Reflexividade do sensível e do cuidado à família no contexto da saúde mental / Reflexivity of the sensitive and family care in the context of mental health / Reflexividad de lo sensible y de la atención familiar en el contexto de la salud mental

Objetivo: descrever a experiência de famílias que vivenciam o sofrimento mental em dispositivos existenciais presentes no território. Método: estudo descritivo, de abordagem qualitativa, fundamentado na fenomenologia de Merleau-Ponty. Com aprovação do comitê de ética em pesquisa, o estudo foi desenvolvido entre julho de 2017 e junho de 2018 em um município da Bahia, Brasil, com a participação de dez famílias, representadas por 24 pessoas. Os dados foram coletados por meio de entrevistas fenomenológicas e rodas de intersubjetividade, tendo sido analisados pela técnica analítica da ambiguidade. Resultados: as descrições foram categorizadas em: família como lugar de re(construção) de virtudes relacionais e liberdade como dispositivo existencial de cuidado. Conclusão: o estudo demostrou o potencial da família para se constituir como espaço de promoção de virtudes e fortalecimento de vínculos; e ressaltou a importância da construção e valorização de experiências dialógicas, a exemplo das rodas de intersubjetividade, que se mostraram como relevante estratégia de cuidado em saúde mental.

Objective: to describe the experience of families who experience mental suffering in existential spaces in the territory. Method: this qualitative, descriptive study, based on the phenomenology of Merleau-Ponty and approved by the research ethics committee, was conducted between July 2017 and June 2018 in a municipality in Bahia, Brazil, with the participation of ten families, represented by 24 people. Data were collected in phenomenological interviews and intersubjectivity groups, and then analyzed using the ambiguity analysis technique. Results: the resulting descriptions were categorized into the family as a place for re(building) relational virtues and freedom as an existential space for care. Conclusion: the study demonstrated the family's potential to constitute a space for promoting virtues and strengthening bonds, and highlighted the importance of building and valuing dialogical experiences, such as the intersubjectivity groups, which proved to be a substantial mental health care strategy.

Objetivo: describir la vivencia de familias que experimentan sufrimiento mental en espacios existenciales del territorio. Método: este estudio cualitativo, descriptivo, basado en la fenomenología de Merleau-Ponty y aprobado por el comité de ética en investigación, se realizó entre julio de 2017 y junio de 2018 en un municipio de Bahía, Brasil, con la participación de diez familias, representadas por 24 personas. Los datos fueron recolectados en entrevistas fenomenológicas y grupos de intersubjetividad, y luego analizados usando la técnica de análisis de ambigüedad. Resultados: las descripciones resultantes se categorizaron en la familia como lugar de reconstrucción de las virtudes relacionales y la libertad como espacio existencial para el cuidado. Conclusión: el estudio demostró el potencial de la familia para constituir un espacio de promoción de virtudes y fortalecimiento de vínculos, y destacó la importancia de construir y valorar experiencias dialógicas, como los grupos de intersubjetividad, que resultó ser una estrategia sustancial de atención en salud mental.

Glioma patients in outpatient care-optimization of psychosocial care in neuro-oncological patients (GLIOPT): Protocol for a cluster randomized controlled trial.

