Estudo da encapsulação de fármacos antineoplásicos em sistemas nanoestruturados: Caracterização estrutural e efeito sinérgico de fármacos / Study of the encapsulation of antineoplastic drugs in nanostructured systems: Structured characterization and synergistic effect of drugs

Dentro da área da nanotecnologia, o sistema drug delivery vem sendo amplamente utilizado, cujo objetivo é proporcionar uma maior eficácia dos ativos farmacêuticos, podendo envolver desde uma distribuição mais seletiva dentro do organismo até a taxa que as moléculas serão liberadas e/ou a atenuação dos efeitos adversos provocados. Para isso, os ativos são encapsulados em nanoestruturas, podendo estas serem de natureza sintética ou natural. Dentre os nanocarreadores promissores encontram-se os cubossomos, que são nanoestruturas complexas capazes de encapsular ativos tanto hidrofílicos quanto hidrofóbicos. O objetivo deste projeto foi estudar a encapsulação de fármacos antineoplásicos em sistemas drug delivery contra linhagens celulares, investigando também as alterações estruturais sofridas pelos cubossomos e os efeitos sinérgicos dos fármacos, sendo eles: a doxorrubicina, a cisplatina, a vemurafenibe e a curcumina. As metodologias empregadas para elucidar o efeito das combinações dos fármacos, a estruturação da nanopartícula e sua citotoxicidade foram: os estudos de viabilidade celular pós-exposição, espalhamento dinâmico de luz, potencial zeta, análise de rastreamento de nanopartículas, espalhamento de raios-x a baixos ângulos, criomicroscopia eletrônica de transmissão, eficiência de encapsulação e ensaio de liberação. Inicialmente os fármacos foram testados isoladamente e em duplas, sendo utilizadas cinco linhagens celulares, afim de se promover um delineamento aos ensaios futuros. A partir destes resultados, foi-se optado por manter duas linhagens celulares, a HeLa, como representante de tecidos tumorais, e a HaCat, modelo de tecido saudável, devido a menor resistência apresentada por elas. Em relação as combinações entre as drogas, pode-se observar que todas as duplas formadas apresentaram resultados sinérgicos na linhagem tumoral, sendo mantida para os testes seguintes a combinação curcumina e vemurafenibe. Os cubossomos foram sintetizados eficientemente, sendo produzidos na ausência de fármacos bem como contendo curcumina e vemurafenibe. As nanopartículas apresentaram uma variação de diâmetro entre 189 ± 3 nm e 224 ± 2 nm, sendo o PDI entre 0,08 e 0,25. A conformação do cubossomo foi confirmada através da criomicroscopia eletrônica de transmissão e pelo espalhamento de raios-x a baixos ângulos, onde foi determinada uma estruturação característica de Pn3m. Para a eficiência de encapsulação os valores variaram entre 79% de encapsulação para a curcumina e 72% para a vemurafenibe, quando utilizadas isoladamente. No caso da encapsulação em dupla, os valores se converteram para 63% e 53% para a curcumina e vemurafenibe, respectivamente. A liberação das drogas do interior da nanopartícula oscilou entre 1500, 480 e 420 minutos para os cubossomos de curcumina, vemurafenibe e curcumina + vemunafenibe, respectivamente. Os testes de citotoxicidade demonstraram que as concentrações de 0,01 e 0,03 mg/mL foram capazes de promover uma viabilidade acima de 70%, porém, utilizando estas proporções não foi possível observar resultados significativos. Por fim, o sistema se mostrou estável e homogêneo, sendo capaz de promover a encapsulação dos fármacos tanto singularmente quanto em dupla e, apesar da quantidade de fármacos não ter sido suficiente para ocasionar alterações ao sistema celular, a execução deste trabalho abre portas para que novos estudos sejam realizados, podendo-se testar diferentes ativos bem como alterando a composição da nanopartícula afim de se reduzir a citotoxicidade

