Influencia de las características demográficas y variables clínicas en la percepción de apoyo social en pacientes con cáncer

The purpose of this study was to evaluate how socio-demographic and clinical variables were related to the different dimensions of perceived social support in cancer patients receiving oncology treatment. The sample included 740 cancer out-patients. Socio-demographic and clinical predictors showed lower levels of variance in each dimension of social support. Patients reported less perceived instrumental support at a longer duration since diagnosis. Women perceived less instrumental support than men (p < 0.01). Also, significant group differences were observed for patients who were married compared with non partnered. Patients with personal psychiatric antecedents compared with non psychiatric antecedent, perceived significantly less Emotional/Informational (p < 0.01) and Affective support (p < 0.01), in addition to lower scores in overall index of social support (p < 0.01). The findings pointed that, assessing socio-demographic and illness-related characteristics of cancer patients can allow us a better understanding of the differences of perceived social support.El objetivo de este estudio fue evaluar cómo las características socio-demográficas y clínicas, estaban relacionadas con diferentes dimensiones de apoyo social percibido en pacientes con cáncer durante el tratamiento oncológico. Formaban la muestra 740 pacientes con cáncer. Las características socio-demográficas y clínicas eran poco predictoras de la varianza en cada dimensión de apoyo social. Los pacientes informaban menor percepción de apoyo instrumental a mayor tiempo transcurrido del diagnóstico. Las mujeres percibían menos apoyo instrumental que los hombres (p < 0.01). Con diferencias significativa entre pacientes casados y aquellos sin pareja. Los pacientes con antecedentes psiquiátricos percibían menos apoyo Emocional/Informacional (p < 0.01) y Afectivo (p < 0.01), además de bajas puntuaciones en el índice general de apoyo social (p < 0.01). Los resultados señalan que, la valoración socio-demográfica y de variables relacionadas con la enfermedad en pacientes con cáncer puede ayudar a un mejor entendimiento de las diferencias en apoyo social percibido

Calidad de vida en pacientes con dolor lumbar crónico

Objetivo: describir la calidad de vida en relación a la salud (CVRS) de pacientes lumbalgia crónica inespecífica, así como su relación con distintas variables médicas, socio-demográficas y psicosociales. Diseño: estudio descriptivo- correlacional transversal. Participantes: 94 pacientes con dolor lumbar crónico inespecífico pertenecientes al área de Rehabilitación (Algias) del hospital de referencia. Instrumentos de evaluación: los datos médicos y socio-demográficos fueron obtenidos a partir de las historias clínicas y de una entrevista semi-estructurada. Asimismo, se administraron cuestionarios de CVRS, dolor auto-percibido, discapacidad, sintomatología ansioso-depresiva, apoyo social y satisfacción vital. Resultados: el aspecto físico de la CVRS fue el más deteriorado y éste estuvo explicado en gran parte (R2 =47.3%) por la edad del paciente y su disfunción valorada a partir de la escala Oswestry. Asimismo, el aspecto mental de la CVRS, que se mostró más cercano al promedio poblacional, se explicó por la disfunción y la ansiedad-rasgo (STAI/R) de los pacientes (R2 =47.3%). Conclusiones: la disfunción, la edad y la ansiedad-rasgo de los participantes con lumbalgia crónica han mostrado ser factores clave para explicar su CVRS global. Así pues, es preciso tomarlos en consideración a la hora de favorecer un adecuado abordaje integral y multidisciplinar de esta población.Objective: To describe health-related quality of life in (HRQoL) in a sample of patients with nonspecific chronic low back pain, and their relationship with various medical, socio-demographic and psychosocial variables. Design: Descriptive- correlational cross-sectional study. Participants: A total of 94 patients with nonspecific chronic low back pain treated in the Rehabilitation Department from the reference hospital. Assessment tools: Medical and socio-demographic data were obtained from medical records and a semi-structured interview. Furthermore, HRQoL, self-perceived pain, functional disability, anxiety-depressive symptoms, social support and life satisfaction questionnaires were administered. Results: The physical domain of HRQoL was the most impaired and it was largely explained (R2 = 47.3%) by patient age and functional dysfunction assessed by means of the Oswestry scale. Similarly, the mental domain of HRQoL, that showed average mean scores more similar to normative population, was also explained by functional dysfunction and anxiety trait (STAI/T) of patients (R2 = 47.3%). Conclusions: Functional dysfunction, age and anxiety trait of participants with chronic low back pain have been shown to be key factors in explaining their overall HRQoL. Thus, these factors should be properly consider

A propósito de un caso: supresión emocional en estado avanzado de la enfermedad.