BACKGROUND: Patients with high-grade gliomas (HGG) often suffer from high distress and require psychosocial support. However, due to neurological and neurocognitive deficits, adequate assessment of distress and support needs remains challenging in clinical practice. The objective of the present study is to investigate whether a systematic implementation of signaling questions into the routine outpatient consultation will be helpful to bridge this gap. METHODS/DESIGN: This is a multicenter cluster randomized study with two arms. Randomization is done on a cluster level with 13 hospitals providing regular neuro-oncological outpatient services conducted by neurologists and/or neurosurgeons. The intervention will include an assessment of psychosocial distress of patients in doctor-patient conversation compared to assessment of psychosocial distress via questionnaire (control, standard of care). In total, 616 HGG patients will be enrolled. The outcome will be the number of HGG patients with increased psychosocial distress who receive professional support from psychosocial services. Secondary endpoints are inter alia number of patients reporting psychosocial distress and unmet needs detected correctly by the respective method; quality of life; psychological well-being and burden of the patients before and after doctor-patient consultation; as well as the length of the doctor-patient consultation. DISCUSSION: Patients with HGG are confronted with an oncological diagnosis and at the same time with high symptom burden. This often leads to distress, which is not always adequately recognized and treated. So far, only a limited number of adequate instruments are available to assess HGG patient's distress. Yet, an adequate care and support network might facilitate the course of the disease and tumor therapies for patients. Our hypothesis is that an assessment conducted directly by attending doctors and in which the doctors talk to patients with HGG will be more effective than an assessment via a questionnaire, leading to better identifying patients in need of support. This may lead to an improvement of health care in these patients. Further, this method might be implemented also in other brain tumor patients (e.g., patients with brain metastases). TRIAL REGISTRATION: German Clinical Trials Register, DRKS00018079. Registered on 3rd September 2019.

Systematic screening as a tool for individualized rehabilitation following primary breast cancer treatment: study protocol for the ReScreen randomized controlled trial.

BACKGROUND: It is well known that women suffer from negative consequences following breast cancer (BC) treatment and that their largely varying needs for rehabilitation are often unmet. Up to 43% of these women are at risk of developing chronic distress requiring complex interventions; however, how to early identify and meet these women's needs is unknown, leaving them with suboptimal chances of rehabilitation. The aim of the ReScreen study is to develop a model for and evaluate the effect of screening-based, individualized rehabilitation following primary BC treatment. METHODS: The ReScreen study is designed as a complex intervention. Women with newly diagnosed BC are consecutively included in a three-armed randomized controlled trial. At inclusion, patients score their distress level on the Distress Thermometer (scale of 0-10) aiming to identify patients with extended rehabilitation needs. Patients scoring ≥5 are randomized to the intervention or control group while patients scoring ≤4 are followed longitudinally as an observational group. Patients in the intervention group, in conjunction with a dedicated research nurse, create an individualized rehabilitation plan based on an evidence-based decision support tool that was developed to create a solid base for the intervention. The research nurse will act as a continuous health care contact and be responsible for proactively and systematically evaluating patients' needs to ensure that potential new problems or changed rehabilitation needs are identified throughout the 1-year follow-up period. The intervention will be evaluated through self-reported data focusing on physical and psychological outcomes as well as evaluation of satisfaction with care at baseline, 2 weeks and 3, 6, 9 and 12 months. Evaluation will also include health economic aspects based on register data and patients' and relatives' experiences of the rehabilitation process. In addition, optimal cut-off levels for distress as an indicator for extended rehabilitation needs will be investigated. DISCUSSION: This study will provide important knowledge related to effectiveness of screening-based identification of rehabilitation needs and standardized evidence-based, individualized rehabilitation after primary BC treatment. With a complex intervention design, this study has the potential to form a comprehensive knowledge base which includes tools and guidelines for implementation into clinical practice. TRIAL REGISTRATION: ClinicalTrials.gov NCT03434717. Registered February 15, 2018.

Association Between Family Support, Coping Strategies and Anxiety in Cancer Patients Undergoing Chemotherapy at General Hospital in Medan, North Sumatera, Indonesia.

