Patients' Desire for Psychological Support When Receiving a Cancer Diagnostic.

BACKGROUND: Factors related to the desire of receiving psychological help in cancer patients are not well known. The aim of this study is to assess the prevalence of patients who would ask for psychological assistance in the first weeks following diagnosis, and to identify their psychosocial and disease-related profile. METHOD: This cross-sectional study assessed 229 consecutive cancer outpatients at a visit with their oncologist to be informed about the treatment they will receive. Disease-related and medical characteristics were assessed, and patients were asked about their mood states, levels of self-efficacy, and difficulties coping with the disease. Finally, patients were asked about their desire to receive psychological assistance. RESULTS: Only 20% of patients expressed a desire for psychological help. These patients were lower in age and had previous history of mood disorders and reported higher discouragement and coping difficulties. These variables explained 30.6% of variance. CONCLUSIONS: Although psycho-oncologists can provide helpful interventions, the percentage of patients interested in receiving psychological assistance in this study is low. Although further studies are needed, results from this study suggest methods that could easily be used by oncologists and nurses to identify patients who would like to receive psychological support.

Jumping rope and whole-body vibration program effects on bone values in Olympic artistic swimmers.

INTRODUCTION: Artistic swimming seems not to benefit bone development like other out-of-water physical activities. To increase bone acquisition, artistic swimming should combine water training with weight-bearing impact or strength activities. Artistic swimmers can be a population at risk of developing osteopenia and osteoporosis in later life. The aim of the present study was to evaluate the effects of a training program on bone mineral density (BMD), bone mineral content (BMC) and body composition in an Olympic artistic swimming team. METHODS: Sixteen women aged 17-21 years, who train 30 h/week, at the Olympic Training Centre (Barcelona, Spain), were followed up over two seasons. The 1st season involved regular artistic swimming training without specific training to reduce the risk of osteopenia. The exercise intervention, jumping rope and whole-body vibration, was added in the 2nd season. The protocol included 20 min of training 2 days per week, over a 22-week period. Dual energy x-ray absorptiometry measured the bone variables and body composition. The daily diet, medical history and bone turnover markers were evaluated. RESULTS: The intervention program increased BMD on lumbar spine (2.10%, p = 0.002), total hip (2.07%, p = 0.001), and femoral neck (2.39%, p = 0.02). Lower limb's fat mass decreased (10.17%, p = 0.038). No significant differences were found for any of the measured anthropometric characteristics between both time points in the 1st season. In conclusions, combined jump rope and vibration should be considered to reduce the risk of bone damage in artistic swimmers.

Terapia de rehabilitación cognitiva para trastornos depresivos: estudio piloto sobre la mejora y mantenimiento del funcionamiento cognitivo y psicosocial / Cognitive remediation therapy for depressive disorders: Pilot study on the improvement and maintenance of cognitive and psychosocial functioning

Los trastornos depresivos son una de las principales causas de discapacidad global y la presencia de déficits cognitivos se relacionan con un peor pronóstico. Dado que la rehabilitación cognitiva en este trastorno está poco estudiada, y menos sus efectos a largo plazo, nuestro objetivo fue investigar sus beneficios en la mejora cognitiva y funcional de estos pacientes. Veintidós participantes fueron asignados aleatoriamente a: a) terapia cognitivo conductual grupal; y b) terapia cognitivo conductual grupal+terapia de rehabilitación cognitiva. Se realizó una evaluación al inicio del tratamiento, a los 3 y 6 meses de la finalización del mismo. Los participantes asignados al grupo con terapia de rehabilitación cognitiva mejoraron más su funcionamiento ejecutivo y estos efectos se mantenían en el tiempo. Sin embargo, no se encontraron diferencias entre ambos grupos en funcionamiento psicosocial. Estos resultados apoyan la importancia de seguir investigando la utilidad de la rehabilitación cognitiva en la recuperación de pacientes con trastornos depresivos

Depressive disorders are one of the main causes of global burden disease and cognitive impairment is associated with worse prognosis. Cognitive Remediation Therapy (CRT) and its long-term effects are understudied; our aim is to investigate the benefits of CRT in the cognitive and functional improvement and maintenance of theses patients. Twenty-two participants were randomly assigned to: a) Group Cognitive Behavioral Therapy (CBT-G) and b) CBT-G plus CRT. Patients were evaluated before treatment, at 3 and 6 months after the end of the treatment. Participants assigned to the TRC group improved more in executive function and its effects remain over time. However, no differences were found between groups in psychosocial functioning improving. These results support the relevance of continue investigating the usefulness of CRT in depression patients recovery

Bone mineral density and bone mineral content among female elite athletes.

