A latent classes analysis to detect cognitive and emotional profiles in cancer patients.

Thought style has been described as a mediator between cancer diagnosis and the emotional response to cancer. Describe the latent profiles related to thought style (rumination, cognitive engagement, and cognitive avoidance) and emotional response in a sample of cancer patients. 159 cancer patients were assessed prior to starting treatment. Measurement instruments used were HADS, Cancer response thought style inventory, distress thermometer, and PTGI. Analysis of latent classes to explore profiles of who share the same thought style. The solution had 4 subgroups: first group was avoidance, the means for anxiety, depression and post-traumatic growth were the lowest of the four groups. The second group was rumination, presenting highest scores for anxiety, depression and post-traumatic growth. The third group was indeterminate, this group presented low anxiety and depression. The fourth group, with cognitive engagement presented low anxiety and depression and post-traumatic growth was high.

Relationship between Thought Style, Emotional Response, Post-Traumatic Growth (PTG), and Biomarkers in Cancer Patients.

(1) Introduction: Cancer diagnosis has been related to depression, anxiety, and distress, as well as to post-traumatic growth (PTG). One of the mediating variables for emotional response is thought style (rumination, cognitive avoidance, and cognitive engagement). (2) Aim: To identify the relationship between thought style and emotional responses to cancer. A secondary aim was to identify the relationship between emotional responses and inflammatory immunological biomarkers. (3) Method: A total of 115 patients with cancer were included in the study. Before initiating cancer treatment, patients were assessed using the Hospital Anxiety and Depression Scale (HADS), distress thermometer, and Post-Traumatic Growth Inventory (PTGI). Patients provided their most recent blood biometry. (4) Results: Rumination correlated with anxiety, depression, and distress. Cognitive avoidance correlated with PTG (-0.240) and distress (-0.209). Cognitive engagement correlated with PTG (0.393). Regarding thought style and biomarkers, a negative correlation was observed for absolute neutrophils with cognitive avoidance (-0.271) and rumination (0.305). Regarding biomarkers and emotional responses, there was a negative correlation between PTG and absolute lymphocytes (-0.291). There was also a correlation between PTG and neutrophils (0.357) and neutrophil-to-lymphocyte ratio (NLR) (0.295). (5) Conclusions: Thought style is related to the emotional response to a cancer diagnosis; rumination is related to depression, distress, and anxiety; and cognitive engagement is related to PTG. PTG is related to inflammation and immunological biomarkers.

Preparación psicológica para radioterapia en paciente con tumor en SNC: presentación de un caso / Psychological preparation for radiotherapy on a patient with a brain tumor: case report

Introducción: los meningiomas forman el 27% de los tumores de encéfalo en población adulta. La radioterapia es uno de los tratamientos para tumores primarios del SNC más efectivos, en el cual se administran altas dosis de radiación que destruye el ADN de las células cancerosas para detener su multiplicación o lentificar su crecimiento. Para este tratamiento es necesaria la inmovilización del paciente, que se asegura por medio de máscaras termoplásticas que fijan al paciente a la camilla del acelerador lineal. Este tipo de inmovilización ha representado una incidencia de ansiedad significativa previa al tratamiento y durante el mismo, puede causar niveles altos de estrés, miedo, malestar físico, dolor e incluso claustrofobia. Tomando en cuenta estos aspectos, como preparación psicológica para el tratamiento se sugiere ofrecer información clara previa y durante la simulación, identificar a los pacientes con niveles altos de ansiedad, y brindar estrategias cognitivas y conductuales para regular la misma. Objetivo: Describir un reporte de caso de preparación para radioterapia en SNC. Método: Se presenta el caso de una mujer de 61 años de edad que fue referida a psico-oncología con el objetivo de la preparación psicológica para radioterapia en SNC. El motivo de la referencia a psico-oncología fue evitar la sedación durante la radioterapia debido a los altos niveles de ansiedad que presentaba la paciente. Se realizaron dos sesiones de preparación psicológica en donde se incluyeron estrategias psicoeducativas, de desensibilización sistemática y respiración diafragmática. Resultados: La paciente disminuyó el reporte subjetivo de ansiedad, logró terminar las 25 sesiones de radioterapia sin necesidad de sedación. Conclusión: La preparación psicológica utilizada en esta paciente fue efectiva para disminuir ansiedad. Es importante realizar estudios aleatorizados y controlados para conocer realmente la efectividad.(AU)

Introduction:Meningiomas represent 27% of brain tumors in adults. Radiotherapy is one of the most frequent treatments for CNS tumors, in which high radiation doses destroy cancer cell’s DNA in order to stop their multiplication or to slow their growth. Patient’s inmovilization is necessary in this treatment, so he has to be attached to treatment bed with a thermogenic mask. This inmovilization has represented significant anxiety prior and during treatment, it can also represent a trigger for stress, fears, physical symptoms, pain and even claustrophobia. Considering this, a psychological preparation is suggested before radiotherapy. It is suggested o include clear information before and during simulation, and to identify patients with high levels of anxiety, and to deliver cognitive and behavioral strategies to regulate it. Aim: to describe a case report of a psychological preparation for CNS radiotherapy. Method: A case of a 61 year old woman who was referred to psycho-oncology service with the aim of psychological preparation for CNS radiation. The reason this patient was referred was to avoid sedation during treatment due to high levels of anxiety. Psychologic preparation consisted in two sessions that included psychoeducational, systematic desensibilization and diaphragmatic breathing strategies. Results: Subjective anxiety report was reduced with psychologic preparation, and the patient finished 25 sessions of radiotherapy without sedation. Conclusion: Psychological preparation in this patient was efective in anxiety reduction. It is important to design randomized controled studies in order to know the effectiveness of these strategies.(AU)

Construcción y análisis de propiedades psicométricas de la Escala de Apertura a la Comunicación en Pacientes de Cáncer (EACPC) / Design and psychometric property analysis of the Opening to Communication in Cancer Patients Scale (OCCPS)

