Exploring the Interplay between Cellular Senescence, Immunity, and Fibrosing Interstitial Lung Diseases: Challenges and Opportunities.

Fibrosing interstitial lung diseases (ILDs) are characterized by the gradual and irreversible accumulation of scar tissue in the lung parenchyma. The role of the immune response in the pathogenesis of pulmonary fibrosis remains unclear. In recent years, substantial advancements have been made in our comprehension of the pathobiology driving fibrosing ILDs, particularly concerning various age-related cellular disturbances and immune mechanisms believed to contribute to an inadequate response to stress and increased susceptibility to lung fibrosis. Emerging studies emphasize cellular senescence as a key mechanism implicated in the pathobiology of age-related diseases, including pulmonary fibrosis. Cellular senescence, marked by antagonistic pleiotropy, and the complex interplay with immunity, are pivotal in comprehending many aspects of lung fibrosis. Here, we review progress in novel concepts in cellular senescence, its association with the dysregulation of the immune response, and the evidence underlining its detrimental role in fibrosing ILDs.

A Redox-Shifted Fibroblast Subpopulation Emerges in the Fibrotic Lung.

Idiopathic pulmonary fibrosis (IPF) is an aggressive and thus far incurable disease, characterized by aberrant fibroblast-mediated extracellular matrix deposition. Our understanding of the disease etiology is incomplete; however, there is consensus that a reduction-oxidation (redox) imbalance plays a role. In this study we use the autofluorescent properties of two redox molecules, NAD(P)H and FAD, to quantify changes in their relative abundance in living lung tissue of mice with experimental lung fibrosis, and in freshly isolated cells from mouse lungs and humans with IPF. Our results identify cell population-specific intracellular redox changes in the lungs in experimental and human fibrosis. We focus particularly on redox changes within collagen producing cells, where we identified a bimodal distribution of NAD(P)H concentrations, establishing NAD(P)Hhigh and NAD(P)Hlow sub-populations. NAD(P)Hhigh fibroblasts exhibited elevated pro-fibrotic gene expression and decreased collagenolytic protease activity relative to NAD(P)Hlow fibroblasts. The NAD(P)Hhigh population was present in healthy lungs but expanded with time after bleomycin injury suggesting a potential role in fibrosis progression. We identified a similar increased abundance of NAD(P)Hhigh cells in freshly dissociated lungs of subjects with IPF relative to controls, and similar reductions in collagenolytic activity in this cell population. These data highlight the complexity of redox state changes in experimental and human pulmonary fibrosis and the need for selective approaches to restore redox imbalances in the fibrotic lung.

Targeted degradation of extracellular mitochondrial aspartyl-tRNA synthetase modulates immune responses.

The severity of bacterial pneumonia can be worsened by impaired innate immunity resulting in ineffective pathogen clearance. We describe a mitochondrial protein, aspartyl-tRNA synthetase (DARS2), which is released in circulation during bacterial pneumonia in humans and displays intrinsic innate immune properties and cellular repair properties. DARS2 interacts with a bacterial-induced ubiquitin E3 ligase subunit, FBXO24, which targets the synthetase for ubiquitylation and degradation, a process that is inhibited by DARS2 acetylation. During experimental pneumonia, Fbxo24 knockout mice exhibit elevated DARS2 levels with an increase in pulmonary cellular and cytokine levels. In silico modeling identified an FBXO24 inhibitory compound with immunostimulatory properties which extended DARS2 lifespan in cells. Here, we show a unique biological role for an extracellular, mitochondrially derived enzyme and its molecular control by the ubiquitin apparatus, which may serve as a mechanistic platform to enhance protective host immunity through small molecule discovery.

Role adoption, anxiety, depression and loneliness in family caregivers of patients with chronic diseases.

OBJECTIVE: to describe and explore the relationship of loneliness, anxiety and depression with adoption of the caregiver role among individuals caring for people with chronic diseases in Colombia. METHODS: this was an exploratory and cross-sectional study involving 960 primary caregivers of individuals with chronic diseases. We applied the Caregiver Role Adoption Scale, the University of California at Los Angeles Loneliness Scale, and the Anxiety and Depression Scale. Principal component and multiple correspondence analyses were performed for clustering. RESULTS: among the participating caregivers, 40.8% reported experiencing depression, 59% reported anxiety, 54.6% reported moderate to severe loneliness, and 88.6% reported satisfactory adoption of the caregiver role. Caregivers who presented basic or insufficient role adoption levels tended to have higher scores for anxiety, depression and loneliness. CONCLUSION: adoption of the caregiver role is a mediator in the anxiety, depression and loneliness levels among caregivers. Strategies aimed at supporting caregivers should include training for the caregiver role to mitigate the negative impacts of anxiety, depression and loneliness. (1) More than half of the caregivers reported moderate or severe anxiety and loneliness. (2) Caregivers with low role adoption levels presented more anxiety, depression and loneliness. (3) Satisfactory adoption of the caregiver role reduces anxiety, depression and loneliness. (4) Role adoption should be intervened to reduce the impact on caregivers' mental health.

