The bright side of sports: a systematic review on well-being, positive emotions and performance.

OBJECTIVE: The objective of this study is to conduct a systematic review regarding the relationship between positive psychological factors, such as psychological well-being and pleasant emotions, and sports performance. METHOD: This study, carried out through a systematic review using PRISMA guidelines considering the Web of Science, PsycINFO, PubMed and SPORT Discus databases, seeks to highlight the relationship between other more 'positive' factors, such as well-being, positive emotions and sports performance. SETTINGS: The keywords will be decided by a Delphi Method in two rounds with sport psychology experts. PARTICIPANTS: There are no participants in the present research. ASSESSMENT: The main exclusion criteria were: Non-sport thema, sample younger or older than 20-65 years old, qualitative or other methodology studies, COVID-related, journals not exclusively about Psychology. MAIN OUTCOMES MEASURES: We obtained a first sample of 238 papers, and finally, this sample was reduced to the final sample of 11 papers. RESULTS: The results obtained are intended to be a representation of the 'bright side' of sports practice, and as a complement or mediator of the negative variables that have an impact on athletes' and coaches' performance. CONCLUSIONS: Clear recognition that acting on intrinsic motivation continues to be the best and most effective way to motivate oneself to obtain the highest levels of performance, a good perception of competence and a source of personal satisfaction.

Quantitative and Qualitative Analysis of Psychosocial Factors Affecting Women's Entrepreneurship.

This work aims to clarify the psychosocial variables that lead women to undertake and those that prevent them from doing so. Two studies were conducted using a mixed methodology to compensate for the inherent weaknesses of using each approach. The first study was based on the collection of quantitative data using the GloPEW questionnaire with a sample of 296 people. The second study, of a qualitative nature, was carried out through focus groups with a sample of 26 people. The results show that self-efficacy and emotional intelligence are the main factors to develop to promote entrepreneurship among women. Although the data show statistical strength, it seems necessary to expand the sample and incorporate more profiles of female entrepreneurs, for example, with different levels of training, given the complexity and variety of intervening factors.

Effect of Biofeedback on the Anxiety of Amateur Athletes / Efecto de la biorretroalimentación sobre la ansiedad de los deportistas aficionados

Biofeedback is an effective strategy to decrease levels of activation and anxiety. The purpose of this study is to determine the degree to which amateur athletes are able to learn to control their autonomic responses through biofeedback. The hypothesis of this study is that amateur athletes with biofeedback intervention will significantly decrease their level of psychophysiological activation compared to those without the intervention. Sixteen amateur marathon athletes participated, from the city of Andria de la Puglia, Italy. They were randomly assigned to two groups, one control and one experimental (i.e., biofeedback condition, which used peripheral temperature, skin conductance, and heart rate techniques). During the intervention period, there were six 15-minute individual sessions over two weeks. Anxiety was evaluated using the STAI survey, which is a subjective scale of activation and a psychophysiological profile. The statistical analysis used in this study is analysis of variance of repeated measurements was used with a significance level of .05. For the Post Hoc or a posteriori comparison, the Sidák and the Bonferroni procedure were conducted. A significant interaction was found between the evaluation conditions, timepoints, group, including peripheral temperature and in the skin conductance. The experimental group has significant lower activation compared to the control group, higher increase of the peripheral temperature and lower conductance. There is no difference in anxiety measured with the STAI. In conclusion, the biofeedback group has learned to control their autonomic responses, as indicated by a significant decrease in the level of psychophysiological activation, compared to the group without intervention.(AU)

Intervención psicológica mediante el coaching motivacional en un caso de pérdida de peso / Psychological intervention through motivational coaching in a case of weight loss

Resumen Objetivo: Construir un índice general de vulnerabilidad del sector salud y un índice específico de vulnerabilidad en enfermedades neumológicas, que identifiquen a los municipios con menor capacidad de respuesta a la pandemia provocada por el virus SARS-CoV-2. Materiales y métodos: Para generar los índices, nos basamos en tres componentes: la infraestructura y el personal disponible; la demanda sanitaria; el alcance del seguro social y de salud, todo ello mediante el método de descomposición de Shapley. Resultados: Los municipios que presentan una mayor capacidad de resiliencia ante la pandemia, en su mayoría son municipios capitales, dato que resalta la mala distribución espacial de los servicios sanitarios. Además, por las características socio económicas del país, los municipios de la región sur oeste (Oaxaca, Guerrero y Puebla); de la sierra Tarahumara (Chihuahua) y la Huasteca (San Luis de Potosí, Querétaro e Hidalgo) son los que presentan un alto índice de vulnerabilidad, al no contar con los recursos sanitarios suficientes y por tener una gran proporción de población sensible a la pandemia. Otro hallazgo importante es que, los municipios capitales, a pesar de contar con un número considerable de infraestructura hospitalaria y personal médico, poseen una alta densidad demográfica, lo que ocasiona que estén más expuestos al virus y por ende se encaminan a la saturación total de su sistema de salud; tal es el caso de municipios como Iztapalapa o Ecatepec que tras la segunda ola de pandemia rebasaron su capacidad hospitalaria. Conclusión: La vulnerabilidad del sector salud vista a través de los índices desarrollados, se agrava si se analiza la capacidad específica de atención a enfermedades respiratorias, en particular en los municipios de alta y media exposición a la pandemia por COVID-19, los hallazgos muestran la importancia de desarrollar políticas focalizadas de protección y mitigación de estos municipios.