La comunicación entre profesionales, pacientes y familiares ha sido objeto de interés y se han desarrollado algunas escalas para evaluar dicho proceso de comunicación. Es importante señalar que poder expresarse de temas que pueden provocar miedo como la muerte y el cáncer es un aspecto fundamental para el paciente. Por ello, disponer de una herramienta de evaluación que permita conocer el grado de apertura que muestra el paciente a la comunicación (aludiendo a la libertad, franqueza y confianza) es de gran utilidad. Sin embargo, no hemos detectado instrumentos diseñados para evaluar la apertura que muestran los pacientes a la comunicación. Objetivo: Diseñar una escala que evalúe de forma breve sólo la apertura a la comunicación del paciente con cáncer y estudiar las propiedades psicométricas de la misma. Método: Estudio instrumental, participaron 225 pacientes diagnosticados de diferentes tipos de cáncer a los que se administraron la escala de 9 reactivos. Posteriormente, se dividió la muestra en dos partes y se estudió la estructura interna mediante un Análisis factorial exploratorio y en la otra mitad un análisis factorial confirmatorio. Resultados: La Escala de Apertura a la Comunicación en Pacientes de Cáncer (EACPC) consta de nueve ítems, y mostró una estructura interna unifactorial. Los valores de alfa de cronbach de la escala resultaron adecuados (α= ,866 en la primera mitad y α= ,865 en la segunda). Conclusión: Las propiedades psicométricas de la EACPC indican que es un instrumento adecuado para ser utilizado en pacientes mexicanos con cáncer. (AU)

Communication process between patients, family and health professionals has been relevant in psycho-oncology, reason why assessment scales have been developed in order to measure this process. Expressing about issues related to concerns about death and cancer has been related to more adaptive coping, and promotes adaptation to cancer. Thus, having an assessment tool to measure the opening patient has to communicate these issues (aluding to liberty and confidence) is useful. Nevertheless we have not detected measurement tools designed to assess the opening patients have related to communication in this context. Aim: To design a scale that measures in a brief form only the opening to communication about death and cancer and to study psychometric properties of the same.Method: Instrumental study, participants were 225 patients diagnosed with different types of cancer. The 9 item scale was administered to the participants in a private oncologic clinic in Querétaro, Mexico. The study sample was splited in halfs and the internal structure was studied by an exploratory factorial analysis in the first half, and in the other half, by a confirmatory factorial analysis.Results:Comunication Opening in Cancer Patients Scale (COCPS) has 9 items, and showed a unifactorial internal structure. Cronbach alfa value from the scale resulted acceptable (α= .866 in the first half, and α= .865 on the second half). Conclusion: The COCPS has psychometric properties that indicate that it can be used in mexican cancer patients. (AU)

Análisis de las respuestas cognitivas relacionadas con el diagnóstico de cáncer en pacientes mexicanos / Cognitive response related to cancer diagnosis in Mexican patients

Resumen La evaluación subjetiva ha sido descripta como una variable mediadora para la respuesta emocional. Se presenta con diferentes contenidos y estilos. El estilo cognitivo se refiere a la manera en que se piensa sobre el estresor, por ejemplo: la rumiación (pensamientos intrusivos, repetitivos, que generan malestar emocional), la evitación (intentos por no pensar en el estresor) y el compromiso cognitivo (enfocados en búsqueda de sentido o solución). En base a esta respuesta emocional, se busca explorar y describir los pensamientos relacionados con el cáncer en un grupo de diez pacientes con la enfermedad. En un estudio cualitativo, se les pidió a diez pacientes con cáncer que indicaran los cinco pensamientos más frecuentes desde su diagnóstico. Se analizó el contenido mediante la técnica top down (teoría a contenido) y, a partir de los estilos de respuestas cognitivas, se clasificó el contenido de los pensamientos reportados por estilo de pensamiento (rumiación, compromiso cognitivo o evitación), por temporalidad (pasado, presente y futuro) y por valencia (positiva o negativa). Posteriormente, se hizo el análisis bottom up (contenido a teoría). Se hicieron tablas cruzadas para identificar los contenidos según el estilo de pensamiento, la temporalidad y la valencia. En los pensamientos con estilo rumiativo, el enfoque temporal se dirigía en su mayoría al futuro y al pasado, mientras que el compromiso cognitivo se enfocaba en el presente. Esta diferencia fue estadísticamente significativa mediante una prueba de chi cuadrado. Dentro de los temas relacionados con la incertidumbre, se refirieron a la muerte, al pronóstico de la enfermedad, a la respuesta de la familia y a las finanzas (en el futuro) y a las causas y culpa (en el pasado).

