Telehealth system (e-CUIDATE) to improve quality of life in breast cancer survivors: rationale and study protocol for a randomized clinical trial.

BACKGROUND Breast cancer survivors suffer physical impairment after oncology treatment. This impairment reduces quality of life (QoL) and increase the prevalence of handicaps associated to unhealthy lifestyle (for example, decreased aerobic capacity and strength, weight gain, and fatigue). Recent work has shown that exercise adapted to individual characteristics of patients is related to improved overall and disease-free survival. Nowadays, technological support using telerehabilitation systems is a promising strategy with great advantage of a quick and efficient contact with the health professional. It is not known the role of telerehabilitation through therapeutic exercise as a support tool to implement an active lifestyle which has been shown as an effective resource to improve fitness and reduce musculoskeletal disorders of these women. METHODS / DESIGN This study will use a two-arm, assessor blinded, parallel randomized controlled trial design. People will be eligible if: their diagnosis is of stages I, II, or IIIA breast cancer; they are without chronic disease or orthopedic issues that would interfere with ability to participate in a physical activity program; they had access to the Internet and basic knowledge of computer use or living with a relative who has this knowledge; they had completed adjuvant therapy except for hormone therapy and not have a history of cancer recurrence; and they have an interest in improving lifestyle. Participants will be randomized into e-CUIDATE or usual care groups. E-CUIDATE give participants access to a range of contents: planning exercise arranged in series with breathing exercises, mobility, strength, and stretching. All of these exercises will be assigned to women in the telerehabilitation group according to perceived needs. The control group will be asked to maintain their usual routine. Study endpoints will be assessed after 8 weeks (immediate effects) and after 6 months. The primary outcome will be QoL measured by The European Organization for Research and Treatment of Cancer Quality of Life Questionnaire Core 30 version 3.0 and breast module called The European Organization for Research and Treatment of Cancer Breast Cancer-Specific Quality of Life questionnaire. The secondary outcomes: pain (algometry, Visual Analogue Scale, Brief Pain Inventory short form); body composition; physical measurement (abdominal test, handgrip strength, back muscle strength, and multiple sit-to-stand test); cardiorespiratory fitness (International Fitness Scale, 6-minute walk test, International Physical Activity Questionnaire-Short Form); fatigue (Piper Fatigue Scale and Borg Fatigue Scale); anxiety and depression (Hospital Anxiety and Depression Scale); cognitive function (Trail Making Test and Auditory Consonant Trigram); accelerometry; lymphedema; and anthropometric perimeters. DISCUSSION This study investigates the feasibility and effectiveness of a telerehabilitation system during adjuvant treatment of patients with breast cancer. If this treatment option is effective, telehealth systems could offer a choice of supportive care to cancer patients during the survivorship phase. TRIAL REGISTRATION ClinicalTrials.gov Identifier: NCT01801527.

16 días de activismo contra la violencia de género: pintando de naranja nuestro mundo

Boletín semanal para profesionales sanitarios de la Secretaría General de Calidad, Innovación y Salud Pública de la Consejería de Igualdad, Salud y Políticas Sociales

Políticas para prevenir los daños causados por el alcohol.

The impact on health of alcohol in a given society is mainly related with the volume and pattern of drinking, and these are related with individual factors, but also with environmental factors, among which public policies are important determinants. Public policies may favour or reduce alcohol use, and thus have a substantial preventive capacity. The effectiveness of policies to prevent the harm caused by alcohol has been reviewed in recent documents, which provide evidence to extract recommendations. This paper reviews the most effective policies to reduce the harm caused by alcohol, with an emphasis in the use of taxes to increase its cost, availability regulation, and policies on drinking and driving. The regulation of alcohol promotion and publicity is also assessed, as well as the detection and treatment of alcohol abuse and dependence. The state of alcohol related policies in Spain is analysed, as well as the obstacles, for the adoption of policies more prone to prevention, and recommendations for the future are made.

Conocimientos y actitudes de los profesionales sanitarios en el proceso de declaración de las voluntades vitales anticipadas.