OBJECTIVE: This study aims to test the association between family support and coping strategies and anxiety at Dr. Pirngadi General Hospital Medan. METHODS: The study was a correlational descriptive study with a cross-sectional approach. The samples were 102 cancer patients undergoing chemotherapy, who were selected through purposive sampling technique. Data was collected using a family support questionnaire instrument developed based on the concept of the House and Friedman theory, a coping strategy questionnaire modified from the Revised Ways of Coping questionnaire by Folkman and Lazarus, and an anxiety questionnaire modified from the Hamilton Anxiety Rating Scale (HAM-A). Bivariate analysis was conducted using the Product Moment correlation coefficient to test the association between family support, coping strategies, and anxiety. Multivariate analysis was conducted using the logistic regression test to investigate dominant variables associated with coping strategies and anxiety. RESULTS: The results of the bivariate analysis showed a significant positive association (p=0.001) and strong correlation (r=0.612) between family support and Problem Focused Coping (PFC) strategy, while there was a significant negative association (p=0.001) and moderate correlation (r=-0.462) with the Emotion Focused Coping (EFC) strategy. A significant negative association (p=0.001) and strong correlation (r=-0.646) was found between family support and anxiety. The multivariate analysis showed a dominant association (p = 0.001) between family support with PFC strategy (OR = 12.2), EFC (OR = 0.142), and anxiety (OR = 0.039). CONCLUSION: Based on the results, it can be concluded that there was an association between good family support and effective coping strategies and lower anxiety levels in cancer patients undergoing chemotherapy. These results can be an input for health services to increase family support for cancer patients undergoing chemotherapy in combination with effective coping strategies to decrease anxiety levels.

A web-based psycho-educational intervention (Fex-Can) targeting sexual dysfunction and fertility-related distress in young adults with cancer: study protocol of a randomized controlled trial.

BACKGROUND: This study protocol describes the clinical trial of the Fex-Can intervention, a web-based self-help program targeting sexual dysfunction and fertility-related distress. The psycho-educational intervention has been developed in collaboration with young patients with cancer and shown to be feasible. The primary objective is to determine whether the Fex-Can intervention, provided in addition to standard care, is superior to standard care in terms of reduction of sexual dysfunction and fertility-related distress directly after end of the 12-week program. The trial also aims to determine whether the intervention has an effect on the secondary outcomes including health-related quality of life, anxiety, depression, body image, fertility knowledge, and self-efficacy related to sexuality and fertility. METHODS: The trial has an randomized clinical trial (RCT) design with two parallel arms. The active groups receive either the version of the Fex-Can intervention targeting sexual problems or the version targeting fertility-related distress. Control groups receive standard care. Primary outcomes will be sexual function assessed with the Patient-Reported Outcomes Measurement Information System® Sexual Function and Satisfaction measure version 2.0 (SexFS) and fertility-related distress assessed with the Reproductive Concerns After Cancer scale (RCAC). The effect of the intervention will be evaluated directly after end of the program. Primary and secondary outcomes will also be assessed at the short- (12 weeks after end of program) and long-term (20 and 44 months after end of program) follow-up. At least 64 completers will be needed in each arm (total n = 256) to achieve adequate statistical power in the analyses. In order to increase the understanding of how the intervention brings about a possible change, semi-structured interviews will additionally be conducted with a purposeful sample shortly after completion of the intervention. DISCUSSION: If the Fex-Can intervention proves to be efficacious the necessary steps will be taken to implement it in routine care for young adults diagnosed with cancer. Healthcare could thereby be provided with an easily accessible, cost-effective intervention to offer to young adults suffering from fertility-related distress or sexual problems. TRIAL REGISTRATION: ISRCTN36621459 . Registered 25 January 2016.

Gynecologic Cancer Survivorship.

Survivorship care includes surveillance and prevention of cancer recurrence, addressing side effects of cancer and cancer treatment and coordination of follow-up care. This article reviews guidelines for surveillance of women with ovarian, endometrial, cervical, and vulvar cancer. It also reviews many of the long-term physical side effects of gynecologic cancer treatment including fatigue, neuropathy, lymphedema, cognitive dysfunction, sexual health concerns, menopausal symptoms, infertility, and economic stressors. Finally, survivorship care plans are reviewed as a tool for coordinating care for women with a history of gynecologic cancer.

The Impact of Preoperative Mindfulness-Based Stress Reduction on Postoperative Patient-Reported Pain, Disability, Quality of Life, and Prescription Opioid Use in Lumbar Spine Degenerative Disease: A Pilot Study.