Abstract Cancer has been defined by the World Health Organization as "a disease caused by abnormal cells growing uncontrollably in the body, going beyond their usual boundaries, invading adjoining parts of the body and spreading to other organs". Being diagnosed with cancer has been described as an experience with diverse emotional reactions and difficulties in adaptation, having psychological consequences, being most common depression, anxiety and psychological distress; but also, some patients present positive consequences after having a cancer diagnosis, such as post traumatic growth, which includes positive changes presented after the disease experience. Subjective appraisal about cancer has been defined as a mediating variable for the emotional response presented after a stressor, such as cancer diagnosis, treatment, or important changes during disease process (initiating and finalizing treatment, presenting relapse or remission, as well as when having control studies). The subjective appraisal can be presented with different thought content and styles. Thought style is referred as the way thoughts about the stressor are presented, it has been classified as rumination (thoughts that are intrusive and repetitive that also increase psychological distress), cognitive engagement (thoughts associated with problem solving and meaning finding) or avoidance (aiming to stop thinking about stressor or feeling associated with it). Depending on the thought style presented at a stressor, could be the emotional response (anxiety, depression, distress, post-traumatic growth). The aim of the present study was to describe the thoughts (style, content, valence and temporality) related to cancer diagnosis in a group of ten oncologic patients. To identify if differences between thought style, valence and temporality were presented. The study design is qualitative from a phenomenological point of view. Ten oncologic (different cancer type, clinical stage and treatment) patients were asked to write the five more frequent thoughts since their cancer diagnosis. Each thought was classified by: thought style, valence, and temporality (top-down, classifying the thoughts according to theory). The same thoughts were also classified in semantic units (bottom-up, classifying the thoughts according to their own contents), generating concerns from the content. Cross tabs were made to identify contents and temporality for thought style and valence, which were analyzed by chi square to identify differences between thought style, temporality and valence. The most common thought style was cognitive engagement, followed by rumination (almost same frequency). On what respects to thought style and temporality, rumination was more focused on past (causes and attributions of cancer) and future (uncertainty about death and treatment effectiveness); meanwhile, cognitive engagement was focused on present (to enjoy present moment and focus on daily actions). Chi square was made to identify if this difference was significant, showing temporality was significantly different in cognitive engagement and rumination. The concerns identified in study participants were uncertainty about future and disease, family (communication and wellness of the family), finances (due to expensive treatments), causes and guilt about having cancer. Thoughts that were more centered in present, were more likely to be associated with cognitive engagement. Cognitive engagement has been described previously as an important variable associated with post traumatic growth. Thoughts centered in the past and present were more associated with rumination. Rumination has been associated with depression and post-traumatic stress disorder. Because of mediating role of thought style in disease adaptation, emotional response to the disease, and the relation of this adaptation with the perception of quality of life in cancer patients, the design of psychological interventions aiming on promoting cognitive engagement by problem solving skills, meaning finding, and focusing on present could be a research line derived from present studies results.

Diseño y análisis de propiedades psicométricas del Inventario de Estilos de Pensamiento en Respuesta al Cáncer (IEPRaC) / Design and psychometric properties analysis of the Thought Style in Response to Cancer Inventory (IEPRaC)

Una de las variables que ha sido definida como mediadora para la respuesta emocional ante el cáncer es el estilo de pensamiento. En contextos patológicos (por ejemplo, rumiación en depresión), y también en contextos normativos, se ha sugerido que el estilo de pensamiento puede predecir el ajuste ante un estresor. Existen instrumentos para evaluar de manera independiente los estilos de pensamiento (rumiación, evitación experiencial), pero ninguno está adaptado para población oncológica y ninguno incluye los tres estilos de pensamiento (rumiación, evitación y compromiso cognitivo). Objetivo: diseñar y estudiar las propiedades psicométricas de un instrumento que mida estilos de pensamiento en respuesta al diagnóstico oncológico. Método: Estudio instrumental, dividido en dos fases: la primera, elaboración de reactivos y jueceo de expertos y la segunda, análisis de propiedades psicométricas. Resultados: La versión final cuenta 15 ítems. La estructura interna resultó de tres factores, obtenidos a partir de un Análisis Factorial Exploratorio y corroborada mediante un Análisis Factorial Confirmatorio. Los valores de alfa de cronbach de las escalas resultaron adecuadas: la de Rumiación resultó de 0,87, la de Compromiso cognitivo de , 0,82 y de 0,72 la de evitación. Todos los ítems cuentan con evidencias de validez de contenido y propiedades psicométricas satisfactorias. La escala de Compromiso cognitivo fue la que obtuvo la puntuación media mayor y la de Rumiación mostró la menor. Conclusión: El Inventario de Estilos de Pensamiento en Respuesta al Cáncer (IEPRaC) cuenta con adecuadas propiedades psicométricas para ser utilizado en población oncológica mexicana (AU)

Thought style has been defined as one of the mediating variables to emotional response at a cancer diagnosis. It has been reported in pathological contexts (rumination in depression), but also in normative ones, it has been suggested that thought styles can predict adjustment to a stressor. There are measurement scales used to assess thought style independently (rumination, experiential avoidance), but none of them is adapted for oncologic population and none of them include all three thought styles. Aim: To design and assess psychometric properties of a scale of thought styles in response to a cancer diagnosis. Method: Instrumental Study, divided in two phases: the first, item elaboration and expert judge; the second, psychometric properties analysis. Results: Final version counts with 15 items. Intern Structure resulted in three factors, obtained by an Exploratory Factorial Analysis and corroborated by a Confirmatory Factorial Analisis. Cronbach’s alphas for the subscales resulted appropriate: for rumination 0.87, for cognitive engagement 0.82 and 0.72 for avoidance. All items have evidence for content validity and adequate psychometric properties. Results of Cognitive Engagement subscale had the higher mean and Rumination subscale was the lowest. Conclusion: Thought style in response to a cancer diagnosis scale (IERPaC) has adequate psychometric properties to be used in Mexican oncologic patients (AU)

Neutrophil-lymphocyte index as prognostic factor for overall survival and disease-free survival in breast cancer patients / Índice neutrófilo-linfocito como factor pronóstico de sobrevida global y periodo libre de enfermedad en pacientes con cáncer de mama

BACKGROUND: Since 2006 breast cancer has been the leading cause of death by cancer in Mexican women. Recently several studies have shown the relationship of neutrophil-lymphocyte index (NLI) and breast cancer as a predictor of overall survival (OS) and disease-free survival (DFS). METHODS: The study included 2711 patients of the Institute of Breast Diseases (FUCAM) treated since April 2006 to March 2011. The NLI and its relation with OS and DFS were evaluated. A receiver operating characteristic curve was used to obtain the cut-off point of greater sensitivity and specificity for the NLI. A multivariate analysis was used to analyze the clinical parameters of prognostic factor. RESULTS: 342 patients were included for the analysis. The follow-up time average of 80.1 months and the mean of NLI was 2.1. In this model, sensitivity was 66.7% (95% CI: 46-64) p = 0.04. The Kaplan-Meier analysis was applied to evaluate OS and the DFS of all patients according to the NLI, comparing two groups: ≤2.1 and ≥ 2.1. No differences were reported between these groups. In triple negative patients (n=32), patients with NLI>2.1 had a shorter DFS in comparison to patients with NLI<2.1 (20 vs 55.6% in 5 years, p = 0.04). The univariate Cox risk model revealed that a NLI>2.1 pretreatment, lymph node stage and Ki-67 were correlated independently with the DFS. CONCLUSIONS: Our study suggests that there is a relationship between the NLI and the breast cancer DFS; especially in triple negative subtypes