INTRODUCTION: Exercise is a protective factor for the appearance of osteoporosis, but not all physical activities have the same effect on bones. Low-impact sports, like swimming, may a have a negative or no effect. The aim of the present study is to evaluate bone mineral density (BMD, g/cm2) and bone mineral content (BMC, kg) among female high performance athletes from aquatic and non-aquatic sports and to assess possible differences with sedentary controls. METHODS: Participants are elite female athletes over 18 years, from the Spanish Olympic teams, with at least 12-15 h of weekly training on aquatic sports: swimming (n = 19), synchronized swimming (n = 24) and water polo (n = 14), and elite female athletes from non-aquatic sports: professional football players of Futbol Club Barcelona team (n = 92), Spanish national volleyball (n = 26) and field hockey teams (n = 29) as well as sedentary controls (n = 126). Bone mineral density scans was performed using dual-energy X-ray absorptiometry for whole body, segmental analysis, proximal femur and lumbar spine. RESULTS: Non-aquatic female athletes have total and segments BMC and BMD values higher than those of aquatic athletes, that in turn show similar BMD values compared to controls. BMD in lumbar spine and proximal femur was higher in non-aquatic sports compared to aquatic sports athletes and both were higher than controls. CONCLUSION: BMD is not negatively compromised by the practice of aquatic sports at a highly competitive level. However, non-aquatic female athletes show a higher BMD. Time training out of the water improves BMD. Our findings suggest that swimming and synchronized swimming should be combined with weight-bearing, impact or strength activities, as they do not seem to be osteogenic sports.

Lidocaine-prilocaine cream as analgesia for hysterosalpingography: a randomized, double blinded, controlled study.

OBJECTIVE: The efficacy of lidocaine-prilocaine cream (EMLA(®)) analgesia in the practice of hysterosalpingography is controversial. This study provides new drill results and a new method of application in terms of mode, time and place. The aim of the paper is to investigate the efficacy of 5% lidocaine 25 mg-prilocaine 25 mg/g cream applied to the uterine cervix for reducing pain during hysterosalpingography. STUDY DESIGN: A randomized, double blinded, controlled study set in the general gynaecology clinic of a university teaching hospital between September 2012 and June 2013. One hundred successive patients programmed to undergo hysterosalpingography were randomized to either 3 ml of EMLA (50) cream or 3 ml of placebo (50), placed endocervically and exocervically, 10 min before hysterosalpingography. Patients' intensity of pain was assessed in four steps: at baseline (speculum application), after application of Pozzi tenaculum and cannula on the uterine cervix, during cervical traction and after contrast medium injection, using a 10-cm Visual Analogue Scale (VAS) immediately after the procedure. The most painful step was also identified. VAS was administered again at one-month follow-up visit. TRIAL REGISTRATION: NCT01303614. RESULTS: The contrast medium injection was the most painful step of hysterosalpingography in both groups (EMLA 3.96, placebo 4.54, 95%CI: -0.481 to 1.641). No differences were found between the two groups (P=0.281) during this step. When comparing the VAS scale after the application of Pozzi tenaculum and cannula (EMLA 1.06, placebo 3.34, 95%CI: 1.495-3.065) and after cervical traction (EMLA 2.54, placebo 3.46, 95%CI: 0.034-1.806), significantly less pain was experienced by the EMLA group than the placebo group: P=0.000 and P=0.042, respectively. CONCLUSION: Endocervical and exocervical topical application of EMLA 10 min before performing hysterosalpingography significantly reduced pain during cervical manipulation with tenaculum and cannula and during cervical traction, but did not reduce pain during injection of contrast that was the most painful step.

Mindfulness para la reducción del malestar emocional en pacientes oncológicos. Estudio comparativo con una intervención psicoeducativa estándar / No disponible

