The effect of treatment and coping on the quality of life in breast cancer patients: a moderated mediation model.

PURPOSE: Breast cancer involves complicated emotional processes. One of the factors that impacts the psychological symptoms and decreases QoL is the side effects of treatment. The purpose of this study is to explore the effect of the main medical treatment (chemotherapy or hormone therapy) on the three domains of quality of life. For this, coping strategies were considered as psychological variables that mediate the relationship based on high or low alexithymia as a moderating variable. METHODS: This study had a cross-sectional design. The participant sample comprised 129 women with breast cancer in early stage (I to III) (63 receiving chemotherapy and 66 hormone therapy) and were evaluated from September 2015 to September 2019. Physical, emotional and social functioning were measured by the Quality of Life Questionnaire for cancer patients (EORTC-QLQ-C30), coping strategies were measured by Mental Adjustment to Cancer Questionnaire (MAC) and alexithymia was evaluated by the Alexithymia Toronto Scale (TAS-20). RESULTS: Treatment had a significant negative effect on physical domain in both patients receiving chemotherapy and hormone therapy. Moderated mediation analysis show that this relationship was significant when it was mediated by helplessness. Furthermore, this model is only significant when there are high levels of alexithymia. No significant effect direct was found on emotional and social functioning of quality of life. CONCLUSIONS: Results confirmed that coping based on helplessness and stable emotional variables such as alexithymia can have an effect, mediator or moderator, respectively, in the decrease of the physical functionality of women with breast cancer. Our findings highlight the need to include psychological therapy to help patients alleviate their psychological state because it can affect their physical condition.

Providing Supportive and Palliative Care Using Telemedicine for Patients with Advanced Cancer During the COVID-19 Pandemic in Mexico.

COVID-19 has overwhelmed the capacity of health care systems, limiting access to supportive and palliative care for patients with advanced cancer. Telemedicine has emerged as a tool to provide care continuity to patients while limiting the risk of contagion. However, implementing telemedicine in resource-limited settings is challenging. We report the results of a multidisciplinary patient-navigator-led telemedicine supportive care program in Mexico City. One-hundred sixty-three telemedicine interventions were provided to 45 patients (median age 68, 57% female). A quarter of the patients had less than or equal to elementary school education, and 15% lived in a rural area. The most common interventions were psychological care (33%), pain and symptom control (25%), and nutritional counseling (13%). Half of the interventions were provided by video conferencing. The most common patient-reported barrier was limited experience using communication technology. Our results demonstrate the feasibility of providing supportive and palliative care interventions using telemedicine in resource-limited settings.

Patient Navigation to Improve Early Access to Supportive Care for Patients with Advanced Cancer in Resource-Limited Settings: A Randomized Controlled Trial.

BACKGROUND: The early integration of supportive care in oncology improves patient-centered outcomes. However, data are lacking regarding how to achieve this in resource-limited settings. We studied whether patient navigation increased access to multidisciplinary supportive care among Mexican patients with advanced cancer. MATERIALS AND METHODS: This randomized controlled trial was conducted between August 2017 and April 2018 at a public hospital in Mexico City. Patients aged ≥18 years with metastatic tumors ≤6 weeks from diagnosis were randomized (1:1) to a patient navigation intervention or usual care. Patients randomized to patient navigation received personalized supportive care from a navigator and a multidisciplinary team. Patients randomized to usual care obtained supportive care referrals from treating oncologists. The primary outcome was the implementation of supportive care interventions at 12 weeks. Secondary outcomes included advance directive completion, supportive care needs, and quality of life. RESULTS: One hundred thirty-four patients were randomized: 67 to patient navigation and 67 to usual care. Supportive care interventions were provided to 74% of patients in the patient navigation arm versus 24% in usual care (difference 0.50, 95% confidence interval [CI] 0.34-0.62; p < .0001). In the patient navigation arm, 48% of eligible patients completed advance directives, compared with 0% in usual care (p < .0001). At 12 weeks, patients randomized to patient navigation had less moderate/severe pain (10% vs. 33%; difference 0.23, 95% CI 0.07-0.38; p = .006), without differences in quality of life between arms. CONCLUSION: Patient navigation improves access to early supportive care, advance care planning, and pain for patients with advanced cancer in resource-limited settings. IMPLICATIONS FOR PRACTICE: The early implementation of supportive care in oncology is recommended by international guidelines, but this might be difficult to achieve in resource-limited settings. This randomized clinical trial including 134 Mexican patients with advanced cancer demonstrates that a multidisciplinary patient navigation intervention can improve the early access to supportive and palliative care interventions, increase advance care planning, and reduce symptoms compared with usual oncologist-guided care alone. These results demonstrate that patient navigation represents a potentially useful solution to achieve the adequate implementation of supportive and palliative care in resource-limited settings globally.

