Imbalance of SARS-CoV-2-specific CCR6+ and CXCR3+ CD4+ T cells and IFN-γ + CD8+ T cells in patients with Long-COVID.

Long-COVID (LC) is characterised by persistent symptoms for at least 3 months after acute infection. A dysregulation of the immune system and a persistent hyperinflammatory state may cause LC. LC patients present differences in activation and exhaustion states of innate and adaptive compartments. Different T CD4+ cell subsets can be identified by differential expression of chemokine receptors (CCR). However, changes in T cells with expression of CCRs such as CCR6 and CXCR3 and their relationship with CD8+ T cells remains unexplored in LC. Here, we performed unsupervised analysis and found CCR6+ CD4+ subpopulations enriched in COVID-19 convalescent individuals upon activation with SARS-CoV-2 peptides. SARS-CoV-2 specific CCR6+ CD4+ are decreased in LC patients, whereas CXCR3+ CCR6- and CCR4+ CCR6- CD4+ T cells are increased. LC patients showed lower IFN-γ-secreting CD8+ T cells after stimulation with SARS-CoV-2 Spike protein. This work underscores the role of CCR6 in the pathophysiology of LC.

An integrated model of psychosocial correlates of insomnia severity in family caregivers of people with dementia.

OBJECTIVES: Research has shown the relevance of stress and coping factors in explaining caregivers' insomnia symptoms. However, few attempts have been made to empirically test an integrative model for insomnia severity in family caregivers of people with dementia. The aim of this study was to test such a model, in which insomnia severity is proposed to be influenced by predisposing factors, precipitated by stressors, and perpetuated by behaviors to cope with these stressors. METHODS: 311 family caregivers of people with dementia were assessed for variables categorized as predisposing (e.g. female gender), precipitating (e.g. care-recipient's behavioral and psychological symptoms of dementia [BPSD]), and perpetuating factors (e.g. sleep aids). A theoretical model was developed and then statistically tested using structural equation modelling, analyzing the direct and indirect effects of the assessed variables on caregivers' insomnia severity. RESULTS: Distress, sleep aids, and experiential avoidance showed a direct association with insomnia severity. Female gender, younger age, cognitive fusion, leisure activities, dysfunctional thoughts, frequency and distress caused by care-recipient's BPSD showed indirect associations with insomnia severity. The model explained 22% of the variance of caregivers' insomnia severity. CONCLUSION: The results provide additional empirical support for the importance of predisposing, precipitating and perpetuating factors associated with caregivers' insomnia severity. The integrative model we propose may also be useful for developing interventions targeting insomnia symptoms in family dementia caregivers.

Associations Between Dysfunctional Thoughts, Leisure Activities, and IL-6 in Caregivers of Family Members With Dementia.

OBJECTIVE: Dementia caregiving is associated with negative physical health consequences, including inflammation processes. The objective of this study was to analyze the associations between dysfunctional thoughts, frequency of leisure activities, and interleukin 6 (IL-6) in a sample of dementia family caregivers. METHODS: One hundred forty dementia caregivers participated in this cross-sectional study. The relationships among caregivers' dysfunctional thoughts, leisure activities, and IL-6 were adjusted for demographic characteristics, stressors, and physical and mental health indicators in a linear regression analysis. RESULTS: Higher levels of dysfunctional thoughts ( t = -2.02, p = .045) were significantly associated with lower frequency of leisure activities. In turn, lower frequency of leisure activities was significantly associated with higher levels of IL-6 ( t = -2.03, p = .045). Dysfunctional thoughts were no longer significantly associated with IL-6 levels when both dysfunctional thoughts and leisure activities were included in the same model ( t = 1.78, p = .076). A significant indirect effect was found for the association between higher levels of dysfunctional thoughts and higher levels of IL-6 (standardized indirect effect = 0.036, bootstrap standard error = 0.026, 95% confidence interval = 0.0001-0.1000) through its association with fewer leisure activities. CONCLUSIONS: Our findings suggest that the direct effect of caregivers' dysfunctional thoughts on IL-6 may be mediated by the impact on caregivers' frequency of leisure activities. Results suggest that training caregivers in reducing dysfunctional thoughts to thereby increase leisure activities may be useful in reducing inflammation.