Abstract Objective: The objective of this study is to obtain data on the effectiveness of the recently created motivational coaching model "La Girafa de Cantón", specifically its ability to positively influence variables such as psychological well-being and self esteem. Materials and method: A single case design of methodological triangulation is used, where the quantitative information obtained through the test-retest evaluation is combined with the Ryff Psychological Well-being scales and the Rosenberg self- esteem test with the qualitative analysis of the interviews. made. The intervention lasts for five sessions and is performed with a 20-year-old woman whose main objective is to lose five kilos of weight in approximately two months. Results: The results show a significant improvement in the retest scores, in the subjective perception of the participant regarding progress in the process and an improvement in skills to maintain healthy behaviors; in addition to significant weight loss. Conclusions: As a result of the results obtained, the intervention carried out has been effective in improving the variables studied through the self-reflection caused by the professional in psychological coaching and based on the "La Girafa de Cantón" model. Therefore, it is important the adequate application of these strategies by trained professionals and the need for future studies to strengthen the effectiveness of this intervention methodology.

Intervención psicológica para el aumento motivacional hacia la actividad física y la pérdida de peso / Psychological Intervention for Increased Motivation Towards Physical Activity and Weight Loss

Resumen Se presenta un estudio de caso con una joven de 22 años (estudiante y entrenadora de baloncesto) que quería motivarse para perder peso y desarrollar hábitos saludables (buena alimentación y ejercicio físico regular). Se utilizó el modelo "La Jirafa de Cantón" como base de la intervención que consta de cuatro partes bien diferenciadas que son: la "cabeza" o meta; el "cuello" o las expectativas x valor; el "cuerpo" o la autoestima, autoeficacia y autoconcepto; y las "patas" de la base que se refieren a las cuatro vías de obtención de información (experiencia directa, experiencia indirecta, persuasión verbal y síntomas psicofisiológicos). El análisis de datos tanto cuantitativos como cualitativos se realizó mediante triangulación metodológica, midiendo en la participante las partes del modelo de la Jirafa de Cantón de manera cualitativa, y cuantitativamente el bienestar psicológico y la autoeficacia. Los resultados muestran una mejora de las variables motivacionales relacionadas con las partes del modelo, en consonancia con la mejora de las puntuaciones cuantitativas de bienestar psicológico y autoeficacia. También se observó un aumento y mantenimiento de hábitos saludables de nutrición, actividad física y pensamientos adecuados. Estos resultados están en la línea de los obtenidos en estudios anteriores similares.

Abstract: A case study is presented with a 22-year-old female (student and basketball coach) who wanted to motivate herself to lose weight and develop healthy habits (good nutrition and regular physical exercise). The "Cantón's Giraffe" model was used as the basis of the intervention, which consists of four well-differentiated parts that are: the "head" or goal; the "neck" or expectations x value; the "body" or selfesteem, self-efficacy and self-concept; and the base "legs" that refer to the four ways of obtaining information (direct experience, indirect experience, verbal persuasion and psychophysiological symptoms). The analysis of both quantitative and qualitative data was carried out through methodological triangulation, measuring the parts of the Cantón's Giraffe model qualitatively in the parti- cipant, and quantitatively for psychological well-being and self-efficacy. The results show an improvement in the motivational variables related to the parts of the model, in line with the improvement in the quantitative scores for psychological well-being and self-efficacy. There was also an increase and maintenance of healthy habits of nutrition, physical activity and proper thinking. These results are in line with those obtained in previous similar studies.

Ajuste y evolución psicológica en pacientes con síndrome coronario agudo tras su participación en un programa de rehabilitación cardiaca / Adjustment and psychological evolution in patients with acute coronary syndrome after participation in a cardiac rehabilitation program / Ajustamento e evolução psicológica em pacientes com síndrome coronariana aguda após a sua participação num programa de reabilitação cardíaca

Las variables psicológicas tienen una especial relevancia en las afectaciones coronarias. El objetivo del presente trabajo fue estudiar la evolución de distintas variables psicológicas, de calidad de vida y de ajuste psicosocial, en pacientes que habían sufrido un síndrome coronario agudo (SCA) y asistido a un programa de rehabilitación cardíaca que incluía, entre otros, un módulo de ejercicio físico. Las mediciones se efectuaron al debutar el SCA y a los 3 meses del evento cardiaco en un total de 146 varones, (57.86 años de edad (dt = 9.45)) a los que se les había realizado un cateterismo diagnóstico con intención terapéutica dentro de los 3 primeros días. El diseño del estudio fue de tipo cuasiexperimental, prospectivo y longitudinal. Los resultados a los 3 meses de sufrir el evento cardiaco muestran menores niveles de ansiedad (Cohen d = .61; p < .01), depresión (Cohen d = .33; p < .05), distrés psicológico (Cohen d = .72; p < .01) e ira (Cohen d = .34; p < .01), y mayores puntuaciones de fuerza personal (Cohen d = .37; p < .01) o apreciación de la vida (Cohen d = .35; p < .01). En el SCA, conocer la evolución psicosocial del paciente se considera fundamental junto al control médico habitual

