BackgroundNon-alcoholic fatty liver disease (NAFLD) is a common chronic liver disease, affecting 25-30% of the general population globally. The condition is even more prevalent in individuals with obesity and is frequently linked to the metabolic syndrome. Given the known associations between the metabolic syndrome and common mental health issues, it is likely that such a relationship also exists between NAFLD and mental health problems. However, studies in this field remain limited. Accordingly, the aim of this systematic review and meta-analysis was to explore the prevalence of one or more common mental health conditions (i.e., depression, anxiety, and/or stress) in adults with NAFLD.MethodsPubMed, EBSCOhost, ProQuest, Ovid, Web of Science, and Scopus were searched in order to identify studies reporting the prevalence of depression, anxiety, and/or stress among adults with NAFLD. A random-effects model was utilized to calculate the pooled prevalence and confidence intervals for depression, anxiety and stress.ResultsIn total, 31 studies were eligible for inclusion, involving 2,126,593 adults with NAFLD. Meta-analyses yielded a pooled prevalence of 26.3% (95% CI: 19.2 to 34) for depression, 37.2% (95% CI: 21.6 to 54.3%) for anxiety, and 51.4% (95% CI: 5.5 to 95.8%) for stress among adults with NAFLD.ConclusionThe present findings suggest a high prevalence of mental health morbidity among adults with NAFLD. Given the related public health impact, this finding should prompt further research to investigate such associations and elucidate potential associations between NAFLD and mental health morbidity, exploring potential shared underlying pathophysiologic mechanisms.Systematic review registrationhttps://www.crd.york.ac.uk/prospero/, identifier CRD42021288934.

Representing a growing ‘silent epidemic’, non-alcoholic fatty liver disease (NAFLD) affects around 25–30% of the general population. Alarmingly, NAFLD increases the risk of cardiovascular disease, both independently and through its strong associations with obesity, type 2 diabetes, and metabolic syndrome, whilst posing a substantial burden from an economic and health-related quality of life perspective. Moreover, growing evidence links NAFLD to common mental health disorders including depression, anxiety, and stress. In this context, recent clinical and research attention further focuses on potential additional problems faced by patients with NAFLD, such as perceived stigma, lack of awareness regarding the condition, and possible feelings of loneliness and isolation that might emerge from unmet support needs. To date, despite a wealth of literature on NAFLD, management of the condition remains challenging and not straightforward, with most cases in primary care being treated with lifestyle modification on top of any other comorbidity treatment. However, for many patients with NAFLD, weight loss is hard to accomplish and/or sustain (e.g., patients may lack the skills, confidence, and motivation required to adhere to dietary changes, and/or may have problems limiting opportunities for increased physical activity). Therefore, tailored interventions which are manageable from the perspective of the individual patient with NAFLD could glean greater results. Accordingly, although there is a lack of research exploring the potential benefits of person-centered and compassion-based approaches to the management of NAFLD, in the present review, we draw on evidence from methods utilized in the treatment of other chronic conditions in postulating the view that such approaches might prove beneficial in the future management of NAFLD.

Non-alcoholic fatty liver disease (NAFLD) is the most frequently occurring chronic liver disease, affecting approximately 25–30% of the adult general population worldwide. NAFLD reflects excess hepatic accumulation of fat in the absence of increased alcohol intake, and, due to its close association with obesity, is frequently referred to as the ‘hepatic manifestation’ of metabolic syndrome. Indeed, a high percentage of individuals with NAFLD present with a combination of the cardio-metabolic comorbidities that are associated with the metabolic syndrome. In addition to its well-established link with the metabolic syndrome and increased risk for cardiovascular disease, NAFLD has also been associated with certain mental health issues (e.g., depression and stress). Although this link is now being increasingly recognized, there are still unmet needs regarding the holistic management of patients with NAFLD, which could further contribute to feelings of social isolation and loneliness. The latter conditions are also increasingly reported to pose a substantial risk to overall health and quality of life. To date, there is limited research that has explored these issues among patients with NAFLD, despite existing data which indicate that perceived loneliness and isolation may pose an additional health risk. Notably, many features associated with NAFLD have been related to these concepts, such as perceived stigma, fatigue, stress, and confusion regarding this diagnosis. As such, this review aimed to assess such potential problems faced by patients with NAFLD, and to explore the possibility of unmet support needs which could lead to perceived social isolation. Moreover, the importance of a compassionate approach towards such patients is discussed, together with potential coping strategies. Future research directions and the need for a multidisciplinary approach are also highlighted.

