Milena Flória-Santos

Integration of Genomics in Cancer Care

PURPOSEnThe article aims to introduce nurses to how genetics-genomics is currently integrated into cancer care from prevention to treatment and influencing oncology nursing practice.nnnORGANIZING CONSTRUCTnAn overview of genetics-genomics is described as it relates to cancer etiology, hereditary cancer syndromes, epigenetics factors, and management of care considerations.nnnMETHODSnPeer-reviewed literature and expert professional guidelines were reviewed to address concepts of genetics-genomics in cancer care.nnnFINDINGSnCancer is now known to be heterogeneous at the molecular level, with genetic and genomic factors underlying the etiology of all cancers. Understanding how these factors contribute to the development and treatment of both sporadic and hereditary cancers is important in cancer risk assessment, prevention, diagnosis, treatment, and long-term management and surveillance.nnnCONCLUSIONSnRapidly developing advances in genetics-genomics are changing all aspects of cancer care, with implications for nursing practice.nnnCLINICAL RELEVANCEnNurses can educate cancer patients and their families about genetic-genomic advances and advocate for use of evidence-based genetic-genomic practice guidelines to reduce cancer risk and improve outcomes in cancer management.

Espiritualidade e religiosidade na perspectiva de enfermeiros

Al considerar el ser humano como una unidad formada por cuerpo, mente y espiritu, es importante que los enfermeros evaluen la necesidad de intervencion en el campo espiritual. Este estudio describe la comprension del significado de la espiritualidad y la religiosidad de los enfermeros que actuan en hospitales. Esta es una investigacion exploratoria y cualitativa y fue desarrollada con 17 enfermeros. La recoleccion de datos fue realizada con entrevistas semiestructuradas y analizadas a traves de analisis de contenido. Los resultados muestran que los enfermeros identifican las particularidades involucradas en los conceptos de espiritualidad y religiosidad, asi como reconocen el vinculo entre ellos. La aplicabilidad de estos terminos en la practica clinica de los enfermeros es influenciada directamente por su propia espiritualidad y religiosidad, su formacion academica y el miedo de las repercusiones negativas derivadas de la aproximacion directa de estas cuestiones con los pacientes.Considering the human being as a unit composed of body, mind and spirit, it is important that nurses evaluate the need for spiritual intervention. This study aims to describe the understanding of nurses about the meaning of spirituality and religiosity at a hospital. This is an exploratory and qualitative research that was carried out with 17 nurses. Data were collected through semistructured interview and analyzed using content analysis. Results show that nurses identify the particularities involved in the concepts of spirituality and religiosity and recognize the link between them. The applicability of these terms in nurses clinical practice is directly influenced by their own spirituality and religiosity, by their academic training and their fear of negative repercussions resulting from the direct approach of these issues with patients. DESCRIPTORS: Spirituality. Religion. Nursing. Professional-patient relations.

Genetic education, knowledge and experiences between nurses and physicians in primary care in Brazil: A cross‐sectional study

Recent advances in genomics and related technologies have the potential to improve health care throughout the world. In this cross-sectional study, we examine genetics education, knowledge, and genetics-related experiences among the nurses and physicians who provide primary care in a Brazilian city. Fifty-four healthcare professionals from family health units participated in the study (response rate: 90%). Data were collected using a structured 36-item questionnaire divided into five axes: sociodemographic data and academic background; genetics education; genetics knowledge; genetics-related experiences in family practice; and knowledge regarding the National Policy for Comprehensive Care in Clinical Genetics in the Unified Health System. Although most participants (85.2%) acknowledged receiving some genetic content during their undergraduate education, the majority (77.8%) advised that they did not feel prepared to deliver genomics-based health care in primary care. The results suggest that nurses and physicians often lack the knowledge to provide genomics-based health care in primary care. Therefore, continuing education in genetics/genomics should be provided to primary healthcare professionals in order to enhance family practice and compliance with national policies.