ANTECEDENTES: El cáncer de mama tiene un enorme impacto en la salud de las mujeres. En México, desde el año 2006, el cáncer de mama ha sido la principal causa de muerte por cáncer en las mujeres mexicanas, y que representa 14% de las muertes relacionadas con el cáncer. Existen diversos factores que representan un papel importante en el desarrollo, progresión y persistencia del cáncer; entre ellos se reconoce a la respuesta inflamatoria. Múltiples estudios han demostrado la relación del índice linfocito neutrófilo (INL) y el cáncer de mama como predictor de sobrevida global y período libre de enfermedad. MATERIAL Y MÉTODOS: El diseño de estudio fue retrospectivo, transversal. Se revisaron 2.711 expedientes de pacientes con cáncer de mama tratados en el Instituto de Enfermedades de la Mama, FUCAM, en el período de abril de 2006 a marzo de 2011; se evaluó el INL previo a recibir tratamiento, y se obtuvo la relación con el período libre de enfermedad y la sobrevida global. Análisis estadístico: para obtener el punto de corte de mayor sensibilidad y especificidad para el INL se utilizó una curva de característica operativa del receptor (COR). Para variables dicotómicas se utilizó la prueba de Chi-cuadrado, mientras que para sobrevida y periodo libre de enfermedad se utilizaron las curvas de Kaplan-Meier. Un análisis multivariable se realizó para analizar el factor pronóstico de los parámetros clínicos. RESULTADOS: De la muestra inicial de 2.711, 342 cumplieron criterios de inclusión y fueron analizados. La media de edad al momento del diagnóstico fue de 51,38 años, un seguimiento promedio de 80,1 meses y la media del INL fue de 2,1. Se evaluó la sensibilidad/especificidad de la prueba para el INL, mediante la curva COR, la sobrevida libre de enfermedad y la sobrevida global. En este modelo, la sensibilidad fue del 66,7%. Al evaluar la sobrevida global y el periodo libre de enfermedad de todas las pacientes con cáncer de mama, de acuerdo al INL, comparando en 2 grupos, por INL, grupo 1, menor a 2,1 y grupo 2, ≥2,1 no se encontraron diferencias estadísticamente significativas. Se realizó otro análisis a una submuestra de pacientes con subtipo triple negativos (n=32), las que obtuvieron un INL>2,1 mostraron una menor supervivencia libre de enfermedad en comparación con los pacientes con IN<2,1 (a 5 años, 20 frente al 55,6%; p = 0,04). Al realizarse el modelo de riesgo univariante de Cox se identificó que un INL>2,1 pretratamiento, el estadio nodular y Ki-67 fueron variables que correlacionaron de manera independiente con el periodo libre de enfermedad. CONCLUSIONES: No se encontraron diferencias estadísticamente significativas en periodo libre de enfermedad, ni en sobrevida global, en pacientes con cáncer de mama agrupados acorde a INL. En la submuestra de pacientes con subtipo triple negativo (n=32), el grupo con mayor INL (> 2,1), mostró una menor supervivencia libre de enfermedad en comparación con el que tuvo menor INL (<2,1). Las variables que mostraron correlación con el periodo libre de enfermedad en este subgrupo (triple negativo), fueron un INL>2,1 pretratamiento, el estadio nodular y Ki-67

Comparación de las percepciones del cáncer entre pacientes oncológicos y personal de salud / Comparison of social representations about cancer between cancer patients and health professional

El cáncer es una de las principales causas de muerte en el mundo. Las percepciones sobre esta enfermedad impactan en la calidad de vida de los pacientes y del personal de salud. El objetivo de esta investigación fue conocer la percepción del cáncer en pacientes oncológicos y profesionales de la salud y compararlas entre sí. La investigación se realizó en un centro oncológico del estado de Querétaro, México, y se trató de un estudio cualitativo, en el que se utilizó la técnica "listados libres" de la antropología cognitiva. Constó de 10 pacientes con cáncer y 10 profesionales de la salud. El instrumento utilizado fue el de "listados libres". El análisis realizado fue perceptual cualitativo categorizando las palabras mencionadas en "listados libres" y un análisis de contenido temático. Se analizaron frecuencias y porcentajes de categorías y posteriormente se compararon entre personal y pacientes. En los resultados, se identificaron categorías de emociones displacenteras, afrontamiento, tratamientos y oportunidad en ambos grupos. Las diferencias identificadas fueron que los profesionales incluían emociones displacenteras en ellos mismos, elementos de relación médico paciente y aspectos administrativos-económicos. Se concluye que existen similitudes entre profesionales de salud y pacientes en la percepción del cáncer, sin embargo, hay diferencias que deben ser tomadas en cuenta, como que el personal de salud también presenta malestar emocional.

In Mexico and the world, cancer is one of the leading causes of death. Associations with this disease can have an impact on the quality of life of patients and health professionals practising oncology. As a result, it was considered relevant to study the social representations (SR) of cancer and to make a comparison between oncology patients and health professionals. Methods: The study was conducted in an oncology centre in the state of Querétaro, Mexico, and the sample consisted of 10 patients and 10 health professionals. Using qualitative perceptual analysis, it categorised the words mentioned in "free listings" and thematic analysis. Results: Categories of unpleasant emotions, coping, treatment and opportunity were identified in both groups. There were differences between SRs of cancer patients and health professionals; professionals included displeasing emotions in themselves (in addition to patients), elements of the doctor-patient relationship and administrative-economic aspects. Conclusions: There are some similarities between health professionals and cancer patients in terms of cancer perception; however, there are differences that should be considered. One of them is that health staff also present emotional discomfort (even if they are not the ones who have the disease), patients did not present the category "death". In contrast, health staff did, this as well as the administrative-economic category. These findings allow us to explore the perceptions of staff and patients to determine future lines of research.

