Theory of health promotion for sexual and gender minority populations with cancer.

BACKGROUND: Structural factors (e.g., cisheteronormativity) promote minority stressors, which generate healthcare disparities among sexual and gender minority (SGM) populations (also known as lesbian, gay, bisexual, transgender, queer, intersexual, asexual, and other sexual and gender-expansive persons--LGBTQIA+) with cancer. The individual's biological, behavioral, social, and psychological response to minority stressors will vary throughout their life course. However, there is a lack of empirical and theoretical guidance for conceptualizing health outcomes among SGM subgroups. PURPOSE: To propose a nursing theory for the health promotion of SGM populations with cancer. METHODS: Walker and Avant's strategies for theoretical derivation were followed. RESULTS: I present the definition, theoretical assumptions, concepts, propositions, and implications for practice, education, research, and policy of the derived theory. DISCUSSION AND CONCLUSION: The theory provides a nursing framework to understand and address the multilevel impact of minority stress on the health of SGM individuals throughout their cancer care continuum.

A sum of its parts: A systematic review evaluating biopsychosocial and behavioral determinants of perinatal depression.

INTRODUCTION: Depression is one of the most common yet underdiagnosed perinatal complications and our understanding of its pathophysiology remains limited. Though perinatal depression is considered to have a multifactorial etiology, integrative approaches to investigation are minimal. This review takes an integrative approach to systematically evaluate determinants (e.g., biological, behavioral, environmental, social) and interactions among determinants of perinatal depression and the quality of methods applied. METHODS: Four databases (i.e., PubMed, CINAHL, APA PsycInfo, Web of Science) were systematically searched to identify studies examining determinants of perinatal depression in adult perinatal persons (≥ 18 years). Articles were excluded if the outcomes were not focused on perinatal persons and depression or depression symptoms, depression was examined in a specific subpopulation evidenced to have psychological consequences due to situational stressors (e.g., fetal/infant loss, neonatal intensive care unit admission), or was considered grey literature. The Critical Appraisal Skills Programme and AXIS tools were used to guide and standardize quality appraisal assessments and determine the level of risk of bias. RESULTS: Of the 454 articles identified, 25 articles were included for final review. A total of 14 categories of determinants were investigated: biological (5), behavioral (4), social and environmental (5). Though only 32% of studies simultaneously considered determinants under more than one domain, a pattern of interactions with the tryptophan pathway emerged. Concerns for risk of bias were noted or were unclear for three types of bias: 13 (52%) selection bias, 3 (12%) recall bias, and 24 (96%) measurement bias. CONCLUSIONS: Future research is needed to explore interactions among determinants and the tryptophan pathway; to strengthen the methods applied to this area of inquiry; and to generate evidence for best practices in reporting, selecting, and applying methods for measuring determinants and perinatal depression.

Abdominal wall muscle weakness outcomes after split abdominal flap repair of large congenital diaphragmatic hernias in newborn.

PURPOSE: Split abdominal wall muscle flap (SAWMF) is a technique to repair large defects in congenital diaphragmatic hernia (CDH). A possible objection to this intervention could be any associated abdominal muscle weakness. Our aim is to analyze the evolution of this abdominal muscle wall weakness. METHODS: Retrospective review of CDH repair by SAWMF (internal oblique muscle and transverse) from 2004 to 2023 focusing on the evolution of muscle wall weakness. RESULTS: Eighteen neonates of 148 CDH patients (12,1%) were repaired using SAWMF. Mean gestational age and birth weight were 35.7 ± 3.5 weeks and 2587 ± 816 g. Mean lung-to-head ratio was 1.49 ± 0.28 and 78% liver-up. Seven patients (38%) were prenatally treated by tracheal occlusion. Ninety-four percent of the flaps were used for primary repair and one to repair a recurrence. One patient (5.6%) experienced recurrence. Abdominal muscle wall weakness was present in the form of a bulge. Resolution of weakness at 1, 2 and 3 years was 67%, 89% and 94%, respectively. No patient required treatment for weakness or died. CONCLUSIONS: Abdominal muscular weakness after a split abdominal wall muscle flap repair is not a limitation for its realization since it is asymptomatic and presents a prompt spontaneous resolution. LEVEL OF EVIDENCE: IV.

The psychosocial health of sexual and gender minority people with anal and colorectal cancer: a mixed methods study.

