Psychological status and role of caregivers in the neuro-rehabilitation of patients with severe Acquired Brain Injury (ABI).

OBJECTIVE: To investigate the relationships between (a) the psychological status of the caregiver, (b) the specific features of caregiving as perceived by the cognitive therapist in neuro-rehabilitation, (c) the caregivers' subjective approach to neuro-rehabilitation, and (d) the functional outcome of the patient. METHODS: Twenty-four patients with severe acquired brain injury and their 24 caregivers participated in this observational study. Caregivers underwent a psychological assessment examining emotional distress, burden and family strain; their subjective approach to neuro-rehabilitation has been evaluated by two specific answers. The patients' cognitive therapists responded to an ad-hoc questionnaire, namely the "Caregiving Impact on Neuro-Rehabilitation Scale" (CINRS), evaluating the features (i.e., amount and quality) of caregiving. Finally, the functional outcome of the patient was assessed through standardized scales of disability and cognitive functioning. RESULTS: The caregivers' psychological well-being was associated to the features of caregiving, to the subjective approach to neuro-rehabilitation, and to the functional recovery of their loved ones. A better caregivers' approach to neuro-rehabilitation was also associated to an overall positive impact of caregiving in neuro-rehabilitation and to a better functional outcome of the patients. CONCLUSIONS: We posited a virtuous circle involving caregivers within the neuro-rehabilitation process, according to which the caregivers' psychological well-being could be strictly associated to a better level of caregiving and to a better functional outcome of the patients that, in turn, could positively influence the caregivers' psychological well-being. Although preliminary, these results suggest a specific psycho-educational intervention, aimed at improving the caregivers' psychological well-being and at facilitating their caring of the loved one.

The compliance of hypocaloric diet in type 2 diabetic obese patients: a brief-term study.

In studies of the effect of diets in obese type 2 diabetic patients, information about the degree of compliance or non-compliance is generally lacking or incomplete, though their poor long-term success rate is widely recognized. We have quantified the degree of short-term compliance with a personalized hypocaloric diet (800-1500 kcal) in 77 obese type 2 diabetic patients (mean age 60, mean BMI 34.4) three months after explaining their dietary schedule and its expected advantages by means of simple but essential nutritional advice lasting about 20 minutes of the type currently used for such patients attending diabetes care institutions or outpatient departments. Even though a mean 14% reduction in daily food intake was achieved, the mean daily energy intake at the interview (assessed by means of the 3-day recall method) still exceeded the prescribed diet by 40-50%. The worst compliance in terms of total excess energy intake or carbohydrate and fat intake was found in the older patients. The greater the excess of food intake, the poorer the metabolic control, as expected.

[Possible correlations between protein-loosing nephropathy and obesity]. / Possibili correlazioni tra nefropatia protido-disperdente ed obesità.

Nephrotic syndrome has been reported in obesity; its precise incidence in obese patients without diabetes mellitus and/or arterial hypertension is however unknown. Thirty-two obese subjects without complications were therefore assessed before and after weight loss, together with 18 healthy control subjects. Overnight albumin excretion rate (AER) was assessed using a RIA method (H. Albumin-Kit, Sclavo). Glomerular filtration rate (GFR) was also evaluated in 10 obese subjects using Cr51 before and after weight loss. AER was found to be higher, although the difference was not statistically significant, in obese subjects compared to controls, but was significantly reduced after weight loss (p = 0.05). GFR also showed a non-significant tendency to decrease following loss of weight. Systolic and diastolic blood pressures were significantly decreased following weight loss (p less than 0.01 and p less than 0.025 respectively). In conclusion, although it is not possible to confirm the presence of true nephropathy in uncomplicated obesity, the latter can facilitate the onset of hemodynamic-type mechanisms which, in the presence of diabetes mellitus or arterial hypertension, may lead to the appearance of the nephrotic syndrome.