Intervenciones no farmacológicas para reducir síntomas depresivos en mujeres con cáncer de mama / Non-pharmacological interventions to reduce depressive symptoms in women with breast cancer

Resumen: Objetivo: Describir y discutir los resultados de las intervenciones no farmacológicas (INF) adyuvantes en el tratamiento de los síntomas depresivos entre mujeres con cáncer de mama (CaMa). Material y métodos: Se realizó una revisión sistemática sobre INF, aplicadas a pacientes con cáncer y síntomas depresivos en siete bases de datos. La revisión se limitó del 1 de enero de 2006 al 31 de diciembre de 2017 y a los idiomas inglés, español y portugués. Los descriptores médicos empleados fueron "breast neoplasm" y "depression". Resultados: Existen diversas INF que pueden estimular principalmente las dimensiones físicas o psicosociales. En este artículo se propone una clasificación basada en nueve estrategias terapéuticas identificadas, entre las que sobresalen el ejercicio, la psicoterapia y el yoga con meditación. Conclusiones: Con base en la evidencia disponible, se concluye que la psicoterapia y yoga con meditación reducen los síntomas depresivos en pacientes con CaMa. Se requiere mayor investigación para determinar la magnitud de la reducción de los síntomas depresivos, de acuerdo con su gravedad, presencia de comorbilidades y diversidad de INF.

Abstract: Objective: To describe and discuss the results of non-pharmacological interventions (NPI) adjuvants in the treatment of depressive symptoms among women with breast cancer (BC). Materials and methods: A systematic review on NPI was performed, which was applied to patients with cancer and depressive symptoms in seven databases. The review was limited from January 1, 2006 to December 31, 2017 and to English, Spanish and Portuguese languages. The medical descriptors used were "breast neoplasm" and "depression". Results: There are several NPI that are able stimulate the physical or psychosocial dimensions. In this article we propose a classification based on nine identified therapeutic strategies, among which exercise, psychotherapy and yoga with meditation stand out. Conclusions: Based on the available evidence, we concluded that psychotherapy and yoga with meditation reduce depressive symptoms in patients with CaMa. More research is needed to determine the magnitude of the reduction of depressive symptoms, according to their severity, presence of comorbidities and diversity of INF.

[Non-pharmacological interventions to reduce depressive symptoms in women with breast cancer]. / Intervenciones no farmacológicas para reducir síntomas depresivos en mujeres con cáncer de mama.

OBJECTIVE: To describe and discuss the results of non-pharmacological interventions (NPI) adjuvants in the treatment of depressive symptoms among women with breast cancer (BC). MATERIALS AND METHODS: A systematic review on NPI was performed, which was applied to patients with cancer and depressive symptoms in seven databases. The review was limited from January 1, 2006 to December 31, 2017 and to English, Spanish and Portuguese languages. The medical descriptors used were "breast neoplasm" and "depression". RESULTS: There are several NPI that are able stimulate the physical or psychosocial dimensions. In this article we propose a classification based on nine identified therapeutic strategies, among which exercise, psychotherapy and yoga with meditation stand out. CONCLUSIONS: Based on the available evidence, we concluded that psychotherapy and yoga with meditation reduce depressive symptoms in patients with CaMa. More research is needed to determine the magnitude of the reduction of depressive symptoms, according to their severity, presence of comorbidities and diversity of INF.

OBJECTIVE: Describir y discutir los resultados de las intervenciones no farmacológicas (INF) adyuvantes en el tratamiento de los síntomas depresivos entre mujeres con cáncer de mama (CaMa). MATERIALS AND METHODS: Se realizó una revisión sistemática sobre INF, aplicadas a pacientes con cáncer y síntomas depresivos en siete bases de datos. La revisión se limitó del 1 de enero de 2006 al 31 de diciembre de 2017 y a los idiomas inglés, español y portugués. Los descriptores médicos empleados fueron "breast neoplasm" y "depression". RESULTS: Existen diversas INF que pueden estimular principalmente las dimensiones físicas o psicosociales. En este artículo se propone una clasificación basada en nueve estrategias terapéuticas identificadas, entre las que sobresalen el ejercicio, la psicoterapia y el yoga con meditación. CONCLUSIONS: Con base en la evidencia disponible, se concluye que la psicoterapia y yoga con meditación reducen los síntomas depresivos en pacientes con CaMa. Se requiere mayor investigación para determinar la magnitud de la reducción de los síntomas depresivos, de acuerdo con su gravedad, presencia de comorbilidades y diversidad de INF.

Non-pharmacological therapies for depressive symptoms in breast cancer patients: Systematic review and meta-analysis of randomized clinical trials.