Objetivo: Comparar la efectividad de una intervención de Mindfulness (MBSR) versus una intervención psicoeducativa estándar en pacientes oncológicos. Método: La intervención MBSR (grupo experimental) consistió en 10 sesiones semanales de 2,5 horas cada una de ellas y el paciente debía practicar Mindfulness diariamente y durante 45 minutos en su casa y la intervención psicoeducativa (grupo control) consistió en 8 sesiones semanales de 2,5 horas. Participaron 20 y 17 personas, respectivamente. Se recogieron datos basales y se administraron (pretest-postest) los siguientes cuestionarios a los participantes de ambos grupos: STAI (ansiedad-estado y ansiedad-rasgo), BDI (depresión) y EORT-QLQ C-30 (calidad de vida). Resultados: En el grupo experimental resultaron diferencias estadísticamente significativas indicativas de mejoría en todas las medidas (depresión, ansiedad-estado, ansiedad-rasgo y calidad de vida) mientras que en el grupo de control sólo aparecieron en la variable ansiedad-estado. Conclusiones: Los datos de esta investigación indican que el MBSR produce una mejoría importante en el malestar emocional y en la calidad de vida, superior a la que puede lograrse con una intervención psicoeducativa. No obstante, no puede afirmarse que el MBSR deba ser la técnica de elección para todos los casos, pues no está claro que pueda ser seguida por cualquier tipo de paciente, al requerir una alta implicación por parte del mismo (AU)

Purpose: To compare the effectiveness of a Mindfulness-Based Stress Reduction (MBSR) intervention versus a psychoeducational standard intervention in oncological patients. Method: MBSR intervention was applied following a 2’5 h-session schedule, across 10 weekly sessions. Patients (n= 20) had to practice mindfulness daily at home during 45 minutes. In the psychoeducational group (n=17) a schedule of 8 weeekly sessions of 2’5 h each was applied. Following a pre-post design, the following questionnaires were applied to both groups of patients: STAI (to assess both state and trait anxiety), BDI (Depression) and EORTC-QLQ-C-30 (quality of life). Results: In the MBSR group, scores in anxiety and depression decreased at post-treatment assessment whereas quality of life scores increased. These differences reached statistical significance. In the psychoeducational group only state anxiety scores decreased at post-treatment, with the difference reaching statistical significance. Conclusions: MBSR produces higher improvements in emotional states and quality of life than those obtained following a psychoeducational standard procedure. However, itcannot be stated that MBSR must be always the intervention to be applied in all cases, since it is not clear that all patients could follow theguidelines, tasks and exercices required by this technique (AU)

Lidocaine-prilocaine (EMLA(®) ) cream as analgesia in hysteroscopy practice: a prospective, randomized, non-blinded, controlled study.

We investigated the efficacy of 5% lidocaine 25 mg-prilocaine 25 mg/g cream (EMLA(®) ) applied to the uterine cervix for reducing pain during diagnostic or operative hysteroscopy, using a visual analogue scale (VAS) for pain in a prospective randomized, non-blinded, controlled study in 92 successive patients. Patients were randomized to either 3 mL of EMLA cream or 3 mL of ultrasound gel (placebo), placed endocervically and exocervically, 10 min before hysteroscopy. Intensity of pain was evaluated immediately after the procedure using a 10-cm VAS. No differences were found between the two groups (p = 0.07). The number of women who wished to stop the procedure was significantly lower in the EMLA group compared with the control group (p = 0.013). We concluded that topical instillation of EMLA does not decrease pain during hysteroscopy, but does reduce a desire to abandon the procedure.

Factores predictores de solicitud de ayuda psicológica en los meses inmediatos al diagnóstico oncológico / No disponible

Objetivo: Determinar la prevalencia de pacientes que, tras conocer el diagnóstico oncológico y el tratamiento prescrito, desearían recibir atención psicooncológica, e identificar las características sociodemográficas, biomédicas y psicológicas de los mismos, con la finalidad de establecer un posible perfil del demandante. Método: Se evaluaron 236 pacientes oncológicos atendidos en el Consorci Sanitari de Terrassa, mediante un cuestionario que recogía información sociodemográfica, datos clínicos y aspectos psicológicos (estado de ánimo, dificultad para afrontar e historia previa de ansiedad o depresión) asociados a las necesidades percibidas tras el diagnóstico, y que administraba el propio oncólogo en los meses inmediatos a la comunicación de la enfermedad. Resultados: Un 24% de los pacientes formularon deseo de atención psicooncológica. Se observó que los pacientes más jóvenes, que presentaban alguna alteración emocional, o que no se encontraban preparados para abordar sin mucho esfuerzo la situación, eran los que expresaban mayor interés junto con los pacientes sin antecedentes de diagnóstico y/o tratamiento psiquiátrico y/o psicofarmacológico. No se encontraron diferencias estadísticamente significativas respecto al género, nivel educativo, pronóstico, el hecho de vivir sólo, tipo de tumor, tiempo transcurrido desde el diagnóstico o grado de diseminación del tumor. Conclusiones: Se confirma que los pacientes que presentan malestar emocional, pero sin antecedentes de trastorno psicológico, son los que principalmente desean ayuda psicológica así como que las variables clínicas y sociodemográficas no tienen una clara relación con este deseo. Se advierte la necesidad de definir con más precisión qué se entiende por "ayuda psicológica" para que el paciente pueda valorar mejor si lo que se le ofrece puede serle útil para responder a sus necesidades (AU)

