RESUMEN
BACKGROUND: Head and neck cancer (HNC) patients are at high risk for developing lymphedema and fibrosis (LEF) following cancer treatment. Once HNC patients develop LEF, they need to conduct life-long self-care to slow LEF progression and reduce associated symptom burden and functional deficits. Data demonstrate that inadequate LEF self-care may be a potentially remediable issue. The objective of this study is to explore the feasibility and preliminary efficacy of an Information-Motivation-Behavioral (IMB) Skills model-driven self-care program (SCP) to improve LEF management and reduce LEF-related symptom burden and functional impairments. METHODS/DESIGN: This is a three-arm, prospective, randomized controlled clinical trial to compare: Group 1 - Usual Care, Group 2 - Usual Care Plus LEF-SCP, and Group 3 - Usual Care Plus LEF-SCP Plus Follow-Up. Participants will be HNC survivors aged > 18 years of age, who meet predefined inclusion and exclusion criteria. A sample size of 75 participants is targeted. Interventions will be provided by trained staff. The study assessments for all groups will take place at five points: study entry then 3, 6, 9, and 12 months post enrollment. Outcome measures include: (1) feasibility (barriers to implementation, safety, and satisfaction) of the proposed intervention; (2) self-efficacy and adherence to self-care; and (3) preliminary efficacy (LEF progression, symptom burden, and functional status) of the proposed intervention. DISCUSSION: This will be the first study to evaluate the feasibility of a LEF-SCP in the HNC population and its impact on self-efficacy and adherence. Furthermore, it will evaluate the potential benefit of routine follow-up on adherence and fidelity to the self-care protocol. We expect that the trial will provide evidence supporting the feasibility of a LEF self-care program. In addition, we anticipate that preliminary data will support improved outcomes including increased adherence and fidelity, and decreased LEF-associated symptoms. TRIAL REGISTRATION: ClinicalTrials.gov, a service of the US National Institute of Health (NCT03030859). Registered on 22 January 2017.
Asunto(s)
Neoplasias de Cabeza y Cuello , Linfedema , Calidad de Vida , Autocuidado , Adaptación Psicológica , Adulto , Fibrosis/etiología , Fibrosis/psicología , Fibrosis/terapia , Neoplasias de Cabeza y Cuello/complicaciones , Neoplasias de Cabeza y Cuello/terapia , Humanos , Linfedema/etiología , Linfedema/psicología , Linfedema/terapia , Motivación , Evaluación de Resultado en la Atención de Salud , Participación del Paciente , Rendimiento Físico Funcional , Ensayos Clínicos Controlados Aleatorios como Asunto , Proyectos de Investigación , Autocuidado/métodos , Autocuidado/psicología , Cumplimiento y Adherencia al TratamientoRESUMEN
Non-cystic fibrosis (non-CF) bronchiectasis is a condition characterized by an airway inflammatory response to bacterial pathogens. Frequent exacerbations have a major influence on the quality of life. Macrolide antibiotics have not only antibacterial but also immune-regulation effects. It is proved that macrolides have a benefit in preventing exacerbations. However, it is still uncertain whether azithromycin or erythromycin is more effective and safe. The purpose of this study was to answer the following question: Which kind of macrolide antibiotic is more effective and safe in preventing non-CF bronchiectasis exacerbation? We conducted a systematic review to identify randomized clinical trials published up to May 2017 that reported on macrolides for non-CF bronchiectasis and an adjusted indirect treatment comparison (AITC) between macrolides to evaluate their efficacy and safety. The direct comparison meta-analysis found that macrolides decreased the rate of exacerbation of non-CF bronchiectasis (risk ratio (RR) = 0.45; 95% confidence interval (CI) 0.36-0.55) with heterogeneity ( I2 = 63.7%, p = 0.064). The AITC showed that azithromycin had a significantly lower bronchiectasis exacerbation rate than erythromycin (RR = 0.35; 95% CI: 0.403-0.947). Azithromycin increased the risk of diarrhea and abnormal pain. This meta-analysis suggested that long-term treatment with macrolides significantly reduced the incidence of non-CF bronchiectasis exacerbation. Moreover, azithromycin is more efficient than roxithromycin and erythromycin in preventing exacerbation.