BACKGROUND: Prescription opioid medications negatively affect postoperative outcomes after lumbar spine surgery. Furthermore, opioid-related overdose death rates in the United States increased by 200% between 2000 and 2014. Thus, alternatives are imperative. Mindfulness-based stress reduction (MBSR), a mind-body therapy, has been associated with improved activity and mood in opioid-using patients with chronic pain. This study assessed whether preoperative MBSR is an effective adjunct to standard postoperative care in adult patients undergoing lumbar spine surgery for degenerative disease. METHODS: The intervention group underwent a preoperative online MBSR course. The comparison group was matched retrospectively in a 1:1 ratio by age, sex, type of surgery, and preoperative opioid use. Prescription opioid use during hospital admission and at 30 days postoperatively were compared with preoperative use. Thirty-day postoperative patient-reported outcomes for pain, disability, and quality of life were compared with preoperative patient-reported outcomes. Dose-response effect of mindfulness courses was assessed using Mindful Attention Awareness Scale scores. RESULTS: In this pilot study, 24 participants were included in each group. Most intervention patients (70.83%) completed 1 session, and the mean Mindful Attention Awareness Scale score was 4.28 ± 0.71 during hospital admission. At 30 days, mean visual analog scale back pain score was lower in the intervention group (P = 0.004) but other patient-reported outcomes did not differ. CONCLUSIONS: During hospital admission, no significant dose-response effect of mindfulness techniques was found. At 30 days postoperatively, MBSR use was associated with less back pain. Further research is needed to assess the effectiveness of preoperative MBSR on postoperative outcomes in lumbar spine surgery for degenerative disease.

Prehabilitation is better than cure.

PURPOSE OF REVIEW: With a continuously growing number of older patients undergoing major surgical procedures, reliable parameters practicable in perioperative routine revealing those patients at risk are urgently needed. Recently, the concept of 'prehabilitation' with its key elements exercise, nutrition and psychological stress reduction especially in frail patients is attracting increasing attention. RECENT FINDINGS: Literature search revealed a huge amount of publications in particular within the last 12 months. Although a single definition of both frailty and prehabilitation is still to be made, various players in the perioperative setting obviously are becoming increasingly convinced about a possible benefit of the program - referring to different components and measures performed. Although physiologically advantages seem obvious, there is hardly any reliable data on clinical outcomes resulting from properly performed studies. This applies especially to octogenarians; thus those at risk for adverse events the concept originally addresses. SUMMARY: Identifying high-risk patients at the earliest possible stage and increasing their physiological reserve prior to surgery is a promising approach that seems to result in remarkable improvements for older patients. However, further studies on effectiveness in a highly heterogeneous population and agreement on a common concept are mandatory before a final judgement can be given.

(Con) viver com a loucura: por um cuidado extramuros / (Co) existing with the madness: for a care outside the walls / (Con) vivir con la locura: Por un cuidado extramuros

O presente texto pretende refletir sobre o dispositivo do Centro de Convivência como uma ferramenta de empoderamento, de auxílio na construção de maior autonomia e promoção da cidadania da pessoa em sofrimento mental. Procura-se pensar a contribuição desse serviço para a efetivação da dimensão sociocultural da Reforma Psiquiátrica brasileira, auxiliando na inserção social do louco, a partir do fomento de atividades laborativas e artísticas e da articulação com diversos setores da sociedade. Assim, por meio da revisão de literatura de legislações sobre o tema, artigos científicos e textos de Conferências e Fóruns da Saúde Mental, busca-se analisar os desafios postos a esse serviço da Rede de Atenção Psicossocial frente a discursos e práticas homogeneizantes em nossa sociedade. Desse modo, verifica-se que, mesmo após grandes avanços da luta antimanicomial para a sensibilização da sociedade sobre a loucura, ainda persiste um imaginário social intolerante à diferença, ao louco. (AU)

The present article intends to reflect how the health mechanism of the Center of Coexistence can be a tool of empowerment, of help in the construction of greater autonomy and promotion of citizenship of the people in mental suffering. It is sought to think about the contribution of this service to the effectiveness at the socio-cultural dimension of the Brazilian Psychiatric Reform, contributing to the social insertion of the people in mental suffering, through the promotion of work and artistic activities and the articulation with various sectors of society. Thus, through the literature review of scientific articles and texts of Mental Health Conferences and Forums we seek to analyze the challenges imposed to this service of Primary Health Care, which works as an open and community space, face to speeches and practices homogenizers in our society. In this way, it is verified that even after great advances of the antimanicomial fight for the awareness of the society on the madness, still persists a social imaginary which is intolerant to the difference, to the madman. (AU)