Uso de biofeedback de variabilidad de la frecuencia cardiaca durante la radioterapia como método de distracción cognitiva y autorregulación en un paciente pediátrico: Informe de caso / Biofeedback use of heart rate variability during radiotherapy as a method of cognitive distraction and self-regulation in a pediatric patient: A case report

Objetivo: Evaluar la efectividad del uso de biofeedback de variabilidad de frecuencia cardiaca (VFC) durante la radioterapia como método de distracción cognitiva y autoregulación emocional en un paciente pediátrico. Método: La paciente es una niña de 11 años con diagnóstico de sarcoma de Ewing en la pierna izquierda. Recibió 28 sesiones de radioterapia. Antes de iniciar tratamiento, se evaluó psicológicamente a la paciente con la entrevista Mini Kid, identificando que no tenía psicopatología. Dos semanas previas a iniciar, se evaluó la frecuencia cardiaca (FC) y variabilidad (VFC) de la misma (indicadores que han sido utilizados previamente como correlatos fisiológicos de estrés y relajación) con un software especializado llamado EmWave, identificando que sí presentaba activación fisiológica asociada a estrés. Se hizo entrenamiento en respiración diafragmática apoyado con el equipo de retroalimentación dos semanas previas a la radioterapia. El día que inició tratamiento, se volvió a evaluar la frecuencia y variabilidad antes de comenzar. Durante la radioterapia se instrumentó a la paciente al software y se permitió que ella escogiera el juego (que registra las variables de FC y VFC e interactúa conforme ella logra autoregulación fisiológica) y éste era proyectado en el techo de la sala mientras recibía la radiación. Resultados: Se identificaron cambios en la variabilidad de la frecuencia cardiaca, logrando una autoregulación, mostrando así que la paciente aprendió a relajarse y que lo puso en práctica durante la radioterapia. Conclusión: El uso del biofeedback es innovador en el tratamiento con radioterapia; permite al paciente integrar los dos métodos más utilizados como preparación para la misma: distraer el foco atencional y lograr una autoregulación. Se sugiere ampliar la muestra para conocer los efectos y generalizar los resultados (AU)

Aim: To assess the effectiveness of heart rate variability (HRV) biofeedback during radiotherapy as an intervention to promote cognitive distraction and emotional regulation un a paediatric patient. Method: Patient is an 11 years old female with Ewing Sarcoma on left leg. She recieved 28 radiotherapy sessions. Before initiating treatment, the patient was assessed with Mini International Neuropsychiatric Interview KID (MINI KID). She did not have a psychiatirc diagnostic, nor significative anxiety as rated by these instruments. Two weeks prior initiating radiotherapy, Heart rate (HR) and heart rate variability (HRV) (measures that have been used previously as physiologic corralates of stress and relaxation) were measured with a specialized software called EmWave. Results identified that there was a psysiologic activation related to stress. At the same session, the patient was trained in diaphragmatic breathing assisted with HRV biofeedback. The day the radiotherapy treatment started, HR and HRV were assessed an hour before. During radiotherapy, patient was instrumented to the software and the display was projected on the ceiling so that she could interact with the program at the same time she recieved radiotherapy. Patient was asked to choose the display she prefered (presented as interactive games by EmWave) and HR as well as HRV were measured during treatment. Results: Changes in HRV during radiotherapy were presented, these changes have been reported as indicative of self regulation, reflecting that the patient learned this behavior and was able to implement it during her treatment. Conclussion: The use of biofeedback is innovative in treatment with radiotherapy; it allows the patient to integrate the two most used methods for psychological preparation: attentional distraction and self regulation methods. It’s suggested to amplify the sample in order to learn more about the use of biofeedback in radiotherapy and generalize results (AU)

Hábitos de alimentación de pacientes con obesidad severa / Eating habits of patients with severe obesity

Introducción: La obesidad severa es un problema de salud que tiene consecuencias médicas, emocionales y socioeconómicas. La etiología de la obesidad severa es multifactorial; no obstante, se sabe que los hábitos de alimentación representan un factor importante en su desarrollo. Objetivo: Este estudio tuvo como objetivo identificar los patrones de ingesta y los hábitos alimentarios específicos que es necesario modificar para lograr la pérdida de peso. Método: Se llevó a cabo un estudio observacional- descriptivo, prolectivo y transversal con 250 pacientes candidatos a cirugía bariátrica, 79.2% mujeres y 20.8% hombres con una edad de 37.7 ± 10.2 años y un IMC 44.3 ± 7.7 kg/m2. Resultados: Se encontró que 'tomar agua', 'comer más rápido que la mayoría que las personas', 'dejar el plato vacío', 'tener ayunos prolongados', 'antojos dulces' y 'tomar refresco' fueron los hábitos más frecuentes en pacientes con obesidad severa. También se examinó la existencia de diferencias significativas entre los hábitos de los hombres y las mujeres y por estratos o grupos de IMC. Se identificó que 'picar alimentos' y 'comer hasta sentirse incómodo' fueron significativamente distintos entre sexos y 'comer solo por sentir pena con los demás' fue significativo entre estratos de IMC. Discusión: Se concluyó que es importante que el tratamiento de estos pacientes incluya técnicas de evaluación y modificación de conductas encaminadas a estos hábitos, así mismo se recomienda incluir en futuros estudios pacientes con peso normal y sobrepeso, así como el uso de instrumentos con propiedades psicométricas adecuadas (AU)