The psychological variables have a special relevance in the coronary affectations. The aim of the present work was to study the evolution of different psychological variables, of quality of life and of adjustment psychosocial, in patients who have suffered an acute coronary syndrome (ACS) and attended a cardiac rehabilitation program, which included, among other, a module of physical activity. The measurements were made when the ACS debuted and 3 months after the cardiac event in a total of 146 men (57.86 years of age (dt = 9.45)) who had undergone a diagnostic catheterization with therapeutic intent within 3 days. The study design was of the quasi-experimental, prospective and longitudinal type. The results at 3 months after suffering the cardiac event show lower levels of anxiety (Cohen's d = .61; p < .01), depression (Cohen's d = .33; p < .05), psychological distress (Cohen's d =. 72; p < .01) and anger (Cohen's d = .34; p < .01), and higher personal strength scores (Cohen's d = .37; p < .01) or life appreciation (Cohen's d =. 35, p < .01). In the ACS, knowing the psychosocial evolution of the patient is considered fundamental next to the usual medical control

As variáveis psicológicas têm uma relevância especial nos distúrbios coronários. O objetivo deste trabalho foi estudar a evolução de diferentes variáveis psicológicas, qualidade de vida e ajuste psicossocial, em pacientes que sofreram síndrome coronariana aguda (SCA) e participaram de um programa de reabilitação cardíaca que incluiu, entre outros, um módulo de exercício físico. As medidas foram feitas quando a SCA estreou e 3 meses após o evento cardíaco em um total de 146 homens (57,86 anos (dt = 9,45)) submetidos a cateterismo diagnóstico com intenção terapêutica em 3 primeiros dias. O desenho do estudo foi quase experimental, prospectivo e longitudinal. Os resultados três meses após sofrer o evento cardíaco mostram níveis mais baixos de ansiedade (Cohen d = 0,61; p <0,01), depressão (Cohen d = 0,33; p <0,05), sofrimento psicológico (Cohen d =. 72; p <0,01) e raiva (Cohen d = 0,34; p <0,01) e maiores escores de força pessoal (Cohen d = 0,37; p <0,01) ou valorização da vida (Cohen d =. 35; p <0,01). Na SCA, o conhecimento da evolução psicossocial do paciente é considerado essencial, juntamente com o controle médico usual

Intervención clínica desde la psicología motivacional en una gimnasta joven de alta competición / Clinical intervention from motivational psychology in a highly competitive young gymnast / Intervenção clínica da psicologia motivacional numa jovem ginasta de alta competição / Intervention clinique de la psychologie motivationnelle dans une jeune gymnaste de haute compétition

Resumen Objetivo: Comprobar si se producen mejoras en las variables psicológicas de bienestar psicológico, autoeficacia y autoestima, en una gimnasta joven, aplicando una intervención psicológica basada en el modelo de coaching motivacional "La Jirafa de Cantón" Se espera que las mejoras se reflejen en datos cuantitativos de cuestionarios que recoge dichas variables, así como de forma cualitativa mediante la valoración de la gimnasta sobre la intervención realizada y sus efectos. Materiales y Métodos: Se empleó un diseño de caso único, con una joven de 12 años que practica gimnasia rítmica. La demanda vino de su entrenadora, quien percibía riesgos para su bienestar y salud mental. Se utilizó una metodología de triangulación metodológica, al combinar aspectos cuantitativos (medición pre y post de bienestar psicológico, autoeficacia y autoestima) y análisis cualitativo de las sesiones. Se empleó un protocolo de intervención, diseñado para el modelo, con las fases de identificación, intervención y seguimiento. Se realizaron un total de 11 sesiones. Resultados: Los resultados cuantitativos muestran un aumento de la puntuación en los cuestionarios de bienestar psicológico, autoestima y autoeficacia, apoyado por el análisis cualitativo favorable de las respuestas de la paciente. Conclusión: La intervención realizada se ha mostrado eficaz para mejorar las variables psicológicas medidas, en la percepción de la deportista de su ejecución deportiva, y en las percepciones de sus progenitores y su entrenadora. Intervenciones de este tipo se estiman necesarias para prevenir riesgos para la salud mental, sobre todo en deportes tan exigentes como es la gimnasia rítmica.

Abstract Objective: To demonstrate if there are improvements in the psychological variables of psychological well-being, selfefficacy and self-esteem, in a young gymnast, applying a psychological intervention based on the motivational coaching model the "Cantón's Giraffe". It is expected that the improvements will be reflected in quantitative data of questionnaires that include these variables, as well as qualitatively by the evaluation of the gymnast on the intervention performed and its effects. Method: A unique case design was used, with a 12-year-old girl who practices rhythmic gymnastics. The demand came from his coach, who perceived risks to his well-being and mental health. A methodology of methodological triangulation was used, combining quantitative aspects (pre and post measurement of psychological well-being, self-efficacy and self-esteem) and qualitative analysis of the sessions. An intervention protocol was used, designed for the model, with the identification, intervention and follow-up phases. A total of 11 sessions were made. Results: The quantitative results show an increase in the scores in the psychological well-being, self-esteem and self-efficacy questionnaires, supported by the favorable qualitative analysis of the patient's responses. Conclusion: The intervention carried out has been shown to be effective in improving the psychological variables measured, in the athlete's perception of her sport performance, and in the perceptions of her parents and her coach. Interventions of this type are considered necessary to prevent risks to mental health, especially in sports as demanding as rhythmic gymnastics.