Skeletal Muscle SIRT3 Deficiency Contributes to Pulmonary Vascular Remodeling in Pulmonary Hypertension Due to Heart Failure With Preserved Ejection Fraction.

BACKGROUND: Pulmonary hypertension (PH) is a major complication linked to adverse outcomes in heart failure with preserved ejection fraction (HFpEF), yet no specific therapies exist for PH associated with HFpEF (PH-HFpEF). We have recently reported on the role of skeletal muscle SIRT3 (sirtuin-3) in modulation of PH-HFpEF, suggesting a novel endocrine signaling pathway for skeletal muscle modulation of pulmonary vascular remodeling. In this study, we attempted to define the processes by which skeletal muscle SIRT3 defects affect pulmonary vascular health in PH-HFpEF. METHODS AND RESULTS: Skeletal muscle-specific Sirt3 knockout mice (Sirt3skm-/-) exhibited reduced pulmonary vascular density accompanied by pulmonary vascular proliferative remodeling and elevated pulmonary pressures. Using mass spectrometry-based comparative secretome analysis, we demonstrated elevated secretion of LOXL2 (lysyl oxidase homolog 2) in SIRT3-deficient skeletal muscle cells. Elevated circulation and protein expression levels of LOXL2 were also observed in plasma and skeletal muscle of Sirt3skm-/- mice, a rat model of PH-HFpEF, and humans with PH-HFpEF. In addition, expression levels of CNPY2 (canopy fibroblast growth factor signaling regulator 2), a known proliferative and angiogenic factor, were increased in pulmonary artery endothelial cells and pulmonary artery smooth muscle cells of Sirt3skm-/- mice and animal models of PH-HFpEF. CNPY2 levels were also higher in pulmonary artery smooth muscle cells of subjects with obesity compared with nonobese subjects. Moreover, treatment with recombinant LOXL2 protein promoted pulmonary artery endothelial cell migration/proliferation and pulmonary artery smooth muscle cell proliferation through regulation of CNPY2-p53 signaling. Last, skeletal muscle-specific Loxl2 deletion decreased pulmonary artery endothelial cell and pulmonary artery smooth muscle cell expression of CNPY2 and improved pulmonary pressures in mice with high-fat diet-induced PH-HFpEF. CONCLUSIONS: This study demonstrates a systemic pathogenic impact of skeletal muscle SIRT3 deficiency in remote pulmonary vascular remodeling and PH-HFpEF. This study suggests a new endocrine signaling axis that links skeletal muscle health and SIRT3 deficiency to remote CNPY2 regulation in the pulmonary vasculature through myokine LOXL2. Our data also identify skeletal muscle SIRT3, myokine LOXL2, and CNPY2 as potential targets for the treatment of PH-HFpEF.

FOXK2 targeting by the SCF-E3 ligase subunit FBXO24 for ubiquitin mediated degradation modulates mitochondrial respiration.

FOXK2 is a crucial transcription factor implicated in a wide array of biological activities and yet understanding of its molecular regulation at the level of protein turnover is limited. Here, we identify that FOXK2 undergoes degradation in lung epithelia in the presence of the virulent pathogens Pseudomonas aeruginosa and Klebsiella pneumoniae through ubiquitin-proteasomal processing. FOXK2 through its carboxyl terminus (aa 428-478) binds the Skp-Cullin-F-box ubiquitin E3 ligase subunit FBXO24 that mediates multisite polyubiquitylation of the transcription factor resulting in its nuclear degradation. FOXK2 was detected within the mitochondria and targeted depletion of the transcription factor or cellular expression of FOXK2 mutants devoid of key carboxy terminal domains significantly impaired mitochondrial function. In experimental bacterial pneumonia, Fbxo24 heterozygous mice exhibited preserved mitochondrial function and Foxk2 protein levels compared to WT littermates. The results suggest a new mode of regulatory control of mitochondrial energetics through modulation of FOXK2 cellular abundance.

Single Cell MALDI-MS Imaging of Lipids and Proteins in Senescent Fibroblasts.

In this study, we evaluate the lipidomic and proteomic profiles of human lung fibroblasts (hLFs) to interrogate changes occurring due to senescence. To study single cell populations, a comparison of cell adhered onto slides utilizing poly-D-lysine versus centrifugal force deposition was first analyzed to determine whether specific alterations were observed between preparations. The poly-D-lysine approach was than utilized to interrogate the lipidome of the cell populations and further evaluate potential applications of the MALDI-IHC platform for single-cell level analyses. Altogether, our results show the ability to detect lipids implicated in senescence and alterations to protein expression between normal and senescent fibroblast populations. This report is the first time that the MALDI-IHC system has been utilized at a single-cell level for analyzing the expression of proteins.

Comparative Analysis of Quality of Life of Family Caregivers of Patients With Heart Failure and Cancer Who Receive Palliative Care.