Introduction: Severe obesity is a health problem that has medical, emotional and economic consequences. The etiology of severe obesity is multifactorial; however, it is known that the eating habits represent a major factor in the development of this disease. Objective: This study aimed to identify eating patterns and specific habits that need to be changed to achieve weight loss. Method: An observational, descriptive, retrospective and cross-sectional study with 250 candidates for bariatric surgery, 79.2% women and 20.8% men aged 37.7 ± 10.2 years and 44.3 ± 7.7 kg/m2 BMI patients was performed. Results: It was found that “drinking water”, “eat faster than most people”, “leave the plate empty”, “have long fasts”, “sweet cravings”, and “drinking soda” were the most common habits in patients with severe obesity. The existence of significant differences between the habits of men and women and between BMI strata or groups are also discussed. “Snacking” and “eat until you feel uncomfortable” were significantly different between men and women and “eat by yourself because you feel ashamed of eating with others” was significant between BMI strata. Discussion: It was concluded that it is important that the treatment of these patients includes assessment techniques and behavior modification aimed at these habits. It is recommended to include in future studies patients with normal weight and overweight as well as the use of instruments with adequate psychometric properties (AU)

Correlation between the gastrojejunostomosis area, documented endoscopically, and the loss of weight in laparoscopic gastric bypass postoperative patients: results of 1 year after surgery.

Laparoscopic Y Roux gastric bypass (YRGB) is the most performed bariatric surgery. There are 3 main techniques in the construction of the gastrojejunostomosis (GJA). The size of the GJA and its relation to the reduction of excess weight has been previously debated. The aim of our study was to determine whether the GJA area in YRGB correlates with the loss of excess weight at 1 year postoperatively. Patients who complied 1 year after YRGB underwent an upper gastrointestinal endoscopy. Images of the GJA were obtained and the area of the GJA was calculated. A statistical analysis, adjusting for age and body mass index preoperatively obtained an r of -0474 and P=0.032, demonstrating a significant negative correlation between the GJA area and the percentage of excess weight loss. A statistically significant negative correlation between the GJA area and the percentage of the excess weight loss was shown. The number of patients evaluated should be increased for a higher statistical significance to corroborate whether the stoma size influences the loss of weight in YRGB patients.

Intervención cognitivo-conductual grupal para pérdida de peso y calidad de vida en pacientes candidatos a cirugía bariátrica / Cognitive behavioral group intervention for weight loss and quality of life in patients candidates for bariatric surgery / Intervenção cognitivo-condutual grupal para perda de peso e qualidade de vida em pacientes candidatos a cirurgia bariátrica

La obesidad es un problema de salud mundial asociado con el desarrollo de enfermedades crónico degenerativas. La cirugía bariátrica es el tratamiento que ha mostrado mayor efectividad para la obesidad severa; el paciente debe modificar su estilo de vida para mantener la pérdida de peso a largo plazo. Se ha visto que las intervenciones cognitivo conductuales han sido efectivas para lograr este cambio en el paciente. El presente estudio busca evaluar la efectividad de una intervención cognitivo conductual grupal en la pérdida de peso y calidad de vida antes de la cirugía. Se incluyeron nueve pacientes con obesidad mórbida candidatos a cirugía bariátrica sin comorbilidades psiquiátricas. Se realizó una evaluación inicial de calidad de vida que medía peso e IMC (Índice de Masa Corporal, por sus siglas en español). Los pacientes fueron sometidos a una intervención grupal con el objetivo de promover la pérdida de peso mediante técnicas cognitivo conductuales. El promedio de pérdida de peso fue de 5.7 kg en las cinco semanas que duró el tratamiento, mostrando significancia estadística de .001; a su vez, con la pérdida de peso disminuyó el IMC con una significancia estadística de .002. En cuanto a calidad de vida, hubo mejoría significativa en la percepción corporal y en la actitud al tratamiento.

Obesity is a global health problem associated with the development of chronic degenerative diseases. Bariatric surgery has proven to be the most effective treatment for severe obesity. Despite surgery, patients must change their lifestyle in order to maintain weight loss in the long term. It has been reported that cognitive behavioral interventions have been effective to promote a lifestyle change and weight loss in obese patients. The aim of this study was to assess the effectiveness of a cognitive behavioral group intervention on weight loss and quality of life before surgery. Participants were nine morbidly obese patients, without psychiatric comorbidities, candidates for bariatric surgery. An initial assessment of quality of life that measured weight and BMI (Body Mass Index, for its English acronym) was performed. Patients underwent a group intervention in order to promote weight loss through cognitive behavioral techniques. The average weight loss was 5.7 kg during the five weeks of treatment, showing statistical significance of .001. In turn, along with weight loss, there was a decrease in BMI, with a statistical significance of .002. Regarding quality of life, there was significant improvement in body perception and attitude toward treatment.

A obesidade é um problema de saúde mundial associado com o desenvolvimento de enfermidades crônico degenerativas. A cirurgia bariátrica é o tratamento que mostrou maior efetividade para a obesidade severa; o paciente deve modificar seu estilo de vida para manter a perda de peso a longo prazo. Observa-se que intervenções cognitivo conductuais têm sido efetivas para conseguir esta mudança no paciente. O presente estudo busca avaliar a efetividade de uma intervenção cognitivo conductual grupal na perda de peso e qualidade de vida antes da cirurgia. Incluíram-se nove pacientes com obesidade mórbida candidatos a cirurgia bariátrica sem co-morbilidades psiquiátricas. Realizou-se uma avaliação inicial de qualidade de vida que media peso e IMC (Índice de Massa Corporal). Os pacientes foram submetidos a uma intervenção grupal com o objetivo de promover a perda de peso mediante técnicas cognitivo conductuais. A média de peso perdido foi de 5.7 kg nas cinco semanas que o tratamento durou, mostrando significância estatística de .001; ao mesmo tempo a perda de peso fez com que o IMC diminuísse com uma significância estatística de .002. Com respeito à qualidade de vida, houve melhoria significativa na percepção corporal e na atitude com respeito ao tratamento.