Evaluation of cerebral dysfunction in patients with chronic kidney disease using neuropsychometric and neurophysiological tests.

BACKGROUND: Uremic encephalopathy is defined as cerebral dysfunction due to toxin accumulation in patients with chronic kidney disease (CKD). This condition is characterized by subtle to florid symptoms, and its clinical course is always progressive when untreated but partially reversible with renal replacement therapy. While no test exists to measure subclinical uremic encephalopathy, two tests have been validated to measure minimal hepatic encephalopathy: the critical flicker frequency (CFF) test and the psychometric hepatic encephalopathy score (PHES). OBJECTIVE: To use CFF and PHES to measure the prevalence of cerebral dysfunction in individuals with CKD. METHODS: This cross-sectional study included a total of 69 patients with stage-5 CKD. Cutoff points for minimal encephalopathy were established using existing clinical guidelines: ≤39 Hz for CFF and < -4 for PHES. All participants were also screened for cognitive function and depression. RESULTS: Eighteen cases (26.1%) of cerebral dysfunction linked to uremic encephalopathy were detected with CFF, while twelve (17.4%) were detected by PHES; only six cases (8.7%) were diagnosed by both methods. Half of the cases (50%) had diabetes, and 61% were on hemodialysis. Cognitive function scores did not differ significantly between those receiving dialysis, hemodialysis, or no renal replacement therapy. CONCLUSIONS: It is essential to identify cerebral dysfunction when uremic encephalopathy is in early subclinical stages to reduce preventable events as traffic and work accidents.

Association between quality of life and positive coping strategies in breast cancer patients.

According to the World Health Organization, breast cancer is one of the most prevalent cancers in the Hispanic female population, and it carries a great psychological impact. Acceptance and personal learning derived from the individual's life experiences and understanding of their emotional state has been suggested as an adaptive profile toward the patient's perception of the disease. This study aims to explore which psychological variables are related to breast cancer patients' perception of their quality of life. A cross-sectional, correlational, and non-probabilistic study was performed on 113 women diagnosed with stage 1-3 breast cancer in Mexico and Spain, based on self-reporting through the Mental Adjustment to Cancer Scale, the Positive and Negative Affect Scale, and the EORTC Quality of Life Questionnaire. Recruitment was conducted from March 2015 to April 2018. Through multiple regression analysis, the study found that fighting spirit and positive affect explained 34.2% of quality of life variance F (2, 110) = 30.14, p <.005 of participants. The results support the need to contemplate the importance of positive psychological variables for a multidisciplinary approach to women diagnosed with breast cancer.

Tailoring Cognitive Behavioral Therapy for Depression and Anxiety Symptoms in Mexican Terminal Cancer Patients: A Multiple Baseline Study.

