Cuidando al final de la vida. Un programa de intervención online para familiares de pacientes oncológicos en fase paliativa / Caring the caregivers. An online psychological intervention for family caregivers of oncological palliative patients

Resumen: Objetivo: Analizar la eficacia de un programa de intervención psicológica grupal en formato online diseñado para reducir la sobrecarga y el malestar emocional de los cuidadores informales de pacientes oncológicos en fase final de vida. Método: El programa se desarrolló para cuidadores principales de pacientes oncológicos en situación de enfermedad avanzada, con pronóstico de vida inferior a 6 meses. La intervención consistió en cuatro sesiones semanales. Los instrumentos de evaluación fueron la Escala de Detección de Malestar Emocional del Cuidador Principal y la Escala Zarit Reducida y se aplicaron al inicio y al final del programa. Además, se categorizaron las principales preocupaciones de los cuidadores a través de la Escala de Detección del Malestar del Cuidador Principal. Se utilizaron estadísticos descriptivos y t de Student. Resultados: En el estudio participaron 38 familiares de los cuales el 81,6% eran mujeres. En cuanto el grado de parentesco, el 44,7% eran descendientes del paciente. El malestar emocional se redujo significativamente después de la intervención. La incertidumbre se mantuvo como principal preocupación en ambos momentos de medida. Antes del programa, la segunda preocupación más frecuente fue el sufrimiento por el ser querido enfermo, mientras que después de la intervención fue la preocupación por el sufrimiento de otros miembros de la familia. Conclusiones: La realización de este programa de intervención psicológica grupal online demostró ser efectiva para reducir el malestar emocional en los cuidadores principales de pacientes oncológicos al final de la vida. La incertidumbre fue una preocupación constante a lo largo del programa en los familiares. (AU)

Abstract:Aim: analyze the effectiveness of an online delivered psychological intervention program for oncological palliative caregivers in order to reduce the distress and caregiver burden. Methods: The program was developed for primary caregivers of advanced cancer patients, with a life expectancy of less than 6 months. The intervention consisted of 4 weekly sessions. The assessment instruments were the Caregiver Emotional Distress Detection Scale and the Zarit’s Reduced Scale and were applied at the beginning and end of the program. In addition, the main worries of the caregivers were categorized by the Caregiver Emotional Distress Detection Scale. Descriptive statistics and Student’s t were used. Results: 38 caregivers enrolled in intervention, 81.6% of whom were women. Regarding the degree of kinship, 44.7% were descendants of the patient. The distress was significantly reduced after the intervention. Uncertainty remained the main worry at both moments of measurement. Before the program, the second most frequent worry was the suffering of the patient, while after the intervention it was worries about the suffering of other family members. Conclusions: Carrying out this online group psychological intervention program proved to be effective in reducing emotional distress in the main caregivers of cancer patients at the end of life. Uncertainty was a constant concern throughout the program in the relatives. (AU)

Refits, cobbles, and fire: Approaching the temporal nature of an expedient Gravettian lithic assemblage from Lagar Velho (Leiria, Portugal).

Upper Paleolithic lithic assemblages have traditionally been considered a paramount example of the high level of complexity characterizing the technological behavior of prehistoric modern humans. The diversity and standardization of tools, as well as the systematic production of blades and bladelets, show the high investment of time, energy and knowledge often associated with Upper Paleolithic technocomplexes. However, more expedient behaviors have also been documented. In some cases, such low-cost behaviors can be dominant or almost exclusive, giving assemblages of Upper Paleolithic age an "archaic" appearance. In this paper, we address these expedient Upper Paleolithic technologies through the study of a lithic assemblage recovered from a Gravettian-age layer from the Lagar Velho rockshelter (Leiria, Portugal). Due to the specific formation processes characterizing this site, we also discuss the distinction between artifacts and geofacts, an aspect that is particularly difficult in expedient assemblages. Moreover, the combination of lithic refitting and data on thermal damage allows us to approach the temporal nature of the lithic assemblage and the timing of the different agents contributing to its formation.

