ICD-11 post-traumatic stress disorder and complex post-traumatic stress disorder in mental health support-seeking former-serving Australian defence force veterans.

BACKGROUND: ICD-11 complex post-traumatic stress disorder is a more severe condition than post-traumatic stress disorder, and recent studies indicate it is more prevalent among military samples. In this study, we tested the psychometric properties of the International Trauma Questionnaire, assessed the relative prevalence rates of post-traumatic stress disorder and complex post-traumatic stress disorder in the sample population and explored relationships between complex post-traumatic stress disorder and post-traumatic stress disorder and a range of risk factors. METHODS: Survey participants (N = 189) were mental health support-seeking former-serving veterans of the Australian Defence Force (ADF) recruited from primary care. Confirmatory factor analysis was used to test the factorial validity of the International Trauma Questionnaire. RESULTS: The latent structure of the International Trauma Questionnaire was best represented by a two-factor second-order model consistent with the ICD-11 model of complex post-traumatic stress disorder. The International Trauma Questionnaire scale scores demonstrated excellent internal reliability. Overall, 9.1% (95% confidence interval = [4.8%, 13.5%]) met diagnostic requirements for post-traumatic stress disorder and an additional 51.4% (95% confidence interval = [44.0%, 58.9%]) met requirements for complex post-traumatic stress disorder. Those meeting diagnostic requirements for complex post-traumatic stress disorder were more likely to have served in the military for 15 years or longer, had a history of more traumatic life events and had the highest levels of depression, anxiety and stress symptoms. CONCLUSION: The International Trauma Questionnaire can effectively distinguish between post-traumatic stress disorder and complex post-traumatic stress disorder within primary care samples of Australian Defence Force veterans. A significantly greater proportion of Australian Defence Force veterans met criteria for complex post-traumatic stress disorder than post-traumatic stress disorder. Australian military mental health services should adopt the International Trauma Questionnaire to routinely screen for complex post-traumatic stress disorder and develop complex post-traumatic stress disorder specific interventions to promote recovery in Australian Defence Force veterans with complex post-traumatic stress disorder.

Behavioural activation for depressive symptoms in young people with emerging or early psychosis: A pilot study protocol.

BACKGROUND: Theoretically, behavioural activation may have a valuable role to play in the treatment of depression among young people with emerging/early psychosis, however we lack trial evidence concerning its acceptability and feasibility. This study will establish the feasibility of clinician-delivered behavioural activation as an adjunct to standard care for this population. We aim to train and support clinicians in delivering behavioural activation to improve depressive symptoms in young people with early/emerging psychosis. Our objectives are to: Establish the number of young people with early/emerging psychosis with clinically meaningful depression symptoms.Establish the proportion of clinicians that complete the behavioural activation training and are deemed to be competent.Determine the proportion of eligible participants approached who agree to consent to the research.Determine the proportion of participants that complete baseline measures, complete behavioural activation treatment (attending for at least fifteen minutes in a minimum of eight sessions), and complete follow-up measures (immediately post-intervention and at 3 months follow-up).Establish clinicians' fidelity to treatment (by recording randomly selected treatment sessions and completing a fidelity checklist).Calculate preliminary efficacy of behavioural activation against primary and secondary outcomes.Explore participants' experiences of facilitating behavioural activation (clinicians) and receiving behavioural activation (young people with emerging/early psychosis). METHOD: This is a pilot controlled clinical trial with a two-arm parallel-group study. Approximately 60 young people with emerging/early psychosis will be randomly allocated to either behavioural activation treatment plus standard care or standard care alone. The primary outcome: depressive symptoms; and secondary outcomes: negative symptoms, overall psychiatric symptoms, medication side effects and functioning, will be assessed at baseline, post-intervention and at 3-months follow-up. The protocol is registered with the Australian New Zealand Clinical Trials Registry (reference number: ACTRN12622000756729). DISCUSSION: The findings will inform the design of a full-scale randomised controlled trial.

