Who will care for the caregiver? Distress and depression among spousal caregivers of older patients undergoing treatment for cancer.

PURPOSE: Although it is accepted that in general spousal caregivers of patients with cancer are under high emotional and physical strain, little is known about the quality of life specifically among spousal caregivers of older cancer patients. The aim of the current study is to explore the emotional toll of spousal caregivers of cancer patients aged 65-85 years. METHODS: This study surveyed 242 spousal caregivers of patients ≥ 65 years old, diagnosed with cancer, treated with curative or palliative intent, and within 6 months of treatment at enrollment. Standardized measures completed by the caregivers included depression measure (Geriatric Depression Scale); distress (Distress Thermometer); and social support (the Cancer Perceived Agents of Social Support). Logistic regression analyses were used in order to identify the predictor of clinical depression and distress. The analyses were adjusted for patient (sociodemographic, functional performance, and medical status) and caregiver (sociodemographic and social support) factors. RESULTS: Among the caregivers, the frequencies of clinical depression and distress were 16.5% and 28% respectively. Increasing patient age and time from diagnosis were associated with reduced levels of caregiver depression. Higher levels of friends and spousal support (support from the patients) were associated with non-clinical levels of depression and distress. CONCLUSION: Increasing patient age and caregiver's perceived spousal support may both have a positive effect on caregivers' levels of depression. This can be utilized by clinicians in the process of empowering older patients and their spousal caregivers to confront the challenges of cancer treatment into advanced old age.

[Complexes of nitric oxide with hemoglobin and paramagnetic metalloenzymes in the brain and blood of mammals after intermittent hypoxia]. / Kompleksy oksida azota s gemoglobinom i paramagnitnye metallofermenty v mozge i krovi mlekopitayushchikh posle kratkovremennoi gipoksii.

AIM: To investigate an effect of hypoxia on the formation of nitric oxide (NO) in the brain and blood of rats and an influence of L-NNA, the NO-synthase inhibitor, and sodium nitrite on NO generation in separate and simultaneous introduction of these compounds in the animal body. MATERIAL AND METHODS: Experiments were conducted on 42 rats of Krushinsky-Molodkina (K-M) line without adaptation to hypoxia and short-term adaptation to hypobaric hypoxia. Animals were intraperitoneally injected with sodium nitrite (0.5 mg/100 g) and the non-specific inhibitor of NO-synthase L-NNA (2.5 mg/100 g) at different times. Changes in NO content were assessed using electron paramagnetic resonance (EPR) by the intensity of nitrosyl Hb-NO complexes in ERP blood spectra. RESULTS AND CONCLUSION: The production of NO in the brain, compared with that in the blood, was significantly reduced, not only under physiological conditions, but also after the administration of moderate doses of NaNO2. In the short-term hypobaric hypoxia, there was the intensification of the processes of the reduction of NO2- to NO and the formation of nitrosyl heme-NO complexes not only in the blood but also in the mammalian brain.

Promoting new approaches for cancer care in the Middle East.

Cancer is now the fastest growing killing disease in the Middle East. Accordingly, there is an urgent need to train local health professionals: oncologists, palliative care experts, oncology nurses, psychologists, along with social workers, physiotherapists and spiritual counselors on strategies for early detection, curative therapies and palliation. Professionals in the region, along with the public, need to convince medical administrators, regulators and policymakers about investing in education and training of YOUNG professionals, as well as those with already proven experience in cancer care. Training is the basis for any future cancer care program, which aims at the integration of palliative care practices into standard oncology care across the trajectory of the illness.

Informal caregiving to older cancer patients: preliminary research outcomes and implications.

BACKGROUND: The population of the Western world is aging while cancer survival rates are rising. Older patients with cancer will increasingly be taken care of by informal family caregivers. The current study describes levels of psychological distress, social support and coping abilities reported by partners who are caregivers to older patients with cancer (60+ years), comparing them to a control group of spouses of similarly aged people not suffering from life-threatening illness. PATIENTS AND METHODS: Two hundred sixteen partners who are primary caregivers of cancer patients aged 60+ were compared with 76 partners of healthy people aged 60+ and never diagnosed with any terminal illness. Participants completed self-reporting measures on psychological distress, coping ability and social support. RESULTS: Caregivers to cancer patients reported high levels of distress, low levels of social support and low levels of coping abilities which are negatively correlated to distress. Increased patient age was found to accentuate these processes. CONCLUSION: Age and the progression of cancer as a chronic illness present the physician with the reality that focus of care should be on the dyad (patient and caregiver), with high priority given to partners who are informal caregivers.

[The use of hydroxamic acids and sodium nitrate to enhance the antitumor effect of cyclophosphamide].

It has been showed that the introduction of nitrocompounds (as nitic oxide donors) in to the compositions of cyclophosphamide and hydroxamic acids for curing animals having leukemia P-388 increased duration of life by 290%. Thereby 40% of animals have recovered. The therapeutic dose cyclophosphamide have been reduced by 6 times.

[Copper-induced change in the ESR signal of hemoglobin nitrosyl complexes in wound by the action of copper nanoparticles].