[Eating habits of patients with severe obesity]. / Hábitos de alimentación de pacientes con obesidad severa.

INTRODUCTION: Severe obesity is a health problem that has medical, emotional and economic consequences. The etiology of severe obesity is multifactorial; however, it is known that the eating habits represent a major factor in the development of this disease. OBJECTIVE: This study aimed to identify eating patterns and specific habits that need to be changed to achieve weight loss. METHOD: An observational, descriptive, retrospective and cross-sectional study with 250 candidates for bariatric surgery, 79.2% women and 20.8% men aged 37.7 ± 10.2 years and 44.3 ± 7.7 kg/m2 BMI patients was performed. RESULTS: It was found that "drinking water", "eat faster than most people", "leave the plate empty", "have long fasts", "sweet cravings", and "drinking soda" were the most common habits in patients with severe obesity. The existence of significant differences between the habits of men and women and between BMI strata or groups are also discussed. "Snacking" and "eat until you feel uncomfortable" were significantly different between men and women and "eat by yourself because you feel ashamed of eating with others" was significant between BMI strata. DISCUSSION: It was concluded that it is important that the treatment of these patients includes assessment techniques and behavior modification aimed at these habits. It is recommended to include in future studies patients with normal weight and overweight as well as the use of instruments with adequate psychometric properties.

Introducción: La obesidad severa es un problema de salud que tiene consecuencias médicas, emocionales y socioeconómicas. La etiología de la obesidad severa es multifactorial; no obstante, se sabe que los hábitos de alimentación representan un factor importante en su desarrollo. Objetivo: Este estudio tuvo como objetivo identificar los patrones de ingesta y los hábitos alimentarios específicos que es necesario modificar para lograr la pérdida de peso. Método: Se llevó a cabo un estudio observacional- descriptivo, prolectivo y transversal con 250 pacientes candidatos a cirugía bariátrica, 79.2% mujeres y 20.8% hombres con una edad de 37.7 ± 10.2 años y un IMC 44.3 ± 7.7 kg/m2. Resultados: Se encontró que "tomar agua", "comer más rápido que la mayoría que las personas", "dejar el plato vacío", "tener ayunos prolongados", "antojos dulces" y "tomar refresco" fueron los hábitos más frecuentes en pacientes con obesidad severa. También se examinó la existencia de diferencias significativas entre los hábitos de los hombres y las mujeres y por estratos o grupos de IMC. Se identificó que "picar alimentos" y "comer hasta sentirse incómodo" fueron significativamente distintos entre sexos y "comer solo por sentir pena con los demás" fue significativo entre estratos de IMC. Discusión: Se concluyó que es importante que el tratamiento de estos pacientes incluya técnicas de evaluación y modificación de conductas encaminadas a estos hábitos, así mismo se recomienda incluir en futuros estudios pacientes con peso normal y sobrepeso, así como el uso de instrumentos con propiedades psicométricas adecuadas.

El rol del psicólogo en el equipo Interdisciplinariasciplinario de cirugía bariátrica / The psychologist's role in a bariatric Interdisciplinariasciplinary team

La obesidad ha sido declarada por la OMS como una epidemia y es factor de riesgo para diversas enfermedades tanto físicas como psicológicas, por lo que supone una creciente carga económica para los sistemas de salud. Actualmente el tratamiento que mayor efectividad ha mostrado para tratar la obesidad severa es la cirugía bariátrica; sin embargo, a pesar de los cambios anatómicos realizados por la cirugía, no todos los pacientes se ven beneficiados por la misma. Se ha reportado que el 20% de estas cirugías fracasan y generalmente este fracaso es atribuido a causas psicológicas. El número de cirugías bariátricas realizadas en el mundo está aumentando exponencialmente y dentro de las guías norteamericanas se sugiere el tratamiento Interdisciplinariasciplinario, incluyendo en este el tratamiento psicológico. El trabajo que se informa busca describir el rol del psicólogo en un equipo Interdisciplinariasciplinario de cirugía bariátrica.

Obesity has been declared by the WHO as an epidemic. It has been described as a multicausal disease and that it's etiology is influenced by biological, psychological, environmental and other factors. It is a risk factor for many diseases not only physical (diabetes, hypertension, hypercholesterolemia, an so on) but also psychological (depression, anxiety, eating behavior disorders, etc.); reason for which it's supposed to be a raising charge for worldwide health systems. Among the approved treatments for overweight and obesity are included: nutritional (caloric restriction), increase physical activity and behavioral therapy. When talking about patients with severe obesity (BMI 40), the most effective treatment that has been proven is bariatric surgery, indicated for patients with a BMI 40 or 35 in case of presenting co morbidities. It has been described that surgical treatment for obesity promotes mayor weight loss, generates significant improvement of the co morbidities associated with the obese condition and helps to prolong life expectancy and to increase quality of life. Despite all of the advantages that this treatment has proven to offer, not all of the patients benefit from it, even with the anatomical changes made by the surgery, some of the patients don't get to loose a significant amount of weight; differences in the variations of weight after the surgery at short and long term have been reported. It has been reported that approximately 20% of bariatric surgeries fail due to poor weight loss and that this failure is generally attributed to psychological or behavioral causes. Nowadays the American Society for Metabolic and Bariatric Surgery (ASMBS) guidelines suggest that surgical treatment for obesity must be performed in a Interdisciplinariasciplinary approach that includes surgeon, nutritionist, internist, physical rehabilitator and a psychologist. According to the same guidelines, the psychologist's role in this team consists on initially evaluating surgery candidates in order to determine if there is existing psychopathology and their ability to implement the lifestyle changes needed before and after the procedure, to give psico educational interventions in order to prepare patients for these changes and to make an informed decision about this treatment. This preparation helps patients having realistic expectations about the surgery results, helps to decrease the uncertainty that generates anxiety. For this reason, psychologist´s work should be focused on motivation and adherence on lifestyle changes by psycho educational and cognitive behavioral specific interventions. In conclusion, the goal of the psychologist in the bariatric surgery team is to identify possible contraindications for the surgery and to identify possible post-surgical challenges as well as to give behavioral specific strategies in order to cope with those challenges. The prevalence of obesity is rising across the world and, in order to treat it, the increase in the number of bariatric surgeries performed. As ASMBS guidelines suggest a Interdisciplinariasciplinary approach where the psychologist plays a fundamental role in order to get a better prognosis after the surgery, it is important to increase the number of psychologists with the necessary skills to work with these patients, and with knowledge about obesity and bariatric surgery. The present research aims to describe the psychologist's role in a bariatric surgery Interdisciplinariasciplinary clinic and some of the strategies described for psychological obesity treatment suggested to be used before and after the surgery, in order to promote a lifestyle change.