Self-Managed Non-Pharmacological Interventions for Breast Cancer Survivors: Systematic Quality Appraisal and Content Analysis of Clinical Practice Guidelines.

Background: A growing number of clinical practice guidelines (CPGs) regarding non-pharmacological interventions for breast cancer survivors are available. However, given the limitations in guideline development methodologies and inconsistent recommendations, it remains uncertain how best to design and implement non-pharmacological strategies to tailor interventions for breast cancer survivors with varied health conditions, healthcare needs, and preferences. Aim: To critically appraise and summarise available non-pharmacological interventions for symptom management and health promotion that can be self-managed by breast cancer survivors based on the recommendations of the CPGs. Methods: CPGs, which were published between January 2016 and September 2021 and described non-pharmacological interventions for breast cancer survivors, were systematically searched in six electronic databases, nine relevant guideline databases, and five cancer care society websites. The quality of the included CPGs was assessed by four evaluators using The Appraisal of Guidelines for Research and Evaluation, second edition tool. Content analysis was conducted to synthesise the characteristics of the non-pharmacological interventions recommended by the included CPGs, such as the intervention's form, duration and frequency, level of evidence, grade of recommendation, and source of evidence. Results: A total of 14 CPGs were included. Among which, only five were appraised as high quality. The "range and purpose" domain had the highest standardized percentage (84.61%), while the domain of "applicability" had the lowest (51.04%). Five CPGs were rated "recommended", seven were "recommended with modifications", and the other two were rated "not recommended". The content analysis findings summarised some commonly recommended self-managed non-pharmacological interventions in the 14 guidelines, including physical activity/exercise, meditation, hypnosis, yoga, music therapy, stress management, relaxation, massage and acupressure. Physical activity/exercise was the most frequently recommended approach to managing psychological and physical symptoms by the included guidelines. However, significant variations in the level of evidence and grade of recommendation were identified among the included CPGs. Conclusion: Recommendations for the self-managed non-pharmacological interventions were varied and limited among the 14 CPGs, and some were based on medium- and low-quality evidence. More rigorous methods are required to develop high-quality CPGs to guide clinicians in offering high-quality and tailored breast cancer survivorship care.

Recruitment, attrition and intervention completion in clinical trials of psychosocial interventions involving people with early and emerging psychosis: a systematic review protocol.

INTRODUCTION: Psychosocial interventions for people experiencing early and emerging psychosis have demonstrated efficacy in reducing symptom severity and supporting recovery; however, much remains unknown about optimising treatment and future research trials are required. Gaining a better understanding of feasibility in trials of psychosocial interventions involving this population would inform the design and planning of future research and support the development of high-quality evidence. The aim of this systematic review is to evaluate the recruitment rate, study attrition rates and intervention completion of psychosocial intervention randomised controlled trial studies involving people with early and emerging psychosis. METHODS AND ANALYSIS: The systematic review will be reported in adherence with the Preferred Reporting Items for Systematic Reviews and Meta-Analysis Protocols 2015 guideline. The Cochrane Library, PubMed, Medline, PsycINFO, Web of Science and CINAHL databases will be searched from inception to September 2021 to identify potentially relevant studies. The title and abstracts of returned records will be assessed for eligibility against the inclusion/exclusion criteria by two reviewers, independently, and records which appear eligible will be included. The full texts of included records will then be assessed using the same procedure. Qualitative and quantitative synthesis will be undertaken. Proportion meta-analyses will be used to calculate the recruitment rate, study attrition rate and intervention completion rate, while subgroup analyses will explore differences among subgroups of study and intervention characteristics. ETHICS AND DISSEMINATION: This study will collate and analyse anonymised data from published research and therefore, ethical approval is not necessary. Study results will be disseminated via publication in academic journals.

Assessment tools measuring health-related empowerment in psychosocially vulnerable populations: a systematic review.

