Longitudinal evolution of meaning in life and its relationship with coping strategies in Spanish patients with a breast cancer diagnosis.

BACKGROUND: Changes in Meaning in life (MIL) have been shown to be particularly important when people face very stressful events such as receiving a cancer diagnosis and treatment. Active coping strategies have been related to higher levels of MIL in people with a diagnosis of cancer. OBJECTIVE: To explore the evolution of MIL in a sample of cancer patients at the time of their diagnosis and three, six, and nine months after surgery, and identify the association between coping strategies three months after diagnosis (T2) and levels of MIL at the different moments in the cancer process (T1-T4). METHODS: We assessed MIL at diagnosis and three, six, and nine months after surgery, and coping strategies (fighting spirit, anxious preoccupation, hopelessness, fatalism, and cognitive avoidance) three months after surgery, in 115 women with a diagnosis of Stage I-III breast cancer. RESULTS: We found higher levels of MIL nine months after surgery, compared to previous stages. MIL correlated significantly and positively with a fighting spirit and cognitive avoidance, and negatively with hopelessness and anxious preoccupation. CONCLUSIONS: Results highlight the importance of coping in relation to meaning-making processes in cancer. Meaning-centred interventions could help patients who are in the process of coping with cancer to make sense of their lives and the experience.

Proporción de carga asistencial generada por la diabetes mellitus en las consultas de enfermería de atención primaria de salud / Proportion of workload generated by diabetes in primary health care nurse consultations

Objetivo: La mayoría de enfermos con diabetes mellitus tipo 2 (DM2) se controla en atención primaria de salud (APS). La atención y educación proporcionadas por enfermería son clave para controlar la glucemia y prevenir las complicaciones macro y microangiopáticas de la DM. El objetivo de este trabajo es conocer la proporción de carga asistencial atribuible a la DM en consultas de enfermería de APS. Material y método: Estudio observacional, analítico y transversal. Durante 2 semanas consecutivas se registraron datos de todos los enfermos que acudieron a 15 consultas de enfermería de APS ubicadas en 14 Áreas Básicas de Salud (ABS) de la provincia de Barcelona. Las variables de estudio fueron: edad, sexo, situación laboral, motivo de consulta, duración de la visita, presencia de DM y, en los enfermos diabéticos, el tipo de tratamiento. La recogida de datos se realizó en 2 períodos. El primero entre noviembre del año 2003 y enero del 2004 y el segundo en abril de 2005. Se realizó un análisis descriptivo de estas variables con un intervalo de confianza del 95% y la asociación entre variables mediante el programa SPSS v.11.1. Resultados: Tenía DM el 29% de los pacientes. La DM es el primer motivo de consulta (29,1%), aumenta con la edad y llega al 40% en mayores de 65 años. La duración media de una visita por DM es de 14,59 min, un 30,8% más elevada que la duración media del resto de los problemas de salud. Globalmente, las mujeres consultan más que los varones (56,6%) excepto en DM, curas y hábito tabáquico. Conclusiones: La DM es el problema de salud que genera más demanda y consume más tiempo de enfermería en la APS. Esta realidad y el futuro que se prevé con relación al incremento de la prevalencia de DM exigen considerar nuevas estrategias organizativas y formativas, y establecer criterios para mejorar la gestión de recursos y promover estrategias educativas más efectivas (AU)

Objective: Most patients with diabetes mellitus type 2 (DM2) are followed-up in primary care (PC). The healthcare and education provided by nurses are crucial to glycemic control and the prevention of macro- and microangiopathic complications. The aim of this study was to determine the workload generated by DM2 in PC nurse consultations. Material and method: An observational, analytical, cross-sectional study was conducted. For 2 consecutive weeks, data were registered from all patients attending 15 PC nurse consultations located in 14 basic health areas in Barcelona. The variables studied were age, gender, employment, reason for consultation, duration of the visit, and the presence or absence of DM2; among patients with DM2, the type of treatment was recorded. Data collection was performed in 2 periods: from November, 2003 to January, 2004 and in April, 2005. A descriptive analysis of these variables was carried out at a 95% confidence interval, and associations among variables were studied using the statistical software program SPSS v. 11.1. Results: Twenty-nine percent of the patients had DM2. DM2 was the main reason for consultation (29.1%) and increased with age, reaching a prevalence of 40% among patients over 65 years of age. The mean duration of the visit was 14.59 minutes, representing a 30.8% increase over the mean duration of visits for other reasons. Overall, women consulted more often than men (56.6%), except for DM2, topical treatments, and smoking-related issues. Conclusions: DM2 is the health issue generating the greatest demand and requiring the highest proportion of nurses' time in PC. In view of these findings and the expected increase in the prevalence of DM2, new organizational and educational strategies should be considered. In addition, criteria to improve resource management and foster more effective educational strategies should be established (AU)