A 39,600-year-old leather punch board from Canyars, Gavà, Spain.

Puncture alignments are found on Palaeolithic carvings, pendants, and other fully shaped osseous artifacts. These marks were interpreted as abstract decorations, system of notations, and features present on human and animal depictions. Here, we create an experimental framework for the analysis and interpretation of human-made punctures and apply it to a highly intriguing, punctured bone fragment found at Canyars, an Early Upper Palaeolithic coastal site from Catalonia, Spain. Changes of tool and variation in the arrangement and orientation of punctures are consistent with the interpretation of this object as the earliest-known leather work punch board recording six episodes of hide pricking, one of which was to produce a linear seam. Our results indicate that Aurignacian hunters-gatherers used this technology to produce leather works and probably tailored clothes well before the introduction of bone eyed needles in Europe 15,000 years later.

The characterization of bearded vulture (Gypaetus barbatus) coprolites in the archaeological record.

The archaeological record of the Lagar Velho rock shelter (Lapedo Valley, Leiria, Portugal) bears testimony to several significant Upper Palaeolithic occupations, most notably the Lapedo Child burial (LV1) dating from the Gravettian. Excavations undertaken at the site since 2018 have seen the recovery of a large quantity of coprolites, above all in layer 143 (c. 29 ka cal BP). The study of these fossilized remains points to the bearded vulture (Gypaetus barbatus) as the main coprogenic agent and provides the first descriptions of these avian coprolites in archaeological assemblages. The analyses reported involved the comparison of the coprogenic samples with modern bearded vulture scats. A new morphotype is proposed for discriminating the faeces of this avian scavenger based on (1) macroscopic analyses, (2) morphometric comparisons with other fossil and modern scats and (3) their mineralogical and elemental composition. Among the criteria proposed here to identify the coprolites of the bearded vulture are their cylindrical shape, diameter, pointed extremities and homogeneous porous texture, as well as their massive internal texture, hard consistency and total absence of bone inclusions (attributable in all likelihood to a high digastric juice acidity capable of dissolving bones). Our results indicate that, as well as being used by humans for short-term stays, the Lagar Velho rock shelter was used by the bearded vulture as a nesting site. We provide new evidence from Iberia of the activity of this avian scavenger as a bone accumulator in archaeological sites.

Frontal sinuses and human evolution.

The frontal sinuses are cavities inside the frontal bone located at the junction between the face and the cranial vault and close to the brain. Despite a long history of study, understanding of their origin and variation through evolution is limited. This work compares most hominin species' holotypes and other key individuals with extant hominids. It provides a unique and valuable perspective of the variation in sinuses position, shape, and dimensions based on a simple and reproducible methodology. We also observed a covariation between the size and shape of the sinuses and the underlying frontal lobes in hominin species from at least the appearance of Homo erectus. Our results additionally undermine hypotheses stating that hominin frontal sinuses were directly affected by biomechanical constraints resulting from either chewing or adaptation to climate. Last, we demonstrate their substantial potential for discussions of the evolutionary relationships between hominin species.

Early evidence of fire in south-western Europe: the Acheulean site of Gruta da Aroeira (Torres Novas, Portugal).

The site of Gruta da Aroeira (Torres Novas, Portugal), with evidence of human occupancy dating to ca. 400 ka (Marine Isotope Stage 11), is one of the very few Middle Pleistocene localities to have provided a fossil hominin cranium associated with Acheulean bifaces in a cave context. The multi-analytic study reported here of the by-products of burning recorded in layer X suggests the presence of anthropogenic fires at the site, among the oldest such evidence in south-western Europe. The burnt material consists of bone, charcoal and, possibly, quartzite cobbles. These finds were made in a small area of the cave and in two separate occupation horizons. Our results add to our still-limited knowledge about the controlled use of fire in the Lower Palaeolithic and contribute to ongoing debates on the behavioural complexity of the Acheulean of Europe.

Taphonomic criteria for identifying Iberian lynx dens in quaternary deposits.