El rol del psicólogo en el equipo Interdisciplinariasciplinario de cirugía bariátrica / The psychologists role in a bariatric Interdisciplinariasciplinary team

La obesidad ha sido declarada por la OMS como una epidemia y es factor de riesgo para diversas enfermedades tanto físicas como psicológicas, por lo que supone una creciente carga económica para los sistemas de salud. Actualmente el tratamiento que mayor efectividad ha mostrado para tratar la obesidad severa es la cirugía bariátrica; sin embargo, a pesar de los cambios anatómicos realizados por la cirugía, no todos los pacientes se ven beneficiados por la misma. Se ha reportado que el 20% de estas cirugías fracasan y generalmente este fracaso es atribuido a causas psicológicas. El número de cirugías bariátricas realizadas en el mundo está aumentando exponencialmente y dentro de las guías norteamericanas se sugiere el tratamiento Interdisciplinariasciplinario, incluyendo en este el tratamiento psicológico. El trabajo que se informa busca describir el rol del psicólogo en un equipo Interdisciplinariasciplinario de cirugía bariátrica.(AU)

Obesity has been declared by the WHO as an epidemic. It has been described as a multicausal disease and that its etiology is influenced by biological, psychological, environmental and other factors. It is a risk factor for many diseases not only physical (diabetes, hypertension, hypercholesterolemia, an so on) but also psychological (depression, anxiety, eating behavior disorders, etc.); reason for which its supposed to be a raising charge for worldwide health systems. Among the approved treatments for overweight and obesity are included: nutritional (caloric restriction), increase physical activity and behavioral therapy. When talking about patients with severe obesity (BMI 40), the most effective treatment that has been proven is bariatric surgery, indicated for patients with a BMI 40 or 35 in case of presenting co morbidities. It has been described that surgical treatment for obesity promotes mayor weight loss, generates significant improvement of the co morbidities associated with the obese condition and helps to prolong life expectancy and to increase quality of life. Despite all of the advantages that this treatment has proven to offer, not all of the patients benefit from it, even with the anatomical changes made by the surgery, some of the patients dont get to loose a significant amount of weight; differences in the variations of weight after the surgery at short and long term have been reported. It has been reported that approximately 20% of bariatric surgeries fail due to poor weight loss and that this failure is generally attributed to psychological or behavioral causes. Nowadays the American Society for Metabolic and Bariatric Surgery (ASMBS) guidelines suggest that surgical treatment for obesity must be performed in a Interdisciplinariasciplinary approach that includes surgeon, nutritionist, internist, physical rehabilitator and a psychologist. According to the same guidelines, the psychologists role in this team consists on initially evaluating surgery candidates in order to determine if there is existing psychopathology and their ability to implement the lifestyle changes needed before and after the procedure, to give psico educational interventions in order to prepare patients for these changes and to make an informed decision about this treatment. This preparation helps patients having realistic expectations about the surgery results, helps to decrease the uncertainty that generates anxiety. For this reason, psychologist´s work should be focused on motivation and adherence on lifestyle changes by psycho educational and cognitive behavioral specific interventions. In conclusion, the goal of the psychologist in the bariatric surgery team is to identify possible contraindications for the surgery and to identify possible post-surgical challenges as well as to give behavioral specific strategies in order to cope with those challenges. The prevalence of obesity is rising across the world and, in order to treat it, the increase in the number of bariatric surgeries performed. As ASMBS guidelines suggest a Interdisciplinariasciplinary approach where the psychologist plays a fundamental role in order to get a better prognosis after the surgery, it is important to increase the number of psychologists with the necessary skills to work with these patients, and with knowledge about obesity and bariatric surgery. The present research aims to describe the psychologists role in a bariatric surgery Interdisciplinariasciplinary clinic and some of the strategies described for psychological obesity treatment suggested to be used before and after the surgery, in order to promote a lifestyle change.(AU)

Psychosocial Profile of Bariatric Surgery Candidates and the Correlation between Obesity Level and Psychological Variables

Bariatric surgery has proven to be the most effective treatment for severe obesity. Weight loss and long-term maintenance depend on patient’s ability to implement permanent lifestyle changes. Presurgical psychological evaluation and intervention are proposed for a better post surgical prognosis. The aim of present study was to make a psychosocial profile with the results of psychological evaluation performed to 129 bariatric surgery candidates and to determine associations between psychological variables with obesity level. Patients were evaluated with an oral interview, the MINI International Neuropsychiatric Interview, and the following self-reported instruments: Beck Depression Inventory, Anxiety Sensitivity Inventory, Stress Control Perception, Risk Factors related to Eating Behavior Disorders Scale, Quality of Life and Health Inventory. Study population was divided in groups according to obesity level, evaluation results were compared according to these groups. Results in present study show a high prevalence of psychiatric disorders; obesity level was not directly associated with level of psychopathology. Another finding is that at higher level of obesity, there is less concern about weight and food and also there is a significant higher perception of family support. The group of patients with higher concerns about weight and food had lower BMI and less perception of family support (AU)

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