7 research outputs found
Psychological and cognitive factors related to prehospital delay in acute coronary syndrome: A systematic review
We would like to thank Yolanda Ramírez
Casas for her help with data collection. This research is part of the
PhD thesis of Mercedes Arrebola Moreno (Programa de Doctorado
en Psicología, Universidad de Granada).Background: In acute coronary syndrome the time elapsed between the start of symptoms and the moment the patient receives treatment is an important determinant of survival and subsequent recovery.
However, many patients do not receive treatment as quickly as recommended, mostly due to substantial
prehospital delays such as waiting to seek medical attention after symptoms have started.
Objective: To conduct a systematic review with meta-analysis of the relationship between nine frequently
investigated psychological and cognitive factors and prehospital delay.
Design: A protocol was preregistered in PROSPERO [CRD42018094198] and a systematic review was conducted following PRISMA guidelines.
Data sources: The following databases were searched for quantitative articles published between 1997 and
2019: Medline (PubMed), Web of Science, Scopus, Psych Info, PAIS, and Open grey.
Review methods: Study risk of bias was assessed with the NIH Quality Assessment Tool for Observational,
Cohort, and Cross-Sectional Studies. A best evidence synthesis was performed to summarize the findings
of the included studies.
Results: Forty-eight articles, reporting on 57 studies from 23 countries met the inclusion criteria. Studies
used very diverse definitions of prehospital delay and analytical practices, which precluded meta-analysis.
The best evidence synthesis indicated that there was evidence that patients who attributed their symptoms to a cardiac event (n = 37), perceived symptoms as serious (n = 24), or felt anxiety in response to
symptoms (n = 15) reported shorter prehospital delay, with effect sizes indicating important clinical differences (e.g., 1.5–2 h shorter prehospital delay). In contrast, there was limited evidence for a relationship
between prehospital delay and knowledge of symptoms (n = 18), concern for troubling others (n = 18),
fear (n = 17), or embarrassment in asking for help (n = 14).
Conclusions: The current review shows that symptom attribution to cardiac events and some degree of
perceived threat are fundamental to speed up help-seeking. In contrast, social concerns and barriers in
seeking medical attention (embarrassment or concern for troubling others) may not be as important as
initially thought. The current review also shows that the use of very diverse methodological practices
strongly limits the integration of evidence into meaningful recommendations. We conclude that there is
urgent need for common guidelines for prehospital delay study design and reporting.Juan de la Cierva Fellowship from the Spanish Ministry of Science
FJCI-2016-28279Ministerio de Economia y Competitividad (Spain)
PSI2014-51842-RAndalusian Regional Goverment
SOMM17-6103-UGREuropean Union (EU)
SOMM17-6103-UGRMinisterio de Economia, Industria y Competitividad, Spain
RYC-2016-2015
Who does what the cardiologist recommends? Psychosocial markers of unhealthy behavior in coronary disease patients
Patients diagnosed with coronary heart disease should follow lifestyle recommendations that
can reduce their cardiovascular risk (e.g., avoid smoking). However, some patients fail to follow these recommendations and engage in unhealthy behavior. With the aim to identify psychosocial factors that characterize patients at high risk of repeated cardiovascular events,
we investigated the relationship between social support, mental health (coping, self-esteem,
and perceived stress), and unhealthy behavior. We conducted a cross-sectional study of
419 patients recently diagnosed with coronary heart disease (myocardial infarction or
angina) who participated in the National Health Survey in Spain (2018). Unhealthy behaviors
were defined according to the European Guidelines on cardiovascular disease prevention.
Only 1% of patients reported no unhealthy behaviors, with 11% reporting one, 40% two, 35%
three, and 13% four or more unhealthy behaviors. In multiple regression controlling for
demographic and traditional risk factors, mental health was the only significant psychosocial
factor, doubling the odds of accumulated unhealthy behaviors, OR(high vs. low) = 2.03, 95%
CI [1.14, 3.64]. Mental health was especially strongly related to unhealthy behavior among
patients with obesity, OR(high vs. low) = 3.50, 95% CI [1.49, 8.45]. The relationship between
mental health and unhealthy behaviors suggests that a large proportion of patients may not
adhere to lifestyle recommendations not because they purposefully choose to do so, but
because they lack coping skills to maintain the recommended healthy behaviors. Low mental
well-being may be especially detrimental for behavior change of patients with obesity.Dafina Petrova is supported by a Juan de
la Cierva Fellowship (FJCI-2016-28279) from the
Spanish Ministry of Economy, Industry, and
Competitiveness. The funders had no role in study
design, data collection and analysis, decision to
publish, or preparation of the manuscript
Matrix metalloproteases and TIMPs as prognostic biomarkers in breast cancer patients treated with radiotherapy: A pilot study
Breast cancer (BC) is the most common tumour in women and one of the most
important causes of cancer death worldwide. Radiation therapy (RT) is widely used
for BC treatment. Some proteins have been identified as prognostic factors for BC
(Ki67, p53, E‐cadherin, HER2). In the last years, it has been shown that variations
in the expression of MMPs and TIMPs may contribute to the development of BC.