The purpose of this study was to assess the effect of tailored cognitive behavioral therapy (CBT) on depression and anxiety symptoms present in Mexican terminal cancer patients. A non-concurrent multiple baseline design was used across individuals. Nine patients participated in the study, each receiving four to six therapy sessions. The effect size of the intervention range (NAP and Tau indexes) in the nine patients indicates that CBT intervention resulted in weak to moderate impact for anxiety and depression symptoms in this population. The overall standardized mean difference is also moderate, with a reduction of 0.54 and 0.76 standard deviations in depression and anxiety symptoms, respectively. This study provides initial evidence to support a positive effect from CBT on patients with terminal cancer and with mood disorders when facing their impending death.

Supportive care needs among older Mexican adults with metastatic cancer.

INTRODUCTION: Supportive care needs may vary according to age. The purpose of this research is to describe and compare supportive care needs between older adults with metastatic cancer (age ≥ 65 years) and their younger counterparts. MATERIALS AND METHODS: We conducted a retrospective secondary analysis of a cohort of patients with newly diagnosed metastatic solid tumors. Supportive care needs were assessed at baseline and at a three-month follow-up. Patients were divided into two groups (aged ≥65/<65 years). Differences in clinical characteristics and supportive care needs were compared utilizing descriptive statistics. Multivariate logistic regression models were employed to identify patient characteristics associated with specific supportive care needs. RESULTS: Between 2018 and 2022, 375 patients were enrolled. Median age was 66 years (interquartile range 19-94). At baseline, older adults had a higher number of supportive care needs (4.8 vs. 4.2, p = 0.01) and were at higher risk of malnutrition (75 vs. 65%, p = 0.05). Increasing age (odds ratio [OR] 1.02 (95% confidence interval [CI] 1.0-1.04, p = 0.03) and an estimated life expectancy <6 months (OR 3.0, 95%CI 1.5-6.1; p < 0.01) were associated with higher odds of malnutrition, while a higher educational level was associated with decreased odds (OR 0.68, 95%CI 0.5-0.8; p < 0.01). At three-month follow-up, older adults still had a higher number of supportive care needs (3.8 vs.2.6, p < 0.01) and were more likely to have fatigue (62 vs. 47%, p = 0.02). An estimated life expectancy of <6 months was associated with increased odds of fatigue (OR 3.0, 95%CI 1.5-6.3; p < 0.01). DISCUSSION: Older adults reported significantly more supportive care needs, particularly risk of malnutrition and fatigue. This information can help in the creation of supportive care services tailored to the needs of older individuals.

Financial Toxicity Among Older Mexican Adults With Cancer and Their Families: A Mixed-Methods Study.

PURPOSE: The financial toxicity (FT) of cancer is common among older adults in high-income countries, but little is known about the financial hardships faced by older patients with cancer living in developing countries. The aim of this study was to explore the financial burden of cancer among older Mexican adults and their relatives, as well as factors that might mitigate such burden. METHODS: This mixed-methods study included patients age 65 years and older with the 10 most common malignancies in Mexico and 3-24 months from diagnosis at two cancer centers in Mexico City and their relatives. For the quantitative component, patients and relatives answered the Spanish version of the Consumer Financial Protection Bureau Financial Well-Being Scale. Patients completed the Comprehensive Score for Financial Toxicity-Functional Assessment of Chronic Illness Therapy (COST-FACIT) scale and a 3-month, self-reported cost diary. For the qualitative component, focused interviews were used to explore the individual experiences of patients and their relatives. RESULTS: Ninety-six patients and their relatives were included, of whom 45% had stage IV disease. On the COST-FACIT scale, 9% reported no FT, 52% mild FT, 39% moderate FT, and 0% severe FT. The mean Consumer Financial Protection Bureau Financial Well-Being Scale score was 45.2, with 78% reporting poor financial well-being (score ≤ 50). On cost diaries, most expenses were associated with purchasing medications, including chemotherapy. Focused interviews showed that most patients and relatives had to acquire debt to face costs of cancer care. CONCLUSION: A high proportion of Mexican older adults with cancer reported FT and poor financial well-being. Understanding experiences associated with FT and strategies to mitigate it represents an essential first step to design public policies aimed at protecting older adults with cancer and their families from catastrophic spending.