BACKGROUND: Quality of life (QoL) is the criterion-standard outcome in palliative care for patients with various illnesses and their family caregivers. There is a need to determine the factors affecting caregivers' QoL in each population and the differences between groups to design differentiated intervention strategies. PURPOSE: The aims of this study were to compare the role adoption, social support, and QoL of family caregivers of patients with heart failure and cancer in palliative care and to examine the determinants of QoL. METHODS: A comparative study was conducted with the family caregivers of patients with cancer (n = 81) and heart failure (n = 80) in palliative care. Quality of life in life-limiting situations, role adoption, and social support questionnaires were also administered. A χ2 test, Student t test, and Mann-Whitney U test were used for between-group comparisons. Multiple linear regression was used to examine the effects of the correlated variables on caregivers' QoL. RESULTS: Caregivers of patients with heart failure had better QoL (P = .006) and lower tangible social support (P = .007) than caregivers of patients with heart failure. No differences were found in caregiver role adoption between the groups. Linear regression indicated that for caregivers of patients with cancer, social support, role adoption, caregiver age, and patient functional status affect caregiver QoL. For caregivers of patients with heart failure, role adoption and patient functional status are predictors of QoL. CONCLUSIONS: Overall, healthcare professionals should focus on improving social support and caregiver role adoption and provide greater attention to the QoL of caregivers of patients with cancer.

NETosis Secondary to the Use of Levamisole-Adulterated Cocaine: A Likely Underlying Mechanism of Vasculopathy.

Background: Since 2010, several cases of a new vasculopathy induced by the use of levamisole-adulterated cocaine (LAC) have been reported. This vasculopathy is characterized by retiform purpura, earlobe necrosis, multisystem compromise, and multiple autoantibodies. Given its similarity to antineutrophil cytoplasmic antibody (ANCA)-associated vasculitis, LAC-associated vasculopathy is postulated to be mediated by pathophysiologic processes resulting from neutrophil cell death by NETosis, a phenomenon previously described in ANCA vasculitis. This study tries to establish the presence of NETosis induced by cocaine, levamisole, or both. Methodology. Neutrophils were isolated from the peripheral blood of healthy controls by Ficoll-Hystopaque density gradient centrifugation followed by dextran sedimentation. Cell viability and purity were evaluated by flow cytometry after staining with PI/DiOC6 and labeling with fluorescent anti-CD45/anti-CD3 monoclonal antibodies (mAbs), respectively. Neutrophils were exposed to levamisole, cocaine, a cocaine-levamisole mixture, and sera pools from healthy controls and patients with LAC-associated vasculopathy. NETosis was then assessed by flow cytometry after staining cells with Sytox Green, Hoechst-33342, and fluorescent antineutrophil elastase (NE) and antimyeloperoxidase (MPO) mAbs. In addition, NETosis was morphologically confirmed by fluorescence microscopy. Proinflammatory cytokine levels in culture supernatants and reactive oxygen species (ROS) synthesis were determined by flow cytometry. The involvement of calcium and muscarinic receptors in cell death induction was evaluated in parallel experiments carried out in the presence of 1,2-bis (o-aminophenoxy) ethane-N, N, N', N'-tetraacetic acid (BAPTA) and hyoscine butylbromide (HBB), their respective inhibitors. Results: Cocaine, levamisole, and a cocaine-levamisole mixture induced neutrophil cell death. DNA/MPO extrusion and cell morphology patterns were consistent with NETosis. Neither proinflammatory cytokines nor ROS behaved as proNETotic factors. Preliminary results suggested that muscarinic receptors and calcium-dependent signals were involved in LAC-induced NETosis. Conclusions: Cocaine, levamisole, and a cocaine-levamisole mixture can induce NETosis through mechanisms involving muscarinic receptors and calcium-dependent pathways.

Human iPSC-Based Model of COPD to Investigate Disease Mechanisms, Predict SARS-COV-2 Outcome, and Test Preventive Immunotherapy.

Chronic inflammation and dysregulated repair mechanisms after epithelial damage have been implicated in chronic obstructive pulmonary disease (COPD). However, the lack of ex vivo-models that accurately reflect multicellular lung tissue hinders our understanding of epithelial-mesenchymal interactions in COPD. Through a combination of transcriptomic and proteomic approaches applied to a sophisticated in vitro iPSC-alveolosphere with fibroblasts model, epithelial-mesenchymal crosstalk was explored in COPD and following SARS-CoV-2 infection. These experiments profiled dynamic changes at single-cell level of the SARS-CoV-2-infected alveolar niche that unveiled the complexity of aberrant inflammatory responses, mitochondrial dysfunction, and cell death in COPD, which provides deeper insights into the accentuated tissue damage/inflammation/remodeling observed in patients with SARS-CoV-2 infection. Importantly, this 3D system allowed for the evaluation of ACE2-neutralizing antibodies and confirmed the potency of this therapy to prevent SARS-CoV-2 infection in the alveolar niche. Thus, iPSC-alveolosphere cultured with fibroblasts provides a promising model to investigate disease-specific mechanisms and to develop novel therapeutics.