PURPOSE: Sexual and gender minority (SGM) cancer survivors have poorer psychosocial health than their heterosexual cisgender counterparts. Nevertheless, most research has focused on breast and prostate survivors. It is unknown how different gastrointestinal (GI) cancers affect the psychosocial well-being of SGM individuals. We (1) described the psychosocial health of SGM people with GI cancers and (2) identified differences in psychosocial health outcomes by cancer type. METHODS: We conducted a concurrent mixed-methods secondary analysis with identical samples (n = 295) using data from "OUT: The National Cancer Survey." Likert-type and open-ended questions about demographics, satisfaction with care, social support, and access to mental health resources were included in the analysis. Poor mental health was the primary outcome. Quantitative (linear regression) and qualitative (thematic analysis) data were independently analyzed, then integrated through the narrative, weaving approach. RESULTS: Three concepts emerged after data integration, (1) positive and negative influences on the psychological well-being of the participants; (2) social adaptations with the participants' friends, partners, and family members; and (3) additional factors affecting the psychosocial well-being during and after cancer, particularly interactions with providers, comorbidities, and treatment side effects. CONCLUSION: Clinical characteristics, demographic factors, and culturally responsive care influenced the psychosocial health of SGM survivors of GI cancers. IMPLICATIONS FOR CANCER SURVIVORS: Participants developed their own coping strategies and advocated for the SGM community. Interventions promoting peer support and self-esteem are a priority for this population. Healthcare professional training should incorporate historical trauma awareness and assess the delivery of culturally responsive care.

Evidence of compensatory neural hyperactivity in a subgroup of chemotherapy-treated breast cancer survivors and its association with brain aging.

Chemotherapy-related cognitive impairment (CRCI) remains poorly understood in terms of the mechanisms of cognitive decline. Neural hyperactivity has been reported on average in cancer survivors, but it is unclear which patients demonstrate this neurophenotype, limiting precision medicine in this population. We evaluated a retrospective sample of 80 breast cancer survivors and 80 non-cancer controls, age 35-73, for which we had previously identified and validated three data-driven, biological subgroups (biotypes) of CRCI. We measured neural activity using the z-normalized percent amplitude of fluctuation from resting state functional magnetic resonance imaging (MRI). We tested established, quantitative criteria to determine if hyperactivity can accurately be considered compensatory. We also calculated brain age gap by applying a previously validated algorithm to anatomic MRI. We found that neural activity differed across the three CRCI biotypes and controls (F = 13.5, p < 0.001), with Biotype 2 demonstrating significant hyperactivity compared to the other groups (p < 0.004, corrected), primarily in prefrontal regions. Alternatively, Biotypes 1 and 3 demonstrated significant hypoactivity (p < 0.02, corrected). Hyperactivity in Biotype 2 met several of the criteria to be considered compensatory. However, we also found a positive relationship between neural activity and brain age gap in these patients (r = 0.45, p = 0.042). Our results indicated that neural hyperactivity is specific to a subgroup of breast cancer survivors and, while it seems to support preserved cognitive function, it could also increase the risk of accelerated brain aging. These findings could inform future neuromodulatory interventions with respect to the risks and benefits of up or downregulation of neural activity.

An Exploratory Analysis of Contributors to Cognitive Functioning Among Sexual and Gender Minority Individuals Who Had COVID-19.

Sexual and gender minority (SGM) individuals face mental health disparities. However, research analyzing SGM people's mental health after a COVID-19 diagnosis is scarce. In this secondary analysis of a remote study, we 1) examined associations between cognitive and psychosocial health and 2) explored differences between these health outcomes among SGM (n = 14) and heterosexual cisgender (n = 64) U.S. adults who had COVID-19. We used the Patient Reported Outcome Measures Information System (PROMIS) v2.0 to assess subjective cognition and the BrainCheck cognitive test to analyze objective cognition. We administered the Perceived Stress Scale and PROMIS 57 Profile V.2.0 to measure psychosocial health. SGM COVID-19 survivors had worse scores in depression, anxiety, sleep disturbance, pain, stress, and objective cognition than heterosexual cisgender participants (p-values < .05). Objective cognition was associated with age, SGM classification, racial or ethnic minority classification, income, comorbidities, COVID-19 severity, number of symptoms, and pain (|0.137| < r < |0.373|, p-values < .05). Subjective cognition was associated with comorbidities, number of symptoms, depression, anxiety, sleep disturbance, pain, and stress (|0.158| < r < |0.537|, p-values < .05). Additional studies are needed to expand what is known about post-COVID-19 health disparities and to guide policies and interventions that promote cognitive functioning.

