Supportive care needs among older Mexican adults with metastatic cancer.

INTRODUCTION: Supportive care needs may vary according to age. The purpose of this research is to describe and compare supportive care needs between older adults with metastatic cancer (age ≥ 65 years) and their younger counterparts. MATERIALS AND METHODS: We conducted a retrospective secondary analysis of a cohort of patients with newly diagnosed metastatic solid tumors. Supportive care needs were assessed at baseline and at a three-month follow-up. Patients were divided into two groups (aged ≥65/<65 years). Differences in clinical characteristics and supportive care needs were compared utilizing descriptive statistics. Multivariate logistic regression models were employed to identify patient characteristics associated with specific supportive care needs. RESULTS: Between 2018 and 2022, 375 patients were enrolled. Median age was 66 years (interquartile range 19-94). At baseline, older adults had a higher number of supportive care needs (4.8 vs. 4.2, p = 0.01) and were at higher risk of malnutrition (75 vs. 65%, p = 0.05). Increasing age (odds ratio [OR] 1.02 (95% confidence interval [CI] 1.0-1.04, p = 0.03) and an estimated life expectancy <6 months (OR 3.0, 95%CI 1.5-6.1; p < 0.01) were associated with higher odds of malnutrition, while a higher educational level was associated with decreased odds (OR 0.68, 95%CI 0.5-0.8; p < 0.01). At three-month follow-up, older adults still had a higher number of supportive care needs (3.8 vs.2.6, p < 0.01) and were more likely to have fatigue (62 vs. 47%, p = 0.02). An estimated life expectancy of <6 months was associated with increased odds of fatigue (OR 3.0, 95%CI 1.5-6.3; p < 0.01). DISCUSSION: Older adults reported significantly more supportive care needs, particularly risk of malnutrition and fatigue. This information can help in the creation of supportive care services tailored to the needs of older individuals.

The effect of treatment and coping on the quality of life in breast cancer patients: a moderated mediation model.

PURPOSE: Breast cancer involves complicated emotional processes. One of the factors that impacts the psychological symptoms and decreases QoL is the side effects of treatment. The purpose of this study is to explore the effect of the main medical treatment (chemotherapy or hormone therapy) on the three domains of quality of life. For this, coping strategies were considered as psychological variables that mediate the relationship based on high or low alexithymia as a moderating variable. METHODS: This study had a cross-sectional design. The participant sample comprised 129 women with breast cancer in early stage (I to III) (63 receiving chemotherapy and 66 hormone therapy) and were evaluated from September 2015 to September 2019. Physical, emotional and social functioning were measured by the Quality of Life Questionnaire for cancer patients (EORTC-QLQ-C30), coping strategies were measured by Mental Adjustment to Cancer Questionnaire (MAC) and alexithymia was evaluated by the Alexithymia Toronto Scale (TAS-20). RESULTS: Treatment had a significant negative effect on physical domain in both patients receiving chemotherapy and hormone therapy. Moderated mediation analysis show that this relationship was significant when it was mediated by helplessness. Furthermore, this model is only significant when there are high levels of alexithymia. No significant effect direct was found on emotional and social functioning of quality of life. CONCLUSIONS: Results confirmed that coping based on helplessness and stable emotional variables such as alexithymia can have an effect, mediator or moderator, respectively, in the decrease of the physical functionality of women with breast cancer. Our findings highlight the need to include psychological therapy to help patients alleviate their psychological state because it can affect their physical condition.

Mental health problems among healthcare workers involved with the COVID-19 outbreak

Objective: The mental health problems and perceived needs of healthcare workers involved with coronavirus disease (COVID-19) may vary due to individual and contextual characteristics. The objective of this study was to evaluate healthcare workers' mental health problems during the common COVID-19 exposure scenario in Mexico, comparing those on the frontline with other healthcare workers according to gender and profession, determining the main risk factors for the most frequent mental health problems. Methods: A cross-sectional online study was conducted with a non-probabilistic sample of 5,938 Mexican healthcare workers who completed brief screening measures of mental health problems and ad hoc questions about sociodemographic professional characteristics, conditions related to increased risk of COVID-19 infection, life stressors during the COVID-19 emergency, and perceived need to cope with COVID-19. Results: The identified mental health problems were insomnia, depression, and posttraumatic stress disorder (PTSD), all of which were more frequent in frontline healthcare workers (52.1, 37.7, and 37.5%, respectively) and women (47.1, 33.0 %, and 16.3%, respectively). A lack of rest time was the main risk factor for insomnia (OR = 3.1, 95%CI 2.6-3.7, p ≤ 0.0001). Mourning the death of friends or loved ones due to COVID-19 was the main risk factor for depression (OR = 2.2, 95%CI 1.8-2.7, p ≤ 0.0001), and personal COVID-19 status was the main risk factor for PTSD (OR = 2.2, 95%CI 1.7-2.9, p ≤ 0.0001). Conclusion: The most frequent mental health problems during the common exposure scenario for COVID-19 in Mexico included the short-term psychological consequences of intense adversity. A comprehensive strategy for preventing mental health problems should focus on individuals with cumulative vulnerability and specific risk factors.