El presente trabajo se propone reflexionar sobre el dispositivo del Centro de Convivencia como una herramienta de empoderamiento, de ayuda en la construcción de mayor autonomía y promoción de la ciudadanía de la persona en sufrimiento mental. Así, se busca pensar la contribución de ese servicio para la efectividad de la dimensión sociocultural de la Reforma Psiquiátrica brasileña, ayudando en la inserción social del loco, a partir del fomento de actividades laborativas y artísticas y de la articulación con diversos sectores de la sociedad. Por lo tanto, por medio de la revisión de literatura de legislaciones sobre el tema, artículos científicos y textos de Conferencias y Foros de la Salud Mental, se busca analizar los desafíos puestos a ese servicio de la Red de Atención Psicosocial frente a discursos y prácticas homogeneizantes en nuestra sociedad. De ese modo, se verifica que, incluso después de grandes avances de la lucha antimanicomial para la sensibilización de la sociedad sobre la locura, todavía persiste un imaginario social intolerante a la diferencia, al loco. (AU)

More frequent use of health care services among distressed compared with nondistressed survivors of lymphoma and chronic lymphocytic leukemia: Results from the population-based PROFILES registry.

BACKGROUND: Follow-up care for a growing population of survivors of lymphoma and chronic lymphocytic leukemia (CLL) together with the adverse effects these survivors may experience as a result of their cancer and treatment have led to more pressure being placed on health care services. The objectives of the current study were to: 1) compare the use of medical care services by survivors with that of a normative population; 2) evaluate the use of medical and psychosocial care services among distressed and nondistressed survivors; and 3) identify associated sociodemographic and clinical factors. METHODS: Survivors of lymphoma and CLL diagnosed between 1999 and 2012 were selected via the population-based Netherlands Cancer Registry and completed the Hospital Anxiety and Depression Scale questionnaire and questions regarding health care. Outcomes were compared with an age-matched and sex-matched normative population. RESULTS: A total of 1444 survivors responded (69%). Survivors of lymphoma and CLL contacted their general practitioner (3.8 vs 2.3; P<.001) and medical specialist (5.7 vs 1.6; P<.001) more often within the last year compared with a normative population. In addition, psychologically distressed survivors had even more medical contacts and received psychosocial care more often compared with nondistressed survivors. In addition to psychological distress, comorbidity, female sex, and older age were found to be associated with a greater use of medical services, whereas younger age was associated with receiving psychosocial care. CONCLUSIONS: Survivors of lymphoma and CLL, especially those who are psychologically distressed, report an increased use of health care services compared with a normative population. Further studies are needed to explore whether the use of widely applicable psychosocial interventions could reduce the frequency of medical contacts. Cancer 2018;124:3016-24. © 2018 Netherlands Comprehensive Cancer Organisation. Cancer published by Wiley Periodicals, Inc. on behalf of American Cancer Society.

Pilot study of a multimodal intervention to enhance sexual function in survivors of hematopoietic stem cell transplantation.

