or racism as trauma may perpetuate health inequities in marginalized populations. There is a growing body of the literature on trauma informed and culturally competent care as essential elements of promoting health equity, yet no prior review has systematically addressed trauma informed interventions. The purpose of this study was to appraise the types, setting, scope, and delivery of trauma informed interventions and associated outcomes. METHODS: We performed database searches- PubMed, Embase, CINAHL, SCOPUS and PsycINFO-to identify quantitative studies published in English before June 2019. Thirty-two unique studies with one companion article met the eligibility criteria. RESULTS: More than half of the 32 studies were randomized controlled trials (n = 19). Thirteen studies were conducted in the United States. Child abuse, domestic violence, or sexual assault were the most common types of trauma addressed (n = 16). While the interventions were largely focused on reducing symptoms of post-traumatic stress disorder (PTSD) (n = 23), depression (n = 16), or anxiety (n = 10), trauma informed interventions were mostly delivered in an outpatient setting (n = 20) by medical professionals (n = 21). Two most frequently used interventions were eye movement desensitization and reprocessing (n = 6) and cognitive behavioral therapy (n = 5). Intervention fidelity was addressed in 16 studies. Trauma informed interventions significantly reduced PTSD symptoms in 11 of 23 studies. Fifteen studies found improvements in three main psychological outcomes including PTSD symptoms (11 of 23), depression (9 of 16), and anxiety (5 of 10). Cognitive behavioral therapy consistently improved a wide range of outcomes including depression, anxiety, emotional dysregulation, interpersonal problems, and risky behaviors (n = 5). CONCLUSIONS: There is inconsistent evidence to support trauma informed interventions as an effective approach for psychological outcomes. Future trauma informed intervention should be expanded in scope to address a wide range of trauma types such as racism and discrimination. Additionally, a wider range of trauma outcomes should be studied.

Auricular Point Acupressure Smartphone Application to Manage Chronic Musculoskeletal Pain: A Longitudinal, One-Group, Open Pilot Trial.

BACKGROUND: Chronic musculoskeletal pain (CMP) is the most common self-reported chronic pain condition. Current treatment for CMP is limited. METHODS: This was a two-phase study. In Phase 1, three auricular point acupressure (APA)-naïve participants were recruited to explore their experiences of APA and a smartphone app was developed based on their feedback. In Phase 2, a prospective longitudinal study was used to examine the effectiveness of the smartphone app to self-manage CMP. RESULTS: Phase 1 resulted in the successful development of the APA smartphone app. In Phase 2, after four weeks of APA, participants reported reduced pain intensity (30%), pain interference (35%), and disability (40%), as well as improved physical function (47%). The mean score for the participants' perception of treatment efficacy was 4.94 (SD = 2.08, scale of 0-7) indicating that approximately 70% of participants rated global improvements with noticeable changes. The majority (88%, n = 22) of the participants were satisfied with the treatment: 32% [8] were very satisfied and 56% [n = 14] were somewhat satisfied. The average frequency of pressing APA seeds per day was 2.93 times (SD = 2.27, range 0-10) and 1.60 minutes per time (SD = 2.64, range 0-10); the participants were able to adhere to the suggested pressing time per day, although they only pressed the ear points about 53% of the suggested time. CONCLUSION: It is feasible for individuals to learn APA from the smartphone app and successfully self-administer APA to manage their pain. Participants found the app useful and were satisfied with the information provided through the app.

Health and Academic Consequences of Sexual Victimization Experiences among Students in a University Setting.

The current study examines the association between multiple interpersonal violence victimization types experienced in a university setting and the consequences for each type. Students at a mid-Atlantic university (n = 3977) completed a survey in 2015 assessing attitudes, experiences, consequences of (physical, behavioural, academic, mental), and university resources and reporting procedures for sexual assault, harassment, and intimate partner violence. Effect on mental health was the most cited consequence for all victimization types. Sexual harassment was reported by the largest number of students but with smaller percentages of students reporting consequences, while the opposite was true for sexual assault and multiple forms of abuse (smaller numbers experiencing; larger percentages reporting consequences). In the adjusted models, being in an abusive/controlling relationship and sexual harassment were significantly associated with physical health consequences (ps < .001). Sexual harassment was the only predictor of substance use (p < .001). Being an undergraduate and experiencing an abusive/controlling relationship, sexual harassment, or assault were associated with sexual risk behaviour (all ps < .05). These findings point to a need for holistic approaches to helping students heal from interpersonal victimization-approaches that include mental health services, attention to increased substance use and sexual risk, and monitoring academic performance.

Midwifery Professional Stress and Its Sources: A Mixed-Methods Study.

INTRODUCTION: Professionally-related stress among midwives has been demonstrated in a global context to have deleterious effects on their professional, physical, and psychological health. Despite global interest in the subject, there has been no study about professional stress in a cohort of US midwives. METHODS: A convergent parallel mixed-methods design was used. The Job-Related Tension Index (JRTI) survey was administered to a self-selected sample of certified nurse-midwives and certified midwives in clinical practice in the United States via email solicitation of the American College of Nurse-Midwives' membership. A single qualitative open-ended question was also included in the survey. RESULTS: A total of 644 midwives participated in this study. The mean (SD) score on the JRTI across all midwife participants was 38.3 (9.65); the possible range of scores was 15 to 75. Midwives who were biologically older and/or had practiced longer and who had higher levels of education were shown to have higher levels of job-related tension. Those who believed their stress levels had negatively affected patient care showed higher job-related tension scores than those who did not. Call hours did not significantly affect tension scores in this study sample. Nearly all midwives in the cohort (97.1%) had experienced traumatic birth. Seven themes were identified after content analysis. These included the following: I'm SO tired, conflict with colleagues, selling your midwifery soul, leaving midwifery, non-respectful maternity care, balancing work and personal life, and medicolegal fears. DISCUSSION: Systems should recognize and validate midwives' levels of work-related tension and develop specific interventions to help alleviate it. Because of the size and racial homogeneity of the sample, further studies are recommended to identify stress levels and their contributing factors in a larger, more diverse population of midwives. Qualitative themes should be more fully explored to identify specific contributors to midwifery stress.

Effectiveness of macronutrient supplementation on nutritional status and HIV/AIDS progression: A systematic review and meta-analysis.

BACKGROUND & AIMS: Malnutrition is common in Sub-Saharan Africa, weakening the immune function of persons living with HIV infection (PLWH). Being malnourished at the initiation of antiretroviral therapy (ART) leads to higher risk of early mortality and reduced quality of life. Thus, introduction of protein-energy-fortified macronutrient supplements at ART initiation may improve HIV treatment outcomes. This review aimed to evaluate the effectiveness of macronutrient interventions. METHODS: This systematic review and meta-analysis included 15 studies conducted from 2000 to 2015 among Sub-Saharan African adults. RESULTS: Six randomized controlled trials and 4 retrospective cohort studies provided data eligible for a meta-analysis. Supplementation significantly increased the overall standardized mean difference (SMD) between baseline and follow-up data in weight (SMD = 0.382, p < .001), BMI (SMD = 0.799, p < .001); fat-free mass (SMD = 0.154, p = .009); and CD4 count (SMD = 0.428, p < .001). CONCLUSION: Protein-energy-fortified macronutrient supplementation at ART initiation may positively influence nutritional status and immunologic response in PLWH in Sub-Saharan Africa.