Neurocognitive profile of an adult sample with chronic kidney disease.

Chronic kidney disease (CKD) is a common and debilitating illness that impacts neurocognitive function. However, the majority of previous studies varied in methodologic design and rigor, thus minimizing definitive conclusions. The present study was designed to determine the impact of CKD on neurocognitive function through specific examination of CKD factors and therapeutic interventions. We evaluated 120 CKD outpatients and 41 healthy donors (controls) in terms of neurocognitive function, anxiety, and depressive symptomatology, and somnolence. Information regarding medical and treatment history was recorded. Twenty-three percent of CKD patients presented with cognitive impairment. Stage 5 patients had lower scores (p < .05) compared with controls and patients in stage 3 and 4 on measures of global cognitive function. No differences in global cognitive function were found between stage 3 and 4 patients and controls. A greater proportion of patients undergoing hemodialysis relative to those treated with peritoneal dialysis showed impairment on measures of memory functions. Results suggest that stage 5 CKD patients may present with impaired cognitive functions. Anemia appeared to be a key variable that may explain the memory impairment in this sample. Future longitudinal investigations of CKD are warranted to determine the trajectory of cognitive impairment.

Assessment of emotional distress in chronic kidney disease patients and kidney transplant recipients.

OBJECTIVE: To assess the presence of emotional distress in patients with chronic kidney disease (CKD), and the effect of kidney transplant on these symptoms. MATERIAL AND METHODS: This was a two-part study. Part one was cross-sectional, observational, and descriptive, where 75 patients with CKD were evaluated for emotional distress with the Hospital Anxiety and Depression Scale (HAD) and the Symptom Checklist 90 (SCL-90). In part two, we longitudinally followed 19% of the study cohort to examine symptomatological changes after their kidney transplantation. RESULTS: The results of the HAD indicated that 30.7% of the study cohort with End-Stage Renal Disease (ESRD) showed anxious symptoms, and 25.3% showed depressive symptoms. The change in the HAD total score before and after kidney transplant was not significant. However, a significant decrease in total score on the SCL-90 was observed before and after transplantation. CONCLUSION: Improvement on emotional distress was found after kidney transplantation.

The Importance of Alexithymia in Post-surgery. Differences on Body Image and Psychological Adjustment in Breast Cancer Patients.

Breast cancer is a disease that is difficult to face and that often hinders body acceptance. Body changes due to surgery can be very emotionally challenging for those who experience them. The aim of this study is to explore the differences on body image and psychological adjustment on women with breast cancer with high and low alexithymia according to the type of surgery. In this cross-sectional study, 119 women diagnosed with breast cancer (stages I, II, and III) were evaluated with different self-report questionnaires. Afterward, patients were divided into two groups (high and low levels of alexithymia) to analyze dependent variables (body image and psychological adjustment) according to the type of surgery (radical mastectomy or breast conserving therapy). The results of the General Linear Model suggest that when patients show high alexithymia combined with having undergone a radical mastectomy, they show higher levels of Hopelessness. Furthermore, in patients with high alexithymia, higher scores of maladaptive coping styles and greater distortion of body image were found. Alexithymia seems to play an important role in the way in which women cope with their disease, especially in those with radical mastectomy.

Symptom Assessment and Early Access to Supportive and Palliative Care for Patients With Advanced Solid Tumors in Mexico.