Resumo Objetivo: Verificar a existência de melhorias nas variáveis psicológicas de bem-estar psicológico, autoeficácia e autoestima, numa jovem ginasta, após aplicação de uma intervenção psicológica baseada no modelo de coaching motivacional "La Jirafa de Cantón". Espera-se que as melhorias se refletem quantitativamente nas variáveis dos questionários, bem como qualitativamente pela perspetiva da ginasta sobre a valorização da intervenção realizada e os seus efeitos. Método: Foi utilizado um estudo de caso único, com uma jovem de 12 anos que pratica ginástica rítmica. A solicitação veio da sua treinadora, que percebeu os riscos para o bem-estar e a saúde mental. Utilizou-se uma metodologia de triangulação metodológica, combinando aspetos quantitativos (pré e pós-mensuração do bem-estar psicológico, autoeficácia e autoestima) e análise qualitativa das sessões. Elaborou-se um protocolo de intervenção com base no modelo, com as fases de identificação, intervenção e acompanhamento. Realizaram-se no total 11 sessões. Resultados: Os resultados quantitativos mostram um aumento nos escores de bem-estar psicológico, autoestima e autoeficácia, apoiados pela análise qualitativa favorável das respostas da participante. Conclusão: A intervenção realizada mostrou-se eficaz na melhoria das variáveis psicológicas medidas, na perceção do desempenho desportivo da atleta e nas perceções de seus pais e da sua treinadora Intervenções deste tipo são consideradas necessárias para prevenir os riscos à saúde mental, especialmente nos desportos exigentes como é o caso da ginástica rítmica.

Résumé Objectif: Vérifier si des améliorations se produisent dans les variables du bien-être psychologique, l'auto-efficacité et l'estime de soi, chez un jeune gymnaste, à travers l'application d'une intervention psychologique basée sur le modèle de coaching motivationnel "La Jirafa de Cantón". Les améliorations devraient être reflétées dans les données quantitatives des questionnaires contenant ces variables, ainsi que qualitativement par l'évaluation de la gymnaste sur l'intervention réalisée et ses effets. Méthode: Un design de caisse unique a été utilisé, avec une fille de 12 ans qui pratique la gymnastique rythmique. La demande émanait de son entraîneur, qui percevait des risques pour son bien-être et sa santé mentale. Résultats: Les résultats quantitatifs montrent une augmentation du score dans les questionnaires sur le bien-être psychologique, l'estime de soi et l'efficacité personnelle, étayées par l'analyse qualitative favorable des réponses du patient. Conclusion: L'intervention réalisée s'est révélée efficace pour améliorer les variables psychologiques mesurées, dans la perception de l'athlète de sa performance sportive, et dans les perceptions de leurs parents et de leur entraîneur. Des interventions de ce type sont jugées nécessaires pour prévenir les risques pour la santé mentale, en particulier dans les sports aussi exigeants tels que la gymnastique rythmique.

Motivos de práctica deportiva, bienestar psicológico e inmigración en practicantes de Street Workout / Motives for sports practice, psychological well-being and immigration in Street Workout practitioners / Motivos da prática esportiva, bem-estar psicológico e imigração em praticantes de Street Workout

El objetivo de la investigación es desarrollar un perfil psicosocial de los practicantes de SW y contribuir al conocimiento de esta actividad. Utilizamos un diseño de tipo transversal descriptivo-correlacional, que contó con 216 participantes de entre 18 y 36 años. El 92.6% de la muestra se conformó por hombres y un 21.3% por inmigrantes. Evaluamos los motivos de práctica, bienestar psicológico, las diferencias en función de la situación migratoria y de la práctica de deportes adicionales. Obtuvimos datos sociodemográficos (sexo, edad, situación sociolaboral y país de origen) y relacionados con la actividad (antigüedad en la práctica, tiempo de entrenamiento y modo de aproximación). Los resultados mostraron que el SW se practica principalmente por jóvenes (X= 18.01), estudiantes (77.8%). Los principales modos de aproximación son los conocidos y las redes sociales. El 57.4% practica exclusivamente SW. Adicionalmente, los motivos de práctica más relevantes fueron el disfrute, la competencia y el fitness; también, los participantes obtuvieron puntuaciones altas en el bienestar psicológico. Estos datos nos hacen pensar en el SW como una herramienta útil para la promoción de la actividad física y valores de integración, especialmente destacable por su bajo coste económico y accesibilidad a la población

