Espiritualidad y calidad de vida en mujeres con cáncer de mama: una revisión integrativa / Spirituality and quality of life in women with breast cancer: an integrative review / Espiritualidade e qualidade de vida em mulheres com câncer de mama: uma revisão integrativa

Resumen Introducción: Las mujeres que padecen cáncer de mama requieren de acciones que busquen mejorar su calidad de vida, a pesar del tratamiento. La espiritualidad parece ser un mecanismo de afrontamiento a la enfermedad. Objetivo: Identificar las evidencias disponibles sobre espiritualidad, para la mejora de la calidad de vida de mujeres con cáncer de mama, por medio de una revisión integrativa como metodología. Métodos: La búsqueda fue realizada en las bases de datos: PubMed, LILACS y Scopus, en un intervalo de 10 años. Se incluyeron artículos en los idiomas: inglés, portugués y español; con una temática relacionada a la espiritualidad, calidad de vida y cáncer de mama. Resultados: La muestra final fue de 23 artículos, mismos que se analizaron y agruparon en tres categorías: Calidad de vida y espiritualidad, la espiritualidad como estrategia de afrontamiento y las intervenciones que apoyan la espiritualidad. Discusión: Mujeres con cáncer de mama de diferentes culturas y prácticas espirituales, infieren que la espiritualidad les ayudó a reorganizarse psicológicamente, por lo tanto, es importante reconocer las necesidades espirituales de estas mujeres, proporcionar un cuidado holístico y humanizado, por ende mejorar su calidad de vida. Conclusiones: Las instituciones de salud deben poner énfasis en la incorporación de prácticas espirituales y religiosas, como parte integral en el tratamiento, una vez que, en su mayoría no requieren de recursos financieros, sino de los recursos espirituales propios de cada una de estas mujeres.

Abstract Introduction: Women with breast cancer require actions aimed at improving their quality of life. Spirituality is a way to address this situation. Objective: Through an integrative review, to identify available evidence related to the use of spirituality to improve the quality of life of women with breast cancer. Methods: An integrative search was conducted on the databases of PubMed, LILACS and Scopus, considering an interval of 10 years. Articles written in English, Portuguese, and Spanish, addressing spirituality, quality of life, and breast cancer, were included. Results: The final simple contained 23 articles which were analyzed and clustered into 3 categories: quality of life and spirituality, spirituality as an addressing strategy and spirituality supporting interventions. Discussion: Women from diverse cultures and spiritual practices referred that spirituality had helped them reorganize their minds, suggesting that, it is important to consider spirituality as part of the holistic care aimed at improving the quality of life of women with breast cancer. Conclusion: Health institutions should consider incorporating spiritual and religious practices into their integral treatments, echoing the spiritual needs of patients, including women with breast cancer.

Resumo Introdução: As mulheres que sofrem de câncer de mama requerem de ações que procurem melhorar sua qualidade de vida, apesar do tratamento. A espiritualidade parece ser um mecanismo de enfrentamento da doença. Objetivo: Identificar as evidências disponíveis sobre espiritualidade, para a melhora da qualidade de vida de mulheres com câncer de mama, por meio de uma revisão integrativa como metodologia. Métodos: A busca foi realizada nas bases de dados: PubMed, LILACS e Scopus, em um intervalo de 10 anos. Incluíram-se artigos nos idiomas: inglês, português e espanhol; com una temática relacionada à espiritualidade, qualidade de vida e câncer de mama. Resultados: A amostragem final foi de 23 artigos, mesmos que foram analisados e agrupados em três categorias: Qualidade de vida e espiritualidade; a espiritualidade como estratégia de enfrentamento e as intervenções que apoiam a espiritualidade. Discussão: Mulheres com câncer de mama de diferentes culturas e práticas espirituais, inferem que a espiritualidade lhes ajudou a reorganizar-se psicologicamente, portanto, é importante reconhecer as necessidades espirituais destas mulheres, proporcionar um cuidado holístico e humanizado, por conseguinte melhorar sua qualidade de vida. Conclusões: As instituições de saúde devem dar especial atenção na incorporação de práticas espirituais e religiosas, como parte integral no tratamento, uma vez que, em sua maioria não requeiram de recursos financeiros, senão dos recursos espirituais próprios de cada uma destas mulheres.

Dietary intake of antioxidant vitamins and risk of stroke: the Japan Public Health Center-based Prospective Study.