Patient Navigation to Improve Early Access to Supportive Care for Patients with Advanced Cancer in Resource-Limited Settings: A Randomized Controlled Trial.

BACKGROUND: The early integration of supportive care in oncology improves patient-centered outcomes. However, data are lacking regarding how to achieve this in resource-limited settings. We studied whether patient navigation increased access to multidisciplinary supportive care among Mexican patients with advanced cancer. MATERIALS AND METHODS: This randomized controlled trial was conducted between August 2017 and April 2018 at a public hospital in Mexico City. Patients aged ≥18 years with metastatic tumors ≤6 weeks from diagnosis were randomized (1:1) to a patient navigation intervention or usual care. Patients randomized to patient navigation received personalized supportive care from a navigator and a multidisciplinary team. Patients randomized to usual care obtained supportive care referrals from treating oncologists. The primary outcome was the implementation of supportive care interventions at 12 weeks. Secondary outcomes included advance directive completion, supportive care needs, and quality of life. RESULTS: One hundred thirty-four patients were randomized: 67 to patient navigation and 67 to usual care. Supportive care interventions were provided to 74% of patients in the patient navigation arm versus 24% in usual care (difference 0.50, 95% confidence interval [CI] 0.34-0.62; p < .0001). In the patient navigation arm, 48% of eligible patients completed advance directives, compared with 0% in usual care (p < .0001). At 12 weeks, patients randomized to patient navigation had less moderate/severe pain (10% vs. 33%; difference 0.23, 95% CI 0.07-0.38; p = .006), without differences in quality of life between arms. CONCLUSION: Patient navigation improves access to early supportive care, advance care planning, and pain for patients with advanced cancer in resource-limited settings. IMPLICATIONS FOR PRACTICE: The early implementation of supportive care in oncology is recommended by international guidelines, but this might be difficult to achieve in resource-limited settings. This randomized clinical trial including 134 Mexican patients with advanced cancer demonstrates that a multidisciplinary patient navigation intervention can improve the early access to supportive and palliative care interventions, increase advance care planning, and reduce symptoms compared with usual oncologist-guided care alone. These results demonstrate that patient navigation represents a potentially useful solution to achieve the adequate implementation of supportive and palliative care in resource-limited settings globally.

Providing Supportive and Palliative Care Using Telemedicine for Patients with Advanced Cancer During the COVID-19 Pandemic in Mexico.

COVID-19 has overwhelmed the capacity of health care systems, limiting access to supportive and palliative care for patients with advanced cancer. Telemedicine has emerged as a tool to provide care continuity to patients while limiting the risk of contagion. However, implementing telemedicine in resource-limited settings is challenging. We report the results of a multidisciplinary patient-navigator-led telemedicine supportive care program in Mexico City. One-hundred sixty-three telemedicine interventions were provided to 45 patients (median age 68, 57% female). A quarter of the patients had less than or equal to elementary school education, and 15% lived in a rural area. The most common interventions were psychological care (33%), pain and symptom control (25%), and nutritional counseling (13%). Half of the interventions were provided by video conferencing. The most common patient-reported barrier was limited experience using communication technology. Our results demonstrate the feasibility of providing supportive and palliative care interventions using telemedicine in resource-limited settings.