Role adoption, anxiety, depression and loneliness in family caregivers of patients with chronic diseases / Adopción del rol, ansiedad, depresión y soledad en cuidadores familiares de pacientes con enfermedades crónicas / Adoção do papel, ansiedade, depressão e solidão em cuidadores familiares de pacientes com doenças crônicas

Objective: to describe and explore the relationship of loneliness, anxiety and depression with adoption of the caregiver role among individuals caring for people with chronic diseases in Colombia. Methods: this was an exploratory and cross-sectional study involving 960 primary caregivers of individuals with chronic diseases. We applied the Caregiver Role Adoption Scale, the University of California at Los Angeles Loneliness Scale, and the Anxiety and Depression Scale. Principal component and multiple correspondence analyses were performed for clustering. Results: among the participating caregivers, 40.8% reported experiencing depression, 59% reported anxiety, 54.6% reported moderate to severe loneliness, and 88.6% reported satisfactory adoption of the caregiver role. Caregivers who presented basic or insufficient role adoption levels tended to have higher scores for anxiety, depression and loneliness. Conclusion: adoption of the caregiver role is a mediator in the anxiety, depression and loneliness levels among caregivers. Strategies aimed at supporting caregivers should include training for the caregiver role to mitigate the negative impacts of anxiety, depression and loneliness.

Objetivo: describir y explorar la relación de la soledad, la ansiedad y la depresión con la adopción del rol de cuidador entre personas que se ocupan de cuidar pacientes con enfermedades crónicas en Colombia. Métodos: se trató de un estudio exploratorio y transversal con la participación de 960 cuidadores principales de personas con enfermedades crónicas. Aplicamos la Escala de Adopción del Rol de Cuidador, la Escala de Soledad de la Universidad de California de Los Ángeles y la Escala de Ansiedad y Depresión. Se realizaron análisis de componentes principales y de correspondencia múltiple para el clustering . Resultados: el 40,8% de los cuidadores que participaron en el estudio informó padecer depresión, el 59% informó ansiedad, el 54,6% indicó soledad de moderada a grave y el 88,6% presentó adopción satisfactoria del rol de cuidador. Los cuidadores que presentaron los niveles básico o insuficiente en términos de adopción del rol tendieron a obtener puntuaciones de ansiedad, depresión y soledad más elevadas. Conclusión: adoptar el rol de cuidador es un mediador de los niveles de ansiedad, depresión y soledad entre los cuidadores. Las estrategias dirigidas a apoyar a los cuidadores deberían incluir preparación para dicho rol a fin de mitigar los efectos negativos de la ansiedad, la depresión y la soledad.

Objetivo: descrever e explorar a relação entre a solidão, a ansiedade e a depressão com a adoção do papel de cuidador entre os indivíduos que cuidam de pessoas com doenças crônicas na Colômbia. Método: trata-se de um estudo exploratório e transversal que envolveu 960 cuidadores primários de indivíduos com doenças crônicas. Foi aplicada a Escala de Adoção do Papel de Cuidador, a Escala de Solidão da Universidade da Califórnia em Los Angeles e a Escala de Ansiedade e Depressão. Foram realizadas análises de componentes principais e de correspondência múltipla para o agrupamento. Resultados: entre os cuidadores participantes, 40,8% relataram ter depressão, 59% relataram ansiedade, 54,6% relataram solidão moderada a grave e 88,6% relataram uma adoção satisfatória do papel de cuidador. Os cuidadores que apresentaram níveis básicos ou insuficientes de adoção do papel tenderam a ter pontuações mais elevadas de ansiedade, depressão e solidão. Conclusão: a adoção do papel de cuidador é um mediador nos níveis de ansiedade, depressão e solidão entre os cuidadores. As estratégias destinadas a apoiar os cuidadores devem incluir o treinamento para o papel de cuidador, a fim de atenuar os impactos negativos da ansiedade, da depressão e da solidão.

scResolve: Recovering single cell expression profiles from multi-cellular spatial transcriptomics.

Many popular spatial transcriptomics techniques lack single-cell resolution. Instead, these methods measure the collective gene expression for each location from a mixture of cells, potentially containing multiple cell types. Here, we developed scResolve, a method for recovering single-cell expression profiles from spatial transcriptomics measurements at multi-cellular resolution. scResolve accurately restores expression profiles of individual cells at their locations, which is unattainable from cell type deconvolution. Applications of scResolve on human breast cancer data and human lung disease data demonstrate that scResolve enables cell type-specific differential gene expression analysis between different tissue contexts and accurate identification of rare cell populations. The spatially resolved cellular-level expression profiles obtained through scResolve facilitate more flexible and precise spatial analysis that complements raw multi-cellular level analysis.