Cognitive fusion and distress in family caregivers: the role of satisfaction with personal values.

Objectives: cognitive fusion (the tendency towards behavior that is overly regulated and influenced by cognition) and dissatisfaction with personal values are central processes of psychological inflexibility and are related to distress. Being cognitively fused may interfere with achieving satisfaction from personal values. This study analyzed the role of satisfaction with the value of caregiving and other personal values (e.g. personal growth) in the relationship between cognitive fusion and caregivers' distress.Method: a total of 287 dementia family caregivers participated in this quantitative study carried out in Madrid, Spain, from January 2016 to February 2020. We measured sociodemographic and stressor variables, cognitive fusion, caregivers' satisfaction with values and depressive and anxiety symptoms. The indirect effect of cognitive fusion on distress through caregivers' satisfaction with caregiving value and with other personal values was tested. Four hierarchical regression models were analyzed: the role of satisfaction with the caregiving value in the association between cognitive fusion and depressive (Model 1a) and anxiety (Model 1b) symptoms; and the role of satisfaction with other personal values in the association between cognitive fusion and depressive (Model 2a) and anxiety (Model 2b) symptoms.Results: the results showed an indirect effect of cognitive fusion on both depressive and anxiety symptoms only through satisfaction with other personal values. Those reporting higher cognitive fusion reported lower satisfaction with other personal values, and this association was related to higher scores in depressive and anxiety symptoms (Models 2a and 2b).Conclusion: cognitive fusion could be a variable that interferes in obtaining satisfaction from personal values, something that increases caregivers' distress.

Sociocultural factors, guilt and depression in family caregivers of people with dementia. Kinship differences.

OBJECTIVES: This study aims to analyze the role that family obligations and social desirability have for understanding guilt and depressive symptoms in family caregivers. A theoretical model is proposed to analyze this significance based on the kinship with the person cared for. METHODS: Participants are 284 family caregivers of people with dementia divided into four kinship groups (husbands, wives, daughters and sons). Face-to-face interviews were conducted assessing sociodemographic variables, familism (family obligations), dysfunctional thoughts, social desirability, frequency and discomfort associated with problematic behaviors, guilt and depressive symptoms. Path analyses are performed to analyze the fit of the proposed model and multigroup analysis to study potential differences between kinship groups. RESULTS: The proposed model fits the data well and explains significant percentages of variance of guilt feelings and depressive symptomatology for each group. The multigroup analysis suggests that, for daughters, higher family obligations were associated with depressive symptomatology through a report of higher dysfunctional thoughts. For daughters and wives, an indirect association between social desirability and guilt was observed through reaction to problematic behaviors. CONCLUSION: The results support the need to consider the significance of sociocultural aspects such as family obligations and the desirability bias in the design and implementation of interventions for caregivers, especially for daughters. Considering that the variables that contribute to explaining caregivers' distress vary depending on the relationship with the person cared for, individualized interventions may be warranted depending on the kinship group.

Cystic fibrosis with liver involvement in adults has a benign course. Results from a tertiary referral center cohort.

