ORCID Profile
0000-0003-4312-6909
Current Organisations
Norwegian Institute of Public Health
,
Universidad de Granada, Facultad de Medicina
,
Universidad Santo Tomas
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Publisher: Elsevier BV
Date: 10-2023
Publisher: American Association for Cancer Research (AACR)
Date: 30-06-2016
DOI: 10.1158/1055-9965.EPI-15-1061
Abstract: Several sources of evidence indicate that exercise during and after breast cancer could positively modulate the tumor microenvironment. This meta-analysis aimed to determine the effects of exercise training on mediators of inflammation in breast cancer survivors. We searched for randomized controlled trials published from January 1990 to March 2014. An inverse variance method of meta-analysis was performed using a random effects model in the presence of statistical heterogeneity. Eight high-quality trials (n = 478) were included. Exercise improved the serum concentrations of IL6 [weighted mean difference (WMD) = −0.55 pg/mL 95% confidence interval (CI), −1.02 to −0.09], TNFα (WMD = −0.64 pg/mL 95% CI, −1.21 to −0.06), IL8 (MD = −0.49 pg/mL 95% CI, −0.89 to −0.09), and IL2 (WMD = 1.03 pg/mL 95% CI, 0.40 to 1.67). No significant differences were found in the serum concentrations of C-reactive protein (WMD = −0.15 95% CI, −0.56 to 0.25) or IL10 (WMD = 0.41 95% CI, −0.18 to 1.02). Exercise training positively modulates chronic low-grade inflammation in women with breast cancer, which may impact upon carcinogenic mechanisms and the tumor microenvironment. These findings align with the other positive effects of exercise for breast cancer survivors, reinforcing the appropriateness of exercise prescription in this population. Cancer Epidemiol Biomarkers Prev 25(7) 1009–17. ©2016 AACR.
Publisher: Cold Spring Harbor Laboratory
Date: 06-04-2020
DOI: 10.1101/2020.04.02.20048892
Abstract: To examine the impact of providing healthcare during or after health emergencies caused by viral epidemic outbreaks on healthcare workers′(HCWs) mental health, and to assess the available evidence base regarding interventions to reduce such impact. Systematic rapid review and meta-analysis. MEDLINE, Embase, and PsycINFO, searched up to 23 March 2020. We selected observational and experimental studies examining the impact on mental health of epidemic outbreaks on HCWs. One reviewer screened titles and abstracts, and two reviewers independently reviewed full texts. We extracted study characteristics, symptoms, prevalence of mental health problems, risk factors, mental health interventions, and its impact. We assessed risk of bias for each in idual study and used GRADE to ascertain the certainty of the evidence. We conducted a narrative and tabulated synthesis of the results. We pooled data using random-effects meta-analyses to estimate the prevalence of specific mental health problems. We included 61 studies (56 examining impact on mental health and five about interventions to reduce such impact). Most were conducted in Asia (59%), in the hospital setting (79%), and examined the impact of the SARS epidemic (69%). The pooled prevalence was higher for anxiety (45%, 95% CI 21 to 69% 6 studies, 3,373 participants), followed by depression (38%, 95% CI 15 to 60% 7 studies, 3,636 participants), acute stress disorder (31%, 95% CI 0 to 82%, 3 studies, 2,587 participants), burnout (29%, 95% CI 25 to 32% 3 studies 1,168 participants), and post-traumatic stress disorder (19%, 95% CI 11 to 26%, 10 studies, 3,121 participants). Based on 37 studies, we identified factors associated with the likelihood of developing those problems, including sociodemographic (younger age and female gender), social (lack of social support, social rejection or isolation, stigmatization), and occupational (working in a high risk environment (frontline staff), specific occupational roles (e.g., nurse), and lower levels of specialised training, preparedness and job experience) factors. Five studies reported interventions for frontline HCW, two of which were educational and aimed to prevent mental health problems by increasing HCWs′ resilience. These interventions increased confidence in support and training, pandemic self-efficacy, and interpersonal problems solving (very low certainty). One multifaceted intervention implemented training and organisational changes) targeted at hospital nurses during the SARS epidemic, reporting improvements in anxiety, depression, and sleep quality (very low certainty). The two remaining interventions, which were multifaceted and based on psychotherapy provision, did not assess their impact. The prevalence of anxiety, depression, acute and post-traumatic stress disorder, and burnout, was high both during and after the outbreaks. These problems not only have a long-lasting effect on the mental health of HCWs, but also hinder the urgent response to the current COVID-19 pandemic, by jeopardising attention and decision-making. Governments and healthcare authorities should take urgent actions to protect the mental health of HCWs. In light of the limited evidence regarding the impact of interventions to tackle mental health problems in HCWs, the risk factors identified in this study, more so when they are modifiable, represent important targets for future interventions. 1: Previous studies showed that healthcare workers involved providing frontline care during viral epidemic outbreaks are at high risk of developing mental health problems. Given the current COVID-19 pandemic, there is an urgent need to synthesize the evidence regarding the impact of viral epidemic outbreaks on mental health of healthcare workers. 2: This timely systematic rapid review offers for the first time pooled estimations of the prevalence of the most common mental health problems experienced by HCWs during and after viral epidemic outbreaks, namely anxiety (45%), depression (38%), and acute stress disorder (31%), among others. Our study also identifies a broad number of factors associated with these conditions, including sociodemographic factors such as younger age and female gender, social factors such as lack of social support, social rejection or isolation, stigmatization, and occupational factors such as working in a high risk environment, specific occupational roles, and having lower levels of specialised training, preparedness and job experience. Our study shows that, although educational and multifaceted interventions might mitigate the development of mental health problems, the certainty on the evidence is very low - therefore indicating that further high quality research is urgently needed to inform evidence-based policies for viral pandemics.
No related grants have been discovered for Jose Francisco Meneses Echavez.