Well-being status and post-traumatic stress symptoms in health workers attending mindfulness sessions during the early stage of the COVID-19 epidemic in Mexico / Alteraciones en el bienestar y síntomas de estrés postraumático en trabajadores de la salud mexicanos que participaron en sesiones virtuales de atención plena durante la etapa inicial de la epidemia de COVID-19

Abstract Introduction In Mexico, a National Mental Health Strategy was implemented to identify and attend the mental health repercussions of the COVID-19 pandemic. It included the creation of five virtual clinics for health workers, being the Burnout, Post-traumatic Stress and Compassion Fatigue clinic one of them. Objective To describe the basal sociodemographic and psychological characteristics of health workers attending online mindfulness sessions as part of the treatment of the aforementioned clinic. Method This is a cross-sectional report part of a major nationwide and longitudinal project. All attendants responded to digital sociodemographics and COVID-19 questionnaires, the Extended Physician Well-Being Index (EPWBI), and the Post-traumatic Stress Disorder (PTSD) TOP-8 index. Results Of the 507 health workers that participated, 70.02% of them were at risk of burnout according to the Extended Well-Being Index and 57.31, 7.91 and 2.77% had a mild, moderate, and severe risk of PTSD, respectively. The most affected were the female health workers, from metropolitan or central areas of the country, and those diagnosed with COVID-19 or exposed to a person with the diagnosis. Discussion and conclusion Mexican health workers attending mindfulness sessions presented high frequencies of PTSD symptoms and burnout. Female workers at urban hospitals could be at a special risk for developing PTSD or Well-ness alterations, and thus, they must be cared for closely, particularly those having direct contact with COVID 19 positive persons. The early participation in mental health strategies might lessen the immediate and long-term pandemic effects.

Resumen Introducción En México se crearon cinco clínicas virtuales de salud mental para los trabajadores de la salud como parte de la respuesta nacional de salud mental ante la pandemia por COVID-19. La clínica de desgaste, estrés postraumático y fatiga por compasión es una de ellas. Objetivo Describir las características sociodemográficas y psicológicas basales de los trabajadores de la salud que asistieron a las sesiones virtuales de atención plena, que constituyeron una de las estrategias de atención en la clínica. Método Estudio transversal, parte de un proyecto nacional y longitudinal. Los participantes contestaron un cuestionario digital con preguntas sociodemográficas y sobre la situación actual del COVID-19, el Índice Extendido de Bienestar Médico y la escala TOP-8 de estrés postraumático. Resultados De los 507 trabajadores de la salud que participaron, 70.02% presentaron riesgo de desgaste según el Índice de Bienestar Extendido, y 57.31, 7.91 y 2.77% de riesgo leve, moderado y grave en el TOP-8, respectivamente. Las mujeres, los habitantes de la zona metropolitana o del centro del país, aquellos con diagnóstico de COVID-19 y los expuestos a personas con dicho diagnóstico fueron los más afectados. Discusión y conclusión Los participantes de las sesiones de atención plena presentaron altas frecuencias de síntomas de estrés postraumático y desgaste (burnout). Como las trabajadoras de zonas urbanizadas podrían correr un riesgo especial, debería dárseles un seguimiento especial, en particular a aquellas en contacto directo con personas positivas al COVID-19. La participación temprana en estrategias de salud mental podría amortiguar los efectos inmediatos y de largo plazo de la pandemia.

Hijos de mujeres con trasplante renal: factores de riesgo en el embarazo, estilos de crianza y funciones cognoscitivas / Children of women with kidney transplantation: risk factors in pregnancy, parenting styles and cognitive functions

Las mujeres con trasplante renal (TR) suelen cursar un embarazo de alto riesgo, pues son más susceptibles a presentar complicaciones médicas. Aunado a este hecho pueden presentar alteraciones en su estado emocional y psicológico durante y después del embarazo, lo que impactaría directamente en el estilo de crianza y desarrollo posterior del niño. Se desconoce cómo son los estilos de crianza en los hijos de las mujeres con TR y el posible impacto en su funcionamiento cognoscitivo. El presente trabajo tuvo dos objetivos: 1) determinar si existían diferencias en los estilos de crianza y las funciones cognoscitivas de los hijos de mujeres con trasplante renal en comparación con los hijos de mujeres sanas y 2) identificar la asociación entre las variables asociadas al riesgo en el embarazo y los estilos de crianza con las funciones cognoscitivas. Para ello fueron reclutados de diversos centros de trasplantes 23 niños (9 casos y 14 controles) de 7-15 años con sus respectivas madres a quienes se evaluó mediante el WISC-IV y el cuestionario CRPBI. Las madres fueron evaluadas con el cuestionario BRIEF, el cuestionario PCRI-M y el BDI-II. Se realizó un diseño transversal con alcance correlacional. No se encontraron diferencias entre el grupo caso y control en los estilos de crianza ni en las funciones cognoscitivas. Sin embargo, sí se encontró asociación entre los estilos de crianza y las funciones cognoscitivas. Un estilo en el que predomine la comunicación y la disciplina se asocia con mejores resultados cognoscitivos y conductuales.

