RESUMEN
PURPOSE: Symptom management is of high priority in cancer care. Information and communication technology allows interventions to be provided through the internet to enhance the delivery of care. This study aimed to review the effects of web-based interventions on cancer patients' symptoms. METHODS: MEDLINE, PSychINFO, PubMed, CINAHL, and Cochrane databases were systematically searched. Included were randomized controlled trials (RCTs), pilot RCTs, or quasi-experimental (QE) studies focusing on web-based interventions in adult cancer patients with at least one outcome primary or secondary, in terms of symptoms, treatment side effects, or distress. Data were analyzed study by study. RESULTS: Twenty studies were identified. All web interventions included information, 16 included self-management support, 14 included self-monitoring, 13 included feedback/tailored information, 12 used communication with health-care professionals, and eight used communication with other patients. Overall, 13 studies reported positive symptom outcomes. Psychological distress was reported in eight studies with positive intervention effects in three. Symptoms of anxiety/depression were reported in ten studies with positive intervention effects in five. Somatic symptom severity was reported in ten studies with intervention effects found in six, and symptom distress was reported in six studies with intervention effects found in all. CONCLUSIONS: This review shows the promising potential of web-based interventions for cancer symptom management, although it was limited by considerable heterogeneity in the interventions tested and targeted outcomes. The multidimensional nature of symptoms was partly addressed; only one study was guided by a comprehensive theoretical model of cancer symptom management. It can only be speculated which web elements are important for effective symptom outcomes. Further testing is needed for web-based cancer symptom management.
Asunto(s)
Internet , Neoplasias/terapia , Educación del Paciente como Asunto/métodos , Ensayos Clínicos Controlados Aleatorios como Asunto/estadística & datos numéricos , Telemedicina/métodos , Adulto , Comunicación , Depresión/terapia , Humanos , Neoplasias/psicología , Cuidados Paliativos/métodos , Autocuidado/métodosRESUMEN
Palliative care focuses on improving quality of life (QoL). This study examined the feasibility of the Icelandic version of a provisional European Organisation for Research and Treatment of Cancer (EORTC) measure of spiritual well-being (SWB), and explored the relationship between SWB and QoL for palliative care patients in Iceland. Instruments from the EORTC were used: the provisional measure of SWB, which was undergoing pilot-testing in Iceland, and the EORTC QLQ C15-PAL. The correlation between scores was examined and descriptive statistics were used. Structured interviews explored feasibility. Thirty persons participated with average age 72 years. Belief in God or a higher power had the mean 3.33 on a 1-4 scale and the mean for overall SWB was 5.73 on a 1-7 scale. The mean score for global health/QoL was 59.4, physical functioning 48.5 and emotional functioning 78.9 on a 0-100 scale. Overall QoL was positively correlated with SWB showing r(30) = 0.386, P = 0.035. The participants found that answering the provisional EORTC QLQ-SWB prompted an emotional response and took the opportunity to discuss the subject. The provisional SWB measure was found relevant for the Icelandic context, and the study indicates that SWB and QoL are closely connected.
Asunto(s)
Estado de Salud , Salud Mental , Neoplasias/terapia , Cuidados Paliativos , Calidad de Vida , Espiritualidad , Anciano , Anciano de 80 o más Años , Estudios de Factibilidad , Femenino , Humanos , Islandia , Masculino , Persona de Mediana Edad , Proyectos Piloto , Reproducibilidad de los Resultados , Encuestas y CuestionariosRESUMEN
OBJECTIVE: While a significant number of cancer patients experience distress only a minority are offered appropriate psychosocial interventions. Untreated distress can interfere with compliance to treatment and quality of life. The purpose of this study was to evaluate the psychometric properties and feasibility of the Icelandic translation of the distress thermometer (DT) and problem list, a tool developed to screen for distress in cancer patients. METHODS: Participants were 149 cancer patients receiving treatment at outpatient oncology clinics at Landspítali-The National University Hospital of Iceland, mean±SD age 59.06 years ±12.92. Participants answered the DT, HADS and GHQ-30, demographic questions and questions regarding the DT. RESULTS: Scores on the DT ranged from 0 to 10 with a mean ±SD score of 3.09 ± 2.40, 7.30 ± 4.86 on HADS and 5.28 ± 5.60 on GHQ-30. Significant correlations were between the DT and all categories on the Problem List as well as between the DT and HADS (r = 0.45), and between DT and GHQ-30 (r = 0.57). ROC-analysis supported that a cut-off point of 3 gives the best sensitivity and specificity for the DT predicting depression or anxiety according to the HADS and GHQ. Sixty-nine (48.3%) patients scored < or =2 on DT and 74 (51.7%) scored ≥3. CONCLUSION: The Icelandic version of the DT is a valid instrument to screen for distress in clinical practice. The study adds to a growing literature suggesting that this brief instrument may aid in identifying cancer patients suffering from distress and consequently providing appropriate treatment.