Asunto(s)
Azitromicina/uso terapéutico , Bronquiectasia/tratamiento farmacológico , Eritromicina/uso terapéutico , Calidad de Vida , Adulto , Antibacterianos/uso terapéutico , Bronquiectasia/psicología , Fibrosis/tratamiento farmacológico , Fibrosis/psicología , Humanos , Macrólidos/uso terapéuticoRESUMEN
Fundamentos: La mielofibrosis es una enfermedad rara que afecta personas adultas especialmente sobre la cual no se encuentran estudios que investiguen el sentir del padecimiento en los pacientes o que aborden lo que ha representado esta enfermedad en la vida El trabajo buscó determinar el significado, las experiencias y las implicaciones que la mielofibrosis tiene en pacientes colombianos. Métodos: Estudio cualitativo de 10 pacientes con mielo fibrosis. Muestreo teórico intencionado. Técnica: entrevista a profundidad realizada por psicóloga clínica con cuestionario semiestructurado diseñado por los investigadores. Entre diciembre 2013 - enero 2014. Análisis de contenido con apoyo del software Atlas ti. Versión 7, licencia educativa multiusuario. Resultados: 7 hombres, 3 mujeres con edades entre 19-80 de varias regiones del país, con diagnostico entre 1-17 años. Edad mediana 63.5 años. Cinco con diagnóstico inicial de anemia, leucemia o hepatomegalia. Ninguno conocía previamente la enfermedad. Atribuyen la causa: cocinar con leña, manipulación de materiales en su trabajo, vida agitada sin buena alimentación o razones divinas. El padecimiento de mielofibrosis cambio las concepciones sobre la vida, sus expectativas, hábitos y costumbres. Tienen la convicción de vivir con apoyo del sistema de salud. La familia, la religión y los médicos se convierten en su apoyo. Conclusiones No conocían sobre enfermedad. Manifiestan emociones y sentimientos de incredulidad, angustia, tristeza, miedo entre otros y es la familia, la creencia en Dios y la cercanía y comprensión del médico la mejor red de apoyo. Su expectativa frente a la enfermedad es de esperanza
Background: Myelofibrosis is a rare disease on which no studies about the suffering of patients who have it have been conducted. this work seeks to determine the significance, the experiences and the implications that Myelofibrosis has in Colombian patients. Methods: This is a qualitative study method directed to Myelofibrosis diagnosed patients where theoretical intentional samples were collected. To such end, 10 interviews were conducted between December 2013 and January 2014 by a Clinical Psychologist with semi-structured questionnaires carefully designed by the researchers. The content analysis was developed with Atlas.ti® software support, multi-user educative license, version 7. Results: 7 male and 3 female patients between 19-80 years old from various regions of the country were enrolled whose illness had been diagnosed within the 1 and 17 years from the onset of symptoms. Five of the patients had an initial diagnosis of Anemia, Leukemia or Hepatomegaly. None of them knew about their disease previously. They attributed the cause to such symptoms to factors like cooking with firewood, the handling of materials at their work, busy life with poor eating habits or to spiritual reasons. Suffering from the illness has substantially changed the patients conceptions about life and therefore their expectations, habits, and customs. They have the conviction to continue living with the support of the health system and to overcome the disease. Family, religion, and doctors become their support. Conclusions: They did not know anything about the illness previous to the diagnosis. However, they express emotions and feelings of disbelief, anger, sadness, and fear among others and it is the family, the belief in God and the closeness and understanding of their doctors which constitutes their main support network. Hope is the only expectation he has towards the disease
Asunto(s)
Humanos , Masculino , Femenino , Adulto Joven , Adulto , Persona de Mediana Edad , Anciano , Anciano de 80 o más Años , Enfermedades Raras/psicología , Fibrosis/epidemiología , Fibrosis/psicología , Neoplasias Hematológicas/psicología , Psicología Clínica/métodos , Encuestas y Cuestionarios , Apoyo Social , Consentimiento Informado , Estilo de Vida , Enfermedad/psicologíaRESUMEN
OBJECTIVE: Fibrosis plays an important role in heart failure (HF) and other diseases that occur more frequently with increasing age. Depression is associated with an increased risk of heart failure and other age-related diseases. This study examined the association between depressive symptoms and fibrosis markers in adults aged 65 years and above. METHODS: Fibrosis markers and depressive symptoms were assessed in 870 participants (age=80.9+/-5.9 yrs, 49% women) using a case-control design based on heart failure status (307 HF patients and 563 age- and sex-matched controls, of whom 284 with CVD risk factors (hypertension, diabetes mellitus, or hypercholesterolemia) and 279 controls without these CVD risk factors). Fibrosis markers were procollagen type I (PIP), type I collagen (CITP), and procollagen type III (PIIINP). Inflammation markers included C-reactive protein, white blood cell counts and fibrinogen. Depression was assessed using the Center for Epidemiological Studies-Depression (CES-D) scale using a previously validated cut-off point for depression (CES-D > or = 8). Covariates included demographic and clinical variables. RESULTS: Depression was associated with higher levels of PIP (median=411.0, inter-quartile range (IQR)=324.4-472.7 ng/mL vs. 387.6, IQR=342.0-512.5 ng/mL, p=0.006) and CITP (4.99, IQR=3.53-6.85 vs. 4.53, IQR=3.26-6.22 microg/L, p=0.024), but not PIIIINP (4.07, IQR=2.75-5.54 microg/L vs. 3.58, IQR=2.71-5.01 microg/L, p=0.29) compared to individuals without depression. Inflammation markers were also elevated in depressed participants (CRP, p=0.014; WBC, p=0.075; fibrinogen, p=0.074), but these inflammation markers did not account for the relationship between depression and fibrosis markers. CONCLUSIONS: Depression is associated with elevated fibrosis markers and may therefore adversely affect heart failure and other age-related diseases in which extra-cellular matrix formation plays a pathophysiological role.