A sum of its parts: A systematic review evaluating biopsychosocial and behavioral determinants of perinatal depression.

Introduction: Depression is one of the most common yet underdiagnosed perinatal complications and our understanding of the pathophysiology remains limited. Though perinatal depression is considered to have a multifactorial etiology, integrative approaches to investigation are minimal. This review takes an integrative approach to systematically evaluate determinants and potential interactions among determinants of perinatal depression across four domains (i.e., biological, behavioral, environmental, social) and appraise the quality of methods applied. Methods: Four databases (i.e., PubMed, CINAHL, APA PsycInfo, and Web of Science) were systematically searched to identify studies examining determinants of perinatal depression in adult perinatal persons (≥ 18 years). Articles were excluded if the outcomes were not focused on perinatal persons and depression or depression symptoms, the evaluation of depression was specific to a discrete facet of the perinatal period with probable psychological consequences (e.g., abortion, fetal/infant loss, adoption), or was considered grey literature. The Critical Appraisal Skills Programme and AXIS tools were used to guide and standardize quality appraisal assessments and determine the level of risk of bias. Results: Of the 454 articles identified, 25 articles were included for final review. A total of 14 categories of determinants were investigated: biological (5), behavioral (4), social and environmental (5). Though only 28% of studies simultaneously considered determinants under more than one domain, a pattern of interactions with the tryptophan pathway emerged when determinants across domains were aggregated. Concerns for risk of bias were noted or were unclear for three types of bias: 13 (52%) selection bias, 3 (12%) recall bias, and 24 (96%) measurement bias. Conclusions: Future research is needed to explore interactions among determinants and the tryptophan pathway; to strengthen the methods applied to this area of inquiry; and to generate evidence for best practices in reporting, selecting, and applying methods for measuring determinants and perinatal depression.

Cancer-related cognitive impairment in racial and ethnic minority groups: a scoping review.

PURPOSE: Disparities in cognitive function among racial and ethnic groups have been reported in non-cancer conditions, but cancer-related cognitive impairment (CRCI) in racial and ethnic minority groups is poorly understood. We aimed to synthesize and characterize the available literature about CRCI in racial and ethnic minority populations. METHODS: We conducted a scoping review in the PubMed, PsycInfo, and Cumulative Index to Nursing and Allied Health Literature databases. Articles were included if they were published in English or Spanish, reported cognitive functioning in adults diagnosed with cancer, and characterized the race or ethnicity of the participants. Literature reviews, commentaries, letters to the editor, and gray literature were excluded. RESULTS: Seventy-four articles met the inclusion criteria, but only 33.8% differentiated the CRCI findings by racial or ethnic subgroups. There were associations between cognitive outcomes and the participants' race or ethnicity. Additionally, some studies found that Black and non-white individuals with cancer were more likely to experience CRCI than their white counterparts. Biological, sociocultural, and instrumentation factors were associated with CRCI differences between racial and ethnic groups. CONCLUSIONS: Our findings indicate that racial and ethnic minoritized individuals  may be disparately affected by CRCI. Future research should use standardized guidelines for measuring and reporting the self-identified racial and ethnic composition of the sample; differentiate CRCI findings by racial and ethnic subgroups; consider the influence of structural racism in health outcomes; and develop strategies to promote the participation of members of racial and ethnic minority groups.

Clinical, psychosocial, and sociodemographic factors of sexual and gender minority groups with cancer: A systematic review.

PURPOSE: Psychosocial health varies depending on demographic and clinical factors and the social context in which individuals grow and live. Sexual and gender minority (SGM) populations experience health disparities due to systemic factors that privilege cisgender and heterosexual identities. We reviewed the literature on the psychosocial, sociodemographic, and clinical factors in SGM groups with cancer and described the associations among these factors. METHODS: We conducted a systematic review according to Fink's methodology and the Preferred Reporting Items for Systematic Reviews and Meta-Analysis guidelines in the PubMed, PsycInfo, Cumulative Index of Nursing and Allied Health Literature, and LGBTQ+ Life databases. Quantitative articles published in English or Spanish were included. Grey literature and studies with participants in hospice care were excluded. The quality of the publications was assessed with the Joanna Briggs Institute criticalappraisal tools. RESULTS: The review included 25 publications. In SGM groups, systemic cancer treatment was associated with worse psychosocial outcomes; and older age, employment, and higher income were associated with better psychosocial outcomes. CONCLUSIONS: SGM groups with cancer are different from their heterosexual cisgender peers in sociodemographic, psychosocial, and clinical factors. Clinical and sociodemographic factors are associated with psychosocial outcomes among SGM individuals with cancer.