BACKGROUND: Many programs are undertaken to facilitate the empowerment of vulnerable populations across the world. However, an overview of appropriate empowerment measurements to evaluate such initiatives remains incomplete to date. This systematic review aims to describe and summarise psychometric properties, feasibility and clinical utility of the available tools for measuring empowerment in psychosocially vulnerable populations. METHODS: A systematic literature review following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines was completed. A descriptive approach was used for data analysis. Papers were eligible if they explored the development, validation, cross-cultural translation or the utility of an empowerment measurement tool in the context of psychosocially vulnerable populations. RESULTS: Twenty-six included articles described twenty-six separate studies in which 16 empowerment measurement tools were developed, validated/translated, or used. There was heterogeneity in empowerment constructs, samples targeted, and psychometric properties measured. The measurement of reliability of the included instruments was satisfactory in most cases. However, the validity, responsiveness, interpretability, feasibility and clinical utility of the identified measurement tools were often not adequately described or measured. CONCLUSION: This systematic review provides a useful snapshot of the strengths as well as limitations of existing health related empowerment measurement tools used with psychosocially vulnerable populations in terms of their measurement properties, and constructs captured. It highlights significant gaps in empowerment tool measurement, development and evaluation processes. In particular, the results suggest that in addition to systematic assessments of psychometric properties, the inclusion of feasibility and clinical utility as outcome measures are important to assess relevance to clinical practice.

Massage Therapy for Fatigue Management in Breast Cancer Survivors: A Systematic Review and Descriptive Analysis of Randomized Controlled Trials.

BACKGROUND: Fatigue is one of the most common symptoms among breast cancer survivors. Although massage therapy has been commonly used for fatigue management, relevant evidence on the effectiveness of massage therapy for the reduction of fatigue in breast cancer survivors is still unclear. OBJECTIVE: To identify the research evidence on the effectiveness and safety of massage therapy to manage fatigue in breast cancer survivors and summarize the characteristics of massage therapy protocols utilized for fatigue management in breast cancer survivors. METHODS: Randomized controlled trials (RCTs) using massage therapy to manage cancer-related fatigue were searched in PubMed, Medline, Web of Science, Cochrane Library, Cumulative Index to Nursing and Allied Health Literature (CINAHL), ScienceDirect, PsycINFO, Wan Fang Data, and China National Knowledge Infrastructure (CNKI) from the inception of each database to March 2021. The Cochrane Back Review Group Risk of Bias Assessment Criteria was used to assess the methodological quality of the included studies. Descriptive analysis was applied for a summary and synthesis of the findings. The primary outcome was fatigue measured by any patient-reported questionnaires, and the secondary outcomes were quality of life and massage-therapy-related adverse events. RESULTS: Ten RCTs were included. Massage therapy was found to have a positive effect on fatigue management compared with routine care/wait list control groups and sham massage. Despite these encouraging findings, the review concluded that most of the included studies exhibited an unsatisfactory experimental design, particularly, inadequate blinding and allocation concealment. The duration and frequency of the massage therapy interventions varied across the studies. Adverse events were reported in three included studies, with no study conducting causality analysis. CONCLUSION: This systematic review provides the latest research evidence to support massage therapy as an encouraging complementary and alternative medicine approach to managing fatigue in breast cancer survivors. More rigorously designed, large-scale, sham-controlled RCTs are needed to further conclude the specific therapeutic effectiveness and safety issues of massage therapy for fatigue management.

Transforming their lives: post-traumatic growth experience in Chinese women with breast cancer-a grounded theory study.

Our research sought to explore post-traumatic growth experience among Chinese women with breast cancer. Constructivist grounded theory methodology was utilised to understand Chinese women's post-traumatic growth experience. 24 women with breast cancer were recruited from China. Data was collected through semi-structured, interviews. Three categories were developed from the data: renewing self-perception, encountering changes in relationships, and altering philosophical values and beliefs. The unique manifestations of post-traumatic growth highlight the need for development and adaption of the post-traumatic growth inventory to reduce cultural biases within the assessment tool and incorporate new culturally appropriate items.

miR-218 inhibits glucose metabolism in non-small cell lung cancer via the NF-κB signaling pathway.

