Impact of spiritual interventions in individuals with cancer: A systematic review and meta-analysis.

PURPOSE: This meta-analysis aimed to determine how spiritual interventions affect cancer patients' physical, emotional, and spiritual outcomes and quality of life. METHODS: Between 2012 and May 2024, the Cochrane Library, Scopus, PubMed, and Web of Science were searched considering the Preferred Reporting Items for Systematic Reviews and Meta-Analyses checklist. Twenty-six randomized controlled trials were included, and 16 were synthesized in the meta-analysis. Bias risk was evaluated using the Cochrane risk-of-bias methodology for randomized studies. The Grading of Recommendations, Assessment, Development, and Evaluations tool was employed for evidence certainty. Heterogeneity was expressed through I2 and Q statistics. Hedge's g was calculated for effect sizes. Egger's and Kendall's Tau were used for publication bias. RESULTS: Spiritual interventions yielded beneficial effects on fatigue (Hedges's g = 0.900, p < 0.001) and pain (Hedges's g = 0.670, p < 0.001) but not for overall symptom burden (Hedges's g = 0.208, p = 0.176). Significant effects were found for anxiety (Hedges's g = 0.301, p < 0.001), depression (Hedges's g = 0.175, p = 0.016), and psychological distress (Hedges's g = 0.178, p = 0.024), except for hopelessness (Hedges's g = 0.144, p = 0.091). Spiritual interventions enhanced faith (Hedges's g = 0.232, p = 0.035), the meaning of life (Hedges's g = 0.259, p = 0.002), spiritual well-being (Hedges's g = 0.268, p < 0.001), and quality of life (Hedges's g = 245, p < 0.001). Moderator analysis pointed out that cancer stage, total duration, delivery format, providers' qualification, content, and conceptual base of spiritual interventions significantly affect physical, emotional, and spiritual outcomes and quality of life. CONCLUSION: This meta-analysis highlighted the benefits of spiritual interventions with varying effect sizes on patients' outcomes, as well as quality of life in cancer, and shed on how to incorporate these approaches into clinical practice.

Correlation between symptom status, health perception, and spiritual well-being in heart failure patients: A structural equation modeling approach.

AIM: To explore predictors of spiritual well-being behaviors among heart failure patients based on Wilson and Cleary's conceptual model of health-related quality of life and to clarify the interrelationships among these variables. DESIGN: A descriptive and correlational study design was used. METHODS: This study included 202 heart failure patients treated between October 2020 and July 2021. Data were collected using the Symptom Status Questionnaire-Heart Failure, Perception of Health Scale, and Functional Assessment of Chronic Illness Therapy-Spiritual Well-Being Scale. Descriptive analysis, correlation, and structural equation modeling were performed. RESULTS: Characteristic factors positively affected spiritual well-being both directly (ß = 0.19, p = 0.007) and indirectly (ß = 0.19; CI (0.106; 0.311)). The direct relationship between health perception and spiritual well-being was significant (ß = 0.83, p < 0.05). Symptom status acted as an essential mediator between model variables and spiritual well-being (ß = -0.28; CI (-0.449; -0.133)). Comorbidity and symptom status also influence spiritual well-being through health perceptions. These variables explain 77% of the variance in spiritual well-being. CONCLUSION: The modified structural equation modeling based on Wilson and Cleary's conceptual model fits well in predicting spiritual well-being in patients with heart failure. Spiritual well-being was reported to be poor, and changes in spiritual well-being were predicted by age, educational level, marital status, comorbidity, symptom status, and health perception. The results can be applied to patients with heart failure and may serve as a guide for assessment and interventions for improving spiritual well-being. CLINICAL RELEVANCE: This study mainly concludes that symptom status and perceived health status affect spiritual well-being in heart failure patients. Symptom relief and improvement in perceived health status interventions may help enhance spiritual well-being in this population. Future studies are needed to investigate the different predictor's effects on spiritual well-being and examine whether symptom management and health status-enhancing interventions result in improved spiritual well-being in the heart failure population. REPORTING METHOD: This study was reported following the Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) checklist for cross-sectional studies. PATIENT OR PUBLIC CONTRIBUTION: No patient or public contribution.

Theory-based nursing interventions in adults with coronary heart disease: A systematic review and meta-analysis of randomized controlled trials.