Cisheteronormativity and its influence on the psychosocial experience of LGBTQ+ people with cancer: A qualitative systematic review.

OBJECTIVE: Cisheteronormativity refers to the relationship of heterosexual and cisgender privilege stemming from patriarchy. Although studies have shown that cisheteronormativity can impact health outcomes for lesbian, gay, bisexual, transgender, queer and other sexual, gender diverse, and gender nonconforming (LGBTQ+) people, the specific impact on cancer care has not been described. We synthesized the qualitative evidence on how cisheteronormativity impacts the psychosocial experience of LGBTQ+ people with cancer. METHODS: We conducted a historic search in the CINAHL, LGBT+ Health, PsycInfo, and PubMed databases. Qualitative studies that described the psychosocial experience of LGBTQ+ people with cancer were included. After appraising the quality of the publications, 11 articles were included. Then, we conducted inductive nominal coding, taxonomic analysis, and thematic synthesis. RESULTS: Two main themes emerged, (1) Cisheteronormativity as a social determinant of health, and (2) Cancer, sexual orientation, and gender: Associations and introjections. The themes comprise four categories and 13 subcategories that describe the impact of cisheteronormativity on the cancer experience of LGBTQ+ people. CONCLUSION: Cisheteronormativity within the healthcare system impacts the psychosocial experience of LGBTQ+ people with cancer. Understanding how these gender biases, norms, and social expectations impact the cancer experience is necessary to transform social norms and promote health equity.

Remote assessment of cognitive dysfunction in hematologic malignancies using web-based neuropsychological testing.

BACKGROUND: Cognitive impairment is a frequent adverse effect of cancer and its therapies. As neuropsychological assessment is not often standard of care for patients with non-CNS disease, efficient, practical assessment tools are required to track cognition across the disease course. We examined cognitive functioning using a web-based cognitive testing battery to determine if it could detect differences between patients with cancer and controls. METHODS: We enrolled 22 patients with multiple myeloma (MM) or non-Hodgkin lymphoma (NHL) and 40 healthy controls (mean age = 56 ± 11 years, 52% male). Participants completed the BrainCheck cognitive testing battery and online versions of select measures from the Patient Reported Outcome Measures Information System (PROMIS) during a video conference. MANOVA was used to compare BrainCheck and PROMIS scores between groups controlling for age and sex. An exploratory linear regression analysis was conducted within the cancer group to determine potential contributors to cognitive functioning. RESULTS: All participants except for one control completed the online assessment measures without difficulty. Compared to controls, the cancer group demonstrated significantly lower scores in objective and subjective cognitive function, physical functioning, and social role performance and elevated fatigue scores. Corticosteroid treatment, immunotherapy, lower physical functioning, lower income, and older age significantly contributed to lower cognitive function (adjusted R2  = 0.925, F = 19.63, p = 0.002). CONCLUSION: Remote assessment of cognitive and psychosocial functioning is feasible with patients with cancer following treatments. The BrainCheck cognitive testing battery has the potential to detect differences in cognition between patients with cancer and controls.

Cuidados paliativos, cuidados de fin de vida y COVID-19: revisión de alcance / Palliative care, end-of-life care, and COVID-19: A scoping review / Cuidados paliativos, cuidados em fim de vida e COVID-19: uma revisão do escopo