High glucose metabolism is recognized as one of the hallmarks of cancer and increased expression levels of several key factors involved in glucose metabolism have been reported in non-small cell lung cancer (NSCLC). Previous studies showed that microRNA (miR)-218 is reduced in NSCLC, but its function in glucose metabolism in NSCLC is not fully understood. The present study aimed to investigate the effect of miR-218 on glucose metabolism in NSCLC cell lines and the underlying molecular mechanism. The present results suggested that miR-218 reduced glucose consumption, the mechanism of glycolysis and activity in the pentose phosphate pathway. In addition, glucose transporter 1 (GLUT1) was identified to be a direct target of miR-218, while overexpression of GLUT1 did not abolish the effect of miR-218 on glucose metabolism. The present results indicated that phosphorylation of NF-κB p65 was significantly decreased by miR-218 in NSCLC cells and that activation of NF-κB led to the inhibition of miR-218 regulation of glucose metabolism. In conclusion, the present results suggested that miR-218 downregulated glucose metabolism in NSCLC not only by directly targeting GLUT1, but also via the NF-κB signaling pathway.

Emerging From the "Ku:" Fluctuating in Adjusting With Breast Cancer-A Post-Traumatic Growth Theory Situated Within Chinese Culture.

This purpose of the study was to construct a model (theory) to understand Chinese women's adjustment process in living with breast cancer. A constructivist grounded theory method was adopted in this study. A total of 24 women were recruited through purposive and theoretical sampling. Semi-structured, audio-recorded interviews were undertaken in Chinese and transcribed. Initial coding, focused coding, and theoretical coding approaches were used to identify subcategories and categories, and to construct the emergent theory. The basic social process these women used to deal with the breast cancer diagnosis was identified as: Emerging from the 'ku': Fluctuating in adjusting with breast cancer. Four categories were revealed following analysis: confronting challenges, orienting to reality, accommodating the illness, and transforming their lives, which encapsulated the main cognitive and emotional processes in which Chinese women engaged in their adjustment to living with their illness. The core process was influenced by a variety of contextual influences, which were identified as personal factors, social-environmental factors, and some specific cultural factors which emphasized positive changes. Chinese cultural values such as "Wuwei" coping strategies, familial primacy, and Chinese self-disclosure contribute to Chinese women's adjustment processes and post-traumatic growth experiences. Hence, there is a need to consider Chinese cultural features, in designing culturally tailored supportive programs in multi-cultural clinical settings.

Posttraumatic growth experiences and its contextual factors in women with breast cancer: An integrative review.

In this article, we synthesize current research that examines determinants and manifestations of posttraumatic growth (the phenomenon of posttraumatic growth can be embodied in several domains) in women with breast cancer. The findings of the integrative literature review may contribute to facilitating person-centered oncology care by raising health care professionals' awareness and understanding of posttraumatic growth phenomenon among breast cancer survivors. The identification of factors contributing to posttraumatic growth and manifestations of posttraumatic growth are important in increasing the effectiveness of interventions in supporting women during their breast cancer journey. The methods proposed by Whittemore and Knafl ( 2005 ) were adopted to guide this integrative review. Quality assessment was conducted using recognized critical appraisal tools relating to quantitative and qualitative studies. Four main manifestations were synthesized from the literature: new perception of self; relatedness to others; new life philosophy; and spiritual and religious growth. Personal characteristics, illness factors, cognitive processing, coping strategies, social support, religion and spirituality, the body's role and physical activities were identified as influencing posttraumatic growth in women with breast cancer.

Polymorphisms in NF-κB pathway genes & their association with risk of lung cancer in the Chinese population.