Purpose: To state the rate of patients who would ask for psychological assistance, once they have known their diagnosis and treatment assigned. To find the profile of these patients considering their demographic, clinical and psychosocial features. Method: A sample of 236 patients assisted at Consorci Sanitari de Terrassa (CST) was assessed using a questionnaire which asked for demographic and social features, as well as for some psychological variables (mood states, coping problems, previous anxiety or depression disorders) during the months which followed the diagnosis. Results: 24% of patients were interested in receiving psychological assistance. These patients were younger, expressed mood alterations and coping difficulties, and did not have previous anxiety or depression disorders. There were no differences between patients who asked for psychological assistance and those who do not, in gender, educational level, social relationships, diagnostic, or prognosis. Months from the knowledge of diagnosis were also unrelated with desire of receiving psychological assistance. Conclusions: A definition of what does mean "psychological assistance" is needed in order to understand why only 22% of patients ask for this resource. Sociodemographic and clinical variables were unrelated with desire of receiving psychological assistance. Younger patients with psychological distress and without previous history of emotional disturbance are more prone to ask for psychological assistance (AU)

Adapted ice cream as a nutritional supplement in cancer patients: impact on quality of life and nutritional status.

AIMS: The aim of this study was to assess the impact of adapted ice cream as a dietary supplement on the quality of life (QLQ) of malnourished patients with cancer. MATERIAL AND METHODS: We present an exploratory prospective observational study comparing two patterns of nutrition in cancer patients admitted during the study period who presented malnutrition disorders: adapted ice cream (Group I: 39 patients) and nutritional supplements (Group II: 31 patients). Patients were selected from two different hospitals from the same Oncologic Institute. QLQ was evaluated with the Hospital Anxiety and Depression Scale (HADS) and QLQ of the European Organization for Research and Treatment of Cancer (EORTC QLQ C30). Nutrition was determined by the PG-SGA test. RESULTS: HADS showed significant differences in anxiety (p = 0.023) and depression (p = 0.011) at the end of the study only in Group I. QLQ-C30 revealed statistically significant differences in baseline measures of global dimension between the two groups (Group I: 40.64-56.36 CI; Group II: 25.70-43.11 CI; p = 0.017). Differences were also present in the social dimension (Group I: 77.42-93.51 CI; Group II: 55.85-82.85 CI; p = 0.039). Statistically significant differences were observed between the two groups at the end of the study in the global scale: Group I had 49.36-63.88 CI and Group II had 33.05-51.88 CI (p = 0.016), and in the fatigue scale: Group I had 36.19-53.83 CI and Group II had mean = 65.87, 52.50-79.23 CI (p = 0.007). CONCLUSIONS: The administration of ice cream could cover, in part, the social aspect of food and improve QLQ in malnourished cancer patients. These results are encouraging and deserve further confirmation.

Prospective randomized clinical trial assessing the efficacy of a short course of intravenously administered amoxicillin plus clavulanic acid followed by oral antibiotic in patients with uncomplicated acute diverticulitis.

INTRODUCTION: Medical treatment of uncomplicated acute diverticulitis is not standardized, and there is an enormous diversity in clinical practice. Our aim was to demonstrate that uncomplicated diverticulitis can be managed with orally administered amoxicillin plus clavulanic acid and a short hospital admission. METHODS: A prospective randomized trial was established to compare patients with uncomplicated diverticulitis who received oral antibiotic after a short course of intravenous antibiotic with those who received intravenous antibiotic for a longer period. The antibiotic treatment consisted of amoxicillin plus clavulanic acid 1 g every 8 h. We included 50 patients, 25 in each group. Patients in group 1 began oral antibiotic as soon as they improved and were discharged the day after. Patients in group 2 received intravenous antibiotic for 7 days. Both groups received oral antibiotic at discharge. The endpoint of the study was "failure of treatment," which was defined as the impossibility of discharging on the expected day, emergency admission, or hospital readmission. RESULTS: Both groups were comparable in patient demographics and clinical characteristics. Most patients clearly improved between 24 and 48 h after admission. There were no significant differences between the groups when comparing failure of treatment. Treatment of patients in group 1 represented a savings in hospitalization costs of 1,244 per patient. CONCLUSIONS: Most patients with uncomplicated diverticulitis can be managed safely with oral antibiotic; thus, a very short hospital stay is a safe option.