PURPOSE: This systematic review and meta-analysis aimed to synthesize the outcomes of theory-based nursing interventions for coronary heart disease management. DESIGN AND METHODS: Web of Science, Scopus, Science Direct, and PubMed databases were electronically searched from January 2013 to August 2021. The Preferred Reporting Item for Systematic Reviews and Meta-analyses statement guidelines was followed for this meta-analysis. Randomized controlled trials on patients with coronary heart disease, using a theory-based nursing intervention were eligible. Methodological quality was examined by two authors using the Modified Jadad Scale. Based on the heterogeneity test, the results were analyzed using a pool of data with 95% confidence intervals, p-values, and fixed or random-effect models (PROSPERO registration number X). FINDINGS: A total of 1030 studies were initially retrieved, and 8 randomized controlled trials were eventually included in the meta-analysis after screening. The big majority (81.3%) of participants were males, and the mean age was 54.8 (SD = 8.7) years. This meta-analysis found theory-based nursing interventions had no significant effect on blood lipid profile, blood pressure, and healthy lifestyle. However, these interventions significantly reduced fasting blood glucose, and body mass index and improved the physical and psychological domains of quality of life. CONCLUSIONS: The evidence from this meta-analysis reveals that theory-based nursing interventions have a positive effect on fasting blood glucose, body mass index, and quality of life. However, their effects on blood lipid profile, blood pressure, and a healthy lifestyle are inconclusive. The results of this metanalysis are largely based on a few trials and were limited in terms of the number of outcomes. Conducting well-designed randomized controlled trials with adequate power is needed to make a firm conclusion on the influence of theory-based nursing interventions on patient outcomes in the CHD population. CLINICAL RELEVANCE: Considering the high mortality and morbidity of coronary heart disease, nurses may play a significant role in coronary heart disease management by providing interventions that are based on a certain theoretical framework. This meta-analysis provides insights into the implementation of theory-based nursing interventions in heart attack survivors or those newly diagnosed with coronary heart disease led by nurses and lasting longer than 6 months in coronary heart disease. In addition, future studies should consider enhancing the content of training programs for a healthy lifestyle within the theory-based nursing interventions and compare the effects of these interventions on acute and chronic coronary syndromes.

Benson Relaxation Technique Combined With Music Therapy for Fatigue, Anxiety, and Depression in Hemodialysis Patients: A Randomized Controlled Trial.

This study aimed to investigate the effects of the Benson relaxation technique combined with music therapy on fatigue, anxiety, and depression levels of patients undergoing hemodialysis. This randomized controlled study was conducted with 61 patients (30 patients in the intervention group, 31 patients in the control group) in a province located in Turkey. This 8-week, randomized, clinical trial was carried out in 2 hemodialysis units. After the patients in both groups were informed about the study, the Piper Fatigue Scale and the Hospital Anxiety and Depression Scale were administered to the patients. All subdomain scores of the Piper Fatigue Scale in the intervention group were significantly lower at weeks 4, 8, and 10 than those of the control group (P < .05). The intervention group had significantly lower Anxiety subscale scores than those of the control group at week 10 (P < .05). Similarly, Depression subscale scores were significantly lower in the intervention group at weeks 8 and 10 than those in the control group (P < .05). The findings suggest that Benson relaxation technique combined with music therapy is an effective approach to manage fatigue, anxiety, and depression symptoms related to hemodialysis.

Aortic flow propagation velocity, epicardial fat thickness, and osteoprotegerin level to predict subclinical atherosclerosis in patients with nonalcoholic fatty liver disease.

OBJECTIVE: Nonalcoholic fatty liver disease is the most common cause of liver dysfunction in Western countries and an independent risk factor for atherosclerotic heart disease. Appropriate noninvasive parameters are lacking for optimal risk stratification of cardiovascular disease in these patients. We evaluated several recently discovered noninvasive parameters for atherosclerosis in patients with nonalcoholic fatty liver disease: epicardial fat thickness, aortic flow propagation velocity, and osteoprotegerin level. METHODS: Forty-one patients (27 men and 14 women; mean age, 37.9±8.9 years) with nonalcoholic fatty liver disease and 37 control subjects (17 men and 20 women; mean age, 34.5±8.6 years) were enrolled in this observational case-control study. Patients with nonalcoholic fatty liver disease diagnosed at a gastroenterology outpatient clinic were included. Patients with cardiac pathology other than hypertension were excluded. Epicardial fat thickness and aortic flow propagation velocity were measured by echocardiography. The serum concentration of osteoprotegerin was measured using a commercial enzyme-linked immunosorbent assay kit. RESULTS: Nonalcoholic fatty liver disease patients exhibited a significantly lower aortic flow propagation velocity (155.17±30.00 vs. 179.00±18.14 cm/s, p=0.000) and significantly higher epicardial fat thickness (0.51±0.25 vs. 0.29±0.09 cm, p=0.000) than control subjects. Osteoprotegerin levels were higher, but not significant, in patients with nonalcoholic fatty liver disease (28.0±13.0 vs. 25.2±10.8 pg/mL, p=0.244). Binary logistic regression analysis showed that aortic flow propagation velocity (OR, -0.973; 95% CI, 0.947-0.999) and waist circumference (OR, -1.191; 95% CI, 1.088-1.303) were independent predictors of nonalcoholic fatty liver disease. CONCLUSION: In this study, epicardial fat thickness and osteoprotegerin level were higher and aortic flow propagation velocity was lower in patients with nonalcoholic fatty liver disease. Early detection of abnormal epicardial fat thickness and aortic flow propagation velocity may warrant a search for undetected cardiovascular disease in patients with nonalcoholic fatty liver disease.