Pregnancy in Kidney Transplant (KT) recipients is usually considered of high risk. KT recipients are susceptible to have obstetric complications. Studies report that KT recipients are at higher risk of experiencing distress during and after pregnancy, situation that may have an impact in parenting styles and child's development. Characteristics of parenting styles in KT recipients' offspring and its possible impact in cognitive functions remain unknown. The aims of the study were: 1) to determine if there are differences in parenting styles and cognitive functions among KT recipients' offspring and healthy women's offspring, and 2) to identify associations between high risk pregnancy variables, parenting styles and cognitive functions. Twenty-three children (9 cases and 14 controls) aged 8-15 years and their mothers were assessed with the (WISC-V) and the CRPBI. Mothers were asked to complete BRIEF, PCRI-M, BDI-II and a socioeconomic status instrument. A transversal correlational design was performed. No differences were found between case and control group in parenting styles or cognitive functions. However, an association between parenting styles and cognitive functions was found. Being raised with communication and discipline is associated with increased cognitive results.

Association between quality of life and positive coping strategies in breast cancer patients.

According to the World Health Organization, breast cancer is one of the most prevalent cancers in the Hispanic female population, and it carries a great psychological impact. Acceptance and personal learning derived from the individual's life experiences and understanding of their emotional state has been suggested as an adaptive profile toward the patient's perception of the disease. This study aims to explore which psychological variables are related to breast cancer patients' perception of their quality of life. A cross-sectional, correlational, and non-probabilistic study was performed on 113 women diagnosed with stage 1-3 breast cancer in Mexico and Spain, based on self-reporting through the Mental Adjustment to Cancer Scale, the Positive and Negative Affect Scale, and the EORTC Quality of Life Questionnaire. Recruitment was conducted from March 2015 to April 2018. Through multiple regression analysis, the study found that fighting spirit and positive affect explained 34.2% of quality of life variance F (2, 110) = 30.14, p <.005 of participants. The results support the need to contemplate the importance of positive psychological variables for a multidisciplinary approach to women diagnosed with breast cancer.

Nicotine dependence and psychiatric disorders.

Nicotine addiction is the single largest preventable cause of morbidity and mortality in the Western World. Smoking is not any more just a bad habit, but a substance addiction problem. The pharmacological aspects of nicotine show that this substance has a broad distribution in the different body compartnents, due mainly to its lipophilic characteristic. There are nicotinic receptors as members of cholinergic receptors' family. They are located in neuromuscular junction and in the central nervous system (CNS). Although they are similar, pentameric structure with an ionic channel to sodium, there are some differences in the protein chains characteristics. Repeated administration of nicotine in rats, results in the sensitization phenomenon, which produces increase in the behavioral locomotor activity response. It has been found that most psychostimulants-induced behavioral sensitization through a nicotine receptor activation. Nicotine receptors in CNS are located mainly in presynaptic membrane and in that way they regulated the release of several neurotransmitters, among them acetylcholine, dopamine, serotonin, and norepinephrine. In some activities like sleep-wake cycle, nicotine receptors have a functional significance. Nicotine receptor stimulation promotes wake time, reduces both, total sleep time and rapid eye movement sleep (REMS). About nicotine dependence, this substance full fills all the criteria for dependence and withdrawal syndrome. There are some people that have more vulnerability for to become nicotine dependent, those are psychiatric patients. Among them schizophrenia, major depression, anxiety disorders and attention deficit disorder, represent the best example in this area. Nicotine may have some beneficial effects, among them are some neuroprotective effects in disorders like Parkinson's disease, and Gilles de la Tourette' syndrome. Also there are several evidences that support the role of nicotine in cognitive improvement functions like attention, concentration, and memory. Finally there are several strategies to deal with nicotine dependence, Nicotine Replacement Therapy (NRT), which are nicotine chewing-gum, transdermal nicotine patches, and nicotine inhalators device. Also some antidepressants like bupropion has shown to be effective in smoking cessation treatment. To know more about nicotine phenomenon would be important, because that will allow a more mature perspective about the damage and beneficial effects of that substance.