BACKGROUND: Cystic Fibrosis Liver Disease is a poorly understood entity, especially in adults, in terms of its real prevalence, natural history and diagnostic criteria, despite being the most important extrapulmonary cause of mortality. The aim was to evaluate the prevalence, characteristics and potential risk factors of liver disease in adults with cystic fibrosis, according to two diagnostic criteria accepted in the scientific literature. METHODS: Patients were recruited in a tertiary referral hospital, and laboratory, ultrasound, non-invasive liver fibrosis tests (AST to Platelet Ratio Index; Fibrosis-4 Index) and transient elastography (Fibroscan) were performed. The proportion of patients with liver disease according to the Debray and Koh criteria were evaluated. RESULTS: 95 patients were included, 48 (50.5%) females, with a mean age of 30.4 (28.6-32.2) years. According to the Debray criteria, 6 (6.3%) patients presented liver disease. According to the Koh criteria, prevalence increased up to 8.4%, being statistically different from the 25% value described in other published series (p = 0.005). Seven (7.5%) presented ultrasonographic chronic liver disease. Eleven (13%) presented liver fibrosis according to the APRI score; 95 (100%) had a normal FIB-4 value. Mean liver stiffness value was 4.4 (4.1-4.7) kPa. FEV1 (OR=0.16, p 0.05), meconium ileus (OR=14.16, p 0.002), platelets (Pearson coefficient -0.25, p 0.05) and younger age (Pearson coefficient -0.19, p 0.05) were risk factors. CONCLUSIONS: Prevalence and severity of liver disease in adult cystic fibrosis patients were lower than expected. Meconium ileus, platelets, age and respiratory function were confirmed as risk factors associated to cystic fibrosis liver disease.

Family caregivers of people with dementia in the context of the sociocultural stress and coping model: An examination of gender differences.

The study assessed gender differences in the associations between familism dimensions, dysfunctional thoughts, and resource and outcome variables in 190 Spanish dementia family caregivers. A theoretical model was tested through path analysis, obtaining an excellent fit of the model to the data. Higher scores in the familial obligations dimension were associated with lower self-efficacy for self-care and obtaining respite and leisure frequency, and higher anxious and depressive feelings, in female caregivers only. Significant between-gender differences were obtained, suggesting that female caregivers holding strong familistic values are more vulnerable to the negative consequences of caregiving compared to male caregivers.

Efficacy of continuous glucose monitoring on maternal and neonatal outcomes in gestational diabetes mellitus: a systematic review and meta-analysis of randomized clinical trials.

AIMS: This systematic review aims to evaluate the effect of continuous glucose monitoring (CGM) on maternal and neonatal outcomes in gestational diabetes mellitus (GDM). METHODS: Two authors conducted a systematic search using PubMed, Embase, CENTRAL, CINAHL, Scopus, Web of Science, ClinicalTrials.gov and the World Health Organization International Clinical Trials Registry Platform. The inclusion criteria for the systematic review were randomized clinical trials that compared the effects of CGM and blood glucose monitoring (BGM) in women with GDM. A restricted maximum likelihood random-effects model was used for the meta-analysis. The measures of effect were risk ratios for categorical data and mean differences for continuous data. RESULTS: Of the 457 studies reviewed, six randomized clinical trials met the inclusion criteria. A total of 482 patients were included in the meta-analysis. The use of CGM was associated with lower HbA1c levels at the end of pregnancy (mean difference: -0.22; 95%CI -0.42 to -0.03) compared to BGM. Women using CGM also had less gestational weight gain (mean difference: -1.17, 95%CI -2.15 to -0.19), and their children had lower birth weight (mean difference: -116.26, 95%CI -224.70 to -7.81). No differences were observed in the other outcomes evaluated. CONCLUSION: Women with GDM using CGM may achieve lower average blood glucose levels, lower maternal weight gain and infant birth weight than women using BGM. Nevertheless, current evidence is limited by the low number of studies and the small sample sizes of these studies. Larger clinical trials are needed to better understand the effects of CGM in GDM. REGISTRATION: PROSPERO registration ID CRD42021225651.

Longitudinal Correlates of Depressive Symptoms and Positive and Negative Affects in Family Caregivers of People With Dementia.