Within the area of nanotechnology, the drug delivery system has been widely used, whose objective is to provide greater effectiveness of pharmaceutical active ingredients, which may range from a more selective distribution within the organism to the rate at which the molecules will be released and/or the attenuation of adverse effects caused. To achieve this, the active ingredients are encapsulated in nanostructures, which may be synthetic or natural in nature. Among the promising nanocarriers are cubosomes, which are complex nanostructures capable of encapsulating both hydrophilic and hydrophobic active ingredients. The objective of this project was to study the encapsulation of antineoplastic drugs in drug delivery systems against cell lines, also investigating the structural changes undergone by the cubosomes and the synergistic effects ofthe drugs, namely: doxorubicin, cisplatin, vemurafenib and curcumin. The methodologies used to elucidate the effect of drug combinations, the structuring of the nanoparticle and its cytotoxicity were: post-exposure cell viability studies, dynamic light scattering, zeta potential, nanoparticle tracking analysis, small angle x-rays scattering, transmission electron cryomicroscopy, encapsulation efficiency and release assay. Initially, the drugs were tested alone and in pairs, using five cell lines, in order to promote a design for future trials. Based on these results, it was decided to maintain two cell lines, HeLa, as a representative oftumor tissues, and HaCat, a model ofhealthy tissue, due to their lower resistance. Regarding the combinations between the drugs, it can be observed that all the pairs formed presented synergistic results in the tumor lineage, with the combination of curcumin and vemurafenib being maintained for the following tests. Cubosomes were efficiently synthesized, being produced in the absence of drugs as well as containing curcumin and vemurafenib. The nanoparticles varied in diameter between 189 ± 3 nm and 224 ± 2 nm, with the PDI being between 0.08 and 0.25. The conformation ofthe cubosome was confirmed through transmission electron cryomicroscopy and small angle x-rays scattering, where a characteristic structure of Pn3m was determined. For encapsulation efficiency, values varied between 79% encapsulation for curcumin and 72% for vemurafenib, when used alone. ln the case of double encapsulation, the values converted to 63% and 53% for curcumin and vemurafenib, respectively. The release of drugs from the interior of the nanoparticle ranged between 1500, 480 and 420 minutes for the curcumin, vemurafenib and cubosomes with curcumin + vemunafenib, respectively. Cytotoxicity tests demonstrated that concentrations of 0.01 and 0.03 mg/mL were capable of promoting viability above 70%, however, using these proportions it was not possible to observe significant results. Finally, the system proved to be stable and homogeneous, being able to promote the encapsulation of drugs both singly and in pairs and, although the quantity of drugs was not enough to cause changes to the cellular system, the execution of this work opens doors for new studies are carried out, with the possibility oftesting different active ingredients as well as changing the composition of the nanoparticle in order to reduce cytotoxicity

Prediction of the Impact of CYP2C19 Polymorphism on Drug-Drug Interaction between Voriconazole and Tacrolimus Using Physiologically-Based Pharmacokinetic Modelling

Abstract Voriconazole increases tacrolimus blood concentration significantly when coadministrated. The recommendation of reducing tacrolimus to 1/3 in voriconazole package insert seems not to be satisfactory in clinical practice. In vitro studies demonstrated that the magnitude of inhibition depends on the concentration of voriconazole, while voriconazole exposure is determined by the genotype status of CYP2C19. CYP2C19 gene polymorphism challenges the management of drug-drug interactions(DDIs) between voriconazole and tacrolimus. This work aimed to predict the impact of CYP2C19 polymorphism on the DDIs by using physiologically based pharmacokinetics (PBPK) models. The precision of the developed voriconazole and tacrolimus models was reasonable by evaluating the pharmacokinetic parameters fold error, such as AUC0-24, Cmax and tmax. Voriconazole increased tacrolimus concentration immediately in all population. The simulated duration of DDIs disappearance after voriconazole withdrawal were 146h, 90h and 66h in poor metabolizers (PMs), intermediate metabolizers (IMs) and extensive metabolizers(EMs), respectively. The developed and optimized PBPK models in this study can be applied to assit the dose adjustment for tacrolimus with and without voriconazole.

The role of Magnetic Resonance Images (MRIs) in coping for patients with brain tumours and their parents: a qualitative study.