BACKGROUND: Early specialized palliative care improves quality of life of patients with advanced cancer, and guidelines encourage its integration into standard oncology care. However, many patients fail to obtain timely palliative/supportive care evaluations, particularly in limited-resource settings. We aimed to determine the proportion of patients with advanced cancer who received an assessment of symptoms and were referred to supportive and palliative care services during the first year after diagnosis in a Mexican hospital. METHODS: Individuals with newly diagnosed advanced solid tumors and 1 year of follow-up at the oncology clinics in the Instituto Nacional de Ciencias Medicas y Nutricion Salvador Zubiran in Mexico City from October 2015 to April 2016 were included in this retrospective study. RESULTS: Seventy-seven patients were included. Forty-two (54.5%) were referred to the various supportive care services during the first year after diagnosis, and 23 (29.8%) were referred to the palliative care clinic. The most commonly assessed symptoms by oncologists were pain (77.9%), anorexia (74.0%), fatigue (68.8%), and nausea (55.8%), while depression/anxiety were evaluated in 10 (12.9%) patients. The oncologist offered to clarify treatment goals in 39 (50.6%) cases and evaluated the understanding of diagnosis/illness and prognosis in 22 (28.5%). CONCLUSION: Palliative and supportive care services were widely underutilized, which may be related to a lack of standardized symptom assessments and poor end-of-life communication. Novel strategies are needed to improve the implementation of tools for systematic symptom assessment and to optimize the integration of supportive care interventions into oncology care in developing countries.

Intellectual performance of kidney transplant recipients' offspring: a cross-sectional, multicenter study.

OBJECTIVE: The number of successful pregnancies in kidney transplant (KT) recipients has increased in recent years. Little evidence is available about the risk of in utero immunosuppressive exposure for long-term cognitive consequences. The aim of this study was to evaluate the impact of immunosuppression during pregnancy on intellectual performance of children born to KT recipients. METHODS: Using a cross-sectional design, women who had undergone KT and their children (aged 4+ years) were recruited at the outpatient follow-up in five transplant centers. Women who did not receive immunosuppression during pregnancy with similar distributions of socioeconomic status and length of gestation and their children were also recruited. Children were assessed with Wechsler Intelligence Scales. RESULTS: The study sample included 50 exposed and 50 unexposed children. No differences between groups in all the proposed confounding factors were found. Full-scale IQ did not differ significantly between both groups. Also, significant differences in any index or subscale score were not observed, with the exception of time required to complete the Wechsler preschool and primary scale of intelligence (WPPSI) Zoo locations subtest, which was done quicker in the unexposed group (p = .007). Exposure to immunosuppression during pregnancy was not a significant predictor of low IQ in logistic regression after adjustment for other factors. CONCLUSIONS: Immunosuppression therapy during pregnancy of KT women did not affect global intellectual performance of their offspring, except maybe for visuospatial working memory in preschool children.

[Anxiety and depression in patients with chronic pain: neuropathic and nociceptive]. / Ansiedad y depresión por dolor crónico neuropático y nociceptivo.

OBJECTIVE: To describe and compare anxiety and depression symptoms between two group patients with neuropathic and nociceptive pain those arrive for first time to a clinic of pain. METHODS: Non-experimental, exploratory and descriptive design. Seventy-eight patients that arrive the first time to a clinic of pain were evaluated; those patients were divided in two groups: neuropathic pain with 44 patients and nociceptive pain with 34 patients. To evaluate anxiety and depression we use the Anxiety and Depression Scale (HAD), this scale is adapted and validated in Mexico. RESULTS: From the 78 patients in the study, the 76.9% were female and 23.1% were male. The age average was (56.9 +/- 16.8 year-old for neuropathic pain and 63.1 +/- 17.2 year-old for nociceptive pain). The reliability of the scale HAD was evaluated by the Chronbach's alpha analysis with an r = 0.826. There was no significance difference in anxiety and depression between types of pain, but after analyzing all of the patients we found that anxiety was more frequent than depression p < 0.0001. CONCLUSIONS: Independently of the algological diagnosis, patients presented almost the same affective symptoms.

[Burden, anxiety and depression in patient's caregivers with chronic pain and in palliative care]. / Sobrecarga, ansiedad y depresión en cuidadores primarios de pacientes con dolor crónico y terminales.