The objective of this research is to develop a psychosocial profile of the SW practitioners and contribute to the knowledge of this activity. A descriptive-correlational single-measure design was used, which included 216 participants aged 18-36 years old. 92.6% of the sample was formed by men and 21.3% by immigrants. We evaluate practice motivation, psychological well-being, and differences depending on the migratory situation and the practice of additional sports. We obtained sociodemographic data (sex, age, socio-labor situation and country of origin) and data related to the activity (seniority in practice, training time and approach mode). The results showed that SW is practiced mainly by the young male (X= 18.01), students (77.8%). The main modes of approach by acquaintances and social networks. The 57.4% of the participants practice SW exclusively. The most relevant reasons for practice were enjoyment, competence and fitness; also, the participants obtained high scores in psychological well-being. These data make us think of the SW as a useful tool for the promotion of physical activity and values of integration, especially remarkable for its low economic cost and accessibility to the population

O objetivo da investigação é desenvolver um perfil psicossocial dos participantes de SW e contribuir ao conhecimento da atividade. Usamos um desenho de tipo transversal descritivo - correlacionado, que contava com 216 participantes entre 18 y 36 años de idade. 92.6% da mostra foi composta por homens e um 21.3% por imigrantes. Avaliamos os motivos da prática, bem-estar psicológico, as diferenças dependendo da situação migratória e a prática de esportes adicionais. Obtivemos dados sócios-demográficos (sexo, idade, situação sócio-trabalhista e o país de origem) e relacionado com a atividade (antiguidade na prática, o tempo de treinamento e modo de aproximação). Os resultados mostraram que o SW é praticado principalmente por jovens (x = 18.01), estudantes (77.8%). As principais maneiras de abordagem são os conhecidos e as redes sociais. 57.4% práticas exclusivamente SW., Os motivos da prática mais importantes foram o prazer, a competição e o fitness; da mesma forma, os participantes obtiveram altas pontuações no bem-estar psicológico. Esses dados nos fazem pensar sobre o SW como uma ferramenta útil para a promoção da atividade física e valores de integração, especialmente notável por seu baixo custo econômico e acessibilidade à população

Spectrum of BRCA1/2 variants in 940 patients from Argentina including novel, deleterious and recurrent germline mutations: impact on healthcare and clinical practice.

BRCA1/2 mutations in Latin America are scarcely documented and in serious need of knowledge about the spectrum of BRCA pathogenic variants, information which may alter clinical practice and subsequently improve patient outcome. In addition, the search for data on testing policies in different regions constitutes a fundamental strength for the present study, which analyzes BRCA1/2 gene sequences and large rearrangements in 940 probands with familial and/or personal history of breast/ovary cancer (BOC). In non-mutated DNA samples, Multiplex Ligation-dependent Probe Amplification assays (MLPA) were used for the analysis of large rearrangements. Our studies detected 179 deleterious mutations out of 940 (19.04%) probands, including 5 large rearrangements and 22 novel mutations. The recurrent mutations accounted for 15.08% of the total and only 2.87% of the probands analyzed, very different from a Hispanic panel previously described. IN CONCLUSION: a) this first comprehensive description of the spectrum in BRCA1/2 sheds light on the low frequency of recurrent mutations; b) this information is key in clinical practice to select adequate sequencing studies in our population, subsequently improve patient outcome and prevent damage associated to false normal reports resulting from the use of invalid population panels; c) panels of mutations from other populations should be cautiously validated before imported, even those of apparently similar origin, a concept to be considered beyond significance in Argentina.

Programa de intervención basada en el coaching en jóvenes deportistas de alto rendimiento, y su relación con la percepción de bienestar y salud psicológica / Programa intervenção baseada no coaching no desempenho atletas jovens, e sua relação com a percepção de bem-estar ea saúde psicológica / Intervention program based on coaching in young high performance athletes and their relationship with the perception of well-being and psychological health

El objetivo de este trabajo es el de estudiar el efecto de un programa de coaching sobre la percepción de la salud general y emocional (medido con el GHQ-12; Sánchez-López y Dresch, 2008) y el bienestar psicológico (medido con el EBP; Díaz et al., 2006) en un grupo de jóvenes atletas de alto rendimiento. Los resultados indican que el grupo experimental (n = 38), tras la realización del programa de coaching (con un promedio de 4 a 6 sesiones y 45 a 60 minutos por sesión), mejora su percepción de bienestar y salud psicológica. Estos cambios no se observan en el grupo control (n = 41). Se concluye que cuando una intervención en coaching aporta mejoras en la vida de la persona es posible que se favorezca su percepción de bienestar y salud psicológica (AU)

The aim of this work is to study the effect of a coaching program on the perception of general and emotional health (measured by the GHQ-12; Sánchez-López and Dresch, 2008) and the psychological well-being (measured using the EBP; Diaz et al, 2006) in a group of young elite athletes. The results indicate that the experimental group (n = 38), after completion of the coaching program (with an average of 4-6 sessions, and 45-60 minutes per session), improved their perception of well-being and psychological health. These changes are not observed in the control group (n = 41). We conclude that when a coaching intervention makes improvements in the life of the person is possible that the psychological well-being and the perception of his/her health are also enhanced (AU)

O objetivo deste trabalho é estudar o efeito de um programa de treinamento sobre a percepção da saúde geral e emocional (medida pelo GHQ-12; Sánchez-López e Dresch, 2008) e bem-estar psicológico (medido com EBP; Diaz et al, 2006) em um grupo de atletas jovens de alto desempenho .. Os resultados indicam que o grupo experimental (n = 38) após a conclusão do programa de treinamento (com uma média de quatro a seis sessões e 45 a 60 minutos por sessão), melhora a percepção de bem-estar e saúde psicológica. Estas mudanças não são observados no grupo de controlo (n = 41). Conclui-se que, quando uma intervenção de coaching traz melhorias na vida da pessoa é possível que a sua percepção de bem-estar e saúde psicológica é favorecido (AU)

Novel approaches to target HER2-positive breast cancer: trastuzumab emtansine.