Conventional markers in determination of activity of sarcoidosis.

AIM AND BACKGROUND: Currently, there are no objective criteria to determine sarcoidosis activity. The present study aimed to discover a sensitive serum marker that would determine the activity of sarcoidosis and can be used during disease follow-up. METHODS: Forty-eight patients with sarcoidosis and twenty healthy volunteers as a control group were included in the study. On their control visits, the patients were divided into active and inactive groups based on their clinical, physiological, and radiological status. Angiotensin converting enzyme (ACE), adenosine deaminase (ADA), total IgE (T-IgE), C-reactive protein (CRP), serum amyloid-A (SAA), and soluble interleukin-2 receptor (sIL2R) serum levels and classical findings of activity were compared, and the utilization of these parameters as markers of activity was investigated. RESULTS: Thirty-nine cases were female (female/male: 39/9) and the mean age was 44.29±10.9years. Thirty-seven cases were active and 11 cases were inactive. Serum ACE, ADA, sIL2R, and SAA levels were significantly higher while T-IgE levels were lower in the sarcoidosis cases. A comparison of the markers between active and inactive cases showed that only SAA was significantly higher (p<0.001). sIL2R was elevated in cases with extra-pulmonary involvement (p<0.014). The area under the curve value was rather high for ADA (0.98 CI: 0.96-1.0); it also had high sensitivity (93.8%) and specificity (100%), and therefore had the highest diagnostic value (96.6%). CONCLUSION: The current study showed that SAA wil be helpfull for detecting the activity of srcoidosis, IL2R measurement in exploring the extra-pulmonary organ involvement.

Vitamin D deficiency is related to thyroid antibodies in autoimmune thyroiditis.

INTRODUCTION: It has been known that vitamin D has some immunomodulatory effects and in autoimmune thyroid diseases, vitamin D deficiency was more prevalent. In this study, our aim was to investigate the relationship between thyroid autoantibodies and vitamin D. MATERIAL AND METHODS: Group 1 and 2 consisted of 254 and 27 newly diagnosed Hashimoto's thyroiditis (HT) and Graves' disease (GD) cases, respectively; age-matched 124 healthy subjects were enrolled as controls (group 3). All subjects (n = 405) were evaluated for 25OHD and thyroid autoantibody [anti-thyroid peroxidase (anti-TPO) and anti-thyroglobulin (anti-tg)] levels. RESULTS: Group 2 and group 1 patients had lower 25OHD levels than group 3 subjects 14.9 ±8.6 ng/ml, 19.4 ±10.1 ng/ml and 22.5 ±15.4 ng/ml, respectively (p < 0.001). Serum 25OHD levels inversely correlated with anti-tg (r = -0.136, p = 0.025), anti-TPO (r = -0.176, p = 0.003) and parathormone (PTH) (r = -0.240, p < 0.001). Group 2 patients had higher anti-tg and anti-TPO levels than group 1 and 3 (p < 0.001). CONCLUSIONS: In this study, we found that patients with autoimmune thyroid disease (AITD) present with lower vitamin D levels and GD patients have higher prevalence. Since we found an inverse correlation between vitamin D levels and thyroid antibody levels, we may suggest that vitamin D deficiency is one of the potential factors in pathogenesis of autoimmune thyroid disorders.

The decreased CD4+CD25+ FoxP3+ T cells in nonstimulated allergic rhinitis patients sensitized to house dust mites.

OBJECTIVE: Regulatory (CD4(+)CD25(+)) T cells have been shown to play an important role in the development of allergic diseases. This study aims to investigate CD4(+)CD25(+) T cells, Forkhead box P3 (FoxP3(+) cells), and T-helper 1/T-helper 2 (Th1/Th2) cytokines in newly diagnosed allergic rhinitis (AR) patients. METHODS: Altogether, 10 subjects with AR and 12 age-matched nonallergic healthy subjects were included in this study. CD4(+)CD25(+) T cells, FoxP3(+) T cells in peripheral blood mononuclear cells (PBMCs) were evaluated by flow cytometry, and the Th1/Th2 cytokine levels were determined by cytometric bead array immunoassay in both PBMC supernatants and nasal lavage fluids. RESULTS: The percentage of CD4(+)CD25(+) T cells were significantly higher, whereas the percentage of FoxP3(+) cells were lower in AR patients compared with healthy subjects. In PBMC culture supernatants, interleukin-10 (IL-10) levels were significantly lower (p = .012), whereas IL-4, IL-5, and tumor necrosis factor-α (TNF-α) levels in nasal lavage fluids were higher in AR patients compared with healthy subjects (p = .026, p = .015, p = .03, respectively). CONCLUSIONS: Our findings indicate that decrease in CD4(+)CD25(+)FoxP3(+) T cell fraction and diminished levels of IL-10 are noteworthy without allergen stimulation in house dust mite AR patients.