Introducción: La COVID-19 exacerbó el déficit en la prestación de cuidados paliativos y de fin de vida y aumentó la sobrecarga de los servicios de salud, pero se desconoce la extensión de la literatura sobre dicho tema. Objetivo: Describir la evidencia sobre la prestación de cuidados paliativos y de fin de vida en adultos durante la pandemia de COVID-19. Materiales y métodos: Revisión de alcance según el marco metodológico de Arksey y O'Malley. La búsqueda se realizó en inglés y español; en PubMed, Scielo, la Biblioteca Virtual en Salud, y la base de datos de investigación en Coronavirus. Las publicaciones se filtraron por título, resumen y lectura completa. Los resultados se sintetizaron de acuerdo con la técnica "charting". Resultados: Se incluyeron 51 publicaciones. En total emergieron cinco categorías: 1) caracterización de los cuidados paliativos, 2) planificación avanzada de cuidados, 3) acompañamiento a familiares y seres queridos, 4) telesalud, 5) rol de enfermería en los cuidados paliativos. Discusión:: El coste social de la pandemia se refleja en el aumento en la carga de unidades de cuidados paliativos, mayor porcentaje de mortalidad y la disminución de la edad promedio de fallecimiento. Futuros estudios deben abordar el impacto psicosocial en los seres queridos de los pacientes, así como el impacto a nivel comunitario. Conclusión: Los cuidados paliativos y de fin de vida constituyen una herramienta fundamental para la atención de pacientes con COVID-19. La pandemia potenció el desarrollo de las tecnologías de la información y las comunicaciones para la prestación de cuidados paliativos.

Introduction:COVID-19 exacerbated the deficit of palliative and end-of-life care provision and increased healthcare services' burden, but the extent of the literature on that topic is unknown. Objetive: To describe the evidence of palliative and end-of-life care provision in adults during the COVID-19 pandemic. Materials and Methods:The scoping review was performed according to Arksey and O'Malley's methodological framework. The search was conducted in English and Spanish, in PubMed, SciELO, the Virtual Health Library, and the Coronavirus research database. The articles were filtered by title, abstract, and full text. The results were summarized according to the charting technique. Results: Fifty-one publications were included. A total of five categories emerged: 1) Palliative care characteristics, 2) advanced care planning, 3) support for family members and loved ones, 4) telehealth, and 5) nursing role in palliative care. Discussion:The social cost of the pandemic is reflected in the increased burden of palliative care units, higher mortality rates, and the decreased average age of death. Future studies should address the psychosocial impact of COVID-19 on patients' loved ones, as well as the impact at the community level. Conclusions: Palliative and end-of-life care is an essential tool for COVID-19 patients care. The pandemic has enhanced the development of information and communication technologies to deliver palliative care.

Introdução: A COVID-19 exacerbou o déficit na prestação de cuidados paliativos e em fim de vida e aumentou a sobrecarga sobre os serviços de saúde, mas a extensão da literatura sobre tal tópico é desconhecida. Objetivo: Descrever as evidências sobre a prestação de cuidados paliativos e de fim de vida em adultos durante a pandemia da COVID-19. Materiais e Métodos: Revisão do escopo de acordo com a estrutura metodológica de Arksey e O'Malley. A pesquisa foi realizada em inglês e espanhol; PubMed, Scielo, a Biblioteca Virtual de Saúde e o banco de dados de pesquisa do Coronavirus. As publicações foram filtradas por título, resumo e texto completo. Os resultados foram sintetizados de acordo com a técnica gráfica. Resultados: 51 publicações foram incluídas. No total, surgiram cinco categorias: 1) caracterização dos cuidados paliativos, 2) planejamento de cuidados avançados, 3) acompanhamento de parentes e entes queridos, 4) telesaúde, 5) papel de enfermagem nos cuidados paliativos. Discussão: O custo social da pandemia se reflete no aumento da carga sobre as unidades de cuidados paliativos, maiores taxas de mortalidade e uma diminuição da idade média de morte. Estudos futuros devem abordar o impacto psicossocial sobre os entes queridos dos pacientes, bem como o impacto a nível comunitário. Conclusões: Os cuidados paliativos e de fim de vida são uma ferramenta fundamental para o cuidado de pacientes com COVID-19. A pandemia tem melhorado o desenvolvimento das tecnologias de informação e comunicação para o fornecimento de cuidados paliativos.

Describing cognitive function and psychosocial outcomes of COVID-19 survivors: A cross-sectional analysis.