OBJECTIVE: To investigate the association of NFKB1 -94 ins/del ATTG, NFKBIA -826C>T and NFKBIA -881A>G polymorphisms with risk of lung cancer in a Chinese population. METHODS: Genotyping of the polymorphisms were performed on 1,436 subjects (718 cases and 718 controls) by using PCR-RFLP technique, followed by DNA sequencing. RESULTS: We found a significant risk reduction associated with heterozygous ins/del (OR=0.705, 95% CI=0.566-0.878, P=0.002) and variant del/del (OR=0.342, 95% CI=0.221-0.528, P<0.001) genotypes of the NFKB1 polymorphism. In contrast, the heterozygous and variantgenotypes of theNFKBIA polymorphisms showed association with increased lung cancer risk (NFKBIA -826 CT,OR=1.256, 95%CI=1.004-1.572, P=0.046; TT,OR=1.773, 95% CI=1.131-2.778, P=0.013; NFKBIA -881 AG,OR=1.277, 95% CI=1.023-1.599, P=0.031; GG,OR=1.801, 95% CI=1.169-2.775, P=0.008). Several genotypic combinations of the three polymorphisms also showed significant association with lung cancer risk. The risk association of NFKB1 polymorphism remained significant when analyses were done according to gender and smoking status (P<0.05). The significance of NFKBIA risk association was not observed when gender-specific analyses were made (P>0.05), while only NFKBIA -881 GG genotype showed significant risk association among smokers when analyzed according to smoking status (P=0.032). CONCLUSIONS: Polymorphisms in NFKB1 and NFKBIAgenes were associated with risk of lung cancer.

Post-trauma growth in a mainland Chinese population with chronic skin disease.

OBJECTIVES: This study aimed to determine the underlying factor structure of the mainland Chinese version of the Post-traumatic Growth Inventory (PTGI-MC) and the determinants of post-trauma growth (PTG). METHODS: A total of 297 participants who had been treated for chronic skin diseases completed the PTGI-MC and other self-report inventories assessing resilience, optimism, hope, and self-efficacy. RESULTS: Similarly to other populations which have experienced trauma and adversity, chronic skin disease patients also report PTG. Exploratory factor analysis and confirmatory factor analysis showed a factor structure that differed from that of the original English-language version of the PTGI. The dimensions of growth could also be broadly summarized into three dimensions in this mainland Chinese sample. Stepwise regression analysis showed that resilience was the strongest determinant of PTG compared with optimism, hope, and self-efficacy. DISCUSSION: Implications for further research and interventions facilitating PTG are discussed.

What does posttraumatic growth mean to Chinese burn patients: a phenomenological study.

The purpose of this research was to explore dimensions of posttraumatic growth (PTG) in the population of mainland China and to find out the factors facilitating positive change. Ten patients with severe burn injuries were recruited from a metropolitan hospital in Shanghai. Sampling was purposive; qualitative phenomenological methodology was used to depict the main theme, the data were collected through individual semi-structured interviews using open-ended questions. A reflective diary was also kept. The findings are presented under two thematic headings: "process of PTG" and "presentation of PTG." Results indicate that there are commonalities between the Chinese sample and Tedeschi and Calhoun's (Psychol Inq 2004;15:1-18) model of the process and outcomes of PTG. There are some differences; specifically, "for the significant others" is an important facet in the process of PTG; also there is no clear growth of a spiritual or a religious aspect.

Coping strategies of eight patients with significant burn injury.

The aim of this study was to describe the differences in coping strategies that affected psychological and physical rehabilitation in Chinese burn patients. Eight burn survivors with TBSA more than 30% or full-thickness area more than 10% had been interviewed. In depth, information on the strategies used to address physiological and psychological damage was collected on these patients. We found that optimistic personality, positive coping styles, and social support played very important roles. Coping techniques aimed at passing time were frequently used, whereas religious coping was seldom used. The availability of a mentor was beneficial to the patients. Therefore, instruction on coping techniques such as searching for a mentor and promoting recreation should be approached by health professionals in burn care units and taught to burn patients.