Efficacy of acupuncture on cancer pain: A systematic review and meta-analysis.

BACKGROUND: Pain associated with cancer is one of the greatest causes of reduced quality of life in patients. Acupuncture is one of the treatments used to address this issue, with the great advantage of having little or no side effects, especially when compared with pharmacological pain-killers. OBJECTIVE: The aim of this systematic review and meta-analysis was to evaluate the current evidence regarding the efficacy of acupuncture for cancer pain. SEARCH STRATEGY: Six electronic databases (PubMed, EBSCO, Cochrane Library, Scielo, b-On and Scopus) were searched for relevant articles about pain relief in cancer patients from their beginning until 2022 using MeSH terms such as "acupuncture," "electroacupuncture," "ear acupuncture," "acupuncture analgesia," ''oncological pain," and "cancer pain." INCLUSION CRITERIA: Studies included were randomized controlled trials (RCTs) where acupuncture was compared with no treatment, placebo acupuncture or usual care. DATA EXTRACTION AND ANALYSIS: Three independent reviewers participated in data extraction and evaluation of risk of bias, and a meta-analysis was conducted. The primary outcome was pain intensity, measured with the visual analog scale, numeric rating scale, or brief pain inventory. Secondary outcomes also assessed were quality of life, functionality, xerostomia, pain interference, and analgesic consumption. Results were expressed as standardized mean difference (SMD) with 95% confidence interval (CI). RESULTS: Sixteen RCTs with a total of 1124 participants were included in the meta-analysis, with the majority of the studies presenting a low or unclear risk of bias. Acupuncture was more effective in reducing pain than no treatment (SMD = -0.90, 95 % CI [-1.68, -0.12]), sham acupuncture (SMD = -1.10, 95 % CI [-1.59, -0.61]) or usual care (SMD = -1.16, 95 % CI [-1.38, -0.93]). CONCLUSION: The results of this study suggest that acupuncture may be an effective intervention to reduce pain associated with cancer. Despite some limitations due to the low quality and small sample size of some included studies, as well as the different types and stages of cancer, acupuncture might provide an effective and safe treatment to reduce cancer pain. Please cite this article as: Faria M, Teixeira M, Pinto MJ, Sargento P. Efficacy of acupuncture on cancer pain: A systematic review and meta-analysis. J Integr Med. 2024; 22(3): 235-244.

Systematic review and meta-analysis of the prevalence of coronavirus: One health approach for a global strategy.

Coronaviruses have been responsible for major epidemic crises in 2003 with SARS-CoV-1, in 2012 with MERS-CoV and in 2019 with SARS-CoV-2 (COVID-19), causing serious atypical pneumonia in humans. We intend, with this systematic analysis and meta-analysis, to clarify the prevalence of the various strains of coronavirus in different animal species. For this purpose, we carried out an electronic survey using Pubmed's Veterinary Science search tool to conduct a systematic assessment of published studies reporting the prevalence of different strains of coronavirus in different animal species between 2015 and 2020. We conducted different analysis to assess sensitivity, publication bias, and heterogeneity, using random effect. The final meta-analysis included 42 studies for systematic review and 29 in the meta-analysis. For the geographic regions with a prevalence greater than or equal to 0.20 (Forest plot overall; prevalence = 0.20, p < 0.01, Q = 10,476.22 and I2 = 100%), the most commonly detected viruses were: enteric coronavirus (ECoV), pigeon-dominant coronavirus, (PdCoV), Avian coronavirus M41, Avian coronavirus C46, Avian coronavirus A99, Avian coronavirus JMK, MERS-CoV, Bovine coronavirus, Ro-BatCoV GCCDC1, Alphacoronavirus, Betacoronavirus, Deltacoronavirus, Gamacoronavirus and human coronaviruses (HCoVs). The wide presence of different strains of coronavirus in different animal species on all continents demonstrates the great biodiversity and ubiquity of these viruses. The most recent epidemiological crises caused by coronavirus demonstrates our unpreparedness to anticipate and mitigate emerging risks, as well as the need to implement new epidemiological surveillance programs for viruses. Combined with the need to create advanced training courses in One Health, this is paramount in order to ensure greater effectiveness in fighting the next pandemics.

The role of social support in suicidal ideation: a comparison of employed vs. unemployed people.

Background: With the financial crisis, the number of unemployed has grown up, and so has suicidal ideation in these individuals. Although extensive research has been done about the factors associated with it, studies about protective factors are also necessary.Aims: To examine the relationship between unemployment and suicidal ideation, and the protective effect of social support.Methods: Participants were 149 people in full-time employment (age M = 41.63, SD = 10.37), 55 unemployed (M = 42.25, SD = 10.23 years), and 32.72 months average unemployment time (SD = 26.13). Instruments were a sociodemographic questionnaire, the Suicide Ideation Questionnaire (SIQ) and the Social Support Appraisal (SSA). Results: Suicidal ideation was significantly higher in the unemployed group, and positively associated with duration of unemployment. Social support, both from family and friends, was found to be a protective factor in suicidal ideation, particularly in long-term unemployment.Limitations: Cross-sectional study, convenience sample.Conclusions: Suicidal ideation is markedly present in unemployed individuals, particularly those unemployed for a year or more, and social support from family and friends may act as a significant protective factor.