Escalas en español para valoración de personas en cuidados paliativos y sus familias: revisión sistemática psicométrica / Scales in Spanish for Assessing People in Palliative Care and their Families: Psychometric Systematic Review / Escalas en español para valoración de personas en cuidados paliativos y sus familias: revisão sistemática psicométrica

Introducción: una de las bases de la atención en cuidados paliativos es la valoración regular e integral de síntomas en pacientes y familias. Al respecto, es importante reconocer las escalas usadas en cuidados paliativos en idioma español y sus propiedades psicométricas. Objetivo: identificar las escalas en español para la valoración del paciente en cuidados paliativos y su familia, evaluar sus propiedades psicométricas y calidad metodológica de sus propiedades basados en los estándares Cosmin. Método: revisión sistemática psicométrica. Se realizó una búsqueda de literatura de las escalas de valoración en cuidados paliativos en español y sus propiedades psicométricas de acuerdo con la propuesta Prisma. Se utilizaron los estándares propuestos por Cosmin para la evaluación de propiedades psicométricas. Resultados: se evaluaron 21 escalas de valoración. La escala de calidad de vida EORTC-QLQ fue la que mayor número de propiedades reportó. La consistencia interna, validez de constructo, contenido y fiabilidad fueron las pruebas más reportadas. Ningún estudio reportó pruebas de validez transcultural. Conclusión: los resultados de este estudio indican una gran variedad de instrumentos disponibles en español para valorar al paciente y al cuidador familiar en cuidados paliativos. Sin embargo, un gran número de propiedades psicométricas de los instrumentos aún se encuentran incompletas. Los resultados muestran la necesidad de seguir investigando las propiedades psicométricas de dichas escalas para garantizar la confiabilidad de estos instrumentos, así como su uso en la práctica e investigación.

Introduction: One of the bases of palliative care is the regular and comprehensive assessment of symptoms in patients and families. In this regard, it is important to recognize the scales used in palliative care in Spanish and their psychometric properties. Objective: Identify the scales in Spanish for the assessment of palliative care patients and their families, evaluate their psychometric properties, and the methodological quality of their properties based on the Cosmin standards. Method: Psychometric systematic review. A literature search of the assessment scales in palliative care in Spanish and its psychometric properties was carried out according to the Prisma proposal. The standards proposed by Cosmin for the evaluation of psychometric properties were used. Results: 21 rating scales were evaluated. The EORTC-QLQ quality of life scale was the one that reported the highest number of properties. Internal consistency, construct validity, content and reliability were the most reported tests. No study reported evidence of cross-cultural validity. Conclusion: The results of this study indicate a wide variety of instruments available in Spanish to assess the patient and the family caregiver in palliative care. However, a large number of psychometric properties of the instruments are still incomplete. The results show the need to continue investigating the psychometric properties of these scales to guarantee the reliability of these instruments, as well as their use in practice and research.

Introdução: uma das bases dos cuidados paliativos é a avaliação regular e abrangente dos sicomet em pacientes e familiares. Nesse sentido, é importante reconhecer as escalas utilizadas em cuidados paliativos em sicome e suas propriedades psicométricas. Objectivo: identificar as escalas em sicome para a avaliação de pacientes em cuidados paliativos e suas famílias, avaliar suas propriedades psicométricas e a qualidade metodológica de suas propriedades com base nos sicom Cosmin. Método: revisão sistemática psicométrica. Foi realizada uma pesquisa bibliográfica para escalas de avaliação de cuidados paliativos em sicome e as suas propriedades psicométricas de sicom com a proposta do Prisma. Foram utilizadas as normas propostas pelo Cosmin para a avaliação das propriedades psicométricas. Resultados: Vinte e uma escalas de classificação foram avaliadas. A escala de qualidade de vida EORTC-QLQ relatou o maior número de propriedades. A sicometría interna, validade da construção, conteúdo e fiabilidade foram os testes mais relatados. Nenhum estudo relatou provas de validade transcultural. Conclusão: os resultados deste estudo sicome uma grande variedade de instrumentos disponíveis em sicome para avaliar o paciente e o cuidador familiar em cuidados paliativos. No entanto, um grande número de propriedades psicométricas dos instrumentos estão ainda incompletas. Os resultados mostram a necessidade de mais investigação sobre as propriedades psicométricas destas escalas para sicomet a fiabilidade destes instrumentos, bem como a sua utilização na prática e na investigação.