BACKGROUND: Neurological and psychological symptoms are increasingly realized in the post-acute phase of COVID-19. PURPOSE: To examine and characterize cognitive and related psychosocial symptoms in adults (21-75 years) who tested positive for or were treated as positive for COVID-19. METHODS: In this cross-sectional study, data collection included a cognitive testing battery (Trails B; Digit Symbol; Stroop; Immediate and Delayed Verbal Learning) and surveys (demographic/clinical history; self-reported cognitive functioning depressive symptoms, fatigue, anxiety, sleep disturbance, social role performance, and stress). Results were compared with published norms, rates of deficits (more than 1 standard deviation (SD) from the norm) were described, and correlations were explored. RESULTS: We enrolled 52 participants (mean age 37.33 years; 78.85% female) who were, on average, 4 months post illness. The majority had a history of mild or moderate COVID-19 severity. Forty percent of participants demonstrated scores that were 1 SD or more below the population norm on one or more of the cognitive tests. A subset had greater anxiety (21.15%), depressive symptoms (23.07%), and sleep disturbance (19.23%) than population norms. Age differences were identified in Stroop, Digit Symbol, and Trails B scores by quartile ( p < .01), with worse performance in those 28-33 years old. CONCLUSIONS: Cognitive dysfunction and psychological symptoms may be present in the weeks or months after COVID-19 diagnosis, even in those with mild to moderate illness severity. IMPLICATIONS FOR PRACTICE: Clinicians need to be aware and educate patients about the potential late/long-term cognitive and psychological effects of COVID-19, even in mild to moderate disease.

Cancer Survivorship Care in Colombia: Review and Implications for Health Policy.

INTRODUCTION: The number of cancer survivors is increasing in Colombia, and health policy changes are necessary to meet their unmet needs and improve their health outcomes. Similar trends have been identified in developed countries, and positive changes have been made. METHODS: We conducted a narrative review to provide an overview of Colombia's social structure, health care system, and health care delivery in relation to cancer, with recommendations for improving cancer survivorship in Colombia based on the model of survivorship care in the United States. RESULTS: We proposed general recommendations for improving cancer survivors' care including (1) recognizing cancer survivorship as a distinct phase of cancer, (2) strengthening methods and metrics for tracking cancer survivorship, (3) assessing and monitoring cancer symptoms and quality of life of cancer survivors, (4) publishing evidence-based guidelines considering the social, economic, and cultural characteristics of Colombian population and cancer survivors' specific needs. CONCLUSION: These recommendations could be used to inform and prioritize health policy development in Colombia related to cancer survivorship outcomes.

Intervenciones de enfermería para el manejo de síntomas en personas con cáncer: una revisión de alcance / Nursing Interventions for Symptom Management in People with Cancer: A Scoping Review / Intervenções de enfermagem para o tratamento de sintomas em pessoas com câncer: revisão de escopo

Objetivo: describir las intervenciones de enfermería para el manejo de los síntomas en adultos con cáncer en tratamiento de intención curativa. Métodos: revisión de alcance; con el uso de descriptores en ciencias de la salud, se adelantó una búsqueda en las bases de datos Cochrane, PubMed y Biblioteca Virtual en Salud (BVS) en idiomas inglés y español en el periodo 2013-2020. Resultados: tras el proceso de búsqueda, análisis y evaluación crítica de la literatura, diecisiete publicaciones (n = 17) conformaron la muestra. Las piezas investigativas del estudio fueron agrupadas en cuatro categorías: intervenciones con el uso de tecnologías de la información y la comunicación, intervenciones personalizadas y adaptadas al individuo, medicina complementaria e intervenciones realizadas en el momento del tratamiento.Conclusión: las intervenciones de enfermería constituyen una importante herramienta para el adecuado manejo de síntomas. Existen varios tipos de intervención y diferentes mecanismos para su ejecución que facilitan el manejo de diversos síntomas, disminuyen la carga general del síntoma y fomentan el automanejo de estos.

Objective: To describe nursing interventions for symptom management in adults with cancer receiving curative treatment. Method: Scoping review. Using Health Sciences Descriptors, a search in the Cochrane, PubMed, and Virtual Health Library (VHL) databases, in English and Spanish, was carried out in the period 2013-2020. Results: After the processes of search, analysis, and critical evaluation of the literature, seventeen publications (n = 17) made up the sample. The study's research pieces were grouped into four categories: interventions that use information and communication technologies, personalized interventions adapted to the individual, complementary medicine, and interventions carried out at the time of treatment. Conclusion: Nursing interventions are an important tool for proper symptom management. There are several types of intervention and different mechanisms for implementing them that facilitate the management of various symptoms, decrease the overall symptom burden and foster symptom self-management.