BACKGROUND: When children and young people (CYP) are diagnosed with a brain tumour, Magnetic Resonance Imaging (MRI) is key to the clinical management of this condition. This can produce hundreds, and often thousands, of Magnetic Resonance Images (MRIs). METHODS: Semi-structured interviews were undertaken with 14 families (15 parents and 8 patients), and analysed using Grounded Theory. Analysis was supported by the Framework Method. RESULTS: Although the focus of the research was whether paediatric patients and their families find viewing MRIs beneficial, all patients and parents discussed difficult times during the illness and using various strategies to cope. This article explores the identified coping strategies that involved MRIs, and the role that MRIs can play in coping. Coping strategies were classified under the aim of the strategy when used: 'Normalising'; 'Maintaining hope and a sense of the future'; 'Dealing with an uncertain future'; and 'Seeking Support'. CONCLUSIONS: Coping and finding ways to cope are clearly used by patients and their families and are something that they wish to discuss, as they were raised in conversations that were not necessarily about coping. This suggests clinicians should always allow time and space (in appointments, consultations, or impromptu conversations on the ward) for patient families to discuss ways of coping. MRIs were found to be used in various ways: to maintain or adapt normal; maintain hope and a sense of the future; deal with an uncertain future; and seek support from others. Clinicians should recognise the potential for MRIs to aid coping and if appropriate, suggest that families take copies of scans (MRIs) home. Professional coaches or counsellors may also find MRIs beneficial as a way to remind families that the child is in a more stable or 'better' place than they have been previously.

A longitudinal evaluation of psychosocial changes throughout orthognathic surgery.

BACKGROUND: Jaw correction surgery can cause significant psychosocial impacts on patients. This prospective study investigated the longitudinal changes of psychosocial characteristics of patients with dentofacial deformities after jaw correction surgery and the factors that predict the psychological resilience in Hong Kong Chinese undergoing jaw correction surgery. METHODS: A longitudinal cohort study was conducted on 92 Hong Kong Chinese patients (32 males, 60 females; mean age = 24.75 ± 5.65 years), who had jaw correction surgery as treatment for their dentofacial deformities, from 1st June 2011 to 30th June 2015. Self-completed psychological inventories including Brief Symptom Inventory, Life Orientation Test, and the Adult Trait Hope Scale were used to measure distress, optimism, and hope levels respectively. Patients completed the inventories in five time points: the surgical consent signing day (usually two to three months before the surgery) (T1); one day before operation (T2), first to second post-operative week (T3), third post-operative month (T4) and sixth post-operative month (T5). RESULTS: Latent class growth analysis revealed two outcome trajectory classes: a resilience trajectory (n = 45, 48.9%) and a chronic dysfunction trajectory (n = 14, 15.2%). Another 33 (35.9%) showed erratic trajectory patterns that would not be classified into any categories. The psychological distress levels of patients in the resilience trajectory group, on average, were below the clinical threshold of the Brief Symptom Inventory at all time points. However, the opposite result was obtained for patients in the chronic dysfunctional group. Patients exhibiting a resilience trajectory pattern, when compared to those showing a chronic dysfunction pattern, had higher optimism (t(57) = 3.69, p < .0001) and hope (t(57) = 2.46, p < .05) levels at T1. Logistic regression analyses were conducted to compare the relative power of optimism and hope levels at T1 to predict resilience or chronic dysfunctional group membership. A test of the full model against a constant only model was statistically significant (χ2(2) = 24.096, p < .01). Preoperative baseline optimism (B = -.276, p < .05) but not hope (B = -.25, ns) was a significant variable to classify the outcome trajectories for psychological distress. CONCLUSIONS: Most patients were resilient to dentofacial deformities jaw correction surgery. About 15% exhibited a chronic distress pattern. An optimistic view about the surgery may enhance resilience. Pre-surgical counselling or educational sessions to facilitate a realistic positive outlook about the operation would be beneficial.

Navigating physical activity engagement following a diagnosis of cancer: A qualitative exploration.