For decades, taphonomists have dedicated their efforts to assessing the nature of the massive leporid accumulations recovered at archaeological sites in the northwestern Mediterranean region. Their interest lying in the fact that the European rabbit constituted a critical part of human subsistence during the late Pleistocene and early Holocene. However, rabbits are also a key prey in the food webs of Mediterranean ecosystems and the base of the diet for several specialist predators, including the Iberian lynx (Lynx pardinus). For this reason, the origin of rabbit accumulations in northwestern Mediterranean sites has proved a veritable conundrum. Here, we present the zooarchaeological and taphonomic study of more than 3000 faunal and 140 coprolite remains recovered in layer IIIa of Cova del Gegant (Catalonia, Spain). Our analysis indicates that this layer served primarily as a den for the Iberian lynx. The lynxes modified and accumulated rabbit remains and also died at the site creating an accumulation dominated by the two taxa. However, other agents and processes, including human, intervened in the final configuration of the assemblage. Our study contributes to characterizing the Iberian lynx fossil accumulation differentiating between the faunal assemblages accumulated by lynxes and hominins.

Protein tyrosine phosphatase 1b deficiency protects against hepatic fibrosis by modulating nadph oxidases.

Inflammation is typically associated with the development of fibrosis, cirrhosis and hepatocellular carcinoma. The key role of protein tyrosine phosphatase 1B (PTP1B) in inflammatory responses has focused this study in understanding its implication in liver fibrosis. Here we show that hepatic PTP1B mRNA expression increased after bile duct ligation (BDL), while BDL-induced liver fibrosis was markedly reduced in mice lacking Ptpn1 (PTP1B-/-) as assessed by decreased collagen deposition and α-smooth muscle actin (α-SMA) expression. PTP1B-/- mice also showed a significant increase in mRNA levels of key markers of monocytes recruitment (Cd68, Adgre1 and Ccl2) compared to their wild-type (PTP1B+/+) littermates at early stages of injury after BDL. Interestingly, the lack of PTP1B strongly increased the NADPH oxidase (NOX) subunits Nox1/Nox4 ratio and downregulated Cybb expression after BDL, revealing a pro-survival pattern of NADPH oxidase induction in response to liver injury. Chimeric mice generated by transplantation of PTP1B-/- bone marrow (BM) into irradiated PTP1B+/+ mice revealed similar hepatic expression profile of NOX subunits than PTP1B-/- mice while these animals did not show differences in infiltration of myeloid cells at 7 days post-BDL, suggesting that PTP1B deletion in other liver cells is necessary for boosting the early inflammatory response to the BDL. PTP1B-/- BM transplantation into PTP1B+/+ mice also led to a blockade of TGF-ß and α-SMA induction after BDL. In vitro experiments demonstrated that deficiency of PTP1B in hepatocytes protects against bile acid-induced apoptosis and abrogates hepatic stellate cells (HSC) activation, an effect ameliorated by NOX1 inhibition. In conclusion, our results have revealed that the lack of PTP1B switches NOX expression pattern in response to liver injury after BDL and reduces HSC activation and liver fibrosis.

Amber imitation? Two unusual cases of Pinus resin-coated beads in Iberian Late Prehistory (3rd and 2nd millennia BC).

A group of beads from the artificial cave of La Molina (Lora de Estepa, Sevilla) and Cova del Gegant (Sitges, Barcelona) were made from a biogenic raw material and intentionally covered by a layer of resin. This is the first time this type of treatment has been documented on elements of adornment in the Late Prehistory of the Iberian Peninsula. The composition and nature of the coatings are analysed and the symbolic role of such alterations and imitations of prehistoric adornments is discussed.

The bony labyrinth in the Aroeira 3 Middle Pleistocene cranium.