The results concerning changes in the ESR signal of hemoglobin nitrosyl complexes in wound tissues in the course of healing by the action of ointments with copper nanoparticles (patent N2460532, Russia) are presented. It is shown that the wound healing process modified by the influence of copper nanoparticles demonstrates the increase in the ESR signal amplitude for :hemoglobin nitrosyl complexes as compared with controls (the ointment base without nanoparticles). Planimetric measurements of wound area through reparation course indicate an active process of wound healing for injuries treated with copper nanoparticles in the ointment, resulting in lessening half-reparation time up to 5.0 times as compared with controls (treatment with the ointment base). The paper discusses the role of copper nanoparticles, NO and their potential synergistic effect on the skin wound regeneration.

Cultural diversity: family path through terminal illness.

In trying to comprehend a culture and its ways of structuring the world, much can be learned from addressing the manner in which intimate family relationships are ordered and family crises channeled toward care. A family's experience with illness cannot be considered in isolation from the cultural milieu in which it occurs. Family adaptation to cancer diagnosis is a continuous motion between many critical strata--a fragile oscillation between hope and desperation. Processes for optimal functioning and the well-being of members are seen to vary over time, as challenges unfold and families evolve across the life cycle and illness trajectory. The manner in which the healthcare system and family manage illness and terminal care is a particularly helpful window into the cultural, religious and traditional values of every family in a particular society.

[Experimental hemorrhagic stroke: the effect of the peptide preparation cortexin in the formation of Hb-NO-complexes and other blood paramagnetic centers].

Using electronic paramagnetic resonance (EPR), we studied the effect of the peptide cortexin on the content of hemoglobin nitrozyl complexes (Hb-NO-complexes) and other paramagnetic centers (transferrin, methemoglobin) in the blood of rats of Krushynsky-Molodkina line in the experimental hemorrhagic stroke induced by acoustic stress. After the acoustic exposure, the level of Hb-NO-complexes have increased by more than 6 times. The intensity of the EPR signal of the plasma peptide transferrin increased by 1,5 times. The level of blood methemoglobin was also elevated, though not significantly, after the acoustic stress. Cortexin substantially reduces the formation of Hb-NO-complexes and, therefore, the level of nitride oxide while the contents of transferrin and methemoglobin remain intact.

Psychological distress among male patients and male spouses: what do oncologists need to know?

BACKGROUND: The aim of the current study was to strengthen the knowledge of oncologists concerning psychological distress and social support among married and unmarried male cancer patients and healthy male spouses of female cancer patients. PATIENTS AND METHODS: Three groups of men were recruited from three major cancer centers in Israel: 185 married colon and rectal cancer patients, 54 single (unmarried) colon and rectal cancer patients, and 153 male spouses of female cancer patients. Participants were evaluated on four standardized instruments measuring psychological distress, coping, and social support. RESULTS: About 42.6% of the participants reported on a clinical level of psychological distress, with the highest rates (61.1%) among the single (unmarried) patients. Distress was negatively correlated to Karnofsky score and coping variables among all study groups. Distress was significantly and negatively correlated to social support variables among the spouses and married patients but not among the single patient groups. CONCLUSIONS: Social support received by male cancer patients from friends and family may be mediated by spouse support. As a result, single male patients are at higher risk for psychological distress. Male spouses were also found to have high rates of distress. These two groups need special attention by oncologists.

[EPR study of the influence of hypoxia on nitric oxide formation in the blood of Krushinskii-Molodkina rats].

The influence of hypoxia on nitric oxide formation in the blood of Krushinskii-Molodkina rats has been studied by electron paramagnetic resonance. It was found that nitric oxide synthesis in Krushinskii-Molodkina rats is increased compared with that in Wistar rats. A significant enhancement of the EPR signal of Hb-NO complexes in the animal blood was observed after hypoxia simulating the altitude of 5000 m above the sea level, in particular in the presence of sodium nitrite and the NO-synthase inhibitor L-nitroarginine. It was assumed that NO synthesis and nitro-/nitrite- reductase systems are activated under hypoxic conditions.

[Lipid peroxidation and antioxidative protection in patients with coronary heart disease].

Total cholesterol as well as cholesterol of low and high density lipoproteins, lipid peroxidation products (LPP), such as dienic conjugates and compounds reacting with thiobarbituric acid, were measured in a single blood sample from each of the 295 patients with CHD and 20 apparently healthy subjects. FC II and III angina was diagnosed in 142 and 151 CHD patients respectively. Certain samples were used to additionally detect homocysteine, activity of anti-oxidative enzymes (superoxide dismutase and glutathione peroxidase) in erythrocytes and ceruloplasmin/transferrin anti-oxidative system in plasma. Patients with FC III angina had significantly higher LPP levels but lower activity of tissue and plasma anti-oxidative systems than patients with FC II angina or healthy subjects. Patients with stable forms of CHD showed correlation between lipid composition, LPP contents, homocysteine level, and activity of anti-oxidative enzymes.

[Correction of antioxidative state during statin therapy of coronary heart disease with dyslipidemia].