Objective: To identify the underlying interests of the Living Will Declaration (LWD) process and to determine the consensus, using a questionnaire, of the knowledge and attitudes of health professionals. Design: A study was performed in two phases using a Delphi technique with a Rand method. 1. Dimensions proposed: generation of ideas and their subsequent prioritizing; 2. Proposal andprioritizing of items grouped into blocks of Knowledge and Attitudes, developed between August 2012 and January 2013.Setting: The work was carried out by initial telephone contact with panellists, and then later by the panellists belonged to the Andalusia Public Health System.Participants: The criteria for selecting the eight components of the panel were knowledge andexperience in the field of the freedom of the patient in Andalusia. Results: The Knowledge identified included: 1 A) Legal and general aspects; 2 A) A conceptual definition; 3 A) Standardised LWD documents: 4 A) Practical experience; 5 A) Procedure and registering of the LWDs. The second block included Attitudes: 1 B) Attitudes of the professional in the application of LWDs in clinical practice, and 2 B) Attitudes of the professional in «complex» ethical scenarios The 7 panellists who finally took part proposed 165 items. After applying the prioritizing criteria, scores, and scenario selection, 58 (35.2%) items were identified as suitable scenarios. Conclusions: The proposed questionnaire included wide parcels of concepts and contents that, once validated, will help to measure the training interventions carried out on health professionals in order to improve knowledge and attitudes on the subject of LWDs.

Programa de salud infantil y adolescente de Andalucía (PSIA-A). Actividades individuales

Programa de Salud Infantil y Adolescente de Andalucía (http://www.repositoriosalud.es/handle/10668/1741)

Programa de salud infantil y adolescente de Andalucía. Actividades grupales y comunitarias

Sesiones grupales: 01. ‘Una vida familiar’; 02. ‘Adaptación y vínculo de apego’; 03. ‘Cómo estimular el desarrollo infantil’; 04. ‘El arte de educar’; 05. ‘Adolescencia’. Programa de Salud Infantil y Adolescente de Andalucía (http://www.repositoriosalud.es/handle/10668/1741)

Programa de salud infantil y adolescente de Andalucía (PSIA-A). Guías anticipatorias y consejos

Contiene: Guías para las visitas del PSIA-A individual; Guías específicas para familias; y Consejos específicos para adolescentes. En Guías específicas para familias: Bebé a bordo: una nueva vida familiar; Desarrollo psicológico y evolutivo saludable. Consejos para familias; La estimulación del desarrollo; El logro de la autonomía; El arte de educar; Aprender y divertirse al salir de clase; Llegó la adolescencia; Educación sexual; Consejos para prevenir la violencia de género; Consejos para prevenir el tabaquismo pasivo y el inicio del consumo de tabaco; ¿Qué deben saber acerca de las drogas o el alcohol?; Guía para acompañar a un menor en la pérdida de un ser querido; Consejos para fomentar la autoestima; Recomendaciones de actuación en caso de acoso escolar o bullying; Uso responsable de las nuevas tecnologías: Internet; Bebés con necesidades especiales; Familias en proceso de separación o divorcio. En Consejos específicos para adolescentes: Uso responsable de las nuevas tecnologías: Internet Programa de Salud Infantil y Adolescente de Andalucía; Consejos sobre el consumo de alcohol; ¿Qué debes saber acerca de las drogas?; Consejos para prevenir la violencia de género; Consejos sobre el consumo de tabaco. Programa de Salud Infantil y Adolescente de Andalucía (http://www.repositoriosalud.es/handle/10668/1741)

Programa de salud infantil y adolescente de Andalucía (PSIA-A). Temas

Programa de Salud Infantil y Adolescente de Andalucía (http://www.repositoriosalud.es/handle/10668/1741)

Movimiento actívate, por una generación saludable

Boletín semanal para profesionales sanitarios de la Secretaría General de Calidad, Innovación y Salud Pública de la Consejería de Igualdad, Salud y Políticas Sociales