Non-alcoholic fatty liver disease (NAFLD) constitutes the most common liver disease worldwide, and is frequently linked to the metabolic syndrome. The latter represents a clustering of related cardio-metabolic components, which are often observed in patients with NAFLD and increase the risk of cardiovascular disease. Furthermore, growing evidence suggests a positive association between metabolic syndrome and certain mental health problems (e.g., depression, anxiety, and chronic stress). Given the strong overlap between metabolic syndrome and NAFLD, and the common underlying mechanisms that link the two conditions, it is probable that potentially bidirectional associations are also present between NAFLD and mental health comorbidity. The identification of such links is worthy of further investigation, as this can inform more targeted interventions for patients with NAFLD. Therefore, the present review discusses published evidence in relation to associations of depression, anxiety, stress, and impaired health-related quality of life with NAFLD and metabolic syndrome. Attention is also drawn to the complex nature of affective disorders and potential overlapping symptoms between such conditions and NAFLD, while a focus is also placed on the postulated mechanisms mediating associations between mental health and both NAFLD and metabolic syndrome. Relevant gaps/weaknesses of the available literature are also highlighted, together with future research directions that need to be further explored.

This chapter examines the religious explanations of compassion of five major religions and critically explores their similarities and differences. These religious explanations are then related to nursing and healthcare. The five religious perspectives in this chapter are Buddhism, Islam, Judaism, Christianity and Hinduism.

Purpose In recent years, the number of refugees and migrants entering Europe has increased dramatically. Such trauma may affect not only refugees themselves, but also care givers and rescue workers. The purpose of this paper is to discuss the intensity and psychological impact of the refugee crisis, with a view to suggesting ways of moving forward. Design/methodology/approach Based on recent literature, this paper briefly looks at the importance of attention to health and social issues, before discussing the psychological trauma of refugees and potential emotional trauma of those involved in rescue operations. Findings The provision of psychological support which is both compassionate and culturally competent should be viewed as essential. Furthermore, the development of resources and tools to assist with the current refugee crisis could enable care givers, rescue workers, and healthcare professionals to provide psychological support to migrants and refugees. Such resources could also encourage, and support, frontline responders in caring for their own personal psychological well-being. Originality/value The content of this paper could help to encourage further research in this field, including research into the emotional trauma of rescue workers. Furthermore, it is intended that this paper could contribute to an on-line knowledge base when considering the development of tools and resources to assist with the current refugee crisis.

The concept of compassion applies to a number of situations and deserves to play a major role in health care. Within this chapter, we discuss the importance of compassionate care within both the hospital and primary healthcare settings, with a view to identifying ways of improving quality of care. We then discuss the importance of addressing compassion and health with regard to specific societal conditions such as during times of austerity, and towards vulnerable individuals such as the homeless who might experience specific health and social needs. Finally, we address factors that may hinder or promote compassion, before considering how compassion can be sustained in the longer term, and the extent to which the concept may be effectively incorporated in teaching and training programs.

It has been suggested that the biomedical approach towards healthcare professional training may neglect the humanistic nature and personal values of care. As such, discussions with regard to the importance of introducing compassion training into undergraduate programmes and throughout professional practice are of interest. Within this paper, we report on a compassionate care programme designed for, and delivered to, healthcare professionals and managerial/administrative staff at a private hospital in Limassol, Cyprus.

Background: The clinical encounter between nurse and patient is an important and growing strategy in the management of Type 2 Diabetes Mellitus in primary care settings. However, due to time pressures, lack of knowledge, training and skills, the meeting can be a frustrating experience for both the nurse and the patient, and the potential to improve diabetes self-management may be sub-optimal. The Diabetes MyQuest Consultation Tool© (DMCT©) has been designed in collaboration with both patients and nurses to improve the consultation by using a person centred approach, identifying psychological problems which may affect self-management, and promoting a more meaningful meeting between both parties. Methods: The DMCT© was piloted using a randomised control trial to gauge how feasible, practical and acceptable the application of the questionnaire would be in primary care settings to both nurses and patients. The pilot further explored whether the tool would promote diabetes knowledge, increase consultation satisfaction and improve diabetes self-efficacy in patients compared to usual care. The study used a mixed methods approach of qualitative interviews and three measures: a diabetes knowledge questionnaire (DKQ); satisfaction with the consultation questionnaire (DCPNI) and a diabetes empowerment scale (DES-SF). All participants were given the WHO-5 Well-Being Index to complete. Results: The age range of the sample (n = 106) was 40–90 years (m = 67 years) and comprised of 66 males, and 40 females. The average duration of diabetes was 9 years, and at the pre-study visit the mean values for BMI, cholesterol and HbA1c were 30.7 kg/m2; 4.2 mmols/l and 55.0 mmols/mol, respectively. Fifty-six patients were randomised to use the DMCT© tool as part of their consultation. There were no significant differences to HbA1c, Cholesterol or BMI between the control and intervention groups. There were minor but noted improvements in the control group between the pre and post measure for DKQ (mean increase 1.10; p > 0.001), whereas the intervention group demonstrated significant improved changes for all three measures: DKQ (mean increase = 1.41; p > 0.000), DCPNI (mean increase = 2.1; p > 0.002; DES-SF mean increase = 2.5; p > 0.000). All participants completed the WHO-5 Well-Being Index with 34% (n = 36) scoring on or below the clinical cut-off score of 13 – indicating a need for further depression screening. Conclusion: Patients in the intervention group overwhelmingly found the DMCT© tool helpful with their diabetes consultations and nurses’ derived good practical use from the tool in determining the kinds of issues patients may have. The tool seems to have promoted a more patient centred approach to the consultation, empowering patients to discuss management aspects relevant to their individual needs. The results of this pilot indicate that the DMCT© is a feasible, practical tool for use by both patients and nurses. A larger and longer scale study in varied primary care settings to determine further efficacy and using measurable hard end points is now warranted.