Treatment with simvastatin (vasilip) at a daily dose of 20 mg combined with conventional cardiac therapy was given for 3 months to 132 patients with coronary heart disease and postinfarction cardiosclerosis with dyslipidemia. Activity of tissue and plasma antioxidative enzymes increased in 60% of the patients and decreased in 40%. Treatment with antioxidants 2-ethyl-6-methyl-3-oxypiridine succinate (mexidol) and ubichinon (cudesan QIO) improved antioxidative status of the patients and clinical picture of cardiac pathology.

[Nitric oxide is involved in the protective effects of short-term adaptaion to hypoxia in the course of stress-induced disorders in Krushinsky-Molodkina rats].

A possible involvement of nitric oxide in the protective effect of short-term adaptation of Krushinsky-Molodkina rats to mild hypoxia simulating 5000 m above sea level was studied. Nitric oxide proved to have a considerable protective effect on stress-induced disorders in Krushinsky-Molodkina rats as demonstrated using NO-synthase inhibitors and NO monitoring by electron spin resonance under different experimental conditions.

The illness trajectory of elderly cancer patients across cultures: SIOG position paper.

BACKGROUND: Due to the aging of the population, cancer has become a health priority worldwide. While the number of elderly cancer patients is rapidly increasing, many barriers still exist to their effective management. Compared with their younger counterparts, the elderly are less likely to receive optimal medical, psychological and spiritual treatment provided in a culturally competent manner. DESIGN: The scanty literature on cultural competence in elderly cancer patients has been reviewed. Additional material has been selected based on the authors' clinical research in medical oncology and psycho-oncology, and on their scholarly work in anthropology and bioethics. RESULTS: The aging process is a synergistic product of biological, behavioral and social issues within a cultural context. Knowledge about how older people understand, perceive and experience their illness trajectory and make choices is essential to the planning and delivering of effective cancer care. CONCLUSION: This position paper of the SIOG Task Force on Cultural Competence in the Elderly creates awareness of the influence of culture in geriatric oncology. Negotiating cross-cultural issues in geriatric oncology helps managing possible conflicts between patients, families and physicians over differing health care values, beliefs, or practices. Possible areas of future scholarly investigation and clinical research are identified.

[The influence of the bioflanoid dicvertin on the antioxidative system ceruloplasmin-transferrin and lipid peroxidation in patients suffering from stable coronary heart disease with dyslipidemia].

Thirty-two patients with coronary heart disease (CHD)--exertional angina and postinfarction cardiosclerosis with dislipidemia--were treated with dicvertin (2,3-dihydro-3,5,7-trihydroxi-2(3,4-dihydroxiphenyl)-4H-1-benzopyran-4-on), a Russian antioxidant, during two months in a day dose of 80 mg in addition to conventional cardial therapy. The therapy resulted in positive changes including improvement of CHD clinical picture and biochemical serum indices, such as a 6% decrease in cholesterol level, a 12% decrease in low-density lipoproteins cholesterol level, and a 14% increase in high-density lipoproteins cholesterol level. The intensity of lipid peroxidation decreased, the levels of diene conjugates and TBA-reactive products lowered by 38% and 40%, respectively. The fibrinogen level lowered by 20%. The antioxidative status of the patients increased.

[Changes in the electrical characteristics of the internal surface of cytoplasmic membrane of bacteria Escherichia coli after the binding of microdoses of copper ions by its external surface].

The effect of microdoses of copper ions bound with the external surface of the cytoplasmic membrane of Escherichia coli spheroplasts on the charge density of its superficial structures was investigated by the ESR method. Positively charged spin probes of KAT(n)-type and the newly synthesized KAT15 were used. The experimental data were analyzed using the formalism of Gouy-Chapman theory. The binding of microdoses of copper ions by the external surface of the cytoplasmic membrane changed the value of charge density on the membrane internal surface.

Effect of mexidol and nitroglycerine on iron-sulfur centers, cytochrome P-450, and nitric oxide formation in liver tissue of experimental animals.

In experiments on mice we studied the effect of individual or combined treatment with mexidol and nitroglycerine on iron-sulfur centers of the mitochondrial respiratory chain, cytochrome P-450 of the endoplasmic reticulum, and nitric oxide formation in the liver tissue. Mexidol had a potent effect on these parameters and protected iron-sulfur centers from oxidation, including that induced by nitroglycerine.

[Effects of mexidol on the antioxidative status of patients suffering from coronary heart disease with dislipidemia].

The subjects of the study were 36 patients suffering from coronary heart disease with exertional angina and postinfarction cardiosclerosis with dislipidemia. The patients were administered mexidol (2-ethyl-6-methyl-3-oxipyridin succinate), a domestically produced antioxidative agent, for 1 month in a dose of 325 mg/day together with conventional cardial therapy. The result was good and included clinical improvements and improvements in biochemical serum parameters: cholesterol level decreased by 10%, the level of low density lipoprotein cholesterol decreased by 25%, high density cholesterol level elevated by 15%. The intensity of lipid peroxidation lowered, which was manifested by decrease of the level of diene conjugates and TBA-reactive products by 27% and 42%, respectively. The patients' antioxidative status increased.