Role of the arts in the life and mental health of young people that participate in artistic organizations in Colombia: a qualitative study

Q2Q1Background: Adolescents and young adults are vulnerable to developing mental distress. However, evidence suggests that more than half of the young people with symptoms of depression and anxiety overcome their distress within a year. However, there is little research on the exact resources that young people use and help them to recover. The aim of this study was to explore how arts activities can support the recovery of young people engaged with arts organizations in Bogota. Methods: We recruited 38 participants from two arts organizations in Bogotá and conducted six focus groups embedded within artistic workshops. The type of activities in the workshops varied reflecting the different teaching methods of the two organizations. The focus group discussions were recorded and analyzed using thematic analysis. Results: Five themes explained how arts activities can help young people participating in artistic organizations to overcome mental distress: i) allowing the expression of emotions; ii) helping to manage and transform emotions; iii) distracting from problems; iv) facilitating social support and relationships; and v) contributing to the identity of young people. Conclusions: For young people who participate in artistic organizations, the arts are a resource for overcoming negative emotions such as anxiety, depression, and sadness. The beneficial role of arts activities includes different process of managing, expressing, and distracting from distress, and it differs depending on whether arts are perceived as a professional vocation or a hobby.https://orcid.org/0000-0002-9013-5384https://orcid.org/0000-0002-9682-2759https://orcid.org/0000-0003-4284-7886Revista Internacional - IndexadaA1N

Self-Reported Health Problems and Quality of Life in a Sample of Colombian Childhood Cancer Survivors : A Descriptive Cross-Sectional Study

Objetivos: Describir los problemas de salud y calidad de vida auto-referidos entre adultos colombianos sobrevivientes de cáncer infantil y adolescente. Métodos: Este es un estudio transversal descriptivo con sobrevivientes de cáncer infantil (CCS) colombianos que fueron diagnosticados antes de los 18 años, al momento del estudio tenían ≥18 años y habían pasado al menos 5 años desde el diagnóstico. Cada participante completó un cuestionario en línea específico del estudio autoinformado junto con la Encuesta de salud SF-36 para evaluar la prevalencia de los problemas de salud y la calidad de vida actual (QoL). Los datos se analizaron mediante estadística descriptiva y muestra independiente t-pruebas. Resultados: De los 122 CCS que participaron, el 100% reportó al menos un problema de salud, principalmente gastritis, dolores de cabeza y falta de concentración, seguidos de obesidad y problemas de fertilidad. En general, tenían una buena percepción de su CdV, que, en promedio, solo estaba disminuida en las áreas de vitalidad, función emocional y función social. Conclusión: Los problemas de salud percibidos entre las CCS colombianas participantes fueron prevalentes; la mayoría reportó una buena calidad de vida autopercibida. Este es el primer estudio sobre la comprensión de los problemas de salud y la calidad de vida de los CCS tratados en Colombia y América del Sur. Se reabre el debate sobre la necesidad de realizar un seguimiento a largo plazo en esta población entre la sociedad colombiana.Q1Objectives: To describe the self-reported health problems and quality of life among adult-aged Colombian childhood and adolescent cancer survivors. Methods: This is a descriptive cross-sectional study with Colombian childhood cancer survivors (CCS) who were diagnosed before the age of 18, at the moment of study were ≥18 years, and at least 5 years had passed since diagnosis. Each participant completed a self-reported study-specific online questionnaire along with the SF-36 Health Survey to assess the prevalence of health problems and current quality of life (QoL). Data were analyzed using descriptive statistics and independent sample t-tests. Results: Out of the 122 CCS who participated, 100% reported at least one health problem, mostly gastritis, headaches, and lack of concentration, followed by obesity and fertility issues. In general, they had a good perception of their QoL, which was, on average, only diminished in the areas of vitality, emotional role functioning, and social functioning. Conclusion: Perceived health problems among the participating Colombian CCS were prevalent; most reported a good self-perceived QoL. This is the first study on understanding health problems and QoL of CCS treated in Colombia and South America. It reopens the debate on the need to carry out long-term follow-up in this population among Colombian societyhttps://orcid.org/0000-0002-1262-6436https://orcid.org/0000-0002-5560-2258Revista Internacional - IndexadaS

