Cancer-related fatigue in a couples’ context:The role of daily cognitions and partner behaviors

The group of people living with a history of cancer is growing. Fatigue is not only among the most prevalent symptoms cancer patients experience, it also impairs their quality of life and can remain for years after completion of treatment. Evidence suggests that cancer and its treatment initially trigger fatigue, but how patients and their partners cope explains how fatigue remains. In this thesis, we examined how patients’ and their partners’ daily cognitions and behaviors impact patients’ cancer-related fatigue and also the couples’ relationship. To study this, colorectal cancer survivors and their partners (n = 101) filled in digital diaries during 14 days about their daily coping with fatigue. The results showed that both patients’ and partners’ negative thoughts about fatigue (e.g., ‘I cannot bear my (partner’s) fatigue any longer’) worsened patients’ fatigue. Negative thoughts of partners could worsen patients’ fatigue because these lead to couples’ ruminative conversations about fatigue. The way partners responded to patients’ behaviors (e.g., resting or being active despite fatigue) influenced patients’ fatigue burden as well as their relationship satisfaction. Responses that encouraged resting worsened fatigue, but were beneficial for the relationship. The only response that had positive outcomes for patients’ fatigue as well as their relationship satisfaction were partners’ encouragement for patients to be active. These results on the impact of daily coping processes can help us improve the treatment of fatigue in cancer survivors. Effective treatment should involve the patients’ partners and target couples’ negative thoughts about fatigue, their ruminative conversations and partner responses

Feasibility, usability and clinical value of intensive longitudinal diary assessments in older persons with cognitive impairment and depressive symptoms

OBJECTIVES: To evaluate the feasibility, usability and clinical value of daily diary assessments combined with actigraphy in older persons with cognitive impairment.METHODS: For 63 days, patients ≥60 years with cognitive impairments filled out a daily diary (including standardized questionnaires and cognitive test battery), and wore an actiwatch (sleep). After the study, participants and clinicians received personal feedback about patterns and daily triggers of depressive symptoms, sleep and cognitive performance. We assessed feasibility (participation rate, compliance and subjective burden), usability (variability and floor- or ceiling effects) and clinical value for patients and their clinicians (questionnaires).RESULTS: Of 96 eligible patients, 13 agreed to participate (13.5%). One patient dropped out after 2 days, another after 37 days, and another did not complete the cognitive test battery. Compliance rate was high (6.7-10% missing values). Subjective burden was relatively low. Time-series data showed sufficient variability and no floor- or ceiling effects, except for one relevant ceiling effect on the One Back task. The personal feedback report was considered insightful by 4 out of 11 participants and 5 out of 7 clinicians.CONCLUSION: Daily assessments are suitable for a minority of cognitively impaired older persons, but is helpful to increase insight into their symptoms.</p

“Não é como hoje em dia, era tudo muito mais difícil”: a chegada da energia elétrica na localidade de Linha Sítio, Cruzeiro do Sul (Rio Grande do Sul - Brasil)

The present article makes some reflections regarding the arrival of electric power in a small locality in the coutryside of the municipality of Cruzeiro do Sul/RS. The electric power was installed in the locality of Linha Sítio in the 1960s, and it was necessary to integration and cooperativism of the population in order for the project to materialize. The objective of this research is to understand how this transformation was marked in the memory of local residents who experienced the change. The interviews were based on the method of Oral History and combined with bibliographical references on the installation of electric energy in Brazil. The concept of memory is also part of the analysis of the interviews, given that it helps in their problematization. The obtained results allow to infer that, from the perspective of the interviewees, the process of electrification of the community did not happen quickly and was responsible for significant changes in the daily life of these people, which convey a positive feeling in relation to the technology that gave a more dynamic way of life.Resumo: O presente artigo realiza algumas reflexões a respeito da chegada da energia elétrica em uma pequena localidade rural no interior do município de Cruzeiro do Sul/RS. A energia elétrica foi instalada na localidade de Linha Sítio na década de 1960, e foi necessária a integração e o cooperativismo da população para que o projeto se concretizasse. O objetivo desta pesquisa é perceber como essa transformação ficou marcada na memória de moradores locais que vivenciaram a mudança. As entrevistas realizadas foram pautadas no método da História Oral e combinadas com referências bibliográficas sobre a instalação da energia elétrica no Brasil. O conceito de memória também faz parte da análise dos relatos, tendo em vista que auxilia na problematização das mesmas. Os resultados alcançados permitem inferir que, a partir da perspectiva dos entrevistados, o processo de eletrificação da comunidade não se deu de maneira rápida e foi responsável por mudanças significativas no cotidiano dessas pessoas, as quais transmitem um sentimento positivo em relação à tecnologia que oportunizou um modo de vida mais dinâmico. Palavras-Chave: Energia Elétrica. História Oral. Memória