The human epidermal growth factor receptor 2 (HER2) is overexpressed in 20% of breast carcinomas. Prior to the development of targeted therapies, HER2-positive breast cancer was associated with more aggressive disease and poor prognosis. Trastuzumab emtansine (T-DM1) is an antibody-drug conjugate that results from the combination of trastuzumab and DM1, a derivative of the antimicrotubule agent maytansine. This molecule has the ability to enhance cytotoxic drug delivery to specifically targeted cells that overexpress HER2, therefore, maximizing efficacy while sparing toxicity. In recent years, T-DM1 has shown to improve outcomes in metastatic HER2-positive breast cancer that is resistant to trastuzumab. In addition, T-DM1 is currently being tested in the neoadjuvant and adjuvant settings to identify patients who may benefit from this therapy. This review focuses on the mechanism of action, early and late-phase clinical trials, and ongoing studies of T-DM1 in HER2-positive breast cancer.

Trastuzumab subcutaneo en el tratamiento del cancer de mama HER2 positivo / Subcutaneous trastuzumab in breastcancer treatment of her2 positive

La sobreexpresión o amplificación del receptor HER2 seobserva en el 20% de pacientes con cáncer de mama y seasocia con un pronóstico adverso. El agente anti HER2más ampliamente utilizado en la clínica es el trastuzumab,anticuerpo monoclonal. El tratamiento adyuvante tieneuna duración de 12 meses y en cáncer de mama metastásicose continúa más allá de la progresión. La mayoría delos pacientes recibirá trastuzumab durante 1 año, muchosrecibirán 2 a 3 años, y algunos han recibido/recibirán más de8 años. Surge así un interés creciente por la vía subcutánea(SC) de administración: menos invasiva, menos costosay más cómoda. El estudio HannaH, ensayo de fase III,abierto y aleatorizado, utilizó una dosis fija subcutánea de600 mg de trastuzumab en combinación con quimioterapianeoadyuvante y la comparó con la vía de administraciónendovenosa (EV) aprobada. Se incluyeron pacientes concáncer de mama HER2 (+) operable, localmente avanzado einflamatorio. Los objetivos primarios fueron: concentraciónsérica mínima predosis del ciclo 8 y respuesta patológicacompleta. Se aleatorizaron 299 pacientes a trastuzumab EVy 297 a trastuzumab SC. La concentración sérica mínimamedia fue 57.8 μ/ml en el grupo EV y 78.7 en el grupo SC.El 40.7% de los pacientes en el grupo EV y el 45.4% en elgrupo SC logró respuesta patológica completa. TrastuzumabSC resultó no inferior para ambos objetivos primarios.La incidencia de eventos adversos grados 3 a 5 fue similar enambos grupos. La demostración de no-inferioridad sugiereque el trastuzumab SC ofrece una válida y más convenientealternativa al trastuzumab EV.

Overexpression or amplification of HER2 is found in 20%of patients with breast cancer and is associated with anunfavourable prognosis. Trastuzumab is the anti HER2agent most widely used in clinical practice. Adjuvanttreatment should be given during 12 months, and in themetastatic setting treatment should continue beyond progression.Most patients will receive treatment during oneyear, many will be treated during 2 to 3 years, and somepatients will remain in treatment for more than 8 years.In this context, a subcutaneous route of administrationbecomes an attractive option: less invasive, less costly,and more comfortable for patients. The HannaH study is a phase III, open, randomized clinical trial that used a fixedsubcutaneous dose of 600 mg of trastuzumab in combinationwith neoadjuvant chemotherapy and compared it tothe approved intravenous (IV) route of administration.Patients with HER2 (+) operable, locally advanced andinflammatory breast cancer were included in the study.Primary endpoints included: serum trough concentrationpre-dose cycle 8 and pathologic complete response. Twohundred and ninety-nine patients were randomized to IVtrastuzumab and 297 to SC trastuzumab. Mean serumtrough concentration was 57.8 μ/ml in the IV group and78.7 in the SC group. In the IV group 40.7% of patientsachieved pathologic complete response, and 45.4% in the SCgroup. The SC formulation resulted non-inferior for bothprimary objectives. Incidence of grade 3-5 adverse eventswas similar in both groups. The non-inferior results suggestthat SC trastuzumab is a valid and more convenientalternative to IV trastuzumab.

Role of Anti-HER-2 Therapies in the Neo-Adjuvant Setting: Is Complete Pathological Response a Solid Surrogate?