BACKGROUND: Although sexual dysfunction is common after hematopoietic stem cell transplantation (HCT), interventions to address sexual function are lacking. METHODS: We conducted a pilot study to assess the feasibility and preliminary efficacy of a multimodal intervention to address sexual dysfunction in allogeneic HCT survivors. Transplant clinicians screened HCT survivors ≥3 months post-HCT for sexual dysfunction causing distress. Those who screened positive attended monthly visits with a trained transplant clinician who: 1) performed an assessment of the causes of sexual dysfunction; 2) educated and empowered the patient to address his or her sexual concerns; and 3) implemented therapeutic interventions targeting the patient's needs. Feasibility was defined as having approximately 75% of patients who screened positive agreeing to participate and 80% attending at least 2 intervention visits. We administered the Patient-Reported Outcomes Measurement Information System (PROMIS) sexual function and satisfaction measure, the Functional Assessment of Cancer Therapy-Bone Marrow Transplant (FACT-BMT), and the Hospital Anxiety and Depression Scale (HADS) to evaluate sexual function, quality of life (QOL), and mood, respectively, at baseline and 6 months postintervention. RESULTS: Approximately 33.1% of patients (50 of 151 patients) screened positive for sexual dysfunction causing distress and 94.0% (47 of 50 patients) agreed to participate, with 100% attending 2 intervention visits. Participants reported improvements in satisfaction (P<.0001) and interest in sex (P<.0001), as well as orgasm (P<.0001), erectile function (P<.0001), vaginal lubrication (P = .0001), and vaginal discomfort (P = .0005). At baseline, approximately 32.6% of participants were not sexually active, compared with 6.5% after the intervention (P = .0005). Participants reported improvement in their QOL (P<.0001), depression (P = .0002), and anxiety (P = .0019). CONCLUSIONS: A multimodal intervention to address sexual dysfunction integrated within the transplant clinic is feasible with encouraging preliminary efficacy for improving sexual function, QOL, and mood in HCT survivors. Cancer 2018;124:2438-46. © 2018 American Cancer Society.

Improvement in sexual function after ovarian cancer: Effects of sexual therapy and rehabilitation after treatment for ovarian cancer.

BACKGROUND: Sexual dysfunction is a distressing long-term effect after gynecological cancer and affects the majority of survivors for years after the completion of therapy. Despite its prevalence, treatment-related sexual dysfunction is underrecognized and undertreated for survivors. Thus, the aim of this study was to develop and test a brief psychoeducational intervention for managing sexual dysfunction for women who have undergone treatment for ovarian cancer (OC). METHODS: Forty-six OC survivors with documented, treatment-related sexual dysfunction received a single half-day group intervention that included sexual health education and rehabilitation training, relaxation and cognitive behavioral therapy skills to address sexual symptoms, and a single tailored booster telephone call 4 weeks after the group. Assessment measures were completed at the baseline (baseline 1), after an 8-week no-treatment run-in period (baseline 2), and then again 2 and 6 months after the intervention. The Female Sexual Function Index (FSFI) was used to assess sexual functioning, and the Brief Symptom Inventory 18 (BSI-18) was used to capture psychological distress. RESULTS: Between baseline 1 and baseline 2, there were no significant changes in the study measures, and this indicated no natural improvement during the run-in period. In contrast, the total FSFI scores improved significantly from baseline 1 to the 2- (n = 45; P < .0005) and 6-month time points (n = 42; P < .05). The BSI-18 scores were also significantly improved at the 2- (P < .005) and 6-month time points (P < .01) in comparison with baseline 1. CONCLUSIONS: This brief behavioral intervention led to significant improvements in overall sexual functioning and psychological distress that were maintained at the 6-month follow-up. The results demonstrate the feasibility of this brief, low-intensity behavioral intervention and support the development of a larger randomized controlled trial. Cancer 2018;124:176-82. © 2017 American Cancer Society.

The Value of Rehabilitation Medicine for Patients Receiving Palliative Care.

BACKGROUND: Rehabilitation medicine is a multidisciplinary field aimed at improving patients' quality of life by improving function. Patients receiving palliative care frequently share common symptoms including fatigue, decreased functional independence, mood disorders, pain, and breathlessness. Many rehabilitation interventions can improve these symptoms. OBJECTIVE: To evaluate the scope and effectiveness of rehabilitation interventions and exercise programs in improving quality of life and distressing symptoms in patients receiving palliative care. METHODS: We conducted a literature review of cancer rehabilitation topics and techniques specifically applied to patients with life-limiting conditions. Exercise and other rehabilitation interventions were analyzed for their effects on common symptoms and disabilities experienced by this patient population. CONCLUSION: Current available literature supports the use of exercise programs and rehabilitation interventions to improve fatigue, mood, functional independence, breathlessness, and pain. Rehabilitation and palliative care practitioners share many goals in their approach to patient care and augment one another well. Palliative care providers should consider referral to physiatry (physical medicine and rehabilitation) to help optimize patients' quality of life.