This qualitative descriptive study explored cancer survivors' experiences of barriers and facilitators to undertaking physical activity to inform how services and professionals might offer better support. Purposive and theoretical sampling was used to recruit 25 people who were up to 5 years post-cancer diagnosis. Participants took part in face to face, semi-structured interviews, and transcripts were analysed using thematic analysis. The analysis identified five interrelated themes which represented cancer survivors' views: 1) You're on your own-a sense of abandonment post-treatment, and lack of sufficient and tailored information; 2) Dis-ease-disruption to self and identity, and a heightened awareness of physical self and fragility; 3) Becoming acclimatised-physical activity in the face of treatment-related side effects and residual impairment; 4) Importance of others-encouragement and support from health professionals, family and friends, and cancer-specific exercise groups; 5) Meanings people ascribed to physical activity-these were central and could help or hinder engagement. Our findings suggest being able to live well and re-engage in meaningful activities following a diagnosis of cancer is both complex and challenging. There appear to be gaps in current service provision in supporting the broader health and well-being of cancer survivors.

Coping profiles, perceived stress and health-related behaviors: a cluster analysis approach.

Using cluster analytical procedure, this study aimed (i) to determine whether people could be differentiated on the basis of coping profiles (or unique combinations of coping strategies); and (ii) to examine the relationships between these profiles and perceived stress and health-related behaviors. A sample of 578 French students (345 females, 233 males; M(age)= 21.78, SD(age)= 2.21) completed the Perceived Stress Scale-14 ( Bruchon-Schweitzer, 2002), the Brief COPE ( Muller and Spitz, 2003) and a series of items measuring health-related behaviors. A two-phased cluster analytic procedure (i.e. hierarchical and non-hierarchical-k-means) was employed to derive clusters of coping strategy profiles. The results yielded four distinctive coping profiles: High Copers, Adaptive Copers, Avoidant Copers and Low Copers. The results showed that clusters differed significantly in perceived stress and health-related behaviors. High Copers and Avoidant Copers displayed higher levels of perceived stress and engaged more in unhealthy behavior, compared with Adaptive Copers and Low Copers who reported lower levels of stress and engaged more in healthy behaviors. These findings suggested that individuals' relative reliance on some strategies and de-emphasis on others may be a more advantageous way of understanding the manner in which individuals cope with stress. Therefore, cluster analysis approach may provide an advantage over more traditional statistical techniques by identifying distinct coping profiles that might best benefit from interventions. Future research should consider coping profiles to provide a deeper understanding of the relationships between coping strategies and health outcomes and to identify risk groups.

Coping skills and mental health status in adolescents when a parent has cancer: a multicenter and multi-perspective study.

OBJECTIVE: Parental cancer increases the risk of psychosocial problems in adolescents. We investigated the frequency and efficacy of adolescents' coping strategies and relationships between those strategies and mental health status. Age and gender differences regarding coping and mental health were also investigated. METHODS: In total, 214 adolescents from 167 families participated in a cross-sectional, multicenter study. All participants were recruited from standard oncological care. Among the participants, 52% utilized a child-centered intervention program. Adolescents' coping skills were measured using KIDCOPE. Mental health status was rated by adolescents and parents by the SDQ for symptomatology and the KIDSCREEN for well-being. RESULTS: We found that 29% of the adolescents showed emotional and behavioral problems. We found gender differences in mental health status but not in coping. Adolescents used a broad spectrum of coping strategies. Active problem-solving, distraction, acceptance, wishful thinking and seeking social support were the most frequently used coping strategies. The utilization of certain coping skills was mediated by their perceived efficacy. Problem-focused or approach-oriented coping strategies generally are associated with better mental health, while avoidance-oriented coping are associated with worse mental health. Emotion-focused coping was associated with both lower and higher mental health. CONCLUSION: The strategies used by adolescents to cope with parental cancer are associated with their mental health. Problem-solving and approach-oriented coping strategies should be facilitated by psychological interventions regardless of age and gender. Age and gender differences in adolescents' mental health should be further investigated because these differences are not explained by differences in coping strategies.

Matching intra-procedural information with coping style reduces psychophysiological arousal in women undergoing colposcopy.