Breast cancer continues to be a major health problem. Both patients and clinicians demand faster access to drugs that could result in better outcomes. In part motivated by this necessity, there has been a change in the dominant paradigm regarding how drugs become approved. Complete pathological response (pCR), understood as the absence of remanent and viable tumor after a neoadjuvant treatment, is now considered by a large proportion of the medical community as a valid surrogate. The presumption is that patients achieving pCR are less likely to develop tumor recurrence. Consequently, if a drug can improve the number of patients achieving pCR it could then obtain approval by the regulatory agencies. Pertuzumab, an anti-HER- 2 monoclonal antibody, was granted accelerated approval based on this principle. The unprecedented approval of this drug is now an example that can help us to understand the advantages but also the potential risks associated with this new approach. In this review, we will discuss the results of the two clinical trials leading to the FDA-approval of pertuzumab in the neo-adjuvant setting. We will also analyze the outcomes from long term follow up of two important neoadjuvant clinical trials, the NeoALTTO and the NOAH studies. These last ones had provided further insights regarding the magnitude, the quality as well as some limitations of the relationship between pCR and harder endpoints such as event-free or overall survival. It seems evident that the acknowledgement of pCR as a potential surrogate endpoint represents an important step in the right direction. However, it still remains controversial whether this is applicable to all subtypes of breast cancers. Additional investigations may be necessary to safely generalize this concept.

Anti-Hormonal Therapies for Premenopausal Patients--What did we Learn from the TEXT/SOFT Trials?

Between 20-25% of all breast cancers are diagnosed in patients younger than 50 years of age, most of whom are still premenopausal. Currently, tamoxifen is considered the standard of care for adjuvant treatment in these cases. However, in postmenopausal women, aromatase inhibitors (AIs) are a better choice. Given the superiority of AIs over tamoxifen in postmenopausal women, multiple investigators explored the potential role of AIs in premenopausal patients receiving ovarian suppression. Until very recently, available data derived from the ABCSG-12 clinical trial argued against the combination of AIs and ovarian suppression. This idea, however, may have changed with the release of the combined analysis of two clinical trials: SOFT and TEXT which evaluated the use of ovarian suppression in combination therapy. Clinicians will soon reconsider the possibility of using this strategy for premenopausal patients. Given the availability of this new data this review will analyze the consequences derived from this study, contextualize this new information within the vast available literature of anti-hormonal therapy, and discuss potential arguments in favor of and against the use of this approach.

Therapeutic options for HER-2 positive breast cancer: Perspectives and future directions.

During the last 15 years we have witnessed an unprecedented expansion in the drugs developed to target human epidermal growth factor receptor-2 (HER-2) positive breast cancer. Trastuzumab, pertuzumab, ado-trastuzumab emtansine and lapatinib are currently food and drug administration (FDA)-approved for the treatment of breast cancer patients with HER-2 over-expressed. However, given the amount of information gathered from years of uninterrupted clinical research, it is essential to have periodic updates that succinctly recapitulate what we have learnt over these last years and help us to apply that information in our daily practice. This review will pursue that objective. We will summarize the most relevant and updated information related to the state of the art management of HER-2 positive breast cancer in all the clinical scenarios including the adjuvant, neoadjuvant and metastatic settings. But we will also critically appraise that literature in order to highlight some key clinical concepts that should not be overlooked. Lastly, this review will also point out some of the most promising strategies that are currently being tested and may soon become available.

Advances and new perspectives in the treatment of metastatic colon cancer.

During the last decade we have witnessed an unprecedented outburst of new treatment approaches for the management of metastatic colon cancer. Anti-angiogenic drugs, epidermal growth factor receptor blockers and multi-kinase inhibitors have all resulted in small but consistent improvement in clinical outcomes. However, this progress has paradoxically leaded us into new challenges. In many cases the clinical development was done in parallel and the lack of head-to-head comparison evolved into circumstances where several valid new "standards of care" are available. Even though desirable in essence, the availability of many options as well as different possible combinations frequently leaves the busy clinician in the difficult situation of having to choose between one or the other, sometimes without solid evidence to support each decision. In addition, progress never stops and new agents are continuously tested. For these reason this review will try to summarize all the clinical trials that constitute the theoretical framework that support our daily practice but will also procure the reader with rational answers to common clinical dilemmas by critically appraising the current literature. Lastly, we will provide with a compilation of promising new agents that may soon become our next line of defense against this deadly disease.

Recent treatment advances and novel therapies in pancreas cancer: a review.