Beyond the cure: the need to implement a long-term follow-up system for childhood cancer survivors in Colombia

Con el advenimiento de tratamientos multidisciplinarios y de alta calidad, la supervivencia global a cinco años por cáncer en la población pediátrica ha mejorado considerablemente, llegando a ser hasta de 80% en países de altos ingresos. En Colombia también ha habido un aumento progresivo de la supervivencia global a 5 años, particularmente para las neoplasias hematológicas. En consecuencia, el número de supervivientes de cáncer infantil ha aumentado de forma importante en los últimos años y junto con ellos la aparición de eventos adversos tardíos relacionados con mayor morbilidad y riesgo de muerte prematura en la edad adulta. Aunque se han venido implementando estrategias de seguimiento a supervivientes de cáncer infantil en países de altos ingresos, en Colombia se han realizado pocos esfuerzos para la implementación de estas estrategias. De hecho, la práctica común en la mayoría de los centros de tratamiento consiste en dar de alta al niño que cumple 5 años de seguimiento oncológico, sin instrucciones precisas para dicho seguimiento. El objetivo del presente trabajo es argumentar sobre la necesidad de diseñar e implementar estrategias de seguimiento para supervivientes de cáncer infantil en el contexto colombiano.Q4InfantesWith the advent of high-quality multidisciplinary treatments, the overall 5-year cancer survival in the pediatric population has improved considerably, reaching up to 80% in high-income countries. In Colombia, there has also been a progressive increase in overall 5-year survival, particularly for hematologic malignancies. Consequently, the number of childhood cancer survivors has increased significantly in recent years and, together with them, the occurrence of late adverse events related to increased morbidity and risk of premature death in adulthood. Although follow-up strategies have been implemented for childhood cancer survivors in high-income countries, few efforts have been made in Colombia to implement these strategies. In fact, the common practice in most treatment centers is to discharge children who have had 5 years of cancer follow-up, without precise instructions for long-term follow-up. This paper aims to argue about the need to design and implement follow-up strategies for survivors of childhood cancer in the Colombian context.https://orcid.org/0000-0002-1262-6436https://orcid.org/0000-0002-5560-2258Revista Nacional - IndexadaN

Importancia de la intersectorialidad en la investigación para la salud: conectando comunidades, científicos y tomadores de decisiones

Fragmento. El concepto de intersectorialidad, aplicado al campo de la salud en la región de las Américas, tiene sus bases en la Declaración Salud para Todos de Alma-Ata de 1978. En ese documento, se enfatizó sobre la estrategia de atención primaria y la búsqueda de equidad en salud, resaltando que la intersectorialidad «entraña la participación, además del sector sanitario, de todos los sectores y campos de actividad conexos del desarrollo nacional y comunitario […]». De esa manera 39 años después, el reto de la intersectorialidad sigue vigente tal y como se expresa en la estrategia de investigación para la salud de la Organización Mundial de la Salud (OMS), en la que se destaca la necesidad de incorporar los hallazgos de la investigación científica en las políticas públicas, la promoción y en la atención médica. Siguiendo esa línea, la falta de implementación de medidas e intervenciones, cuya eficacia y costo-efectividad han sido demostradas, genera un impacto negativo en la salud y por ende en la economía de los países tanto con altos como bajos ingresos. En ese sentido, se reconoce que la limitada comunicación entre los actores de los diferentes sectores constituye la barrera más importante para la implementación de los resultados de las investigaciones y su incorporación en el diseño de las políticas públicas. En efecto, la interacción promovida por la intersectorialidad beneficia la comunicación y la generación de políticas de salud pública

Needle gauge and tip designs for preventing post-dural puncture headache (PDPH)

