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

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

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

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

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

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

Nutrición y rendimiento en atletas con discapacidad intelectualy conocimientos de sus cuidadores / Nutrition and physical performance in athletes with intellectual disability and knowledge level of their caregivers

Introduction: It has been proven that the population with intellectual disability presents health and nutrition risk factors; however, there are only a few studies that characterize this problematic situation. Objective: The purpose of this study was to determine the food consumption, nutritional diagnosis, physical performance and hydration status of 179 athletes with intellectual disability affiliated to the Guanajuato Special Olympics, from nine cities, as well as the knowledge level and hydration habits of parents or caregivers. Methodology: A descriptive, prospective and transversal study has been con ducted. Food consumption was obtained through a validated semi-quantitative questionnaire; the nutrition diagnosis was determined by anthropometric parameters; physical performance was evaluated by the tests DIDEFI®; the hydration status was calculated by urinary density using a refractometer; and the knowledge level, hydration and nutrition habits of the caregivers were assessed by two validated questionnaires. Results: The age group 11 to 20 years has the highest calorie and macronutrient ingestion. In relation to the nutritional status: 43.6% is overweight in some degree and 4.5% underweight. A tendency was found in the physical tests to monotonic growth in hand strength and abdominals per minute, a parabolic tendency in horizontal jump and a random representation in trunk flexion. 56.42% of the athletes presented dehydration. Regarding the parents/caregivers, their average knowledge was higher than their grade in the hydration habits questionnaire, with a significant statistics difference. Conclusions: The athletes with intellectual disabilities must be considered as a risk group because of factors such as alterations in weight and dehydration, as well as their parents’/caregivers’ lack of knowledge in nutrition and hydration, which could risk their health and physical performance.