BACKGROUND/OBJECTIVES: Epidemiologic evidence on the relationship between antioxidant vitamin intake and stroke is limited. We aimed to investigate the association between dietary intake of antioxidant vitamins and the incidence of total stroke and ischemic stroke. SUBJECTS/METHODS: The subjects were 82 044 Japanese men and women aged 45-74 years under the Japan Public Health Center-based Prospective Cohort Study. Between 1995 and 1997, dietary assessment was done using a food frequency questionnaire. During 983 857 person-years of follow-up until the end of 2009 we documented 3541 incident total strokes and 2138 ischemic strokes. RESULTS: Dietary intakes of α-carotene, ß-carotene, α-tocopherol and vitamin C were not inversely associated with the incidence of total stroke and ischemic stroke adjustment for cardiovascular risk factors and selected lifestyle variables. When stratified by current smoking status, the inverse association between dietary vitamin C intake and incidence of total stroke observed among non-smokers but not smokers, with respective multivariable hazard ratios for the highest versus lowest quintiles of vitamin C of 0.81 (95% confidence interval (CI), 0.68-0.96; P-trend=0.03) among non-smokers; and 1.03 (0.84-1.25; P-trend=0.55) among smokers. As for ischemic stroke, the corresponding multivariable hazard ratios were 0.76 (0.60-0.96; P-trend=0.02) among non-smokers; and 1.00 (0.78-1.28; P-trend=0.61) among smokers. CONCLUSIONS: Dietary vitamin C intake was inversely associated with the incidence of total stroke and ischemic stroke among non-smokers.

Soy food and isoflavone intake and endometrial cancer risk: the Japan Public Health Center-based prospective study.

OBJECTIVE: Compared with western populations, the consumption of soy foods among Japanese is very high and the incidence of endometrial cancer very low. We evaluated the association of soy food and isoflavone intake with endometrial cancer risk in Japanese women. DESIGN: Prospective cohort study. SETTING: Ten public health centre areas in Japan. POPULATION: Forty nine thousand one hundred and twenty-one women of age 45-74 years who responded to a 5-year follow-up survey questionnaire. METHODS: Intakes of soy foods as well as other covariates were assessed in 1995-1998 by a self-administered food frequency questionnaire. Cox proportional hazards regression models were used to estimate hazard ratios (HR) and 95% confidence intervals (CI). MAIN OUTCOME MEASURE: Incidence of endometrial cancer. RESULTS: During an average of 12.1 years of follow up, 112 newly diagnosed endometrial cancer cases were identified. Energy-adjusted intakes of soy food and isoflavone were not associated with the risk of endometrial cancer. The multivariate-adjusted HR per 25 g/day increase in the intake of soy food was 1.02 (95% CI 0.94-1.10), and the corresponding value for isoflavone intake per 15 mg/day was 1.01 (95% CI 0.84-1.22). CONCLUSION: In this population-based prospective cohort study of Japanese women, we observed no evidence of a protective association between soy food or isoflavone intake and endometrial cancer risk.

Green tea consumption and gastric cancer in Japanese: a pooled analysis of six cohort studies.

BACKGROUND: Previous experimental studies have suggested many possible anti-cancer mechanisms for green tea, but epidemiological evidence for the effect of green tea consumption on gastric cancer risk is conflicting. OBJECTIVE: To examine the association between green tea consumption and gastric cancer. METHODS: We analysed original data from six cohort studies that measured green tea consumption using validated questionnaires at baseline. Hazard ratios (HRs) in the individual studies were calculated, with adjustment for a common set of variables, and combined using a random-effects model. RESULTS: During 2 285 968 person-years of follow-up for a total of 219 080 subjects, 3577 cases of gastric cancer were identified. Compared with those drinking <1 cup/day, no significant risk reduction for gastric cancer was observed with increased green tea consumption in men, even in stratified analyses by smoking status and subsite. In women, however, a significantly decreased risk was observed for those with consumption of > or =5 cups/day (multivariate-adjusted pooled HR = 0.79, 95% confidence interval (CI) = 0.65 to 0.96). This decrease was also significant for the distal subsite (HR = 0.70, 95% CI = 0.50 to 0.96). In contrast, a lack of association for proximal gastric cancer was consistently seen in both men and women. CONCLUSIONS: Green tea may decrease the risk of distal gastric cancer in women.

Calcium sulphate as a bone substitute for various osseous defects in conjunction with apicectomy.