[Areas and challenges of oncopsychological rehabilitation]. / Az onkopszichológiai rehabilitáció területei és kihívásai.

Patients with cancer present a number of different difficulties that adversely affect their health care and recovery (e.g. poor communication with physicians, lack of knowledge about their illness and its management, financial problems). Furthermore, mental health problems, such as distress, depression and anxiety, are common amongst patients with cancer. These mental health problems are additional contributors to functional impairment in carrying out family, work, and other social roles, poor adherence to medical treatments, and adverse medical outcomes. Oncopsychosocial rehabilitation aims to optimize the possibilities of medical health care through psychological interventions by helping cancer patients and their families and/or health care workers with the management of the psychological and social aspects of the illness. Oncopsychosocial rehabilitation includes all psychosocial interventions that are designed to positively influence patient psychosocial adaptation and adjustment to diagnosis, treatment, and survivorship. Oncopsychological rehabilitation could also manage cancer related distress and other psychosocial problems with specific types of treatments or interventions including prevention, relaxation techniques, structured psychoeducational interventions including sexual information and/or preparation for surgery, and various methods of psychotherapy.

Reported distress in patients living with advanced cancer: changes pre-post interdisciplinary palliative rehabilitation.

PURPOSE: Patients are living extended life with advanced cancer making it chronic rather than imminently terminal. Literature on the experience of living with advanced cancer is emerging, indicating ongoing polysymptomatic burden, lack of information, burnout (patients and caregivers), and emotional concerns, all of which contribute to emotional distress. The interdisciplinary Ottawa Palliative Rehabilitation Program (PRP) offers a scarce clinical resource for this population. The current research aimed to explore changes in self-reported distress for patients who completed the PRP, from baseline to program completion. METHODS: A secondary analysis of self-report and clinical measures was performed for 180 patients who completed the PRP. Measures included the Distress Thermometer and the Problem checklists. Descriptive statistics described the sample, paired-sample t tests examined changes in Distress Thermometer scores from baseline to PRP completion, and McNemar's tests revealed whether the most commonly endorsed checklist items changed by PRP completion. RESULTS: Participants (n = 180) had advanced heterogeneous cancers (mean age = 62.18, 49.4% male). From baseline to completion, significant reported changes included decreases in endorsement of clinical distress (from 55.6 to 38.9%; p < 0.001) and decreases in 7/10 of the most commonly endorsed checklist problems (p values ranging from 0.016 to <0.001). CONCLUSIONS: A number of endorsed checklist problems significantly decreased, as did overall self-reported distress. Compared to the existing literature that does not show improvements, our finding begins to support that palliative rehabilitation may benefit patient levels of distress by improving function and quality of life. Psychotherapy, anesthesia, and additional intervention for cognitive difficulties may further benefit patients.

Mindfulness y promoción de la salud mental en adolescentes: efectos de una intervención en el contexto educativo / Effects of a mindfulness intervention in Chilean high schoolers

Background: Mindfulness has been conceptualized as paying attention to present moment experience in a non-judgmental manner, and the practice of developing that skill. Aim: To determine the impact of a mindfulness-based intervention on negative emotional states of anxiety, stress, and depression in Chilean high schoolers. Material and Methods: Eighty-eight teenagers aged 13 ± 0.6 years (46 females) were randomly assigned to a mindfulness group or a control (41 and 47, respectively). The mindfulness intervention consisted in eight weekly 45-minute sessions. A depression, anxiety, and stress scale (DASS-21) was applied at baseline, after the intervention, and at three and six-month follow-up. Results: There was a significant reduction in anxiety, depression, and general symptomatology in the experimental group compared to the control group. However, these changes were not sustained at follow-up. Conclusions: These preliminary results suggest the feasibility and effectiveness of a mindfulness intervention in Chilean schools as a strategy to reduce negative emotional states and prevent risk factors in adolescent population groups.