Impacto de una estrategia educativa para la enseñanza en línea del cuidado paliativo: mediante el análisis de métodos mixtos / Impact of an educational strategy for online teaching of palliative care through mixed methods analysis / Impacto de uma estratégia educativa para capacitação online do cuidado paliativo: mediante a análise de métodos mistos

Resumen Objetivo: medir la aceptabilidad de un curso virtual de cuidados paliativos y el impacto en los conocimientos sobre cuidados paliativos, confort y nivel de tanatofobia en estudiantes de enfermería. Metodología: se utilizó un diseño de métodos mixtos, en el que se incluyeron 39 participantes estudiantes de enfermería de una universidad pública. Para la información cuantitativa, se aplicaron las escalas Palliative Care Quiz for Nursing, confort en cuidados paliativos y la escala de tanatofobia, antes y después de tomar el curso virtual. Para la información cualitativa, se realizaron cinco grupos focales, tres antes de iniciar el curso y dos al terminarlo. Resultados: se encontró que el curso aumentó significativamente el nivel de conocimiento en cuidados paliativos (p = 0,000), el confort en la atención de cuidados paliativos (p = 0,000) y disminuyó los niveles de tanatofobia (p = 0,005). Además, se identificaron cuatro temas que complementaron los resultados cuantitativos: (a) Entender y conectar con las TIC: oportunidades y limitaciones; (b) vivir el proceso de enseñanza de aprendizaje virtual; (c) Percepciones sobre el cuidado paliativo; y (d) Afrontamiento al final de la vida: persona, familia y enfermera. Conclusiones: este curso fue aceptado por los estudiantes y demostró aumentar los conocimientos frente al cuidado paliativo y el confort, además que contribuyó a disminuir la tanatofobia en los participantes. Los resultados evidencian que estrategias como los cursos virtuales, con plataformas y herramientas innovadoras, pueden llenar los vacíos existentes en los currículos frente a la formación en cuidados paliativos en Colombia.

Abstract Objective: to measure the acceptability of a virtual course on palliative care and the impact on knowledge about palliative care, comfort and level of thanatophobia in nursing students. Methodology: a mixed methods design was used in which 39 participating nursing students from a public university were included. For quantitative information, the Palliative Care Quiz for Nursing scales, the Comfort in palliative care and the Thanatophobia scale were applied before and after taking the virtual course. For qualitative information, five focus groups were held, three before starting the course and two after finishing it. Results: It was found that the course significantly increased the level of knowledge in palliative care (p = 0.000), comfort in palliative care (p = 0.000) and decreased levels of thanatophobia (p = 0.005). In addition, four themes were identified that complemented the quantitative results: (a) Understanding and connecting with ICTs: opportunities and limitations; (b) experience the virtual learning teaching process; (c) Perceptions about palliative care; and (d) confrontation at the end of life: person, family and nurse. Conclusions: this course was accepted by the students and proved to increase knowledge about palliative care and comfort, in addition to contributing to reduce thanatophobia in the participants. The results show that strategies such as virtual courses, with innovative platforms and tools, can fill the existing gaps in the curricula regarding training in palliative care in Colombia.

Resumo Objetivo: medir a aceitabilidade de um curso virtual de cuidados paliativos e o impacto nos conhecimentos sobre cuidados paliativos, conforto e nível de tanatofobia em estudantes de enfermagem. Metodologia: Utilizou-se um desenho de métodos mistos, no que se incluíram 39 participantes estudantes de enfermagem de uma universidade pública. Para a informação quantitativa, aplicaram-se as escalas Palliative Care Quiz for Nursing, conforto em cuidados paliativos e a escala de tanatofobia, antes e depois de tomar o curso online. Para a informação qualitativa, realizaram-se cinco grupos focais, três antes de iniciar o curso e dois ao terminá-lo. Resultados: Encontrou-se que o curso aumentou significativamente o nível de conhecimento em cuidados paliativos (p = 0,000), o conforto na atenção de cuidados paliativos (p = 0,000) e diminuiu os níveis de tanatofobia (p = 0,005). Além, se identificaram quatro temas que complementaram os resultados quantitativos: (a) Entender e conectar com as TIC: oportunidades e limitações; (b) viver o processo de ensino de aprendizagem virtual; (c) Percepções sobre o cuidado paliativo; e (d) Afrontamento ao final da vida: pessoa, família e enfermeira. Conclusões: este curso foi aceitado pelos estudantes e demostrou aumentar os conhecimentos frente ao cuidado paliativo e o conforto, além que contribuiu a diminuir a tanatofobia nos participantes. Os resultados evidenciam que estratégias como os cursos online, com plataformas e ferramentas inovadoras, podem encher os vazios existentes nos currículos frente à formação em cuidados paliativos na Colômbia.

Tendencias investigativas de enfermería en personas con cáncer / Nursing Research Trends about People with Cancer

Introducción: El cáncer es una enfermedad prevalente en Latinoamérica. Los profesionales de enfermería deben reconocer las prioridades y desarrollos relacionados con la investigación en torno al cuidado de la persona con cáncer. Objetivo: Describir las tendencias investigativas de enfermería en personas con cáncer de estudios publicados en las 10 mejores revistas de investigación en Enfermería en Latinoamérica. Métodos: Se realizó una revisión de literatura tipo exploratoria. Se buscó información en las 10 mejores revistas clasificadas en Scimago Journal & Country rank para 2020, organizadas en los cuartiles Q1 a Q4, durante el período 2016-2020 usando los términos cancer patients, oncology patient, patients with cancer, cancer. Se seleccionaron 67 investigaciones después de hacerse el proceso de crítica de la evidencia. De la revisión emergieron los siguientes temas: significado de la experiencia del proceso de enfermedad y tratamiento, calidad de vida de la persona con cáncer en Latinoamérica, impacto del cáncer sobre la dimensión física y psicosocial, afrontamiento ante la enfermedad y percepción de la atención del cuidado de enfermería. Conclusiones: Los estudios analizados evidenciaron dos principales tendencias en investigación de enfermería en Latinoamérica relacionadas con el tipo de cáncer y el fenómeno de investigación(AU)