OBJECTIVE: Depressive symptoms are common comorbidities among breast cancer (BC) patients. Non-pharmacological therapies (NPTs) such as exercise and psychotherapy may reduce depressive symptoms; however, the evidence is inconclusive. The objective of this study is to evaluate if NPTs reduce depressive symptoms among BC patients. METHODS: A systematic review and meta-analysis of randomized clinical trials (RCTs) of NPTs for BC patients were performed. A literature search was conducted from eight databases in English, Portuguese and Spanish from 2006 to 2017. Inclusion criteria were: RCTs that evaluated depressive symptoms as a primary or secondary outcome that did not include pharmacological interventions and did include a non-intervened control group, with at least 30 participants in non-terminal BC stage with no current psychiatric illness. A meta-analysis for each NPT was performed with DerSimonian and Laird's method for the random effects model. Sensitivity analyses were conducted. Heterogeneity and publication bias were assessed. RESULTS: A total of 41 eligible RCTs were identified. Overall, NPTs significantly reduced depressive symptoms (Summary standardized mean difference (SMD) = -0.516; 95%CI: -0.814, -0.218; I2 = 96.2). Of the types of NPTs, psychotherapy significantly reduced depressive symptoms (Summary SMD = -0.819; 95% CI: -1.608, -0.030; I2 = 91.53). A significant difference emerged for Mindfulness (Summary SMD = -0.241; 95% CI: -0.412, -0.070; I2 = 28.6%) and yoga (Summary SMD = -0.305; 95% CI: -0.602, -0.007; I2 = 41.0%) when the heterogeneity was reduced. No evidence of publication bias was observed. CONCLUSIONS: Psychotherapy and mind-body therapies may reduce depressive symptoms in women with BC. Laughter and couples therapy warrant attention in future studies.

[Effect of weather temperature on hospital emergencies in the Region of Murcia, Spain, throughout the 2000-2005 and its use in epidemiological surveillance]. / Efecto del calor sobre el número de urgencias hospitalarias en la Región de Murcia durante los veranos del período 2000-2005 y su uso en la vigilancia epidemiológica.

BACKGROUND: The effect of the weather temperature on mortality has been studied more in depth than its effect on morbidity. In Murcia, the number of daily emergencies and the cases of heat stroke for which care is provided at the hospitals in this Region have been studied. OBJECTIVE: to evaluate the effect that the weather temperature has on the number of hospital emergencies and the use of these indicators for the surveillance of hot weather-related morbidity. METHODS: The effect of the weather temperature on the number of summertime emergencies (2000-2005) has been studied by estimating the percentage increase in emergencies when the weather temperature thresholds established by the Ministry of Health and Consumer Affairs (Max. 38 degrees C and Min. 22.4 degrees C) are exceeded, and by each degree of temperature rise. Results have been stated as Relative Risk (RR) with a 95% CI. A comparison has been drawn between the heat strokes notified and the hospital admissions recorded in the Minimum Basic Data Set at Hospital Discharge (MBDS). RESULTS: Within the 2000-2005 period, the number of emergencies rose by 1.6% on those days when the minimum temperature for the day was above 22.4 degrees C (RR: 1.016; 95% CI 1.0076-1.0244) and by 0.21% for each degree of rise in the minimum temperature for the day (RR: 1.0021, 95% CI 1.0000-1.0044). A total of 38% of the heat strokes admitted to hospital were not reported, of which 40% had occupational exposure. CONCLUSIONS: The minimum temperature for the day could have a greater effect in Murcia than the maximum for the day. Based on the current thresholds, the number of emergencies/day does not seem to be a suitable indicator for monitoring the effect of the weather temperature, information on the diagnosis and the age being needed. Heat strokes provide partial information on the impact, but highlight less-considered population groups at risk.

Efecto del calor sobre el número de urgencias hospitalarias en la región de Murcia durante los veranos del período 2000-2005 y su uso en la vigilancia epidemiológica / Effect of weather temperature on hospital emergencies in the region of Murcia, Spain, throught the 2000-2005 and its use in epidemiological surveillance

Fundamento: el efecto de las temperaturas sobre la mortalidad ha sido estudiado más en profundidad que el efecto sobre la morbilidad. En Murcia se monitorizan el número de urgencias diarias y los casos de golpes de calor atendidos en los hospitales de la Región. Objetivo: valorar el efecto de la temperatura sobre el número de urgencias hospitalarias y la utilidad de estos indicadores para vigilar la morbilidad por calor. Métodos: se ha estudiado el efecto de la temperatura sobre el número de urgencias en verano (periodo 2000-2005), estimando el incremento porcentual de urgencias cuando se superan los umbrales establecidos por el Ministerio de Sanidad y Consumo (Tª máxima 38ºC y Tª mínima 22,4ºC) y por cada grado de aumento de temperatura, expresado en Riesgo Relativo (RR) con un IC95%. Se han cotejado los golpes de calor comunicados con los ingresos registrados en el Conjunto Mínimo Básico de Datos al Alta Hospitalaria (CMBD). Resultados: En 2000-2005 las urgencias se incrementaron un 1,6% en los días con más de 22,4ºC de mínima (RR 1,016; IC95% 1,0076-1,0244), y un 0,21% por cada grado de aumento de la mínima (RR 1,0021; IC95% 1,0000-1,0044). El 38% de los golpes de calor ingresados no se notificaron, y el 40% de los notificados tenían exposición laboral. Conclusiones: La temperatura mínima podría tener un mayor efecto en Murcia que la máxima. Con los actuales umbrales, el número de urgencias diarias no parece un indicador adecuado para monitorizar el efecto de la temperatura, necesitándose información sobre el diagnóstico y la edad. Los golpes de calor aportan información parcial del impacto, pero resaltan grupos de población en riesgo menos considerados (AU)