The discovery of a partial cranium at the site of Aroeira (Portugal) dating to 389-436 ka augments the current sample of Middle Pleistocene European crania and makes this specimen penecontemporaneous with the fossils from the geographically close Atapuerca Sima de los Huesos (SH) and Arago sites. A recent study of the cranium documented a unique combination of primitive and derived features. The Aroeira 3 cranium preserves the right temporal bone, including the petrosal portion. Virtual reconstruction of the bony labyrinth from µCT scans provides an opportunity to examine its morphology. A series of standard linear and angular measures of the semicircular canals and cochlea in Aroeira 3 were compared with other fossil hominins and recent humans. Our analysis has revealed the absence of derived Neandertal features in Aroeira 3. In particular, the specimen lacks both the derived canal proportions and the low position of the posterior canal, two of the most diagnostic features of the Neandertal bony labyrinth, and Aroeira 3 is more primitive in these features than the Atapuerca (SH) sample. One potentially derived feature (low shape index of the cochlear basal turn) is shared between Aroeira 3 and the Atapuerca (SH) hominins, but is absent in Neandertals. The results of our study provide new insights into Middle Pleistocene population dynamics close to the origin of the Neandertal clade. In particular, the contrasting inner ear morphology between Aroeira 3 and the Atapuerca (SH) hominins suggests a degree of demographic isolation, despite the close geographic proximity and similar age of these two sites.

Taphonomic inferences about Middle Pleistocene hominins: The human cranium of Gruta da Aroeira (Portugal).

OBJECTIVES: The aim of this work is to describe the taphonomic signatures of the Aroeira 3 cranium, with a specific focus on cranial breakage, comparing the cranium with other Middle and Upper Pleistocene hominin fossils in order to approximate the cause of death and the biological agencies and geologic processes involved in the taphonomic record of this specimen. Aroeira-3 was recovered from Acheulean layer X of Gruta da Aroeira (Portugal), dated to 390-436 ka. MATERIALS AND METHODS: Taphonomic analyses noted surface modifications employing standard methods. The cranial breakage pattern of Aroeira 3 was analyzed to assess the presence/absence of perimortem (fresh bone) and postmortem (dry bone) fractures and the possible causes of perimortem skull bone fractures. RESULTS: Aroeira 3 presents substantial bone loss of the left supraorbital arch and the outer cranial table of the frontal squama. Most of the fractures present features consistent with postmortem injuries. The fracture to the posterior region of the parietal bone, however, displays features more usually present in perimortem bone fractures. No evidence of anthropogenic activity or of carnivore modification has been identified. None of the expected features of interpersonal conflict are observed. Finally, the bone loss in the frontal squama and the supraorbital arch could be attributed to different agencies, and a traumatic event cannot be totally ruled out as origin of the bone alteration. DISCUSSION: Cannibalism, secondary treatment of the corpse and accumulation induced by carnivores can all be discarded, making an accident the most plausible explanation for the cranial fracture.

New Middle Pleistocene hominin cranium from Gruta da Aroeira (Portugal).

The Middle Pleistocene is a crucial time period for studying human evolution in Europe, because it marks the appearance of both fossil hominins ancestral to the later Neandertals and the Acheulean technology. Nevertheless, European sites containing well-dated human remains associated with an Acheulean toolkit remain scarce. The earliest European hominin crania associated with Acheulean handaxes are at the sites of Arago, Atapuerca Sima de los Huesos (SH), and Swanscombe, dating to 400-500 ka (Marine Isotope Stage 11-12). The Atapuerca (SH) fossils and the Swanscombe cranium belong to the Neandertal clade, whereas the Arago hominins have been attributed to an incipient stage of Neandertal evolution, to Homo heidelbergensis, or to a subspecies of Homo erectus A recently discovered cranium (Aroeira 3) from the Gruta da Aroeira (Almonda karst system, Portugal) dating to 390-436 ka provides important evidence on the earliest European Acheulean-bearing hominins. This cranium is represented by most of the right half of a calvarium (with the exception of the missing occipital bone) and a fragmentary right maxilla preserving part of the nasal floor and two fragmentary molars. The combination of traits in the Aroeira 3 cranium augments the previously documented diversity in the European Middle Pleistocene fossil record.