OBJECTIVE: Caring for a relative with dementia is considered a chronically stressful role associated with negative consequences for psychological health such as higher levels of depression. However, the subjective experience of depressive symptomatology is complex as it relates to two unique domains: positive affect (PA) and negative affect (NA). The objective of this study was to analyze, through a longitudinal design, the associations of caregivers' cognitive (avoidance coping, personal mastery, and coping self-efficacy) and behavioral (frequency of pleasant events) coping strategies with depressive symptoms, PA, and NA. METHODS: A total of 111 caregivers of a spouse with dementia participated in this study. They were assessed yearly across 5 years. Mixed model regression analyses were conducted separately for depressive symptoms, PA, and NA, analyzing within and between-person associations of caregivers' age, gender, role overload, sleep quality, and coping variables previously mentioned. RESULTS: The results showed that different coping strategies were associated with different components of depressive symptomatology. While avoidant coping was associated with NA and depressive symptoms but not PA at both within- and between-person levels, frequency of pleasant events was associated only with NA and depressive symptoms at the within-person level, showing no effect at the between-person level. Personal mastery and coping self-efficacy were found to be more transversal variables, being associated with most of the mood outcomes in both within and between-person effects. CONCLUSION: Findings support the concept of depressive mood as a complex construct and highlights the importance of analyzing different coping strategies when trying to comprehend the caregiving stress process.

Medical conditions and depressive symptoms: A study of kinship profiles in dementia caregivers.

OBJECTIVE: To analyze the association between diverse medical conditions and depressive symptoms in different profiles of dementia caregivers based on sex and kinship (wives, husbands, daughters, and sons). METHODS: Individual interviews were conducted with 338 dementia family caregivers. Depressive symptoms were measured with the Spanish version of the Center for Epidemiologic Studies-Depression Scale. Medical conditions encompassed the following physical diseases: high cholesterol, osteoarthritis, hypertension, diabetes, cancer, and cardiovascular, brain, kidney, liver, and stomach diseases.Logistic regression analyses were carried out to identify determinants associated to thepresenceof depressive symptoms. RESULTS: High cholesterol was the most frequent disease among caregivers.Significant differences among groups were found in depressive symptoms: between wives (50.60%) and husbands (28.40%),(p = 0.033), and between daughters (57.00%) and husbands (p = 0.001). Half of the sonsreported thepresenceof depressive symptoms. In daughters, depressive symptomatology was significantly more likely whether they presented a worse reaction to disruptive behaviors, a poor assessment of global deterioration of care recipient, and less perceived health status. Furthermore, daughters were 1.94 times more likely to experience depressive symptoms if they presented medical conditions (p = 0.017). CONCLUSIONS: Daughter caregivers that have depressive and physical diseases may be an especially vulnerable subgroup of caregivers that may not be the ideal population to provide care. Access to high-quality, evidence-based therapies focused on improving caregivers' physical health could have a positiveeffecton thepresenceof depressive symptoms, particularly in the case of daughter caregivers.

Change in levothyroxine requirements after bariatric surgery in patients with hypothyroidism.

Objectives. This study aims to evaluate the need to modify the total and weight-adjusted doses of levothyroxine after bariatric surgery, identify predictors, and assess the influence of the weight loss on the levothyroxine requirements. Methods. A retrospective study in patients with treated hypothyroidism that underwent bariatric surgery. The modification of the levothyroxine dose and its association with the weight loss and other potential predictors were evaluated at 6, 12, and 24 months post-surgery. Results. Among the 63 patients included, 82.54% needed an adjustment of levothyroxine dose during the follow-up. The total weekly dose of levothyroxine (µg) decreased post-surgery at 6 months (ß= -49.1; 95%CI-93.7 to -4.5; p=0.031) and 12 months (ß=-54.9; 95%CI-102 to -7.8; p=0.022), but did not significantly change at 24 months (p=0.114). The weekly weight-adjusted dose (µg/k) increased at 6 months (ß=1.37; 95%CI 0.91 to 1.83; p<0.001), 12 months (ß=2.05; 95%CI 1.43 to 2.67; p<0.001), and 24 months (ß=2.52; 95%CI 1.74 to 3.30; p<0.001). The weight loss showed association with the weight-adjusted dose (OR=1.07; 95%CI 1.02 to 1.12; p=0.004), but not the total dose (p=0.320). Conclusions. This study shows a significant decrease in the total dose of levothyroxine requirements change after bariatric surgery during the first year of the follow-up and an increase in the weight-adjusted dose over the first two years. No predictors of modification of the total dose of levothyroxine were identified.