Asunto(s)
Neoplasias/psicología , Psicometría/instrumentación , Estrés Psicológico/diagnóstico , Encuestas y Cuestionarios , Adulto , Anciano , Trastornos de Ansiedad/diagnóstico , Trastornos de Ansiedad/psicología , Depresión/diagnóstico , Depresión/psicología , Femenino , Hospitales Universitarios , Humanos , Islandia , Masculino , Persona de Mediana Edad , Escalas de Valoración Psiquiátrica/estadística & datos numéricos , Psicometría/estadística & datos numéricos , Calidad de Vida/psicología , Curva ROC , Reproducibilidad de los Resultados , Sensibilidad y Especificidad , Perfil de Impacto de Enfermedad , Apoyo Social , TraducciónRESUMEN
Family support has been recognized in the development of palliative care in Iceland, yet studies focusing on family needs are lacking. The aims of this study were to evaluate the perceived care needs of family members of patients receiving palliative care, to what extent these needs were met, and whether needs differed based on background characteristics and site of care. Family members of 111 patients from acute and palliative care settings agreed to participate, and 67 (60%) completed the study. The Family Inventory of Needs was used to quantify family needs and to what extent they were met. All 20 needs measured were considered important. The number of needs did not differ by site of palliative care. Overall, health care professionals met 67% of needs. Needs were more likely to be met in specialized palliative care settings than on acute units and the needs of spouses were more likely to be met than others.
Asunto(s)
Salud de la Familia , Evaluación de Necesidades , Cuidados Paliativos , Enfermedad Aguda , Adulto , Anciano , Estudios Transversales , Femenino , Humanos , Islandia , Masculino , Persona de Mediana EdadRESUMEN
It is important to explore the potential for health promotion from the perspective of participants in a particular situation. This study focuses on experiences of well-being and the potential for health promotion among unskilled workers in the kitchen and laundry room in an acute care hospital in Iceland. These experiences are analysed in light of the material and structural factors that shape working conditions. The research method used was grounded theory. The data were formal and informal interviews, and participant observation. The findings revealed considerable differences between the two work groups. At both sites strain on the body, caused by excessive noise, heavy lifting and uncomfortable working arrangements, were identified. Similarly, the work was often experienced as monotonous and demanding. Human relations were identified as a key factor in ameliorating the conditions that led to experiences of strain by the workers at both work sites. This was however where the two work places differed. In the laundry room, the workers felt respected and acknowledged by their coworkers and managers. Belonging to the work group was important and they felt listened to by the supervisor. Very little cohesiveness was observed among the workers in the kitchen. The managers seemed to be absent from the floor, workers were divided into work groups that sometimes showed antagonism towards each other and few channels were available for complaints and suggestions for improvement. The workers in the laundry room, on the other hand, related positive experiences of work. They felt that steps were taken by managers to improve working conditions to the extent possible and participated in those attempts by bringing up suggestions, implementing change and developing their own ways of coping with the work. This study gives important directions for health promotion in the workplace, emphasizing human relations at work, rather than individual health behaviour away from the work setting.
Asunto(s)
Actitud Frente a la Salud , Promoción de la Salud/normas , Salud Laboral , Personal de Hospital/psicología , Lugar de Trabajo/psicología , Adaptación Psicológica , Conducta Cooperativa , Ergonomía , Servicio de Alimentación en Hospital , Conductas Relacionadas con la Salud , Humanos , Islandia , Relaciones Interprofesionales , Servicio de Lavandería en Hospital , Elevación/efectos adversos , Moral , Evaluación de Necesidades , Ruido en el Ambiente de Trabajo/efectos adversos , Investigación Metodológica en Enfermería , Apoyo Social , Encuestas y CuestionariosRESUMEN
OBJECTIVE: To investigate a possible association between the carrier frequency of the N314D mutation in the galactose-1-phosphate uridyl transferase (GALT) gene and endometriosis and linkage to the short arm of chromosome 9, where the GALT gene resides. DESIGN: Association and linkage study. SETTING: Population material collected for case and family studies in endometriosis. PATIENT(S): Women diagnosed with endometriosis by laparotomy or laparoscopy. INTERVENTION(S): Association with the GALT gene investigated by genotyping 85 affected women and 213 unrelated control women and a scan for linkage to chromosome 9 in 205 women from 64 families with endometriosis. MAIN OUTCOME MEASURE(S): Multipoint parametric lod scores and frequency of alleles. RESULT(S): There was no significant difference in allele frequency for the N314D polymorphism in patients compared with control subjects. No evidence for linkage was found to chromosome 9p, where the GALT gene resides. CONCLUSION(S): The experiments reported herein provide no evidence supporting involvement of the GALT locus in the development of endometriosis.