Background: The effect of the weather temperature on mortality has been studied more in depth than its effect on morbidity. In Murcia, the number of daily emergencies and the cases of heat stroke for which care is provided at the hospitals in this Region have been studied. Objective: to evaluate the effect that the weather temperature has on the number of hospital emergencies and the use of these indicators for the surveillance of hot weather-related morbidity. Methods: The effect of the weather temperature on the number of summertime emergencies (2000-2005) has been studied by estimating the percentage increase in emergencies when the weather temperature thresholds established by the Ministry of Health and Consumer Affairs (Max. 38ºC and Min. 22.4ºC) are exceeded, and by each degree of temperature rise. Results have been stated as Relative Risk (RR) with a 95% CI. A comparison has been drawn between the heat strokes notified and the hospital admissions recorded in the Minimum Basic Data Set at Hospital Discharge (MBDS). Results: Within the 2000-2005 period, the number of emergencies rose by 1.6% on those days when the minimum temperature for the day was above 22.4ªC (RR: 1.016; 95%CI 1.0076 - 1.0244) and by 0.21% for each degree of rise in the minimum temperature for the day (RR: 1.0021, 95% CI 1.0000-1.0044). A total of 38% of the heat strokes admitted to hospital were not reported, of which 40% had occupational exposure. Conclusions: The minimum temperature for the day could have a greater effect in Murcia than the maximum for the day. Based on the current thresholds, the number of emergencies/day does not seem to be a suitable indicator for monitoring the effect of the weather temperature, information on the diagnosis and the age being needed. Heat strokes provide partial information on the impact, but highlight less-considered population groups at risk (AU)

[Correspondences from 10th to 9th Revision of the International Classification of Diseases in the causes of death lists of the National Institute of Statistics and the Regional Health Authority of Murcia in Spain]. / Correspondencias entre CIE-10 y CIE-9 para las listas de causas de muerte del Instituto Nacional de Estadística y de la Región de Murcia.

BACKGROUND: Different countries have conducted comparability studies between Revisions 10 and 9 of the International Classification of Diseases for aggregate lists of causes of death. In Spain, the COMPARA project was aimed at evaluating the impact of the revision change. METHODS: Descriptive cross-sectional epidemiological study of 88,048 deaths recorded in Spain in 1999 with the underlying cause of death doubled coded in ICD-9 and ICD-10. The theoretical correspondences between the ICD on the lists of the National Institute of Statistics and Murcia are established. The comparability rates and their confidence intervals, and the total kappa index were calculated. RESULTS: A decline in infectious diseases (-1.7%) and viral hepatitis, (-12.3%) declined under Tenth revision, while AIDS showed an increase (5.7%). Neoplasms increased a little (0.3%) with the inclusion of the Mielodisplasic Syndrome (55.2%). Diabetes mellitus is increased (2.1%). Mental disorders declined on dementia being shifted to Alzheimer's disease (28.6%). Cardiovascular diseases dropped slightly (-1.4%), without any impact on cerebrovascular diseases, although acute myocardial infarct decreased (-0.6%) while ischemic heart disease increased (0.3%). Pneumonia decreased (-12.5%) and hepatic cirrhosis grows (4.3%). Ill-defined conditions increased due to cardiorespiratory insufficiencies. The external causes show no change without including the accuracy of ICD-9. The National Institute of Statistics 102 groups list obtained a total kappa index of 95.4%, similar to the Murcia variants. CONCLUSIONS: Although ICD-10 has a lesser overall impact, the significant comparability rates of the causes of death groups between the revisions with important absolute differences should be taken into account.