On the Computation of the Trace Form of Some Galois Extensions

AbstractWe investigate the trace form trL/K:L→K:x↦trL/Kx2of a finite Galois extensionL/K. In particular, we study 2-extensions of degree ≤16. Using some reduction theorems, these results yield a classification of nearly all trace forms of Galois extensions of degree ≤31. Finally, we study the trace form of a cyclotomic extension and of its maximal real subfield

Potential mechanisms of the fatigue-reducing effect of cognitive-behavioral therapy in cancer survivors:Three randomized controlled trials

OBJECTIVE: Fatigue is a common symptom among cancer survivors that can be successfully treated with cognitive‐behavioral therapy (CBT). Insights into the working mechanisms of CBT are currently limited. The aim of this study was to investigate whether improvements in targeted cognitive‐behavioral variables and reduced depressive symptoms mediate the fatigue‐reducing effect of CBT. METHODS: We pooled data from three randomized controlled trials that tested the efficacy of CBT to reduce severe fatigue. In all three trials, fatigue severity (checklist individual strength) decreased significantly following CBT. Assessments were conducted pre‐treatment and 6 months later. Classical mediation analysis testing a pre‐specified model was conducted and its results compared to those of causal discovery, an explorative data‐driven approach testing all possible causal associations and retaining the most likely model. RESULTS: Data from 250 cancer survivors (n = 129 CBT, n = 121 waitlist) were analyzed. Classical mediation analysis suggests that increased self‐efficacy and decreased fatigue catastrophizing, focusing on symptoms, perceived problems with activity and depressive symptoms mediate the reduction of fatigue brought by CBT. Conversely, causal discovery and post‐hoc analyses indicate that fatigue acts as mediator, not outcome, of changes in cognitions, sleep disturbance and depressive symptoms. CONCLUSIONS: Cognitions, sleep disturbance and depressive symptoms improve during CBT. When assessed pre‐ and post‐treatment, fatigue acts as a mediator, not outcome, of these improvements. It seems likely that the working mechanism of CBT is not a one‐way causal effect but a dynamic reciprocal process. Trials integrating intermittent assessments are needed to shed light on these mechanisms and inform optimization of CBT

The diacylglycerol kinase α/Atypical PKC/β1 integrin pathway in SDF-1α mammary carcinoma invasiveness

Diacylglycerol kinase α (DGKα), by phosphorylating diacylglycerol into phosphatidic acid, provides a key signal driving cell migration and matrix invasion. We previously demonstrated that in epithelial cells activation of DGKα activity promotes cytoskeletal remodeling and matrix invasion by recruiting atypical PKC at ruffling sites and by promoting RCP-mediated recycling of α5β1 integrin to the tip of pseudopods. In here we investigate the signaling pathway by which DGKα mediates SDF-1α-induced matrix invasion of MDA-MB-231 invasive breast carcinoma cells. Indeed we showed that, following SDF-1α stimulation, DGKα is activated and localized at cell protrusion, thus promoting their elongation and mediating SDF-1α induced MMP-9 metalloproteinase secretion and matrix invasion. Phosphatidic acid generated by DGKα promotes localization at cell protrusions of atypical PKCs which play an essential role downstream of DGKα by promoting Rac-mediated protrusion elongation and localized recruitment of β1 integrin and MMP-9. We finally demonstrate that activation of DGKα, atypical PKCs signaling and β1 integrin are all essential for MDA-MB-231 invasiveness. These data indicates the existence of a SDF-1α induced DGKα - atypical PKC - β1 integrin signaling pathway, which is essential for matrix invasion of carcinoma cells