A Common Genetic Origin for Early Farmers from Mediterranean Cardial and Central European LBK Cultures.

The spread of farming out of the Balkans and into the rest of Europe followed two distinct routes: An initial expansion represented by the Impressa and Cardial traditions, which followed the Northern Mediterranean coastline; and another expansion represented by the LBK (Linearbandkeramik) tradition, which followed the Danube River into Central Europe. Although genomic data now exist from samples representing the second migration, such data have yet to be successfully generated from the initial Mediterranean migration. To address this, we generated the complete genome of a 7,400-year-old Cardial individual (CB13) from Cova Bonica in Vallirana (Barcelona), as well as partial nuclear data from five others excavated from different sites in Spain and Portugal. CB13 clusters with all previously sequenced early European farmers and modern-day Sardinians. Furthermore, our analyses suggest that both Cardial and LBK peoples derived from a common ancient population located in or around the Balkan Peninsula. The Iberian Cardial genome also carries a discernible hunter-gatherer genetic signature that likely was not acquired by admixture with local Iberian foragers. Our results indicate that retrieving ancient genomes from similarly warm Mediterranean environments such as the Near East is technically feasible.

The Neandertals of northeastern Iberia: new remains from the Cova del Gegant (Sitges, Barcelona).

The present study describes a new juvenile hominin mandible and teeth and a new juvenile humerus from level V of the GP2 gallery of Cova del Gegant (Spain). The mandible (Gegant-5) preserves a portion of the right mandibular corpus from the M1 distally to the socket for the dc mesially, and the age at death is estimated as 4.5-5.0 years. Gegant-5 shows a single mental foramen located under the dm1/dm2 interdental septum, a relatively posterior placement compared with recent hominins of a similar developmental age. The mental foramen in Gegant-5 is also placed within the lower half of the mandibular corpus, as in the previously described late adolescent/adult mandible (Gegant-1) from this same Middle Paleolithic site. The Gegant-5 canine shows pronounced marginal ridges, a distal accessory ridge, and a pronounced distolingual tubercle. The P3 shows a lingually-displaced protoconid cusp tip and a distal accessory ridge. The P4 shows a slightly asymmetrical crown outline, a continuous transverse crest, a mesially placed metaconid cusp tip, a slight distal accessory ridge, and an accessory lingual cusp. The M1 shows a Y5 pattern of cusp contact and a well-developed and deep anterior fovea bounded posteriorly by a continuous midtrigonid crest. Gegant-4 is the distal portion of a left humerus from a juvenile estimated to be between 5 and 7 years old at death. The specimen shows thick cortical bone. Although fragmentary, the constellation of morphological and metric features indicates Neandertal affinities for these specimens. Their spatial proximity at the site and similar ages at death suggest these remains may represent a single individual. The addition of these new specimens brings the total number of Neandertal remains from the Cova del Gegant to five, and this site documents the clearest evidence for Neandertal fossils associated with Middle Paleolithic stone tools in this region of the Iberian Peninsula.

Personality profiles between obese and control subjects assessed with five standardized personality scales.

BACKGROUND/AIM: Psychopathology may exert influence on developing and maintaining obesity. Studies of personality traits or psychopathology of personality in obesity are scarce and contradictory. The aim of this study was to compare personality profiles between obese and normal-weight subjects and to determine the most useful tool to detect differences, considering that psychological assessment and psychotherapeutical support should be included within the overall management of these patients.* METHOD: We examined 55 obese subjects (mean BMI=43kg/ m2) and 66 controls (mean BMI =21.7kg/m2). We used the personality assessment tools: MCMI-II, TCI-R, EPQ-A, BIS-111 and SSS. Factorial multivariate analysis of variance was applied; with factors BMI, Gender and Age as a covariate. RESULTS: Significant differences between groups were more marked in the clinical syndrome scales of MCMI-II, particularly in Major-Depression, Thought-Disorder, Anxiety, Somatoform and Alcohol-Dependence. Among obese, women scored higher than men in all scales but not significantly. We have found significant differences in normal personality dimensions between both groups in TCI-R. Obese showed higher scores in Harm Avoidance, and lower in Novelty Seeking, Persistence and Self-transcendence. The remaining tests have not been useful for differentiating personality traits between both groups. CONCLUSION: Obese subjects showed different personality profiles than control subjects. The most useful scales for determining these differences might be those designed to assess pathological personality such as MCMI-II. Less important would be those intended to measure normal personality traits, such as TCI-R and EPQ-A.