Sensitivity and specificity of Frontal Assessment Battery in newly diagnosed and untreated obstructive sleep apnea patients.

BACKGROUND: Executive dysfunction (ED) is often observed in subjects diagnosed with obstructive sleep apnea (OSA), but their assessment requires facilities that are not always available. We aim to evaluate the extent to which Frontal Assessment Battery (FAB) discriminates ED in newly diagnosed, untreated, and without-comorbidity OSA patients. METHODS: Sixty subjects participated in the study. Of these, 40 (31 males and 9 females) were newly diagnosed for OSA through full-night polysomnography (apnea/hypopnea index; M = 39.01, SD = 27.16), untreated, with a mean age of 54.50 years (SD = 8.90), while the remaining 20 (15 males and 5 females) had no symptoms of OSA (M = 51.60 years, SD = 10.70). The instruments used were the following: Questionnaire for Sleep Apnea Risk, Epworth Sleepiness Scale, Mini-Mental State Examination, and FAB. RESULTS: The group with OSA exhibited significantly lower values in the FAB global score (p = 0.003) and in Conceptualization (p = 0.001) and Mental Flexibility (p = 0.009) subtests. ROC analysis showed adequate discriminative capacity for the FAB global score (AUC = 0.74) and for Conceptualization (AUC = 0.75) and Mental Flexibility (AUC = 0.70) scores. CONCLUSIONS: The FAB is a short and no-time-consuming tool that can be used to investigate the presence of ED in untreated OSA patients with no comorbidities, providing clinicians with a simple and effective way of detecting the presence of this dysfunction and allowing a more informed decision for the need of a full neuropsychological assessment.

The Epworth Sleepiness Scale in Portuguese adults: from classical measurement theory to Rasch model analysis.

BACKGROUND: The Epworth Sleepiness Scale (ESS) is a largely wide used scale for sleepiness assessment. Measurement properties are studied in a sample of Portuguese adults, using different statistical procedures. METHODS: The sample consisted of 222 Portuguese adults (97 men and 125 women) with a mean age of 42 years old (SD = 12.5), 46 of which had obstructive sleep apnea (OSA) confirmed by polysomnography. The participants were assessed with the ESS, which was tested through a quantitative analysis based on the classical measurement theory (CMT) or the Rasch model (RM) conventions. RESULTS: A principal component factor analysis was performed according to the CMT, revealing a single factor explaining 39.92% of the total variance of the scale. Internal consistency measured by Cronbach's α coefficient was of .77. The mean of inter-item correlation was of .31 (.05 < r > .47), whereas the item-total correlations were considered good (.46 < r > .73). The ESS total score for OSA patients was significantly higher than healthy participants (p < .05). Overall data from the RM analysis was consistent with the guidelines of Linacre and essential unidimensionality was empirically corroborated (61% the percentage of variance explained by the Rasch analysis). Model fit is adequate and the reliability coefficients for both items (.99) and subjects (.78) were considered good. The Cronbach's α coefficient was also satisfactory (.78). CONCLUSIONS: The ESS showed an adequate structural, internal, and criterion validity, both in the CMT and the RM, suggesting this as a useful and effective measure for assessing sleepiness in Portuguese adults.

Measurement properties of a screening questionnaire of obstructive sleep apnea risk: Little information, great prediction?(☆).

INTRODUCTION: Previous research had shown the suitability of several questionnaires predicting the obstructive sleep apnea syndrome. Measurement properties of an online screening questionnaire were studied. METHODS: The sample consisted of 184 Portuguese adults (89 men and 95 women); 46 of them were polysomnographically diagnosed with the untreated obstructive sleep apnea syndrome. The participants were assessed with an online questionnaire of sleep apnea risk, from University of Maryland. RESULTS: A principal component factor analysis was performed, revealing a single factor (49.24% of the total variance). Internal consistency was minimally adequate (α=0.74). The mean of inter-item correlation was of 0.35 (0.120.61), whereas the item-total correlations were considered good (0.520.81). The total score for patients was significantly higher than for healthy participants (p<0.000), but no significant statistical differences between severity groups of patients were found (p>0.05). Furthermore, the ability of the measure in discriminating between healthy subjects and OSA subjects was good. Overall data from the Rasch analysis was consistent with the guidelines of Linacre, scores show good model fit and psychometric adequacy. CONCLUSIONS: The measure showed an adequate structural, internal and criterion validity, suggesting this as a useful and effective screening for sleep apnea risk in Portuguese adults.