La supresión emocionalse ha definido como un mecanismo predictorde la respuesta de afrontamiento a enfermedades físicas,pudiendo bloquear en la persona el desarrollo deestrategias activas para el manejo de sus emociones.Se expone el caso de una mujer de 59 años que durantelos últimos años presenta una clínica somaticadifusa. Su historia vital de pérdidas significativas, ysu tendencia a la supresión emocional como estrategiabàsica de afrontamiento, enmascararon un cuadrodepresivo cronificado, dificultando la atención y tratamientomedico, así como retrasaron el diagnósticocertero de la enfermedad. Se plantea la importancia deevaluar con prontitud estas posibles dificultades emocionales,de manera que puedan rescatarse estrategiasde afrontamiento positivas que permitan al paciente unadecuado manejo de la enfermedad y de conductas debúsqueda de salud

Propiedades psicométricas de la escala revisada del impacto del evento estresante (IES-R) en una muestra española de pacientes con cáncer

La Escala del Impacto Esfresante y su versión revisada (IES-R) han sido utilizadas para evaluar slntomatologla en trastornos de ansiedad. El objetivo de este estudio es analizar las propiedades psicométricas de la versión espal1o/a del IESR y averiguar su punto de corte para discriminar malestar emocional significativo. Un total de 193 pacientes ambulatorios con cáncer cumplimentan la escala IES-R y se les evalúa con la entrevista psiquiátrica. Se realiza un análisis factorial exploratorio como aproximación a la estructura interna del cuestionario, seguido de un análisis factorial confirmatorio para calcular la bondad de ajuste de la dimensionalidad del cuestionario. La exactitud discriminatoria de una prueba para un determinado punto de corte se halla con la curva ROC (<<Receivíng Operate Curve»). En pacientes con cáncer el modelo con parámetros de bondad de ajuste adecuados es el formado por dos dimensiones: intrusión/hiperactivación y evitación ()(2 = 166, 11; g./: 188), explican el 39, 77% de la varianza total. Con la curva ROC los in dices de sensibilidad y especificidad no ofrecen una exactitud aceptable en los puntos de corte para discn'minar casos c/lnicos. En la comparación de medias de la puntuación total de la escala IES-R entre pacientes con diagnostico de trastorno psiquiátn'co (X= 20,08; Sdx= 1,27) ypacientes sin diagnostico de trastorno psiquiátrico IX= 14,4; Sdx= 0,88) las diferencias son significativas T= 3,78 (P<0,001). La escala IES-R es un instrumento con adecuadas propiedades psicométn'cas pero que en pacientes con cáncer no consigue replicar la estructura 'acton'al propuesta desde el modelo teón'co del que surge.The impact of event scale and the revised version (IES-R) have been used to assess cases with anxious disorders. The main objective in this study is to analyse the psychometric properties in the IES-R Spanish version, and to determine the cut-off score to detect cases with high level of di stress. A total of 193 out-patients cancer completed the IES-R, and were assessed throl.!gh a psychlatric in terview. We did an exploratory fa cton'a I analysls to evaluate the Internal structure in this scale, and a conflrmatory factorial analysis to determine the adjustment goodness of the dimensionality in thls scale. The discrlminatoryexactitude of a scale for a cut-off score is determlned through the receiving operate curve (ROC). In patients wlth cancer, the model with fit adjustment goodness ís composed by two dimenslons: intruslon/ hyperactivation and avoidance (X2=166, 11; g.I:188), that explain 39,77% o, the total variance. With the ROC ahalysls, the sensibility and specificity scores not offer an acceptable accuracy in the cut-off scores to detect cllnical cases. The differeríces in the mean companson between the total score of the IES-R in patients with psychiatric disorders (X=20,08; DS=1,27) and non-psychiatric diagnosis (X= 14, 4; DS=0,88) were signiflcant (T=3,78;P<0,001). The IES-R is an instrument wffh satisfactory psychometric propertles but the factor structure of the translation in caneer patlents was not similar to the proposed theoretical structure o, the IES-R

Perfil de personalidad en pacientes con trasplante renal: el modelo alternativo de los cinco factores