SPIRITUALITY AND RELIGIOSITY IN THE PERSPECTIVES OF NURSES

Al considerar el ser humano como una unidad formada por cuerpo, mente y espiritu, es importante que los enfermeros evaluen la necesidad de intervencion en el campo espiritual. Este estudio describe la comprension del significado de la espiritualidad y la religiosidad de los enfermeros que actuan en hospitales. Esta es una investigacion exploratoria y cualitativa y fue desarrollada con 17 enfermeros. La recoleccion de datos fue realizada con entrevistas semiestructuradas y analizadas a traves de analisis de contenido. Los resultados muestran que los enfermeros identifican las particularidades involucradas en los conceptos de espiritualidad y religiosidad, asi como reconocen el vinculo entre ellos. La aplicabilidad de estos terminos en la practica clinica de los enfermeros es influenciada directamente por su propia espiritualidad y religiosidad, su formacion academica y el miedo de las repercusiones negativas derivadas de la aproximacion directa de estas cuestiones con los pacientes.Considering the human being as a unit composed of body, mind and spirit, it is important that nurses evaluate the need for spiritual intervention. This study aims to describe the understanding of nurses about the meaning of spirituality and religiosity at a hospital. This is an exploratory and qualitative research that was carried out with 17 nurses. Data were collected through semistructured interview and analyzed using content analysis. Results show that nurses identify the particularities involved in the concepts of spirituality and religiosity and recognize the link between them. The applicability of these terms in nurses clinical practice is directly influenced by their own spirituality and religiosity, by their academic training and their fear of negative repercussions resulting from the direct approach of these issues with patients. DESCRIPTORS: Spirituality. Religion. Nursing. Professional-patient relations.

How to write an abstract for a manuscript publication

Martha Driessnack responds: The term nature-deficit disorder is credited to Richard Louv, the author of Last Child in the Woods (2008). It is not an official diagnosis in the International Classification of Diseases and Related Health Problems (ICD-10-CM). Instead, it is a label used to address the increasing cost to children as they are increasingly deprived of direct contact with nature and the experience of unstructured free play in the out-of-doors. Should pediatric nurses know about it? Yes. Childhood has moved indoors, and children are paying the price. One recent study described today’s children as the backseat generation (Karsten, 2005). These are the children escorted by car to and from school, after-school activities, sports team practices and games, dance classes, and other adult-supervised and structured events. Their experience of nature most often occurs from the inside of an automobile looking out or as they watch nature DVDs projected on car headrest screens directly in front of them (Louv, 2008). In 2004, Clements surveyed over 800 mothers in the United States and found that while mothers recognized the diverse benefits of outdoor play, they felt television, computers, and concerns about crime, safety, and injury were keeping their children inside. Louv shared that no child can truly know or benefit from nature if the natural world remains behind glass, seen only through windows or on screens and computer monitors. Today, children between the ages of 8 and 18 years spend an average of 6.5 hr a day with electronic media (Roberts, Foehr, & Rideout, 2005; Roberts & Foehr, 2008). In one study, 8-year-old children were better able to identify Pikachu , Metapod , and Wigglytuff (characters from the Japanese card-trading game Pokémon ) than common neighborhood flora or fauna, such as local oak trees (Balmford, Clegg, Coulson, & Taylor, 2002). Others report that young children can define global warming and describe the rainforest and the impact of deforestation in the Amazon Basin, but they have no idea what plants grow in their backyards or what watershed is affected if they litter in the street outside their house. For this new generation of children, direct experiences with nature—whether in the backyard, in a neighborhood field or woods, or along a beach, stream, or lake—are slowly being replaced by indirect experience through electronic media and machinery (Louv, 2008). Children are losing their ability to experience the world directly, which in turn contributes to a growing inability of children to relate to others’ life experience as well (Reed, 1996). In short, children are in some ways on house arrest and in danger of losing their capacity to think or learn about the world directly. Such changes in learning are now being examined as potential sources of stress and anxiety and may even contribute to increasing incidence of depression and other diagnoses in children (Ginsburg, 2007). Research related to children’s direct experience with nature is growing. In 2000, Wells reported that proximity to nature and exposure to natural settings enhanced children’s cognitive abilities, especially in terms of executive function. She and others (Burdette & Whitaker, 2005) found that direct experience with/in nature increased children’s attention spans and abilities to focus, their creative thought processes, problemsolving abilities, self-discipline, and self-regulation. She also found that access to natural play areas helped reduce stress in children (Wells, 2003). There is growing evidence that indicates direct exposure to nature is essential for children’s physical and emotional health, improving their cognitive abilities and resistance to negative stresses and depression. It is not surprising that it also appears to reduce symptoms in attention-deficit/hyperactivity disorder (ADHD) (Kuo & Taylor, 2004; Taylor, Kuo, & Sullivan, 2001). These studies on ADHD also report that the “greener” the natural setting, the greater the relief from symptoms. In contrast, indoor activities, such as watching TV, or outdoor play on paved, “nongreen” areas, increase ADHD symptoms (Louv, 2008). Kuo and Taylor also point out that prescribing “green time” as an adjunct in the treatment of ADHD may have other advantages as well. In contrast to prescription medications and behavioral therapy, green time is widely accessible, free from adverse side effects, is nonstigmatizing, and inexpensive, if not free.