Correspondencias entre CIE-10 y CIE-9 para las listas de causas de muerte del Instituto Nacional de Estadística y de la región de Murcia / Correspondences from 10th to 9th revision of the International Classification of Diseases in the causes of death lists of the National Institute of Statistics and the regional health authority of Murcia in Spain

Fundamento: Diversos países han realizado estudios de comparabilidadentre las revisiones 10ª y 9ª de la Clasificación Internacionalde Enfermedades para listas agregadas de causas de muerte. EnEspaña el proyecto COMPARA pretende evaluar el impacto delcambio de revisión.Métodos: Estudio epidemiológico transversal descriptivo de88.048 defunciones inscritas en 1999 en España con la causa demuerte doblemente codificada en CIE-9 y 10. Se establecen lascorrespondencias teóricas entre CIE en las listas INE y Murcia. Secalculan las razones de comparabilidad e intervalos de confianza y elíndice kappa global.Resultados: Descienden las enfermedades infecciosas (-1,7%),las hepatitis víricas (-12,3%), mientras que aumenta el Sida (5,7%).Las neoplasias aumentan el 0,3% por la incorporación del síndromemielodisplásico (55,2%). Se incrementa la diabetes mellitus (2,1%).Se reducen los trastornos mentales al salir las demencias hacia laenfermedad de Alzheimer (28,6%). Las enfermedades cardiovascularesdescienden ligeramente (-1,4%), sin impacto sobre las cerebrovasculares,aunque el infarto agudo de miocardio decrece (-0,6%)con aumento de la enfermedad isquémica cardiaca (0,3%). La neumoníadecrece (-12,5%) y la cirrosis hepática se aumenta (4,3%).Las entidades mal definidas aumentan por la cesión de las insuficienciascardiorrespiratorias. Las causas externas no varían sin querecojan la precisión de la CIE-9. La lista INE - 102 grupos obtiene uníndice kappa del 95,4%, similar a las variantes de Murcia. Conclusiones: Aunque el impacto global de la CIE-10 es menor,se deberían tener en cuenta las razones de comparabilidad significativasde los grupos de causas de muerte con diferencias absolutasimportantes entre las revisiones

Background: Different countries have conducted comparabilitystudies between Revisions 10 and 9 of the International Classificationof Diseases for aggregate lists of causes of death. In Spain,the COMPARA project was aimed at evaluating the impact of therevision change.Methods: Descriptive cross-sectional epidemiological study of88,048 deaths recorded in Spain in 1999 with the underlying cause ofdeath doubled coded in ICD-9 and ICD-10. The theoretical correspondencesbetween the ICD on the lists of the National Institute ofStatistics and Murcia are established. The comparability rates andtheir confidence intervals, and the total kappa index were calculated.Results: A decline in infectious diseases (-1.7%) and viral hepatitis,(-12.3%) declined under Tenth revision, while AIDS showed anincrease (5.7%). Neoplasms increased a little (0.3%) with the inclusionof the Mielodisplasic Syndrome (55.2%). Diabetes mellitus isincreased (2.1%). Mental disorders declined on dementia being shiftedto Alzheimer's disease (28.6%). Cardiovascular diseases droppedslightly (-1.4%), without any impact on cerebrovascular diseases,although acute myocardial infarct decreased (-0.6%) while ischemicheart disease increased (0.3%). Pneumonia decreased (-12.5%) andhepatic cirrhosis grows (4.3%). Ill-defined conditions increased dueto cardiorespiratory insufficiencies. The external causes show nochange without including the accuracy of ICD-9. The National Instituteof Statistics 102 groups list obtained a total kappa index of95.4%, similar to the Murcia variants. Conclusions: Although ICD-10 has a lesser overall impact, thesignificant comparability rates of the causes of death groups betweenthe revisions with important absolute differences should be takeninto account

Interpretando correctamente en salud pública estimaciones puntuales, intervalos de confianza y contrastes de hipótesis / Accurate interpretation of point estimates, confidence intervals, and hypothesis tests in public health

El presente ensayo trata de aclarar algunos conceptos utilizados habitualmente en el campo de investigación de la salud pública, que en numerosas situaciones son interpretados de manera incorrecta. Entre ellos encontramos la estimación puntual, los intervalos de confianza, y los contrastes de hipótesis. Estableciendo un paralelismo entre estos tres conceptos, podemos observar cuáles son sus diferencias más importantes a la hora de ser interpretados, tanto desde el punto de vista del enfoque clásico como desde la óptica bayesiana.

This essay reviews some statistical concepts frequently used in public health research that are commonly misinterpreted. These include point estimates, confidence intervals, and hypothesis tests. By comparing them using the classical and the Bayesian perspectives, their interpretation becomes clearer.

[Accurate interpretation of point estimates, confidence intervals, and hypothesis contrasts in public health]. / Interpretando correctamente en salud pública estimaciones puntuales, intervalos de confianza y contrastes de hipótesis.

This essay reviews some statistical concepts frequently used in public health research that are commonly misinterpreted. These include point estimates, confidence intervals, and hypothesis tests. By comparing them using the classical and the Bayesian perspectives, their interpretation becomes clearer. The English version of this paper is available at:http://www.insp.mx/salud/index.html.