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Medellín, Colombia

Yennurajalingam S.,University of Houston | Noguera A.,University of Houston | Parsons H.A.,University of Houston | Torres-Vigil I.,University of Houston | And 6 more authors.
Palliative Medicine | Year: 2013

Background: Understanding family caregivers' decisional role preferences is important for communication, quality of care, and patient and family satisfaction. The family caregiver has an important role in a patient's decisional role preferences. There are limited studies on family caregivers' preferences of the patient's decision control at the end of life among Hispanics. Aims: To identify Hispanic caregivers' preferences of the decision control of patients with advanced cancer and to compare the preferences of caregivers in Hispanic Latin American and Hispanic American caregivers. Design: We surveyed patients and their family caregivers referred to outpatient palliative care clinics in the United States, Chile, Argentina, and Guatemala. Caregiver preferences of patient's decision control were evaluated using the Control Preference Scale. Caregivers' and patients' sociodemographic variables, patient performance status, and Hispanic American patient acculturation level were also collected. Participants: A total of 387 caregivers were surveyed: 100 (26%) in Chile, 99 (26%) in Argentina, 97 (25%) in Guatemala, and 91 (24%) in the United States. The median age was 56 years, and 59% were female. Results: Caregiver preference of patient's decision control was passive, shared, and active for 10 (11%), 45 (52%), and 32 (37%) Hispanic American caregivers and 54 (19%), 178 (62%), and 55 (19%) Hispanic Latin American caregivers (p = 0.0023), respectively. Caregiver acculturation level did not affect the preferences of the Hispanic American sample (p = 0.60). Conclusions: Most Hispanic family caregivers preferred the patient to make shared decisions. Hispanic Latin American caregivers more frequently preferred patients to assume a passive decisional role. Acculturation did not influence the preferences of Hispanic American caregivers. © The Author(s) 2013.

Nathalia Acosta T.,Institute Cancerologia | Carolina Ramirez B.,Pontifical Bolivarian University
Techniques in Regional Anesthesia and Pain Management | Year: 2013

In 1985, approximately 50 million people died in the world of which 37.9 million were in developing countries, where cancer was the cause in 10% of the cases. In these developing countries, most cancer resources are destined to curative treatments, which do not always have the best results. Roughly 12.7 million new cases are diagnosed globally each year; without substantial improvement in cancer control, it is predicted that this worldwide annual toll will rise to 21.3 million new cancer cases and 13.1 million deaths by 2030. That is why education, along with rules to facilitate the availability of opioid analgesics and the development of health programs, is one of the basic pillars for implementing a successful palliative care program, which is available for the entire population. Palliative care aims to relieve suffering and improve the quality of life for patients with advanced illnesses and their families through specific knowledge and skills, including communication with patients and family members; management of pain and other symptoms; psychosocial, spiritual, and bereavement support; and coordination of an array of medical and social services. © 2013 Elsevier Inc.

Yennurajalingam S.,University of Texas M. D. Anderson Cancer Center | Parsons H.A.,University of Texas M. D. Anderson Cancer Center | Duarte E.R.,Institute Cancerologia | Palma A.,University of Santiago de Chile | And 5 more authors.
Journal of Pain and Symptom Management | Year: 2013