High Validity and Reliability of the PedsQL™ Multidimensional Fatigue Scale for Brazilian Children With Cancer

Among the main factors that affect patients’ quality of life, fatigue is a significant symptom experienced by children during treatment. Despite the high incidence, there has been no validated scale to evaluate fatigue in children with cancer in Brazil. The purpose of this study was to examine the psychometric properties of the PedsQL™ Multidimensional Fatigue Scale, using self-reports of Brazilian children, 8 to 18 years of age, and proxy reports. A cross-sectional method was used to collect data from 216 subjects over an 18-month period. Reliability ranged from .70 to .90 except for sleep/rest fatigue, self-report (α = .55). No floor or ceiling effects were found in any dimension. Convergent validity was higher than .40 and divergent validity had 100% adjustment. The root mean square error of approximation was acceptable. The comparative fit index was lower than expected. The agreement between self and proxy responses was weak and moderate. The results demonstrate the reliability and validity of the Brazilian version in children with cancer. This is the first validated scale that assesses fatigue in Brazilian children and adolescents with cancer.

Elevated serum levels of proinflammatory cytokines potentially correlate with depression and anxiety in colorectal cancer patients in different stages of the antitumor therapy

ABSTRACT Depression and anxiety, the most important psychological disorders in cancer patients, have now been considered as psychoneuroimmunological disorders, in which peripheral immune activation, through the release of proinflammatory cytokines, is implicated in the variety of behavioral, neuroendocrine and neurochemical alterations associated with these disorders. Along with the tumor itself, cancer treatment can also contribute to exacerbate the production of proinflammatory cytokines. This study aimed to investigate whether proinflammatory cytokine levels are related to depression and anxiety in CRC patients in different stages of the antitumor therapy We evaluated 60 patients in three stages of antitumor therapy (Pre‐chemotherapy, Under‐chemotherapy and Post‐chemotherapy, n = 20 in each group) and 20 healthy volunteers by the Hospital Anxiety and Depression Scale (HADS). Serum levels of cytokines were measured by CBA. Depression and/or anxiety were found at clinically relevant levels in CRC patients during all antitumor therapy. Patients in pre‐chemotherapy group exhibited the highest concentrations of pro‐inflammatory cytokines and the lowest levels of IL‐10. In latter stages of treatment, cytokines reached levels similar to the control group. Correlation analysis between HADS score and cytokine serum levels revealed positive associations of anxiety and/or depression with IL‐1&bgr;, IL‐6, IL‐8, and TNF‐&agr;, and a negative correlation with IL‐10, suggesting that cytokines are involved in the pathophysiology of these psychological disorders in CRC patients. A better understanding of the molecular mechanisms involved in these psychological disorders will allow the design of new therapeutic strategies to assist in alleviating such symptoms in cancer patients.

ONCOLOGY NURSING PRACTICE FROM THE PERSPECTIVE OF GENETICS AND GENOMICS

This study aimed to reflect on oncology nurses practice from the perspective of genetics and genomics, and their role as a member of the multiprofessional and interdisciplinary cancer genetics counseling team. This reflection is a result of the detailed reading of literature in the area, increased by the authors experience and research group discussions. In the course of this work, it was verified that the nurse needs to consider genomic-based health care and incorporates essential competencies. These competencies include the ability to mobilize genomic resources in the family history assessment and in the guidelines on genetic testing for families at risk for hereditary neoplastic syndromes. The nursing staff may act as a reference for other members of the health team, with the potential to integrate their knowledge on care, teaching and research in oncology from the viewpoint of genetics and genomics. DESCRIPTORS: Nursing. Oncology. Genomics.

Atuação do enfermeiro em oncologia na perspectiva da genética e genômica

This study aimed to reflect on oncology nurses practice from the perspective of genetics and genomics, and their role as a member of the multiprofessional and interdisciplinary cancer genetics counseling team. This reflection is a result of the detailed reading of literature in the area, increased by the authors experience and research group discussions. In the course of this work, it was verified that the nurse needs to consider genomic-based health care and incorporates essential competencies. These competencies include the ability to mobilize genomic resources in the family history assessment and in the guidelines on genetic testing for families at risk for hereditary neoplastic syndromes. The nursing staff may act as a reference for other members of the health team, with the potential to integrate their knowledge on care, teaching and research in oncology from the viewpoint of genetics and genomics. DESCRIPTORS: Nursing. Oncology. Genomics.

[Perception of cancer causes and risk, family history and preventive behaviors of users in oncogenetic counseling].

The aims of the present study were to describe cancer causes and risk perception, and to associate behaviors adopted for the prevention of tumors and cancer family history in individuals with suspect of hereditary cancer syndromes. A convenience sample of 51 individuals was selected from an oncogenetic counseling outpatient clinic in a university hospital in the countryside of the state of Sao Paulo. An instrument adapted to Brazilian culture was used. The respondents considered their own risk as being the same as the populations risk, and family history was not statistically associated with the performing of preventive exams. These findings highlight the need for intervention by health professionals, especially nurses, who may conduct health education activities for this population, which is an essential component of nursing care in oncogenetics.