Asunto(s)
Endometriosis/genética , Ligamiento Genético , UTP-Hexosa-1-Fosfato Uridililtransferasa/genética , Mapeo Cromosómico , Cromosomas Humanos Par 9/genética , Femenino , Heterocigoto , Humanos , Escala de Lod , Repeticiones de Microsatélite , Polimorfismo Genético , Valores de ReferenciaRESUMEN
cis-3-(9H-Purin-6-ylthio)acrylic acid (PTA) is a structural analog of azathioprine, a prodrug of the antitumor and immunosuppressive drug 6-mercaptopurine (6-MP). In this study, we examined the in vitro and in vivo metabolism of PTA in rats. Two metabolites of PTA, 6-MP and the major metabolite, S-(9H-purin-6-yl)glutathione (PG), were formed in a time- and GSH-dependent manner in vitro. Formation of 6-MP and PG occurred nonenzymatically, but 6-MP formation was enhanced 2- and 7-fold by the addition of liver and kidney homogenates, respectively. Purified rat liver glutathione S-transferases enhanced 6-MP formation from PTA by 1.8-fold, whereas human recombinant alpha, mu, and pi isozymes enhanced 6-MP formation by 1.7-, 1.3-, and 1.3-fold, respectively. In kidney homogenate incubations, PG accumulation was only observed during the first 15 min because of further metabolism by gamma-glutamyltranspeptidase, dipeptidase, and beta-lyase to yield 6-MP, as indicated by the use of the inhibitors acivicin and aminooxyacetic acid. Based on these results and other lines of evidence, two different GSH-dependent pathways are proposed for 6-MP formation: an indirect pathway involving PG formation and further metabolism to 6-MP, and a direct pathway in which PTA acts as a Michael acceptor. HPLC analyses of urine of rats treated i.p. with PTA (100 mg/kg) showed that 6-MP was formed in vivo and excreted in urine without apparent liver or kidney toxicity. Collectively, these studies show that PTA is metabolized to 6-MP both in vitro and in vivo and may therefore be a useful prodrug of 6-MP.
Asunto(s)
Acrilatos/metabolismo , Antimetabolitos Antineoplásicos/metabolismo , Glutatión/metabolismo , Mercaptopurina/metabolismo , Profármacos/metabolismo , Purinas/metabolismo , Acrilatos/farmacocinética , Ácido Aminooxiacético/farmacología , Animales , Antimetabolitos Antineoplásicos/farmacocinética , Liasas de Carbono-Azufre/antagonistas & inhibidores , Liasas de Carbono-Azufre/metabolismo , Dipeptidasas/antagonistas & inhibidores , Dipeptidasas/metabolismo , Inhibidores Enzimáticos/farmacología , Glutatión/farmacología , Glutatión Transferasa/metabolismo , Humanos , Isoxazoles/farmacología , Riñón/metabolismo , Cinética , Hígado/metabolismo , Masculino , Mercaptopurina/farmacocinética , Profármacos/farmacocinética , Purinas/farmacocinética , Ratas , Ratas Sprague-DawleyRESUMEN
The copper-containing enzyme superoxide dismutase (SOD) is a key enzyme in suppressing the amounts of superoxide anion radicals. Ceruloplasmin, the copper-transporting protein in plasma, also possesses an important redox capacity. In this study the levels of copper and ceruloplasmin as well as SOD-activity and ceruloplasmin oxidative activity were analyzed in order to throw some light on possible defects in copper mechanisms in patients diagnosed with Alzheimer's disease (AD). The study included 44 patients with AD and their healthy age- and gender-matched controls. No difference of significance was seen when comparing the copper or ceruloplasmin concentration in plasma of AD patients to that of their paired controls. The SOD activity in red blood cells was significantly lower in the patients than in their controls (p = 0.019). The ceruloplasmin oxidative activity in plasma of Alzheimer's patients was greatly reduced as compared to that of age- and gender-matched controls and the difference was highly significant (p = 0.0005). Ceruloplasmin activity and SOD activity were not found to be intrinsically correlated. It was postulated that reduced oxidative activity of ceruloplasmin in plasma might be either a cause or a consequence of AD and that reduced SOD activity might further add to the oxidative disturbances in AD due to defective ceruloplasmin activity.