Background: Post-dural puncture headache (PDPH) is one of the most common complications of diagnostic and therapeutic lumbar punctures. PDPH is defined as any headache occurring after a lumbar puncture that worsens within 15 minutes of sitting or standing and is relieved within 15 minutes of the patient lying down. Researchers have suggested many types of interventions to help prevent PDPH. It has been suggested that aspects such as needle tip and gauge can be modified to decrease the incidence of PDPH. Objectives: To assess the effects of needle tip design (traumatic versus atraumatic) and diameter (gauge) on the prevention of PDPH in participants who have undergone dural puncture for diagnostic or therapeutic causes. Search methods: We searched CENTRAL, MEDLINE, Embase, CINAHL and LILACS, as well as trial registries via the World Health Organization (WHO) International Clinical Trials Registry Platform (ICTRP) search portal in September 2016. We adopted the MEDLINE strategy for searching the other databases. The search terms we used were a combination of thesaurus-based and free-text terms for both interventions (lumbar puncture in neurological, anaesthesia or myelography settings) and headache. Selection criteria: We included randomized controlled trials (RCTs) conducted in any clinical/research setting where dural puncture had been used in participants of all ages and both genders, which compared different tip designs or diameters for prevention of PDPH Data collection and analysis: We used the standard methodological procedures expected by Cochrane. Main results: We included 70 studies in the review; 66 studies with 17,067 participants were included in the quantitative analysis. An additional 18 studies are awaiting classification and 12 are ongoing. Fifteen of the 18 studies awaiting classification mainly correspond to congress summaries published before 2010, in which the available information does not allow the complete evaluation of all their risks of bias and characteristics. Our main outcome was prevention of PDPH, but we also assessed the onset of severe PDPH, headache in general and adverse events. The quality of evidence was moderate for most of the outcomes mainly due to risk of bias issues. For the analysis, we undertook three main comparisons: 1) traumatic needles versus atraumatic needles; 2) larger gauge traumatic needles versus smaller gauge traumatic needles; and 3) larger gauge atraumatic needles versus smaller gauge atraumatic needles. For each main comparison, if data were available, we performed a subgroup analysis evaluating lumbar puncture indication, age and posture. For the first comparison, the use of traumatic needles showed a higher risk of onset of PDPH compared to atraumatic needles (36 studies, 9378 participants, risk ratio (RR) 2.14, 95% confidence interval (CI) 1.72 to 2.67, I2 = 9%). In the second comparison of traumatic needles, studies comparing various sizes of large and small gauges showed no significant difference in effects in terms of risk of PDPH, with the exception of one study comparing 26 and 27 gauge needles (one study, 658 participants, RR 6.47, 95% CI 2.55 to 16.43). In the third comparison of atraumatic needles, studies comparing various sizes of large and small gauges showed no significant difference in effects in terms of risk of PDPH. We observed no significant difference in the risk of paraesthesia, backache, severe PDPH and any headache between traumatic and atraumatic needles. Sensitivity analyses of PDPH results between traumatic and atraumatic needles omitting high risk of bias studies showed similar results regarding the benefit of atraumatic needles in the prevention of PDPH (three studies, RR 2.78, 95% CI 1.26 to 6.15; I2 = 51%). Authors' conclusions: There is moderate-quality evidence that atraumatic needles reduce the risk of post-dural puncture headache (PDPH) without increasing adverse events such as paraesthesia or backache. The studies did not report very clearly on aspects related to randomization, such as random sequence generation and allocation concealment, making it difficult to interpret the risk of bias in the included studies. The moderate quality of the evidence for traumatic versus atraumatic needles suggests that further research is likely to have an important impact on our confidence in the estimate of effect.Fil: Arevalo-Rodriguez, Ingrid. Fundación Universitaria de Ciencias de la Salud; Colombia. Universidad Tecnologica Equinoccial; EcuadorFil: Muñoz, Luis. Hospital de San Jose; ColombiaFil: Godoy-Casasbuenas, Natalia. Hospital de San Jose; ColombiaFil: Ciapponi, Agustín. Consejo Nacional de Investigaciones Científicas y Técnicas. Oficina de Coordinación Administrativa Parque Centenario. Centro de Investigaciones en Epidemiología y Salud Pública. Instituto de Efectividad Clínica y Sanitaria. Centro de Investigaciones en Epidemiología y Salud Pública; ArgentinaFil: Arevalo, Jimmy J.. VU University Medical Center; Países BajosFil: Boogaard, Sabine. VU University Medical Center; Países BajosFil: Roquéi Figuls, Marta. Iberamerican Cochrane Centre; Españ