PURPOSE: Over the last couple of years, we have witnessed the availability of a wide variety of different therapeutic agents and the identification of effective combinations of existing ones that have transformed the way we approach and treat pancreatic cancer. Proof of this are the recent validations that combinations of conventional chemotherapy drugs, the FOLFIRINOX regimen and gemcitabine plus nab-paclitaxel, significantly improves clinical outcomes in patients with metastatic disease. However, deeper and more sophisticated understanding of the biology of this cancer as well as the ability to develop better and perhaps more precise drugs predict that the landscape may be changing even more. METHODOLOGY AND RESULTS: In this review, we will summarize the most recent treatment advances including FOLFIRINOX, gemcitabine plus nab-paclitaxel and discuss novel approaches such as immune-mediated therapies, drugs that disrupt the tumor-stromal compartment, PARP inhibitors for BRCA pathway-deficient pancreatic cancer and new generations of conventional chemotherapeutics, which are in early phases of clinical development and have shown promising early results. We will also discuss some examples of drugs that failed, despite very good preliminary data, in order to appraise the lessons learned from these negative clinical trials. Lastly, we will comment on ongoing adjuvant and neoadjuvant trials. CONCLUSION: We hope that at least some of these will result in positive trials and add to our armamentarium for treating this challenging malignancy.

Novel targeted agents for the treatment of advanced breast cancer.

The discovery of the molecular processes involved in cancer development has led to the design of an array of targeted agents. These agents, directed to specific proteins in the machinery of cancer cells, interfere with vital cascades involved in cell invasion, metastasis, apoptosis, cell-cycle control and angiogenesis. In breast cancer, the main pathways studied and targeted by drugs are the HER2 pathway, EGFR, VEGF, PI3K/Akt/mammalian target of rapamycin (PI3K-M-Tor), IGF/IGFR, poly(ADP ribose) polymerase 1, HDAC and many others. In this review, we present the most promising studies of these new targeted therapies and novel combination of targeted therapies with cytotoxic agents for the treatment of breast cancer patients.

Tratamiento medico del cancer colorrectal / Medical treatment of colorectal cancer

El cáncer de intestino grueso es, en los EE UU, la segunda causa de mortalidad por câncer en ambos sexos despues del cáncer de pulmón. Se estima que en 1995 los tumores malignos del colon y recto se ubicarón en el tercer lugar como neoplasias má frecuentes siguiendo a los cánceres de pulmón y próstata en el hombre y detrás de los de pulmón y mama en la mujer. Los factores etiológicos del cáncer colorrectal se desconocen aunque se han implicado factores ambientales, genéticos, dietarios y familiares. En cuanto al tratamiento es importante recalcar que estos tumores son curables en un porcentaje significativo de pacientes cuando es detectado a tiempo. La terapia adyuvante con 5-fluorouracilo (5-FU) y levamisole (lev) incrementó la tasa de curación en pacientes con cáncer de colon estadío III o Dukes'C. En pacientes con cáncer de recto, el tratamiento adyuvante combinando quimioterapia y radioterapia incrementó la tasa de curación en pacientes con estadíos II (Dukes'B-2) y III. Cuando el cáncer colorrectal ha metastatizado a distancia (estadío IV o Dukes D) es incurable en la inmensa mayoría de los casos. De hecho la única possibilidad curativa en este grupo de pacientes es, cuando esté indicado, la resección quirúrgica de la/s matástasis. Cuando esto no es posible el tratamiento que se recomienda es 5-FU solo o en combinación con otros fármacos con fines paliativos. A pesar de los avances logrados en los últimos años, todavía la mitad de los pacientes con cáncer colorrectal mueren a causa de progresión de su enfermedad. Mejoras en la prevención primaria y secundaria, nuevas modalidades terapéuticas y mejores agentes quimioterapéuticos será necesarios para mejorar la sobrevida en el grupo de pacientes afectados por esta enfermedad.

Tratamiento medico del cancer colorrectal / Medical treatment of colorectal cancer

El cáncer de intestino grueso es, en los EE UU, la segunda causa de mortalidad por cÔncer en ambos sexos despues del cáncer de pulmón. Se estima que en 1995 los tumores malignos del colon y recto se ubicarón en el tercer lugar como neoplasias má frecuentes siguiendo a los cánceres de pulmón y próstata en el hombre y detrás de los de pulmón y mama en la mujer. Los factores etiológicos del cáncer colorrectal se desconocen aunque se han implicado factores ambientales, genéticos, dietarios y familiares. En cuanto al tratamiento es importante recalcar que estos tumores son curables en un porcentaje significativo de pacientes cuando es detectado a tiempo. La terapia adyuvante con 5-fluorouracilo (5-FU) y levamisole (lev) incrementó la tasa de curación en pacientes con cáncer de colon estadío III o DukesC. En pacientes con cáncer de recto, el tratamiento adyuvante combinando quimioterapia y radioterapia incrementó la tasa de curación en pacientes con estadíos II (DukesB-2) y III. Cuando el cáncer colorrectal ha metastatizado a distancia (estadío IV o Dukes D) es incurable en la inmensa mayoría de los casos. De hecho la única possibilidad curativa en este grupo de pacientes es, cuando esté indicado, la resección quirúrgica de la/s matástasis. Cuando esto no es posible el tratamiento que se recomienda es 5-FU solo o en combinación con otros fármacos con fines paliativos. A pesar de los avances logrados en los últimos años, todavía la mitad de los pacientes con cáncer colorrectal mueren a causa de progresión de su enfermedad. Mejoras en la prevención primaria y secundaria, nuevas modalidades terapéuticas y mejores agentes quimioterapéuticos será necesarios para mejorar la sobrevida en el grupo de pacientes afectados por esta enfermedad. (AU)