Compassion is an important concept in healthcare, and in addition, care should be delivered in a culturally competent manner, taking into account the values, culture, and health beliefs of the individual. However, the training of nurses and other healthcare professionals may not adequately equip them to practice in a manner which is both compassionate and culturally competent. In this paper, we report on the development of three learning tools, designed to promote the skills and strengthen the capacity of nurses and healthcare professionals to provide culturally competent and compassionate care.

Two six hour modules were delivered to nurses, doctors and administrative staff covering all aspects of compassion, including research findings.

This paper represents a commentary to Marianna Fotaki's Editorial: 'Why and how is compassion necessary to provide good quality healthcare?' Within this commentary, I discuss some of the issues raised by Marianna Fotaki, and conclude that we should work towards an organizational culture which considers the important concept of compassion by focusing on the well-being and teamwork of all involved.

If compassion is to be encouraged and sustained, then it could perhaps be helpful to initiate courses within undergraduate training, for example as in the course developed by the University of Crete (Lionis, Shea, Markaki 2011), and for ongoing professional development to utilise the concept by way of courses, reflective learning, and learning from ‘what goes right’ in practice as well as ‘what goes wrong’. Although there is much debate as ‘to what extent compassion can be taught and how it can be taught’, there are some positive and promising signals arising from academic and practice settings where the introduction of compassionate courses has received a warm acceptance by medical/nursing students and practising health care professionals. However, intervening at the undergraduate education level may be insufficient to address the issue and specific measures and policies together with ongoing training may be required in order to sustain the concept of compassion in the longer term. Thus, it might be beneficial to look into ways as to how compassion can be implemented and sustained over time, with the involvement of not just frontline staff, but also health care managers and administrators, and policy makers. This might help us to ensure that the original values of those entering the health care profession do not become lost, and that enthusiasm can be renewed, leading to the longer term benefits for all involved in patient care.

Recent research has addressed the hypothesis that religiosity/spirituality and sense of coherence buffer the negative effects of stress on numerous health issues. The aim of the current study was to further this work by exploring potential links between psycho-social factors such as religiosity/spirituality and sense of coherence with depression.

Homelessness is a wide-spread problem which can lead to high vulnerability and social exclusion. There are many reasons why a person may become homeless, with relationship breakdown being reported as a common cause. Homeless people often encounter a number of other problems such as mental and physical health issues and problems with drugs and alcohol which might represent either a cause or an effect of homelessness. A compassionate approach towards the homeless is crucial, whether this be explicit in taking action to deal with basic needs, or implicit with more of a ‘tough love’ approach in encouraging motivation and independence to help people re-build their lives.

Background Self-management of long term conditions can promote quality of life whilst delivering benefits to the financing of health care systems. However, rarely are the meso-level influences, likely to be of direct relevance to these desired outcomes, systematically explored. No specific international guidelines exist suggesting the features of the most appropriate structure and organisation of health care systems within which to situate self-management approaches and practices. This review aimed to identify the quantitative literature with regard to diabetes self-management arrangements currently in place within the health care systems of six countries (The United Kingdom, The Netherlands, Norway, Spain, Bulgaria, and Greece) and explore how these are integrated into the broader health care and welfare systems in each country. Methods The methodology for a realist review was followed. Publications of interest dating from 2000 to 2013 were identified through appropriate MeSH terms by a systematic search in six bibliographic databases. A search diary was maintained and the studies were assessed for their quality and risk of bias. Results Following the multi-step search strategy, 56 studies were included in the final review (the majority from the UK) reporting design methods and findings on 21 interventions and programmes for diabetes and chronic disease self-management. Most (11/21, 52%) of the interventions were designed to fit within the context of primary care. The majority (11/21, 52%) highlighted behavioural change as an important goal. Finally, some (5/21, 24%) referred explicitly to Internet-based tools. Conclusions This review is based on results which are derived from a total of at least 5,500 individuals residing in the six participating countries. It indicates a policy shift towards patient-centred self-management of diabetes in a primary care context. The professional role of diabetes specialist nurses, the need for multidisciplinary approaches and a focus on patient education emerge as fundamental principles in the design of relevant programmes. Socio-economic circumstances are relevant to the capacity to self-manage and suggest that any gains and progress will be hard to maintain during economic austerity. This realist review should be interpreted within the wider context of a whole systems approach regarding self-care support and chronic illness management.