BACKGROUND: In Mexico there are few studies about the psychological characteristics of the person that voluntary and in a complete sense assumes the role of responsible of a patient. The purpose of this study was to assess and compare the levels of burden, anxiety and depression of 56 caregivers of patients with chronic pain with the ones of 35 caregivers of terminally ill patients. METHODS: The study was conduced at the Chronic Pain and Palliative Medicine Department of the Instituto Nacional de Ciencias Médicas y Nutrición "Salvador Zubirán". We used the Spanish version of the Burden Interview and the Informal Primary Caregiver Health Survey. RESULTS: Both groups went over the cut off point of the Burden Scale even though no significative differences between groups were found nor in burden or in anxiety. The caregivers of terminal patients had more depression symptoms and a greater perception of the impact of the care activity in their mood. Positive correlations between burden and depression, depression and anxiety and burden and anxiety were found. CONCLUSIONS: All caregivers reported multiple depression symptoms--greater if they cared terminally ill patients--so, it may suggest that the patient's illness directly influences the depression symptoms of their caregivers. This study can help to develop intervention programs directed to help this population that is the principal support of the patient's treatment.

[Effectiveness of a cognitive-behavioural program to reduce anxiety in medically ill patients]. / Eficacia de un programa cognitivo-conductual para la disminución de la ansiedad en pacientes médicamente enfermos.

The aim of this work is to evaluate four programs to reduce anxiety in medically ill patients: psicoeducative, cognitive, behavioural or control. One hundred and seventy seven patients from the Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán were assigned randomly to one of this programs and were evaluated before and after them with the Anxiety Hamilton Scale and the State-Trait Anxiety Inventory (STAI). Program effectiveness was evaluated with descriptive and a Pre-post difference mean analysis. Results show that the program that obtained the best results in reducing anxiety levels was the Psicoeducative Program, reducing significantly the anxiety levels evaluated with both measures. This indicates that in patients that assist to a general hospital, the combination of different psychological techniques such as providing information to the patient, relaxation training and other cognitive strategies are effective in reducing tension, worries, nervousness and levels of anxiety related with their illness.

Hijos de mujeres con trasplante renal: factores de riesgo en el embarazo, estilos de crianza y funciones cognoscitivas / Children of women with kidney transplantation: risk factors in pregnancy, parenting styles and cognitive functions

Las mujeres con trasplante renal (TR) suelen cursar un embarazo de alto riesgo, pues son más susceptibles a presentar complicaciones médicas. Aunado a este hecho pueden presentar alteraciones en su estado emocional y psicológico durante y después del embarazo, lo que impactaría directamente en el estilo de crianza y desarrollo posterior del niño. Se desconoce cómo son los estilos de crianza en los hijos de las mujeres con TR y el posible impacto en su funcionamiento cognoscitivo. El presente trabajo tuvo dos objetivos: 1) determinar si existían diferencias en los estilos de crianza y las funciones cognoscitivas de los hijos de mujeres con trasplante renal en comparación con los hijos de mujeres sanas y 2) identificar la asociación entre las variables asociadas al riesgo en el embarazo y los estilos de crianza con las funciones cognoscitivas. Para ello fueron reclutados de diversos centros de trasplantes 23 niños (9 casos y 14 controles) de 7-15 años con sus respectivas madres a quienes se evaluó mediante el WISC-IV y el cuestionario CRPBI. Las madres fueron evaluadas con el cuestionario BRIEF, el cuestionario PCRI-M y el BDI-II. Se realizó un diseño transversal con alcance correlacional. No se encontraron diferencias entre el grupo caso y control en los estilos de crianza ni en las funciones cognoscitivas. Sin embargo, sí se encontró asociación entre los estilos de crianza y las funciones cognoscitivas. Un estilo en el que predomine la comunicación y la disciplina se asocia con mejores resultados cognoscitivos y conductuales.