Effects of previous physical exercise to chronic stress on long-term aversive memory and oxidative stress in amygdala and hippocampus of rats.

Since stressful situations are considered risk factors for the development of depression and there are few studies evaluating prevention therapies for this disease, in the present study we evaluated the effect of previous physical exercise in animals subjected to chronic variable stress (CVS), an animal model of depression, on behavior tasks. We also investigated some parameters of oxidative stress and Na+, K+-ATPase activity, immunocontent and gene expression of alpha subunits in amygdala and hippocampus of rats. Young male rats were randomized into four study groups (control, exercised, stressed, exercised+stressed). The animals were subjected to controlled exercise treadmill for 20min,three times a week, for two months prior to submission to the CVS (40days). Results show that CVS impaired performance in inhibitory avoidance at 24h and 7days after training session. CVS induced oxidative stress, increasing reactive species, lipoperoxidation and protein damage, and decreasing the activity of antioxidant enzymes. The activity of Na+, K+-ATPase was decreased, but the immunocontents and gene expression of catalytic subunits were not altered. The previous physical exercise was able to improve performance in inhibitory avoidance at 24h after training; additionally, exercise prevented oxidative damage, but was unable to reverse completely the changes observed on the enzymatic activities. Our findings suggest that physical exercise during the developmental period may protect against aversive memory impairment and brain oxidative damage caused by chronic stress exposure later in life.

Impaired Pain Modulation in Fibromyalgia Patients in Response to Social Distress Manipulation.

OBJECTIVES: Fibromyalgia (FM), a chronic pain condition, is associated with abnormalities in pain modulation. A growing body of evidence has shown that social distress modulates pain sensitivity. The current study aimed to assess the effects of social distress manipulation on pain in FM patients compared with positive (rheumatoid arthritis, RA) and negative (pain-free) controls. MATERIALS AND METHODS: FM, RA patients and pain-free controls (PFC) were recruited. Demographic, medical, and psychological data were collected. Each participant was exposed to 3 study conditions in a random order: the inclusion (positive social effects) and exclusion (negative social effects) conditions of Cyberball, a game that manipulates social distress, and a control condition. Pain sensitivity in response to nociceptive electrical and thermal (cold) stimuli was assessed before and during each study condition. RESULTS: In response to electrical stimuli, pain decreased in both the inclusion and exclusion conditions in PFC and RA groups, whereas inclusion conditions significantly increased pain in the FM group. Social manipulation (inclusion or exclusion) did not affect pain sensitivity as measured in response to thermal stimulation. DISCUSSION: These results are in line with previous studies demonstrating altered pain inhibition in FM patients, and suggest that unlike PFC or other non-"stress-related" chronic pain conditions, being socially included may increase pain perception in FM patients. Possible underlying mechanisms and clinical relevance are discussed.

The Emotional Freedom Technique: Finally, a Unifying Theory for the Practice of Holistic Nursing, or Too Good to Be True?

The Emotional Freedom Technique (EFT) is defined and described as a clinical procedure for the relief of psychological and physical distress that patients often bring to the attention of nurses. Frequently referred to as "tapping," this technique combines the cognitive reprocessing benefits of exposure and acceptance therapy with the energetic disturbance releases associated with acupuncture and other energy therapies. More than 60 research articles in peer-reviewed journals report a staggering 98% efficacy rate with the use of this procedure from psychological distress (posttraumatic stress disorder, phobias, anxiety, depression, etc.) to physical conditions (asthma, fibromyalgia, pain, seizure disorders, etc.) to performance issues (athletic, academic). Perhaps because of this, this technique has encountered a fair degree of skepticism within the health care community. Easily taught as a self-help aid that patients can administer to themselves, EFT becomes an efficacious tool in the hands of nurses who are seeking whole person approaches for the healing of a wide variety of psychological and physical conditions. A conceptual framework, mechanisms of action, evidence of safety, literature review, and case studies are also included.