Perfiles de personalidad en sujetos obesos y control medidos con cinco escalas estandarizadas de personalidad / Personality profiles between obese and control subjects assessed with five standardized personality scales

Introducción. La psicopatología puede ejercer influencia en el desarrollo y mantenimiento de la obesidad. Los estudios sobre los rasgos de personalidad o la psicopatología de la personalidad en obesidad son escasos y contradictorios. El objetivo de este estudio fue la comparación de los perfiles de personalidad entre sujetos obesos y normo-peso y la determinación de la herramienta más útil para la detección de diferencias, considerando que la evaluación psicológica y el apoyo psicoterapéutico deberían incluirse en el manejo de estos pacientes. Metodología. Examinamos 55 sujetos obesos (IMC=43kg/m2) y 66 controles (IMC=21,7kg/m2). Empleamos las herramientas de valoración de la personalidad: MCMI-II, TCI-R,EPQ-A, BIS-111 y SSS. Aplicamos un análisis multivariado dela varianza incluyendo los factores IMC, sexo y edad como covariables. Resultados. Se encontraron diferencias significativas más marcadas entre los grupos fueron más marcadas en las escalas clínicas del MCMI-II, especialmente en la de Depresión Mayor, Pensamiento psicótico, Ansiedad, Histeriforme y Abuso de alcohol. Entre los obesos, las mujeres puntuaron más que los hombres en todas las escalas, aunque no fue significativo. Encontramos diferencias significativas en los rasgos normales de personalidad entre ambos grupos en el TCI-R. Los obesos presentaron mayores puntuaciones en Evitación del daño y menores en Búsqueda de novedad, Persistencia y Trascendencia. El resto de los test no presentaron utilidad para la diferenciación de los rasgos de personalidad entre ambos grupos. Conclusión. Los sujetos obesos presentaron distintos perfiles de personalidad que los sujetos control. Las escalas de mayor utilidad para la determinación de estas diferencias podrían ser aquellas diseñadas para la evaluación de la personalidad patológica, tales como el MCMI-II. De menor importancia serían aquellas dirigidas a medir los rasgos de personalidad normal, tales como el TCI-R y el EPQ-A (AU)

Background/aim. Psychopathology may exert influence on developing and maintaining obesity. Studies of personality traits or psychopathology of personality in obesity are scarce and contradictory. The aim of this study was to compare personality profiles between obese and normal-weight subjects and to determine the most useful tool to detect differences, considering that psychological assessment and psychotherapeutical support should be included within the overall management of these patients. Method. We examined 55 obese subjects (mean BMI=43kg/m2) and 66 controls (mean BMI =21.7kg/m2). We used the personality assessment tools: MCMI-II, TCI-R, EPQ-A, BIS-111and SSS. Factorial multivariate analysis of variance was applied; with factors BMI, Gender and Age as a covariate. Results. Significant differences between groups were more marked in the clinical syndrome scales of MCMI-II, particularly in Major-Depression, Thought-Disorder, Anxiety, Somatoform and Alcohol-Dependence. Among obese, women scored higher than men in all scales but not significantly. We have found significant differences in normal personality dimensions between both groups in TCI-R. Obese showed higher scores in Harm Avoidance, and lower in Novelty Seeking, Persistence and Self-transcendence. The remaining tests have not been useful for differentiating personality traits between both groups. Conclusion. Obese subjects showed different personality profiles than control subjects. The most useful scales for determining these differences might be those designed to assess pathological personality such as MCMI-II. Less important would be those intended to measure normal personality traits, such as TCI-R and EPQ-A (AU)