AIM: The purpose of this study was to investigate the effect of calcium sulphate on various osseous defects when used in conjunction with apicectomy. METHODOLOGY: Mandibular third and fourth premolars of 11 beagle dogs were used. After root-canal treatment and apicectomy, three types of osseous defects were prepared on both sides of the mandible as follows: type 1, osseous defect communicating with the gingival sulcus: type 2, large osseous defect including two roots; type 3, 'through and through' osseous defect. The experimental side was allocated randomly, and the osseous defects were filled with medical grade calcium sulphate. The defects on the opposite side were left unfilled as controls. The dogs were sacrificed at 8 and 16 weeks postoperatively. Undemineralized sections were obtained and examined histomorphometrically. RESULTS: In type 1 defects, bone was not observed on the buccal side of the root on either experimental or control side at 8 and 16 weeks. In both type 2 and 3 defects, bone volume/tissue volume (BV/TV) values on the experimental side were significantly higher than those on the control side (P < 0.01), and mineral apposition rate (MAR) values on the experimental side were significantly higher than those on the control side (P < 0.01). CONCLUSIONS: The use of calcium sulphate was effective in bone regeneration on both large osseous defects and 'through and through' osseous defects. It was less effective in osseous defects communicating with the gingival sulcus.

Metabolism of vitamin D(3) by human CYP27A1.

Human vitamin D(3) 25-hydroxylase (CYP27A1) cDNA was expressed in Escherichia coli, and its enzymatic properties were revealed. The reconstituted system containing the membrane fraction prepared from the recombinant E. coli cells was examined for the metabolism of vitamin D(3). Surprisingly, at least eight forms of metabolites including the major product 25(OH)D(3) were observed. HPLC analysis and mass spectrometric analysis suggested that those metabolites were 25(OH)D(3), 26(OH)D(3), 27(OH)D(3), 24R,25(OH)(2)D(3), 1alpha, 25(OH)(2)D(3, )25,26(OH)(2)D(3) (25,27(OH)(2)D(3)), 27-oxo-D(3) and a dehydrogenated form of vitamin D(3). These results suggest that human CYP27A1 catalyzes multiple reactions and multiple-step metabolism toward vitamin D(3). The K(m) and V(max) values for vitamin D(3) 25-hydroxylation and 25(OH)D(3) 1alpha-hydroxylation were estimated to be 3.2 microM and 0.27 (mol/min/mol P450), and 3.5 microM and 0.021 (mol/min/mol P450), respectively. These kinetic studies have made it possible to evaluate a physiological meaning of each reaction catalyzed by CYP27A1.

Enzymatic properties of human 25-hydroxyvitamin D3 1alpha-hydroxylase coexpression with adrenodoxin and NADPH-adrenodoxin reductase in Escherichia coli.

We have cloned human 25-hydroxyvitamin D3 1alpha-hydroxylase cDNAs from normal subjects and patients with pseudovitamin D-deficient rickets (PDDR), and expressed the cDNAs in Escherichia coli JM109 cells. Kinetic analysis of normal 1alpha-hydroxylase in the reconstituted system revealed that Km values for 25(OH)D3 and (24R), 25(OH)2D3 were 2.7 and 1.1 microM, respectively. The lower Km value and higher Vmax/Km value for (24R),25(OH)2D3 indicated that it is a better substrate than 25(OH)D3 for 1alpha-hydroxylase. These results are quite similar to those of mouse 1alpha-hydroxylase. To establish a highly sensitive in vivo system, 1alpha-hydroxylase, adrenodoxin and NADPH-adrenodoxin reductase were coexpressed in E. coli cells. The recombinant E. coli cells showed remarkably high 1alpha-hydroxylase activity, suggesting that the electrons were efficiently transferred from NADPH-adrenodoxin reductase through adrenodoxin to 1alpha-hydroxylase in E. coli cells. Using this system, the activities of four mutants of 1alpha-hydroxylase, R107H, G125E, R335P and P382S, derived from patients with PDDR were examined. Although no significant reduction in expression of these mutants was observed, none showed detectable activity. These results strongly suggest that the mutations found in the patients with PDDR completely abolished 1alpha-hydroxylase activity by replacement of one amino acid residue.

Phase-Dependent effects of transforming growth factor beta 1 on osteoblastic markers of human osteoblastic cell line sV-HFO during mineralization.