Introduction: Cancer is a prevalent disease in Latin America. Nursing professionals must recognize the priorities and developments related to research about the care of the person with cancer. Objective: To describe the research trends in nursing about people with cancer, based on studies published in the top ten nursing journals from Latin America. Methods: A scoping review of the literature was carried out. Information was sought in the top ten journals according to the Scimago Journal & Country rank for 2020, organized in the quartiles Q1 to Q4, during the period 2016-2020. The terms cancer patients, oncology patient, patients with cancer, cancer were used. Sixty-seven research papers were selected after the evidence critique process was done. The following topics emerged from the review: meaning of the experience of the disease and treatment process, quality of life of the person with cancer in Latin America, impact of cancer on the physical and psychosocial dimension, coping with the disease, and nursing care perception. Conclusions: The analyzed studies showed two main trends in nursing research in Latin America related to type of cancer and the research phenomenon(AU)

Eficacia de la intervención “Cuidadores PaliActivos” en personas cuidadoras de pacientes con cáncer en cuidados paliativos / Efficacy of the “Cuidadores PaliActivos” (“PaliActive Caregivers”) intervention in caregivers for patients with cancer on palliative care

Objetivo: determinar el efecto de la intervención educativa de Enfermería “Cuidadores PaliActivos” en la mejora de la calidad de vida, la adopción del rol y el aumento de la percepción de soporte social de personas cuidadoras familiares de pacientes con cáncer en cuidados paliativos en un hospital de alta complejidad en Medellín, Colombia. Método: proyecto de ensayo clínico controlado y aleatorizado que se realizará durante el año 2022. Se incluirán personas adultas cuidadoras de pacientes con cáncer en cuidados paliativos con más de tres meses de expectativa vital (tamaño muestral n= 151). Se efectuará una aleatorización 1:1. El grupo experimental recibirá dos sesiones individuales con cartilla educativa y aplicación móvil de apoyo (15 y 75 mín. aprox.). El grupo control educación grupal (2 h) y encuentro individual (25 min). Se medirán variables sociodemográficas, calidad de vida, adopción del rol y percepción de soporte social, antes de la intervención, a la semana y a los dos meses. Se realizarán comparaciones intra e intergrupos. Conclusiones: se espera demostrar la eficacia de la intervención de Enfermería “Cuidadores PaliActivos” en las variables estudiadas y de esta manera aportar una herramienta que pueda ser útil para mejorar la atención de personas cuidadoras.(AU)

Objective: to determine the effect of the educational Nursing intervention “Cuidadores PaliActivos” (“PaliActive Caregivers”) on the improvement of quality of life, role adoption and perception of social support among caregiver relatives of patients with cancer on palliative care in a high-complexity hospital from Medellín, Colombia. Method: a project for a controlled and randomized clinical trial to be conducted during 2022. The study will include adult persons who are caregivers for patients with cancer on palliative care with over three months of life expectancy (sample size n= 151). There will be 1:1 randomization. The experimental arm will receive two individual sessions with educational booklet and mobile application for support (15 and 75 minutes approximately). The control arm will receive group education (2 hours) and individual meeting (25 minutes). Sociodemographic variables will be measured, as well as quality of life, role adoption and perception of social support, before the intervention, at one week and at two months. Intra and inter-arm comparisons will be conducted. Conclusions: it is expected that the efficacy of the “Cuidadores PaliActivos” (“PaliActive Caregivers”) Nursing intervention will be demonstrated in the variables studied; and thus, a tool will be provided that can be useful to improve the care of caregivers.(AU)

El cuidado real frente a la vulnerabilidad del estudiante de enfermería / Real health care in the face of the vulnerability of the nursing student

Introducción: El intercambio de experiencias con pares en la práctica diaria permite al estudiante el aprendizaje del cuidado de enfermería. Objetivo: Comprender las representaciones sociales del cuidado, construidas desde el cotidiano del estudiante de enfermería mexicano. Materiales y métodos: Estudio cualitativo, basado en la teoría de la representación social en 46 estudiantes que realizaban prácticas clínicas, a quienes se les aplicó entrevista semiestructurada, que se analizó a través de la agrupación de categorías empíricas que sustentan la composición de los resultados subsecuentes, comparando los datos con relatos de los informantes. Resultados: La concepción del proceso de cuidado se estructura con rangos que representan lo social de los entrevistados durante su formación, la cual los torna vulnerables en dicho proceso. Las vivencias se construyen y reconstruyen en su afán por descubrir sus experiencias en el cuidar para dar respuesta a los desafíos del ser. Sin embargo, en estas experiencias se altera su mundo, irrumpiendo la paz mental. Conclusiones: Los procesos de interacción posiciona al estudiante frente al mundo social del cuidado a partir de bases filosóficas, a fin de reflexionar con su ser y hacer, acción que orienta sus conductas en el cotidiano del cuidado del otro.