Objetivo: Descrever intervenções de enfermagem para o manejo de sintomas em adultos com câncer em tratamento de intenção curativa. Métodos: Revisão de escopo. Utilizando descritores em ciências da saúde realizou-se uma busca nas bases de dados Cochrane, PubMed e Biblioteca Virtual em Saúde (BVS), nos idiomas inglês e espanhol, no período 2013-2020. Resultados: Após o processo de busca, análise e avaliação crítica da literatura, dezessete publicações (n = 17) constituíram a amostra. As unidades de pesquisa do estudo foram agrupadas em quatro categorias: intervenções com uso de tecnologias de informação e comunicação, intervenções personalizadas e adaptadas ao indivíduo, medicina complementar e intervenções realizadas no momento do tratamento. Conclusão: As intervenções de enfermagem são uma ferramenta importante para o manejo adequado dos sintomas. Existem vários tipos de intervenção e diferentes mecanismos para sua execução que facilitam o manejo de vários sintomas, diminuem a carga geral do sintoma e promovem sua autogestão

Recomendaciones sobre el tratamiento y monitoreo de personas con cáncer durante la pandemia de COVID-19 / Recomendações sobre o tratamento e monitoramento de pessoas com câncer durante a pandemia da covid-19 / Recommendations on the treatment and monitoring of patients with cancer during the COVID-19 pandemic

Objetivo: presentar la evidencia disponible sobre el tratamiento y monitoreo de personas con cáncer durante la pandemia de COVID-19. Síntesis de contenido: revisión exploratoria de alcance en las bases de datos Academic Search Complete, Biblioteca Virtual en Salud, Elsevier, Google Scholar, PubMed y Science Direct, en idiomas inglés y español, a través de ecuaciones de búsqueda preestablecidas. Los hallazgos se organizaron en siete categorías: relación entre COVID-19 y cáncer; población oncológica en mayor riesgo; cuidado de pacientes oncológicos con COVID-19; continuidad del tratamiento antineoplásico; investigación en cáncer; profesionales de la salud, e impacto de la pandemia en el manejo del cáncer. Se resalta que el contagio del virus SARS-CoV-2 podría aumentar el riesgo de morbilidad y mortalidad en este tipo de pacientes, por lo que ha de priorizar-se el tratamiento de COVID-19 frente al tratamiento antineoplásico. Conclusiones: resulta necesario buscar alternativas para darle continuidad al tratamiento de cáncer del resto de la población oncológica. De otra parte, debe propenderse por el bienestar físico y mental del talento humano en salud y por la mitigación del impacto económico y sanitario de la pandemia.

Objetivo: apresentar as evidências disponíveis sobre o tratamento e monitoramento de pessoas com câncer durante a pandemia do novo coronavírus (covid-19). Síntese de conteúdo: revisão de literatura com busca nas bases de dados Academic Search Complete, Biblioteca Virtual em Saúde, Elsevier, Google Scholar, PubMed e Science Direct, em inglês e espanhol, median-te pesquisas preestabelecidas. Os resultados foram organizados em sete categorias: relação entre covid-19 e câncer; população de câncer de maior risco; atendimento a pacientes com câncer com covid-19; continuidade do tratamento antineoplásico; pesquisa sobre câncer; profissionais de saúde, e impacto da pandemia no tratamento do câncer. Destacase que a disseminação do vírus Sars-CoV-2 pode aumentar o risco de morbimortalidade em pacientes com câncer, portanto o tratamento da covid-19 deve ser priorizado em relação ao tratamento antineoplásico. Conclusões: devemse procurar alternativas para continuar o tratamento do câncer no restante da população oncológica. Por sua vez, deve-se propender para a saúde física e mental do talento humano em saúde e para mitigar o impacto da pandemia na saúde e na economia.

Objective: To present available evidence on the treatment and monitoring of people with cancer during the COVID-19 pandemic. Content synthesis: An exploratory search in English and Spanish was made in the databases Academic Search Complete, Biblioteca Virtual en Salud, Elsevier, Google Scholar, PubMed and Science Direct using preestablished search equations. Results were organized into 7 categories: relationship between COVID-19 and cancer; cancer population at highest risk; care of cancer patients with COVID-19; continuity of cancer treatment; cancer research; health professionals; and impact of the pandemic on cancer management. The contagion of SARS-CoV-2 could lead to an increased risk of morbidity and mortality in cancer patients. Therefore, COVID-19 treatment should be prioritized over the antineoplastic treatment. Conclusions: It is necessary to explore alternatives to continue cancer treatment in the rest of the population with cancer. We must also improve the physical and mental wellbeing of healthcare workers and mitigate the impact of this pandemic on economic and healthcare systems.