A human osteoblastic cell line (SV-HFO) established in our laboratory expresses osteoblastic markers, including mineralization in vitro, in response to differentiation-inducing agents such as dexamethasone. In this study, we examined the effects of transforming growth factor beta 1 (TGF-beta 1) on the mineralization of SV-HFO cells and show that TGF-beta 1 inhibited the mineralization of the cells via down regulation of tetranectin and alkaline phosphatase without influencing other osteoblastic markers. To examine precisely the effects of TGF-beta 1 on the process of mineralization, we tentatively divided the whole process of mineralization into four phases: induced ALP activity (days 0-5), maximal ALP activity (days 5-10), early mineralization (days 10-15), and progressive mineralization (days 15-20). These inhibitory effects of TGF-beta 1 on the expression of tetranectin and alkaline phosphatase, like that on mineralization, were observed only when TGF-beta 1 was applied in the early phase of the process of mineralization. On the other hand, the other osteoblastic markers were not influenced by treatment with TGF-beta 1. These results suggest that TGF-beta 1 may inhibit mineralization of osteoblasts by the downregulation of tetranectin and alkaline phosphatase expression in the early phase. Thus, TGF-beta 1 has phase-dependent effects on a human osteoblastic cell line during the process of mineralization.

Development of the blood-retinal barrier in vitro: formation of tight junctions as revealed by occludin and ZO-1 correlates with the barrier function of chick retinal pigment epithelial cells.

To elucidate the molecular mechanisms of the blood-retinal barrier (BRB), we examined chick retinal tissues histochemically using antibodies against tight junction proteins such as ZO-1, 7H6 antigen, and occludin. Retinal pigment epithelial (RPE) cells in situ in chickens and late chick embryos expressed all of the tight junctional proteins examined, showing that tight junctions seal the cell borders of chick RPE cells in vivo. On the other hand, RPE cells isolated from late chick embryos and transferred in vitro did not express occludin, ZO-1 and 7H6 antigen. The effects of differentiation-inducing agents, such as retinoic acid, dexamethasone and dimethyl sulfoxide (DMSO) were tested. Only DMSO induced an increase in transepithelial electrical resistance (TER) in a time-dependent manner. Under supplementation with DMSO, immunofluorescently demonstrable occludin and ZO-1 were induced progressively at cell borders in parallel with the increase in TER that occurred with decreases in inulin and dextran permeability. Electron microscopically tight junction-like junctional apparatus were induced in RPE cells. These results indicated that tight junctions of RPE cells play an important role in the formation of the BRB.

Dealkylation rates of O6-alkyldeoxyguanosine, O4-alkylthymidine and related compounds in an alkyl-transfer system.

Bacterial O6-alkylguanine-DNA alkyltransferase (AGT) removes alkyl group from O6-alkylguanine and O4-alkylthymine residues in DNA, both of which are considered to be DNA damages most related to the induction of cancer and/or mutation. The repair process involves alkyl-transfer of an O-alkyl group to the active site of the enzyme, where an SH-group of cysteine residue plays the role of alkyl acceptor. In order to elucidate the chemical characteristics of substrates for this enzyme, dealkylation rates of O6-alkyldeoxyguanosine, O4-alkylthymidine and related compounds were measured using an alkyl-transfer system. Thiophenol-triethylamine system was employed as an alkyl acceptor and twenty-one O-alkyl compounds were tested. Dealkylation proceeded with pseudo first order kinetics. The half-life of O6-methyldeoxyguanosine (MedG) was 122 h and no remarkable dependence on N-9 substituents (H, CH3 and deoxyribose) was observed. A compound lacking 2-NH2 group underwent demethylation about three times faster than O6-methylguanines did, while, a compound lacking imidazole moiety underwent demethylation about 2.5 times more slowly. The half-life of O4-methylthymidine (MedT) was 38 h and no remarkable dependence on N-1 (H, CH3 and deoxyribose) and C-5 (H and CH3) substituents was observed. Deethylation proceeded much more slowly than demethylation. Substitution of selenophenol for thiophenol resulted in a 4.5 times faster MedG demethylation rate. Demethylation rates were moderately correlated with values for NMR chemical shift of CH3 group, an indicator of electron density, although the correlation curves of a series of MedG and MedT derivatives were quite different. This result suggests that some different rate-determining factors other than electron density are playing a role. These findings may be of help in resolving the details of the mechanisms of enzymic repair by bacterial and mammalian AGT.