Introduction: The exchange of daily practicing experiences with peers is useful for students to learn about nursing care. Objective: To understand the social representations of health care that are constructed from the daily life experiences of the Mexican nursing student. Materials and methods: A qualitative study based on the social representation theory with 46 students who carried out clinical practices. A semi-structured interview was applied, which was analyzed through grouping of empirical categories that support the composition of the subsequent results, comparing the data with reports from the participants. Results: The conception of the health care process is structured with ranges that represent the social aspects of the students during their training, which in turn makes them vulnerable. The experiences are constructed and re-constructed as a consequence of the students' eagerness to discover their experiences in health care in order to respond to their challenges. However, these experiences affect the students' world, disrupting their peace of mind. Conclusions: Interaction processes position students in the face of the social world of health care based on philosophical bases in order to reflect with their being and doing, an action that guides their behavior in the daily care of the other.

Adopción del rol y calidad de vida de cuidadores de pacientes oncológicos en Medellín, Colombia / Adoção do papel e da qualidade de vida em cuidadores de pacientes com câncer em Medellín, Colômbia / Adoption of the role and quality of life in caregivers of cancer patients in Medellín, Colombia

Objetivo: determinar el nivel de adopción del rol y la calidad de vida de los cuidadores familiares de personas con cáncer. Materiales y métodos: estudio descriptivo transversal que incluyó la participación de 50 cuidadores familiares de pacientes con cáncer en tratamiento activo. Se aplicaron los instrumentos Adopción del Rol del Cuidador Familiar y Escala de Calidad de Vida versión Familiar. También se realizaron análisis descriptivos y comparativos. Resultados: los participantes reportaron una edad promedio de 44,8 años y fueron en su mayoría mujeres (66 %). Frente a la adopción del rol, se encontró un nivel satisfactorio, con una mediana de 86,5 puntos. La calidad de vida presentó una mediana de 165 puntos. Se encontraron diferencias significativas en los puntajes de adopción del rol de acuerdo con la edad, el grado de escolaridad y el nivel socioeconómico de los cuidadores familiares. Conclusiones: esta investigación encontró niveles satisfactorios de adopción del rol y calidad de vida. Con el fin de mejorar la adopción del rol de los cuidadores, los profesionales de la salud deben prestar atención a características del perfil del cuidador tales como su edad, escolaridad y nivel socioeconómico.

Objetivo: determinar o nível de adoção do papel e da qualidade de vida do cuidador familiar da pessoa com câncer. Materiais e métodos: estudo transversal descritivo que incluiu 50 cuidadores familiares de pacientes com câncer em tratamento ativo. Foram aplicados os Instrumentos de Adoção do Papel do Cuidador Familiar e a versão familiar da Escala de Qualidade de Vida. Foram realizadas análises descritivas e comparativas. Resultados: os participantes tinham idade média de 44,8 anos e eram em sua maioria mulheres (66 %). Diante da adoção do cargo, constatou-se uma adoção satisfatória do cargo com mediana de 86,5 pontos. A qualidade de vida apresentou mediana de 165 pontos. Diferenças significativas foram encontradas nos escores de adoção de papéis de acordo com a idade, o nível de escolaridade e o nível socioeconômico dos cuidadores familiares. Conclusões: este estudo encontrou níveis satisfatórios de adoção do papel e da qualidade de vida. Para melhorar a adoção do papel de cuidador, os profissionais de saúde devem estar atentos às características do perfil do cuidador, como idade, escolaridade ou nível socioeconômico.

Objective: To determine the level of adoption of the caregiver role and the quality of life of family caregivers of people with cancer. Materials and methods: Descriptive and cross-sectional study with the participation of 50 family caregivers of cancer patients under active treatment. The instrument Adoption of the Role of the Family Caregiver and the Scale of Quality-of-Life, Family version, were applied. Descriptive and comparative analyzes were also carried out. Results: Participants were 44.8 years on average and most of them were women (66%). Regarding the adoption of the role, a satisfactory adoption level was identified, with a median of 86.5 points. Quality of life presented a median of 165 points. Significant differences were found in role adoption scores according to the age, education level and socioeconomic status of family caregivers. Conclusions: This study found satisfactory levels regarding the adoption of the caregiver role and the quality of life of family caregivers. In order to improve the adoption of such role, health professionals should pay attention to characteristics of the profile of caregivers such as age, education or socioeconomic status.