Comunidades Compasivas: intervención comunitaria para la preven-ción del duelo complicado. Modelo implantado por Madrid Salud / Compassionate Communities: Community intervention for the prevention of complicated grief. Model implemented by Madrid Salud

Objetivo: Fortalecer la capacidad de las personas para afrontar y acompañar las situaciones de duelo desde el modelo de Comunidades Compasivas a través de una perspectiva comunitaria. Metodología: Diseño de dos ejes de intervención: sensibilización y formación a la población y profesionales, y desarrollo de espacios grupales dirigidos a prevenir el duelo complicado. Resultado: Se ha realizado un diagnóstico de la ciudad de Madrid. Se han realizado 60 formaciones dirigidas al personal de Madrid Salud y 32 a profesionales entidades del entorno comunitario. Se han realizado 327 sensibilizaciones en torno al final de la vida y el duelo (5.873 personas). Se ha establecido contacto con 283 recursos públicos y 158 recursos privados a lo largo del año. Por último, se han llevado a cabo un total de 15 Espacios Grupales de Acompañamiento al Duelo. Conclusiones: El modelo de comunidades compasivas de la ciudad de Madrid ha conseguido fortalecer las capacidades de la ciudadanía de Madrid para el cuidado colectivo a través de las diferentes actividades de sensibilización e impactar en el fortalecimiento profesional y sensibilidad de los profesionales de la salud en relación con los conceptos clave del proyecto, generando así una comunidad compasiva (AU)

Objective:The main objective of the Compassionate Communities project in the city of Madrid is to strengthen people’s ability to face and accompany grief situations through a community perspective. Methodology: Design of two intervention axes: sensitization and training of the population and professionals, and development of group spaces aimed at preventing complicated grief. Result: A diagnosis of the city of Madrid has been carried out. Sixty trainings have been carried out for Madrid Salud staff and 32 for professionals and community organizations. There have been 327 sensitizations about the end of life and bereavement (5,873 people). Contact was established with 283 public resources and 158 private resources throughout the year. Finally, a total of 15 Group Spaces for Grieving Support have been carried out. Conclusions: The compassionate communities model of the city of Madrid has managed to strengthen the capacities of the citizens of Madrid for collective care through the different awareness-raising activities and to impact on the professional strengthening and sensitivity of health professionals in relation to the key concepts of the project, thus generating a compassionate community (AU)

Exercise Intervention in Pediatric Patients with Solid Tumors: The Physical Activity in Pediatric Cancer Trial.

INTRODUCTION: The randomized controlled trial "Physical Activity in Pediatric Cancer" determined the effects of an inhospital exercise intervention combining aerobic and muscle strength training on pediatric cancer patients with solid tumors undergoing neoadjuvant chemotherapy. METHODS: Participants were allocated to an exercise (n = 24, 17 boys; mean ± SEM age, 10 ± 1 yr) or control group (n = 25, 18 boys; 11 ± 1 yr). Training included three sessions per week for 19 ± 2 wk. Participants were assessed at treatment initiation, termination, and 2 months after end treatment. The primary endpoint was muscle strength (as assessed by upper and lower-body five-repetition-maximum tests). Secondary endpoints included cardiorespiratory fitness, functional capacity during daily life activities, physical activity, body mass and body mass index, and quality of life. RESULTS: Most sessions were performed in the hospital's gymnasium. Adherence to the program averaged 68% ± 4% and no major adverse events or health issues were noted. A significant interaction (group-time) effect was found for all five-repetition maximum tests (leg/bench press and lateral row; all P < 0.001). Performance significantly increased after training (leg press: 40% [95% confidence interval [CI], 15-41 kg); bench press: 24% [95% CI, 6-14 kg]; lateral row 25% [95% CI, 6-15 kg]), whereas an opposite trend was found in controls. Two-month post values tended to be higher than baseline for leg (P = 0.017) and bench press (P = 0.014). In contrast, no significant interaction effect was found for any of the secondary endpoints. CONCLUSION: An inhospital exercise program for pediatric cancer patients with solid tumors undergoing neoadjuvant treatment increases muscle strength despite the aggressiveness of such therapy.

Physical Activity in Pediatric Cancer patients with solid tumors (PAPEC): trial rationale and design.

BACKGROUND: This randomized controlled trial on Physical Activity in Pediatric Cancer (PAPEC) was designed to assess the impact of an exercise program on pediatric cancer patients undergoing chemotherapy for solid tumors. METHODS AND DESIGN: 60 pediatric patients of both sexes, aged 4 to 18 years and undergoing treatment for extracranial primary solid tumors will be recruited for this trial. Each participant will be randomly assigned (with blocking on sex) to either an intervention or control (normal care) group. The intervention group will participate in combined inpatient physical training (aerobic + strength) for the duration of neoadjuvant chemotherapy. The intervention will include 3 weekly 60-70 min exercise sessions in the child's room or in a pediatric gym at the hospital, depending on the child's health state. In both groups, determination of several primary (cardio-respiratory fitness, muscle strength, functional capacity, physical activity levels, body weight and quality of life) and secondary outcomes [immune function and inflammatory profile (blood levels of 47 cytokines)] will be made at the following time points: (i) before the exercise intervention (immediately after diagnosis and before treatment onset); (ii) after the exercise intervention (upon termination of neoadjuvant chemotherapy); and (iii) after a detraining period (2 months after the intervention). DISCUSSION: The PAPEC trial will provide relevant new information on biological mechanisms and inform on the potential clinical use of exercise during pediatric cancer treatment as a simple way to prevent future long-term treatment effects and improve the general health state of pediatric cancer patients.

AMOR II: an effort to eradicate psychosocial barriers induced by immigration phenomenon in children with cancer.

BACKGROUND: Immigration in the childhood cancer population constitutes a stressor factor because of high biopsychosocial vulnerability. In recent years the incidence of immigrant children in our unit has increased. Since 2005 we have developed a psychosocial program to overcome this challenge. Our objective is to assess its impact on the immigrant pediatric population. PROCEDURE: We have compared new cases (n=114) from 2005 to 2010 with historical cases (n=95) from 1995 to 2004. We administered a long-term follow-up questionnaire allowing for the assessment of symptoms associated with biopsychosocial variables. RESULTS: Most of our immigrant patients came from Latin America and we observed a significant increase of cases coming from Morocco and Romania. The most common diagnosis was hematological malignancies. From 2005 to 2010 the disease status was mainly initial, whereas in the period 1995 to 2004 most of the patients arrived with advanced disease. Socioeconomic variables amongst these patients tended towards low incomes, high unemployment, and economic difficulties. The implementation of the biopsychosocial protocol AMOR II improved adaptation (P=0.012), the amount and understanding of information received (P=0.002), and family emotional support (P=0.004). CONCLUSIONS: In brief, our biopsychosocial protocol had significantly increased some psychosocial variables. However, immigration in Spain is still associated with economic difficulties, "aculturism" and failure to adapt.