Decision making in the end-of-life care of patients who are terminally ill with cancer – a qualitative descriptive study with a phenomenological approach from the experience of healthcare workers

Background: In Colombia, recent legislation regarding end-of-life decisions includes palliative sedation, advance directives and euthanasia. We analysed which aspects influence health professionals´ decisions regarding end-of-life medical decisions and care for cancer patients. Methods: Qualitative descriptive–exploratory study based on phenomenology using semi-structured interviews. We interviewed 28 oncologists, palliative care specialists, general practitioners and nurses from three major Colombian institutions, all involved in end-of-life care of cancer patients: Hospital Universitario San Ignacio and Instituto Nacional de Cancerología in Bogotá and Hospital Universitario San José in Popayan. Results: When making decisions regarding end-of-life care, professionals consider: 1. Patient’s clinical condition, cultural and social context, in particular treating indigenous patients requires special skills. 2. Professional skills and expertise: training in palliative care and experience in discussing end-of-life options and fear of legal consequences. Physicians indicate that many patients deny their imminent death which hampers shared decision-making and conversations. They mention frequent ambiguity regarding who initiates conversations regarding end-of-life decisions with patients and who finally takes decisions. Patients rarely initiate such conversations and the professionals normally do not ask patients directly for their preferences. Fear of confrontation with family members and lawsuits leads healthcare workers to carry out interventions such as initiating artificial feeding techniques and cardiopulmonary resuscitation, even in the absence of expected benefits. The opinions regarding the acceptability of palliative sedation, euthanasia and use of medications to accelerate death without the patients´ explicit request vary greatly. 3. Conditions of the insurance system: limitations exist in the offer of oncology and palliative care services for important proportions of the Colombian population. Colombians have access to opioid medications, barriers to their application are largely in delivery by the health system, the requirement of trained personnel for intravenous administration and ambulatory and home care plans which in Colombia are rare. Conclusions: To improve end-of-life decision making, Colombian healthcare workers and patients need to openly discuss wishes, needs and care options and prepare caregivers. Promotion of palliative care education and development of palliative care centres and home care plans is necessary to facilitate access to end-of-life care. Patients and caregivers’ perspectives are needed to complement physicians’ perceptions and practices.</p

Which personal and social resources help adolescents to recover from negative affect in daily life? An experience sampling study

Background: Reducing anxiety and depression of adolescents is a global health priority. Personal and social resources (e.g., hobbies, socializing) may reduce distress. Yet, there is insufficient understanding of how adolescents use such resources to reduce distress.Objective: To identify resources that reduced distress in the everyday lives of adolescents, and whether resource use differed according to symptoms of anxiety and depression. Methods: The experience sampling method was used, a longitudinal method requiring participants to report on context and mood at randomly selected moments across a week. 5558 reports were contributed by 151 adolescents, including 90 with symptoms of anxiety and/or depression. The study was conducted in the poorest neighbourhoods of Bogotá, Buenos Aires and Lima. Results: Multi-level modelling indicated that using resources was significantly associated with less nervousness and sadness. Adolescents with symptoms were less likely to use some resources (e.g., sport). Cross-level interactions showed the efficacy of resources differed according to severity of symptomatology. For adolescents with symptoms, some resources (e.g., peer support) improved mood, while others (e.g., music listening) did not. Discussion: Personal and social resources are important for reducing distress in the everyday life of adolescents, giving insight for potential interventions to help mitigate symptoms of anxiety and depression before escalation. Further research could assess the quality of experiences (e.g., appraisal) to deepen understanding of how engagement promotes resilience. Conclusions: Care must be taken when recommending resource use, since some forms (e.g., music listening) may be unhelpful to adolescents with symptoms of anxiety and depression