Asunto(s)
Enfermedades Cardiovasculares/psicología , Depresión/psicología , Fibrosis/psicología , Anciano , Anciano de 80 o más Años , Biomarcadores , Proteína C-Reactiva/análisis , Proteína C-Reactiva/metabolismo , Enfermedades Cardiovasculares/epidemiología , Colágeno Tipo I/sangre , Depresión/epidemiología , Electrocardiografía , Fibrosis Endomiocárdica/epidemiología , Fibrosis Endomiocárdica/psicología , Fatiga/psicología , Femenino , Fibrosis/epidemiología , Encuestas Epidemiológicas , Insuficiencia Cardíaca/epidemiología , Insuficiencia Cardíaca/psicología , Humanos , Mediadores de Inflamación/sangre , Masculino , Análisis Multivariante , Fragmentos de Péptidos/sangre , Procolágeno/sangre , Escalas de Valoración Psiquiátrica , Factores de Riesgo , Factores SocioeconómicosRESUMEN
CNS involvement is frequent in patients with chronic liver disease, resulting in overt or subclinical ("minimal") encephalopathy. Occasionally, patients liver cirrhosis may develop a progressive encephalopathy known as chronic acquired hepatocerebral degeneration (CAHD), presenting with neuropsychiatric changes and movement disorders. In patients affected by CAHD cognitive dysfunction is the rule, but to date this aspect has not been systematically studied. Our aim was to characterize the neuropsychological profile of cognitive impairment associated with CAHD. Eight patients with CAHD received extensive neuropsychological assessment, far from episodes of acute liver decompensation. Their cognitive performances were compared with those of 8 patients with cirrhosis free from CAHD or overt hepatic encephalopathy (HE) and with those of 8 healthy controls matched for age, sex and educational level. Patients with CAHD revealed a significant impairment of visuo-spatial attention compared to healthy controls, and a lower performance on a single task of visual search and sequencing when compared to cirrhotics without CAHD. Our findings support the hypothesis of a linear decline in attentional performances of patients with chronic liver disease, starting from cognitively intact patients, moving toward patients with minimal HE, and finally progressing to those with overt HE and CAHD.
Asunto(s)
Trastornos del Conocimiento/fisiopatología , Encefalopatía Hepática/fisiopatología , Anciano , Atención/fisiología , Encéfalo/metabolismo , Encéfalo/fisiopatología , Enfermedad Crónica , Trastornos del Conocimiento/diagnóstico , Trastornos del Conocimiento/etiología , Evaluación de la Discapacidad , Progresión de la Enfermedad , Femenino , Fibrosis/complicaciones , Fibrosis/fisiopatología , Fibrosis/psicología , Encefalopatía Hepática/complicaciones , Encefalopatía Hepática/psicología , Humanos , Hígado/metabolismo , Hígado/fisiopatología , Masculino , Persona de Mediana Edad , Pruebas Neuropsicológicas , Desempeño Psicomotor/fisiología , Percepción Espacial/fisiologíaRESUMEN
BACKGROUND: Hepatitis C is a major cause of liver disease worldwide. It has been associated with decreased health-related quality of life (HRQL) and psychiatric symptoms. Our aim was to assess HRQL, depression, and illness understanding in patients with chronic hepatitis C without previous interferon therapy. METHODS: Consecutive patients attending a referral center were enrolled. HRQL was measured using SF-36 questionnaire, depression with Zung self-rating depression scale, and illness understanding with self-applied knowledge test. RESULTS: Of 157 patients enrolled, 112 were female (71%) and 45 male (29%). Ninety-seven patients (61.8%) had cirrhosis. HRQL was significantly decreased in chronic hepatitis C patients compared to historical normal controls in all eight domains of the SF-36 (p < 0.001). In hepatitis C cirrhotic patients, HRQL was significantly lower among Child-Pugh class B and C subjects in domains reflecting physical health (p <0.05). Ninety-two patients (58.6%) had depression that resulted in lower HRQL when compared to nondepressed patients (p <0.05). One hundred fourteen patients (72.6%) had poor illness understanding of hepatitis C. These subjects had significantly lower HRQL scores in six of eight SF-36 domains when compared to patients with better understanding of the disease (p <0.05). CONCLUSIONS: Chronic hepatitis C patients attending a tertiary-referral center had significant decrease in HRQL associated with depression (58.6%) and poor illness understanding (72.6%). Educational programs and their impact on HRQL need to be addressed in detail, particularly for the pre-treatment scenario.
Asunto(s)
Depresión/complicaciones , Hepatitis C/complicaciones , Actitud Frente a la Salud , Femenino , Fibrosis/complicaciones , Fibrosis/psicología , Conocimientos, Actitudes y Práctica en Salud , Hepatitis C/psicología , Humanos , Masculino , Calidad de Vida , Encuestas y CuestionariosRESUMEN
Se hace una revisión sobre la importancia de los acontecimientos vitales ya sean recientes o acumulativos en la aparición y o exacerbación de enfermedades físicas (inflamación de garganta, hernias, apendicitis), el dolor crónico (cefaleas, abdominalgias, dolor en el pecho, etc.) y enfermedades crónicas en la infancia y adolescencia (diabetes, asma, fibrosis cistica, hemofilia, artritis reumatoide, herpes) (AU)