Background: There is limited research on personality traits that characterized kidney transplant patients. The aim of this study was to describe personality profile of kidney transplant patients using the Alternative Five Factor Model (AFFM), and compared it with the Spanish standard population. Method: Personality was assessed using the Zuckerman-Kuhlman Personality Questionnaire (ZKPQ). A sample of 207 kidney transplant patients was matched by age and gender with 207 standard range controls. A logistic regression analyses was utilized to study the contribution of each ZKPQ dimension to describe the distinctive transplant patient’s profile. Results: Significant differences were showed in Neuroticism-Anxiety (p=.001), Aggression-Hostility (p=.009), and Activity (p=.001) dimensions, with lower scores on transplant patients compared with standard population. But Sociability (p=.024) was significantly higher on kidney transplant patients. In logistic regression analysis low scores on Neuroticism-Anxiety (p=.005) and Activity (p=.001) were the significant predictors to characterize personality traits of kidney transplant patients. Conclusions: Kidney transplant patients had a differential profile under the AFFM compared to standardrange sample, with lower scores on Neuroticism-Anxiety and Activity dimensions.Introducción: la investigación sobre rasgos de personalidad en pacientes con trasplante renal es limitada. El objetivo de este estudio fue describir el perfil de personalidad de pacientes con trasplante renal, utilizando el modelo alternativo de cinco factores (AFFM), y compararlo con población estándar española. Material y métodos: la personalidad fue evaluada mediante el Zuckerman-Kuhlman Personality Questionnaire (ZKPQ). Una muestra de 207 pacientes con trasplante renal se emparejó por edad y género con 207controles de la población estándar. El análisis de regresión logística permitió estudiar la aportación de cada dimensión del ZKPQ al perfil distintivo de los pacientes trasplantados. Resultados: aparecieron diferencias significativas en las dimensiones de Neuroticismo-Ansiedad (p=.001), Agresión-Hostilidad (p=.009) y Actividad (p=.001), con puntuaciones bajas en pacientes trasplantados en comparación con la población estándar. La sociabilidad (p=.024) fue significativamente mayor en pacientes trasplantados. En el análisis de regresión, las bajas puntuaciones en Neuroticismo-Ansiedad (p=.005) y Actividad (p=.001) fueron predictores significativos para caracterizar los rasgos de personalidad de pacientes trasplantados. Conclusiones: desde el AFFM, los pacientes con trasplante renal muestran un perfil diferente de personalidad comparado con la población estándar, con bajas puntuaciones en las dimensiones de Neuroticismo-Ansiedad y Actividad

Caching Using Software-Defined Networking in LTE Networks

Research ReportThe data consumption is increasing rapidly in mobile net- works. The cost of network infrastructure is increasing, which will lead to an ”end of profit” within next few years. Thus, mobile operators require technology that allows in- creasing the network capacity within low network costs. There- fore, using caching is the most evident solution to be used in their backhaul networks. However, the current architec- ture of LTE network does not provide sucient flexibility to place the caches in the most optimal locations. The current work on Software-Defined Networking in Evolved Packet Core virtualization has enabled us to integrate dy- namically the caching functionality in a LTE network and improve the caching system performance. In this paper, we present the solution we designed for this aim based on Soft- ware Defined Networking technology. Moreover, we developa testbed for the proof-of-concept and we present perfor- mance analysis of this solution

Engaging Users in the Behavior Change Process With Digitalized Motivational Interviewing and Gamification : Development and Feasibility Testing of the Precious App