Enhanced nerve growth factor expression by mast cells does not differ significantly between idiopathic and allergic rhinitis.

BACKGROUND: The role of neurotrophins in allergic rhinitis (AR) has been well studied, but it has not been evaluated in idiopathic rhinitis (IR). OBJECTIVE: We aimed to evaluate the nasal ß-nerve growth factor (ß-NGF) expressions of mast cells in patients with AR and IR. METHODS: Seventeen patients with house dust mites-induced persistent moderate/severe allergic rhinitis (mean age: 29.7 ± 11.96), 14 patients with idiopathic rhinitis (mean age, 29.3 ± 10.62), and 16 healthy controls (29.9 ± 11.57) were included in the study. Nasal biopsy specimens were taken from the posterior part of the inferior turbinate from all of the study subjects. Nasal ß-nerve growth factor and its receptors, pan-neurotrophin receptor p75, and tyrosine kinase A (trkA) were assessed with an immunofluorescence assay. Mast cells were determined by both an immunofluorescence assay and immunohistochemistry as tryptase-positive cells. RESULTS: The ß-NGF, trkA, and p75 receptor counts were significantly higher in AR and IR patients than in the control group (P < .001, for each), but they were not different between AR and IR patients. Similarly, the ratio of ß-NGF+ mast cells/total mast cells and the ratio of ß-NGF+ mast cells/total ß-NGF+ cells in AR and IR patients was found to be elevated when compared with the control group (P < .001, P < .001, P < .001, and P = .046, respectively); furthermore, the 2 ratios were not statistically different between the 2 patient groups. CONCLUSION: The increase in ß-NGF-expressing mast cells does not differ between idiopathic and allergic rhinitis. Therefore, we propose that mast cells do play a role in the pathogenesis of IR as important as in that of AR.

Tumor necrosis factor alpha, interleukin-6 and interleukin-10 polymorphisms in preeclampsia.

AIM: Preeclampsia (PE) is one of the most serious disorders of pregnancy. The imbalance between pro- and anti-inflammatory cytokines may play a role in its etiology. The aim of the present study was to investigate whether cytokine gene polymorphism is associated with PE, and to evaluate the relationship between genotypes and clinical/laboratory manifestation of PE. METHODS: We investigated single nucleotide polymorphisms of tumor necrosis factor (TNF)alpha(-308 G/A), interleukin (IL)-6 (-174 G/C), IL-10 (-1082 G/A) genes in DNA from peripheral blood leukocytes of 101 PE patients and 95 healthy control women. RESULTS: In PE, there was a significant increase of the IL-10 (-1082) A allele frequency (P = 0.04). No significant differences were found in genotypes or allele frequencies of TNFalpha(-308) and IL-6 (-174) genes between PE women and controls. While TNFalpha(-308) and IL-6 (-174) genotypes did not influence clinical/laboratory parameters in PE, IL-10 (-1082) A allele carrying genotypes (AG + AA) were associated with higher glucose and lower HDL-cholesterol levels. CONCLUSION: Because women with IL-10 (-1082) AA genotype have 3.38-fold increased risk of developing PE according to GG genotype (95% CI 1.21-9.4, P = 0.01), we suggest that IL-10 (-1082) variant A allele is associated with an increased risk of preeclampsia, which is independent from its metabolic effects.

Neurotrophins: are they meaningful in chronic spontaneous urticaria?

Plasma neurotrophin levels are elevated in patients with allergic and autoimmune diseases. The present study was designed to investigate the serum neurotrophin levels in 42 patients displaying chronic spontaneous urticaria, as well as 22 healthy control subjects. Blood samples were obtained from subjects during their first visit to the clinic, and then again after one month of desloratadine therapy. No significant difference was found between patient and control groups in terms of basal serum neurotrophin levels. However, basal nerve growth factor levels in patients whose symptoms persisted despite treatment were significantly lower than those of the drug-responsive patients and the control group. In treatment-responsive patients, nerve growth factor increased after suppression of the symptoms. Our study suggests that chronic spontaneous urticaria is linked with changes serum nerve growth factor levels, and that the deregulation of neurotrophins may contribute to urticaria pathophysiology.