Asunto(s)
Enfermedad de Alzheimer/sangre , Ceruloplasmina/metabolismo , Cobre/sangre , Superóxido Dismutasa/metabolismo , Anciano , Anciano de 80 o más Años , Enfermedad de Alzheimer/enzimología , Estudios de Casos y Controles , Eritrocitos/enzimología , Femenino , Radicales Libres/metabolismo , Humanos , Masculino , Persona de Mediana Edad , Oxidación-ReducciónAsunto(s)
Ácido Glicirretínico/sangre , Glycyrrhiza/metabolismo , Ácido Glicirrínico/farmacocinética , Plantas Medicinales , Administración Oral , Adulto , Área Bajo la Curva , Biotransformación , Cromatografía Líquida de Alta Presión , Femenino , Ácido Glicirretínico/metabolismo , Glycyrrhiza/química , Ácido Glicirrínico/análisis , Humanos , Masculino , Espectrofotometría UltravioletaRESUMEN
The American College of Rheumatology (ACR) classification criteria were used to define the prevalence of clinical hand osteoarthritis (OA) in an elderly population in Iceland. The prevalence of hand OA was 3.3% for men and 6.8% for women, however, 19.6% of the men and 32.0% of the women fulfilled the ACR examination but lacked required symptoms. The prevalence of clinical signs of OA in the interphalangeal joints were similar for both sexes but were much more common in the first carpometacarpal joint of women (31.3% vs. 1.0% in men, p < 0.0001). No differences were observed between former seamen (55% of the men) and nonseamen or between the right and left hand. Intra- and interobserver agreement in diagnosis ranged from 83% to 97%, but only 70% of subjects fulfilling the symptoms criterion fulfilled the same criterion six months later. Our results suggest that the present symptoms criterion of the ACR clinical criteria restricts their use in population surveys, being both insensitive and unstable over time.
Asunto(s)
Mano , Osteoartritis/epidemiología , Anciano , Anciano de 80 o más Años , Femenino , Humanos , Islandia , Masculino , Persona de Mediana Edad , Variaciones Dependientes del Observador , Prevalencia , Reumatología/métodos , Factores Sexuales , Sociedades Médicas , Estados UnidosRESUMEN
Penicillin-tolerant and -sensitive strains of oral streptococci were treated with penicillin to determine the production of a post-antibiotic effect (PAE). No PAE was seen with any of the S. sanguis strains tested but most strains of the other oral streptococcal species produced a PAE. Cultures on nitrocellulose filters treated with penicillin were examined by scanning electronmicroscopy and showed that tolerant and sensitive strains lost the ability to adhere to the filter after application of antibiotic. When the filters were treated with beta-lactamase, before processing for microscopy, the tolerant strains but not the sensitive ones recovered and grew in a confluent lawn similar to the control cultures that had not received antibiotic. Transmission electronmicroscopic examination of similarly treated cultures produced comparable results. Bizarre morphological changes were a feature of the tolerant strains of S. sanguis.
Asunto(s)
Penicilinas/farmacología , Streptococcus sanguis/efectos de los fármacos , Streptococcus/efectos de los fármacos , Adhesión Bacteriana/efectos de los fármacos , Tolerancia a Medicamentos , Humanos , Pruebas de Sensibilidad Microbiana , Microscopía Electrónica , Microscopía Electrónica de Rastreo , Boca/microbiología , Streptococcus/crecimiento & desarrollo , Streptococcus/ultraestructura , Streptococcus mutans/efectos de los fármacos , Streptococcus mutans/crecimiento & desarrollo , Streptococcus mutans/ultraestructura , Streptococcus pneumoniae/efectos de los fármacos , Streptococcus pneumoniae/crecimiento & desarrollo , Streptococcus pneumoniae/ultraestructura , Streptococcus sanguis/crecimiento & desarrollo , Streptococcus sanguis/ultraestructura , beta-Lactamasas/farmacologíaRESUMEN
Concern at the high prevalence of dental caries in Iceland prompted this survey of 158 preschool children in Reykjavik. On initial examination in 1987 45.8% of the children were caries-free and the prevalence of caries was a mean dmft 2.4 and a mean dmfs 3.3. A dietary questionnaire aimed at discovering the frequency of sugar consumption per week revealed a threshold value of 30 instances of sugar intake per week above which caries prevalence increased markedly. Some of this sugar is consumed in paediatric medicines, particularly antibiotics and anti-asthmatics, which are widely used in Iceland. Caries prevalence (dmft) for children taking such medicines regularly was 3.0 compared with 2.1 for remaining children (P less than 0.05). Those children who took fluoride tablets regularly had less caries (mean dmft 1.1) than those who used fluoride tablets irregularly or not at all (mean dmft 2.8; P less than 0.001). Samples of saliva from the dorsum of the tongue were taken for determination of numbers of Streptococcus mutans and lactobacilli. High bacterial counts were strongly associated with caries. Only 5% of children with more than 5 x 10(5 S. mutans cfu per ml were caries free but 27% of subjects had 67% of the total amount of caries for the group and all of these would have been detected by the bacterial test.