The aim of this pilot work was to study the effects of RT on different MMPs (‐1, ‐2,
‐3, ‐7, ‐8, ‐9, ‐10, ‐12 and ‐13) and TIMPs (‐1 to ‐4), as well as their relationship with
other variables related to patient characteristics and tumour biology. A group of
20 BC patients treated with RT were recruited. MMP and TIMP serum levels were
analysed by immunoassay before, during and after RT. Our pilot study showed a
slight increase in the levels of most MMP and TIMP with RT. However, RT produced
a significantly decrease in TIMP‐1 and TIMP‐3 levels. Significant correlations were
found between MMP‐3 and TIMP‐4 levels, and some of the variables studied related
to patient characteristics and tumour biology. Moreover, MMP‐9 and TIMP‐3
levels could be predictive of RT toxicity. For this reason, MMP‐3, MMP‐9, TIMP‐3
and TIMP‐4 could be used as potential prognostic and predictive biomarkers for BC
patients treated with RT.FUNDACIÓN PROGRESO Y SALUD,
Grant/Award Number: PI‐730; Instituto
de Salud Carlos III, Grant/Award Number:
PIE16‐00045; Oncología Básica y Clínica,
Grant/Award Number: CTS‐20
Factores psicológicos en la enfermedad coronaria: estudio de la toma de decisiones y comportamiento de salud
La enfermedad coronaria (EC) es la principal causa de muerte en
Europa, causando unas 1.739.000 muertes al año, representando 20% de todas las
muertes. Tiene varias presentaciones clínicas, entre cuales las más frecuentes son los
síndromes coronarios agudos (SCA) y las anginas. El pronóstico de los pacientes con
EC ha mejorado mucho en las últimas décadas gracias a las terapias farmacológicas e
intervenciones médicas. Sin embargo, la toma de decisiones y el comportamiento de los
pacientes también influyen en su pronóstico y por lo tanto pueden ser objetivo de
intervención. En concreto, tanto el comportamiento durante el evento coronario (p.ej., la
decisión de buscar atención médica cuando comiencen los síntomas o demora
prehospitalaria) como el comportamiento tras el evento (p.ej., la decisión de adoptar un
estilo de vida más saludable o comportamiento de salud) pueden influir en el pronóstico,
estado psicológico y calidad de vida de los pacientes. En esta tesis nos centramos en
investigar sobre los factores psicológicos que influyen en la toma de decisiones y el
comportamiento de los pacientes con EC, en concreto la demora prehospitalaria y los
comportamientos de salud.
El objetivo general de esta tesis fue identificar los factores psicológicos
relacionados con la toma de decisiones, el estado psicológico y el comportamiento de
salud de los pacientes con EC durante y después del evento coronario. Los objetivos
específicos fueron identificar factores psicológicos relacionados con a) la demora
prehospitalaria durante el evento coronario, b) el estado psicológico tras el evento
coronario, y c) el comportamiento de salud en el periodo de recuperación y prevención
secundaria.Tesis Univ. Granada
Who does what the cardiologist recommends? Psychosocial markers of unhealthy behavior in coronary disease patients.
Patients diagnosed with coronary heart disease should follow lifestyle recommendations that can reduce their cardiovascular risk (e.g., avoid smoking). However, some patients fail to follow these recommendations and engage in unhealthy behavior. With the aim to identify psychosocial factors that characterize patients at high risk of repeated cardiovascular events, we investigated the relationship between social support, mental health (coping, self-esteem, and perceived stress), and unhealthy behavior. We conducted a cross-sectional study of 419 patients recently diagnosed with coronary heart disease (myocardial infarction or angina) who participated in the National Health Survey in Spain (2018). Unhealthy behaviors were defined according to the European Guidelines on cardiovascular disease prevention. Only 1% of patients reported no unhealthy behaviors, with 11% reporting one, 40% two, 35% three, and 13% four or more unhealthy behaviors. In multiple regression controlling for demographic and traditional risk factors, mental health was the only significant psychosocial factor, doubling the odds of accumulated unhealthy behaviors, OR(high vs. low) = 2.03, 95% CI [1.14, 3.64]. Mental health was especially strongly related to unhealthy behavior among patients with obesity, OR(high vs. low) = 3.50, 95% CI [1.49, 8.45]. The relationship between mental health and unhealthy behaviors suggests that a large proportion of patients may not adhere to lifestyle recommendations not because they purposefully choose to do so, but because they lack coping skills to maintain the recommended healthy behaviors. Low mental well-being may be especially detrimental for behavior change of patients with obesity
Salvage Radiosurgery for Selected Patients with Recurrent Malignant Gliomas
Purpose. To analyse the survival after salvage radiosurgery and to identify prognostic factors. Methods. We retrospectively reviewed 87 consecutive patients, with recurrent high-grade glioma, that underwent stereotactic radiosurgery between 1997 and 2010. We evaluated the survival after initial diagnosis and after reirradiation. The prognostic factors were analysed by bivariate and multivariate Cox regression model. Results. The median age was 48 years old. The primary histology included anaplastic astrocytoma (47%) and glioblastoma (53%). A margin dose of 18 Gy was administered in the majority of cases (74%). The median survival after initial diagnosis was 21 months (39 months for anaplastic astrocytoma and 18.5 months for glioblastoma) and after reirradiation it was 10 months (17 months for anaplastic astrocytoma and 7.5 months for glioblastoma). In the bivariate analyses, the prognostic factors significantly associated with survival after reirradiation were age, tumour and treatment volume at recurrence, recursive partitioning analyses classification, Karnofsky performance score, histology, and margin to the planning target volume. Only the last four showed significant association in the multivariate analyses. Conclusion. stereotactic radiosurgery is a safe and may be an effective treatment option for selected patients diagnosed with recurrent high-grade glioma. The identified prognostic factors could help individualise the treatment