This study assessed the combined effects of coping style and intra-procedural information on indices of distress (physiological measures, observed distress, self-report measures of anxiety and affect) among a group of patients undergoing colposcopy. High and low monitors were exposed to one of three interventions: high information (live video feed of colposcopy); low information (complete audiovisual distraction); and control. Results revealed a 2 (monitoring style) × 3 (information level) × 2 (time) interaction for systolic blood pressure (SBP), F(2, 111) = 3.55, p = .032. Among low monitors, patients in the low-information group exhibited significant SBP reductions during colposcopy, while those in the high-information group exhibited SBP increases. Among high monitors, patients in the high-information and control groups exhibited SBP reductions. Further, significant differences in observed signs of distress were found between groups with high monitors in the low-information group faring best overall, F(2, 111) = 4.41, p = .014. These findings indicate that tailoring information to suit individual coping style may maximize the apparent efficacy of interventions aimed at reducing stress during medical examinations.

Academic effects of the Prestige oil spill disaster.

The effect of a large scale oil spill disaster on the academic achievement and classroom behavior of children and adolescents who lived on the Galician coast (Spain) is studied from an ecological perspective. 430 participants divided into three age groups of 5, 10, and 15 years of age, were studied. The participants came from three areas differently affected by the disaster. Dependent variables were academic achievement and classroom behavior of the participants after the Prestige disaster. Degree of exposure and other protective or risk factors were investigated as well. Repeated measures ANOVA to assess the main effects of the oil spill and hierarchical regression analyses to assess the contribution of the protective/vulnerability factors were performed. The results indicate that the effects of the disaster were relatively scarce. Some protective factors accounted for a certain degree of variance of different schoolroom behaviors. These results point to the intervention of protective factors in the adaptation to the disaster.

Development and validation of the paediatric cancer coping scale.

AIM: The purpose of this study was to develop and test the psychometric properties of the paediatric cancer coping scale in children with cancer. BACKGROUND: Coping is a mediator between stressful events and adaptation. However, existing tools cannot be used to assess and understand coping strategies in children with cancer in Taiwan. METHODS: A total of 229 children with cancer were recruited from three medical centres in Taiwan in 2008-2009. Internal consistency and test-retest reliability were estimated by Cronbach's alpha and intra-class correlation coefficient respectively. The factor structure was determined by exploratory factor analysis and confirmatory factor analysis. Pearson's correlation coefficient was employed to test the convergent and discriminate validity. RESULTS: The paediatric cancer coping scale demonstrated internal consistency (α = 0·91) and a 2-week test-retest reliability (intra-class correlation coefficient = 0·86). Its construct validity was confirmed by factor analysis, which extracted and defined three categories of coping strategies: cognitive coping, problem-oriented coping and defensive coping; these three factors explained 40% of the total variance with factor loadings ranging from 0·31 to 0·71. Convergent and discriminate validities were demonstrated by significant correlations among the coping, resilience and anxiety subscales. CONCLUSIONS: The paediatric cancer coping scale is a reliable and valid scale to measure and examine coping strategies in children with cancer.

Nine years after child sexual abuse.

OBJECTIVE: During 1988-1990, 103 children presented to Child Protection Units (CPU) at two children's hospitals in Sydney, Australia. Nine years later, the psychological adjustment of these young people (mean age=19.1 years, SD=3.4 years; range=14-25 years) was compared with that of non-abused young people of similar age and gender to assess group differences and examine potential risk factors. METHOD: At intake, data on the nature of the index sexual abuse, demographics and the family environment were collected by clinicians. A comparison group, of similar age and gender, was selected from schools in the catchment area of the CPUs. Six years after presentation for the abuse, records of the statutory child protection authority were checked to determine any further notifications for abuse and/or neglect. Nine years after intake, 49 of the abused young people and 68 of the non-abused young people and/or their parents were interviewed and assessed. RESULTS: The sexually abused young people performed more poorly than non-abused young people on psychometric tests of depression (p=.001), self-esteem (p<.001), anxiety (p<.001), behavior (Child Behavior Checklist: p=.01; Youth Self Report: p=.01; Young Adult Self Report: p<.001), and despair (p=.001). They were also more likely to have a history of bingeing (p=.002), self-inducing vomiting (p=.02), smoking cigarettes (p=.01), and using amphetamines (p=.002), ecstasy (p=.002) and cocaine (p=.004). Potential risk factors were in two groups, family and child. Family factors: family functioning, parental drug/alcohol problems, mother's sexual abuse history, mother's depression and socio-economic status. Child factors: despair and hopefulness, number of negative life events, ratings of their father's care, previous notifications for child sexual abuse and placements in out-of-home care by the statutory child protection authority. In the presence of other risk factors, child sexual abuse was a significant predictor of self-esteem, behavior and bingeing. CONCLUSIONS: Rather than focusing only on the individual's child sexual abuse, treatment may also need to address the family's functioning and the individual's feelings of despair.