Pregnancy in Kidney Transplant (KT) recipients is usually considered of high risk. KT recipients are susceptible to have obstetric complications. Studies report that KT recipients are at higher risk of experiencing distress during and after pregnancy, situation that may have an impact in parenting styles and child's development. Characteristics of parenting styles in KT recipients' offspring and its possible impact in cognitive functions remain unknown. The aims of the study were: 1) to determine if there are differences in parenting styles and cognitive functions among KT recipients' offspring and healthy women's offspring, and 2) to identify associations between high risk pregnancy variables, parenting styles and cognitive functions. Twenty-three children (9 cases and 14 controls) aged 8-15 years and their mothers were assessed with the (WISC-V) and the CRPBI. Mothers were asked to complete BRIEF, PCRI-M, BDI-II and a socioeconomic status instrument. A transversal correlational design was performed. No differences were found between case and control group in parenting styles or cognitive functions. However, an association between parenting styles and cognitive functions was found. Being raised with communication and discipline is associated with increased cognitive results.

[Prevalence of psychiatric disorders in patients with severe obesity waiting for bariatric surgery]. / Prevalencia de trastornos psiquiátricos en pacientes con obesidad extrema candidatos a cirugía bariátrica.

INTRODUCTION: Obesity is a chronic condition, in which different systems of the body are affected. There are some previous studies in which the prevalence of psychiatric disorders in extreme obese patients has been reported, but there are some methodological problems. As far as we know this is the first report of the prevalence of psychiatric disorders in obese patients that need to have a surgical treatment for this disorder in Mexico. The main goal of this study was to determine the prevalence and risk factors of psychiatric disorders in extreme obese patients candidates to bariatric surgery. MATERIAL AND METHODS: The Structured Clinical Interview for DSM-IV (SCID) axis I disorders, were performed in 70 obese patients that will undergo for bariatric surgery. Also the medical files were reviewed in order to obtain the main medical conditions related to obesity. RESULTS: There were 25 men and 35 women in this study (average age +/- s.d = 39.0 +/- 10.4). The Body Mass Index (BMI) was 53.8 +/- 11.9. Sixty percent of the patients had some psychiatric disorder in the axis I of DSM-IV. The most frequent psychiatric problem that was observed was anxiety disorders. The main medical problems observed were: arterial hypertension (59%), diabetes mellitus type 2 (29%) and obstructive sleep apnea syndrome (29%). The BMI and diabetes mellitus were associated with a lower risk for presenting a psychiatric disorder (for a BMI of 65.5 +/- 10.3 kg/m2: OR 0.26, CI 0.05-1.15, p = 0.04; for diabetes mellitus: OR 0.20, CI 0.03-1.05, p = 0.02). CONCLUSIONS: More than half of the patients had at least one psychiatric disorder in axis 1 of DSM-IV, related mostly to anxiety and mood disorders. Our findings point out the importance of psychiatric and psychological intervention in this group of patients, in which a follow up and adherence of medical, nutritional and psychological problems could be the difference, between a good or bad prognosis. Follow-up studies with obese patients after bariatric surgery, will be important to support our findings.

Delirium in adult patients receiving palliative care: a systematic review of the literature.

Delirium in palliative care patients is common and its diagnosis and treatment is a major challenge. Our objective was to perform a literature analysis in two phases on the recent scientific evidence (2007-2012) on the diagnosis and treatment of delirium in adults receiving palliative care. In phase 1 (descriptive studies and narrative reviews) 133 relevant articles were identified: 73 addressed the issue of delirium secondarily, and 60 articles as the main topic. However, only 4 prospective observational studies in which delirium was central were identified. Of 135 articles analysed in phase 2 (clinical trials or descriptive studies on treatment of delirium in palliative care patients), only 3 were about prevention or treatment: 2 retrospective studies and one clinical trial on multicomponent prevention in cancer patients. Much of the recent literature is related to reviews on studies conducted more than a decade ago and on patients different to those receiving palliative care. In conclusion, recent scientific evidence on delirium in palliative care is limited and suboptimal. Prospective studies are urgently needed that focus specifically on this highly vulnerable population.