Acid-Base Status Disturbances in Patients on Chronic Hemodialysis at High Altitudes.

BACKGROUND: Acid-base disorders have been previously described in patients with chronic hemodialysis, with metabolic acidosis being the most important of them; however, little is known about the potential changes in acid-base status of patients on dialysis living at high altitudes. METHODS: Cross-sectional study including 93 patients receiving chronic hemodialysis on alternate days and living in Bogotá, Colombia, at an elevation of 2,640 meters (8,661 feet) over sea level (m.o.s.l.). Measurements of pH, PaCO2, HCO3, PO2, and base excess were made on blood samples taken from the arteriovenous fistula (AVF) during the pre- and postdialysis periods in the midweek hemodialysis session. Normal values for the altitude of Bogotá were taken into consideration for the interpretation of the arterial blood gases. RESULTS: 43% (n= 40) of patients showed predialysis normal acid-base status. The most common acid-base disorder in predialysis period was metabolic alkalosis with chronic hydrogen ion deficiency in 19,3% (n=18). Only 9,7% (n=9) had predialysis metabolic acidosis. When comparing pre- and postdialysis blood gas analysis, higher postdialysis levels of pH (7,41 versus 7,50, p<0,01), bicarbonate (21,7mmol/L versus 25,4mmol/L, p<0,01), and base excess (-2,8 versus 2,4, p<0,01) were reported, with lower levels of partial pressure of carbon dioxide (34,9 mmHg versus 32,5 mmHg, p<0,01). CONCLUSION: At an elevation of 2,640 m.o.s.l., a large percentage of patients are in normal acid-base status prior to the dialysis session ("predialysis period"). Metabolic alkalosis is more common than metabolic acidosis in the predialysis period when compared to previous studies. Paradoxically, despite postdialysis metabolic alkalosis, PaCO2 levels are lower than those found in the predialysis period.

Reproductive consequences of variation in flowering phenology in the dry forest tree Enterolobium cyclocarpum in Guanacaste, Costa Rica.

PREMISE OF THE STUDY: Flowering initiation, duration and magnitude, and degree of flowering synchrony within a population can affect the reproductive fitness of individuals. We examined the flowering phenology within a population of the tropical dry forest Guanacaste tree (Enterolobium cyclocarpum) to gauge the impact of phenological variation among trees on fruit production and progeny vigor. METHODS: We monitored the flowering phenology of 93 trees weekly during 2005, 2006, and 2007, using a scale based on the percentage of the crown with open flowers. We also monitored fruit production for each tree in 2005, 2006, 2007, and 2008. Finally, we evaluated the relationship between phenological variation and progeny performance. KEY RESULTS: Ten measures of flowering phenology and synchrony among flowering trees, based on the number of weeks when anthesis of the crown exceeded 50%, were used to develop four phenological profiles. These profiles were correlated with significant differences in fruit production and progeny vigor. Trees with flowers in >50% of their crown for at least 2 weeks produced more fruits and more vigorous progeny than trees with other profiles. Trees also tended to produce the same phenological profile among years than predicted by chance. CONCLUSIONS: Guanacaste trees vary significantly in the initiation of anthesis, duration and magnitude of flowering, and degree of synchrony among trees. Trees also tend to maintain the same flowering profile among years. Finally, the flowering behavior of E. cyclocarpum leads to significant differences in fruit and seed production, germination, and early progeny growth.

Isolation and characterization of microsatellite loci from Amur honeysuckle, Lonicera maackii (Caprifoliaceae).

PREMISE OF THE STUDY: Lonicera maackii (Caprifoliaceae) is one of the most problematic invasive shrubs in forests of the eastern United States. Microsatellite markers could serve to test putative source-sink relationships among populations to determine whether invasions progress along expanding fronts or through long-distance dispersal events followed by local expansion. • METHODS AND RESULTS: Eleven microsatellite loci were developed for Amur honeysuckle using a modified magnetic bead protocol. Six loci were screened across 158 individuals from seven populations and were shown to be variable, with the number of alleles per locus ranging from seven to 16. Observed heterozygosity ranged from 0.655 to 0.757. Five additional loci were screened using 68 individuals from three different populations, with seven to 12 alleles per locus and observed heterozygosity ranging from 0.682 and 0.831. • CONCLUSIONS: These microsatellite markers will help to elucidate the genetic structure and patterns of dispersal of L. maackii in its invasive range.