A follow-up study of women with cancer: their psychosocial well-being and close relationships.

The psychological and social consequences of having a diagnosis of cancer can continue beyond the initial year of diagnosis. However, very few empirical studies examine the long-term adjustment of cancer survivors and the factors that promote survivors' well-being. This paper presents an 18 month follow-up study of 26 women who were treated for various types of cancer at a major medical center in the United States. They completed questionnaires during the initial treatment phase of the illness and 18 months later. The questionnaire consisted of standardized scales measuring relationship factors (i.e., mutuality, silencing-the-self schemas, and relationship-focused coping) and psychosocial well-being (i.e., quality of life, depression, self-care agency). The results of the follow-up study revealed that the women's psychosocial well-being changed for the better between Time 1 and Time 2, while their relationship factors remained constant. Only one relational factor, silencing-the-self beliefs, at Time 1, was significantly correlated with a well-being variable at Time 2. However, relationship factors at Time 2 were significantly correlated with psychosocial well-being at Time 2, indicating that relational factors continue to play a significant role in the sample's psychosocial adjustment.

Psychological adjustment in breast cancer: processes of emotional distress.

The process of psychological adjustment to breast cancer was examined at diagnosis and at 3- and 6-month follow-ups in a sample of 80 women with Stage I-Stage IV breast cancer. At diagnosis, symptoms of anxiety/depression were predicted by low dispositional optimism, and this path was partially mediated by use of emotion-focused disengagement coping. Younger age also was predictive of anxiety/depression symptoms at time of diagnosis, and this relationship was fully mediated by magnitude of intrusive thoughts. At 3 months, changes in anxiety/depression symptoms were predicted only by intrusive thoughts. At 6 months, low dispositional optimism reemerged as a significant predictor of changes in anxiety/depression and again was partially mediated by the use of emotion-focused disengagement coping. Independent effects for problem-focused engagement and disengagement and emotion-focused engagement coping were also found at 6 months. Implications of these data for psychosocial interventions with breast cancer patients are highlighted.

Predictors of bereavement outcome for family carers of cancer patients.

AIMS: The psychological outcome of family carers after bereavement is an important issue in evaluating palliative care services. Palliative care services have the potential to provide preventive psychosocial intervention to family carers prior to bereavement, but are faced with the need to identify those who may have greatest risk of adverse outcome. This prospective study examines predictors of psychological outcome for family carers of cancer patients following bereavement based on factors identified at referral to a palliative care agency. METHODS: Cancer patients and their family carer were consecutively recruited and assessed on a range of clinical and psychological measures at referral to a palliative home care service in a metropolitan centre (Time 1). Carers were again assessed following the death of the patient, on average at 4 months post-bereavement (Time 2), using measures of bereavement symptoms and psychological morbidity. RESULTS: 178 carers were assessed on both occasions. The chief predictors of carer psychological symptoms and severity of grief at follow-up were psychological symptom scores at the time of referral (Time 1). Factors also measured at Time 1 were significant predictors of symptoms and grief scores at Time 2: greater number of adverse life events, carer's coping responses, past bereavement and separation experiences, the relationship with the patient, and greater severity of patient's illness at the time of palliative care referral. CONCLUSIONS: The findings indicate clinical risk factors for adverse short-term bereavement outcome that can be identified in family carers during palliative care treatment, that have implications for identifying the psychological needs of carers, and that form a potential basis for interventions to enhance the psychological outcome for family carers.