Background: Most adults do not engage in sufficient physical activity to maintain good health. Smartphone apps are increasingly used to support physical activity but typically focus on tracking behaviors with no support for the complex process of behavior change. Tracking features do not engage all users, and apps could better reach their targets by engaging users in reflecting their reasons, capabilities, and opportunities to change. Motivational interviewing supports this active engagement in self-reflection and self-regulation by fostering psychological needs proposed by the self-determination theory (ie, autonomy, competence, and relatedness). However, it is unknown whether digitalized motivational interviewing in a smartphone app engages users in this process. Objective: This study aimed to describe the theory- and evidence-based development of the Precious app and to examine how digitalized motivational interviewing using a smartphone app engages users in the behavior change process. Specifically, we aimed to determine if use of the Precious app elicits change talk in participants and how they perceive autonomy support in the app. Methods: A multidisciplinary team built the Precious app to support engagement in the behavior change process. The Precious app targets reflective processes with motivational interviewing and spontaneous processes with gamified tools, and builds on the principles of self-determination theory and control theory by using 7 relational techniques and 12 behavior change techniques. The feasibility of the app was tested among 12 adults, who were asked to interact with the prototype and think aloud. Semistructured interviews allowed participants to extend their statements. Participants’ interactions with the app were video recorded, transcribed, and analyzed with deductive thematic analysis to identify the theoretical themes related to autonomy support and change talk. Results: Participants valued the autonomy supportive features in the Precious app (eg, freedom to pursue personally relevant goals and receive tailored feedback). We identified the following five themes based on the theory-based theme autonomy support: valuing the chance to choose, concern about lack of autonomy, expecting controlling features, autonomous goals, and autonomy supportive feedback. The motivational interviewing features actively engaged participants in reflecting their outcome goals and reasons for activity, producing several types of change talk and very little sustain talk. The types of change talk identified were desire, need, reasons, ability, commitment, and taking steps toward change. Conclusions: The Precious app takes a unique approach to engage users in the behavior change process by targeting both reflective and spontaneous processes. It allows motivational interviewing in a mobile form, supports psychological needs with relational techniques, and targets intrinsic motivation with gamified elements. The motivational interviewing approach shows promise, but the impact of its interactive features and tailored feedback needs to be studied over time. The Precious app is undergoing testing in a series of n-of-1 randomized controlled trials. KEYWORDS health app; mHealth; human-computer interaction; prevention; service design; usability design; intrinsic motivation; reflective processes; spontaneous processes; engagement; self-determination theory; autonomous motivation; gamification; physical activityPeer reviewe

Dimensões subjetivas na Saúde Digital

As heterogêneas e contraditórias estruturas do capitalismo global vêm moldando de diferentes formas os significados sociais acerca da Saúde Digital e, com isso, também seu desenvolvimento e regulação. Para uma melhor compreensão destas questões, nesta revisão de literatura destacamos que tais estruturas contêm certas dimensões subjetivas que precisam ser investigadas de forma mais detida. Para isso, analisamos como a Saúde Digital se torna um espaço tanto de expansão das potencialidades humanas quanto para o acirramento dessas contradições estruturais. Discutimos como os modos de governamentalidade capitalista seriam atualizados junto a esses movimentos, moldando subjetivamente patologias, pacientes e o cuidado em saúde. Analisamos como esses processos podem se desdobrar em técnicas comportamentais que podem ser embarcadas em dispositivos e aplicativos de saúde e bem-estar, bem como suas consequências e riscos potenciais, o que exige atenção regulatória com participação socia

HTLV infection in HCV-antibody positive patients in Spain.

Since hepatitis C virus (HCV) and human T-lymphotropic virus (HTLV) share transmission routes, dual infection could be frequent. In Spain, HTLV underdiagnosis is highlighted by the high proportion of patients presenting either with tropical spastic paraparesis or adult T cell leukemia at first diagnosis. We examined whether the renewed efforts for expanding HCV testing may provide a sentinel population that might selectively be targeted to unveil asymptomatic HTLV carriers. The presence of anti-HTLV antibodies was examined in 3,838 consecutive individuals with reactive HCV serology attended during the last 3 years at 13 hospitals distributed across the Spanish geography. Overall 71% were male, and the median age was 41 years old. Foreigners represented 9% of the study population. A total of 50 individuals (1.3%) were seroreactive for HTLV, being 30 confirmed as HTLV-2 and 2 as HTLV-1 (0.12%). The remaining 18 had indeterminate Western blot patterns. Most individuals with HTLV-2 and HTLV indeterminate serology were human immunodeficiency virus positive, former injection drug users, and native Spaniards. In contrast, the two HTLV-1 infections were found in men coming from Brazil and the Dominican Republic, respectively. In summary, the overall prevalence of HTLV infection in individuals living in Spain seropositive for HCV is 1.3%, more than 10-fold greater than in general outclinics in Spain. However, immigrants from HTLV-1 endemic regions and former injection drug users with HTLV-2 infection are by far the major contributory groups in HCV patients. Therefore, testing for HTLV in newly diagnosed HCV individuals would not contribute much to improve late HTLV diagnosis in Spain