Context. Understanding cancer patients' preferences in decisional roles is important in providing quality care and ensuring patient satisfaction. There is a lack of evidence on decisional control preferences (DCPs) of Hispanic Americans, the fastest growing population in the U.S. Objectives. The primary aims of this study were to describe DCPs of Hispanics with advanced cancer in the U.S. (HUSs) and compare the frequency of passive DCPs in this population with that of Hispanics with advanced cancer in Latin America (HLAs). Methods. We conducted a prospective survey of patients with advanced cancer referred to outpatient palliative care clinics in the U.S., Chile, Argentina, and Guatemala. Information was collected on sociodemographic variables, Karnofsky Performance Scale scores, acculturation (Marin Acculturation Assessment Tool), and DCP (Control Preference Scale). Chi-square tests were used to determine the differences in DCPs between HUSs and HLAs. Results. A total of 387 patients were surveyed: 91 in the U.S., 100 in Chile, 94 in Guatemala, and 99 in Argentina. The median age of HUSs was 56 years, 59% were female, and the median Karnofsky Performance Scale score was 60; the corresponding values for HLAs were 60 years, 60%, and 80. HLAs used passive DCP strategies significantly more frequently than HUSs did with regard to the involvement of the family (24% vs. 10%; P = 0.009) or the physician (35% vs. 16%; P < 0.001), even after age and education were controlled for. Eighty-three percent of HUSs and 82% of HLAs preferred family involvement in decision making (P = non-significant). No significant differences were found in DCPs between poorly and highly acculturated HUSs (P = 0.91). Conclusion. HUSs had more active DCPs than HLAs did. Among HUSs, acculturation did not seem to play a role in DCP determination. Our findings confirm the importance of family participation for both HUSs and HLAs. However, HUSs were less likely to want family members to make decisions on their behalf. J Pain Symptom Manage 2013;46:376e385. © 2013 U.S. Cancer Pain Relief Committee. Published by Elsevier Inc. All rights reserved.

Weckman A.,University of Toronto | Di Ieva A.,University of Toronto | Rotondo F.,University of Toronto | Syro L.V.,Hospital Pablo Tobon Uribe and Clinica Medellin | And 3 more authors.
Journal of Molecular Endocrinology | Year: 2014

Autophagy is an important cellular process involving the degradation of intracellular components. Its regulation is complex and while there are many methods available, there is currently no single effective way of detecting and monitoring autophagy. It has several cellular functions that are conserved throughout the body, as well as a variety of different physiological roles depending on the context of its occurrence in the body. Autophagy is also involved in the pathology of a wide range of diseases. Within the endocrine system, autophagy has both its traditional conserved functions and specific functions. In the endocrine glands, autophagy plays a critical role in controlling intracellular hormone levels. In peptide-secreting cells of glands such as the pituitary gland, crinophagy, a specific form of autophagy, targets the secretory granules to control the levels of stored hormone. In steroid-secreting cells of glands such as the testes and adrenal gland, autophagy targets the steroid-producing organelles. The dysregulation of autophagy in the endocrine glands leads to several different endocrine diseases such as diabetes and infertility. This review aims to clarify the known roles of autophagy in the physiology of the endocrine system, as well as in various endocrine diseases. © 2014 Society for Endocrinology.

Arnold L.D.,Saint Louis University | Barnoya J.,Washington University in St. Louis | Gharzouzi E.N.,Institute Cancerologia | Benson P.,University of Science and Arts of Iran | Colditz G.A.,Washington University in St. Louis
Bulletin of the World Health Organization | Year: 2014

Problem Guatemala is experiencing an increasing burden of cancer but lacks capacity for cancer prevention, control and research. Approach In partnership with a medical school in the United States of America, a multidisciplinary Cancer Control Research Training Institute was developed at the Instituto de Cancerología (INCAN) in Guatemala City. This institute provided a year-long training programme for clinicians that focused on research methods in population health and sociocultural anthropology. The programme included didactic experiences in Guatemala and the United States as well as applied training in which participants developed research protocols responsive to Guatemala's cancer needs. Local setting Although INCAN is the point of referral and service for Guatemala's cancer patients, the institute's administration is also interested in increasing cancer research - with a focus on population health. INCAN is thus a resource for capacity building within the context of cancer prevention and control. Relevant changes Trainees increased their self-efficacy for the design and conduct of research. Value-added benefits included establishment of an annual cancer seminar and workshops in cancer pathology and qualitative analysis. INCAN has recently incorporated some of the programme's components into its residency training and established a research department. Lessons learnt A training programme for clinicians can build cancer research capacity in low- and middle-income countries. Training in population-based research methods will enable countries such as Guatemala to gather country-specific data. Once collected, such data can be used to assess the burden of cancer-related disease, guide policy for reducing it and identify priority areas for cancer prevention and treatment.

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