The Mental Adjustment to Cancer Scale--a psychometric analysis and the concept of coping.

A psychometric analysis of the Mental Adjustment to Cancer (MAC) scale was performed in a heterogeneous Swedish sample of cancer patients (n = 868). The homogeneity of the original subscales proved to be satisfactory (alpha coefficients 0.61-0.81). The sample was randomly split into two subgroups, and a factor analysis was carried out in one of them using the LISREL 8.20 procedure. This yielded four factors called 'Hopeless', 'Positive', 'Anxious' and 'Avoidant' including 28 of the 40 original items (alpha coefficients 0.58-0.81). The novel factor structure was cross-validated and confirmed in the second subgroup. In contrast to the original scale (one item), 'Avoidance', was indexed by three items. The distinction between mental adjustment and coping is discussed. It is concluded that both versions of the MAC scale are measures of mental adjustment including emotional reactions as well as coping.

Coping and adjustment to breast cancer.

This study examined possible predictors of adjustment to breast cancer. Sixty-one women participated soon after they were diagnosed with Stage I or Stage II breast cancer. Measures were gathered at diagnosis and again 4 months later. Predictor variables included aspects of the disease and treatment process and reported coping behavior. The most consistent predictor of distress and, to a lesser extent, quality of life, was avoidant coping: women who reported more avoidant coping were more distressed. These data fit well with most previous research and suggest one way of identifying women who may be more at risk for special difficulties coping with the diagnosis of breast cancer.

Actitud del niño con asma frente al síntoma en institucione públicas y privadas / The attitude of a child with asthma towards sympton in public and private institutions

La actitud del niño ante la enfermedad se puede dividir en: sobreadaptados (con características de orden y prolijidad, buen rendimiento intelectual y sin dificultades aparentes de perentectomía, con reacción asmática tardía y respecto del conflicto, de alto riesgo en adolescencia), y actuadores (dramatiza su enfermedad, dependencia manifiesta con sus padres generando alto monto de ansiedad familiar, reacción asmática inmediata al conflicto, con pronóstico más favorable). Se comprobará si existe una diferencia significativa según esta clasificación en pacientes del ámbito privado y público. Se estudiaron 60 niños provenientes de un centro de atención privado, y 60 niños de una institución pública, con diagnóstico de asma y edades entre 4-12 años. Se aplicó: Entrevista operativa semi-abierta y entrevista pautada con ambos padres; Tests: Santuchi-Bender, Casa pintada, Figura humana, Familia, Desiderativo, Cat, Nemi y Raven. De acuerdo a la clasificación utilizada se encontraron: ámbito privado: 32 sobreadaptados (53 por ciento) y 28 actuadores (47 por ciento); ámbito público: 38 sobreadaptados (63 por ciento, p=NS) y 22 actuadores (37 por ciento, p=NS). Esto nos plantea la necesidad de un abordaje interdisciplinario para la detección temprana de los rasgos de sobreadaptación, dado que en este tipo de pacientes encontramos la paradoja de que lo ideal esconde lo mortífero: cuando aparece el pasaje al acto puede ser tarde

Relationship between hardiness and risk of burnout in a sample of 92 nurses working in oncology and AIDS wards.

BACKGROUND: The present study tested the hypothesis that particular personality dispositions act as resistance resources in the encounter with stressful life events. METHODS: The sample consisted of 100 student nurses working in critical areas (oncology and AIDS). At the beginning of the 2nd year course subjects were administered the Kobasa Hardiness Scale and at the end of the year the Maslach Burnout Inventory. RESULTS: Higher hardiness levels at the beginning of the course were associated with lower emotional exhaustion and higher personal achievement scores at the end. As predicted, findings show hardiness scores to be predictive of the risk of burnout. CONCLUSIONS: A screening of personality traits could be useful in preventing the risk of burnout in nurses working in critical areas.