Associations between pleasant events, activity restriction, stressors, and blood pressure in caregivers of persons with dementia.

OBJECTIVES: Caring for a relative with dementia is associated with adverse consequences for cardiovascular health. Cognitive and behavioral factors, such as high perceived activity restriction and low frequency of pleasant events have been found to be associated with higher levels of blood pressure, but the role these variables play in the stress and coping process remains understudied. The objective of this study is to analyze the associations between behavioral and psychological symptoms of dementia, activity restriction, frequency of pleasant events, and mean arterial pressure. DESIGN: Face-to-face interviews and cross-sectional analyses. SETTING: Social services, healthcare centers, and adult day services of Comunidad de Madrid, Spain. PARTICIPANTS: One hundred and two family caregivers of a spouse or parent with dementia. MEASUREMENTS: Apart from various sociodemographic and health-related variables, behavioral and psychological symptoms of dementia, activity restriction, and frequency of leisure activities were assessed. In addition, measurement of blood pressure levels was conducted through an electronic sphygmomanometer. RESULTS: The obtained model suggests that there is a significant indirect association between behavioral and psychological symptoms of dementia and mean arterial pressure through activity restriction and frequency of pleasant events. CONCLUSIONS: The findings of this study provide preliminary support for a potential indirect effect between behavioral and psychological symptoms of dementia and blood pressure, through the effects of behavioral and psychological symptoms of dementia on the caregivers' levels of activity restriction and frequency of pleasant activities. Our manuscript provides additional support for the pleasant events and activity restriction model (Mausbach et al., 2011; Chattillion et al., 2013), by highlighting the importance of considering caregiving stressors as a source of caregivers' activity restriction in the theoretical framework of the model.

Medical detransition following transgender identity reaffirmation: two case reports.

Background Recently, increased social and scientific attention has been paid to gender detransition, a phenomenon in which individuals discontinue gender-affirming medical interventions (GAMI) aimed at alleviating gender dysphoria (GD). Yet, clinical knowledge of detransitioners and their experiences is still scarce. Case reports published in the literature suggest that both internal and external factors may influence this decision. Methods Two transgender individuals treated for GD at a gender identity unit presented with a desire to discontinue GAMI. A description of their clinical evolution is presented. Results Increased body satisfaction, self-esteem, self-acceptance, and self-empowerment with respect to their transgender identity were mentioned by the patients as reasons for discontinuing gender-affirming treatments. Coinciding factors included reduced GD, positive changes in social environments, better interpersonal functioning, and higher levels of psychological well-being in general. Conclusions Gender detransition is an under-researched phenomenon. These cases highlight the need for a more nuanced approach to gender-related clinical presentations, which involves providing individuals the opportunity to work on their social ecosystems and explore alternative options to manage GD before initiating GAMI.

"I Feel Guilty". Exploring Guilt-Related Dynamics in Family Caregivers of People with Dementia.

Objectives: Family caregivers of people with dementia often report feelings of guilt. However, the number of studies analyzing guilt and the factors associated with its appearance are scarce. The aim of this study is to explore the subjective experience of guilt in the family care of people with dementia.Methods: A qualitative analysis of the narratives of 13 family caregivers of people with dementia about their feelings of guilt was done.Results: Seven categories for understanding guilt in caregiving were obtained: guilt derived from actions themselves; guilt derived from one's limitations; guilt for feeling negative emotions; guilt associated with the change in the relationship with the person cared for; guilt for neglecting other areas; guilt induced by the person cared for, and guilt induced by others. The results showed the existence of cases in which guilt is absent by distress-avoiding processes.Conclusions: Guilt is a relevant variable in understanding caregiver distress, and its analysis is necessary for therapeutic work in the field of care.Clinical implications: Psychological interventions aimed at family caregivers should include specific techniques in order to address guilt feelings.

Stress, Insomnia, and Leisure in Dementia Family Caregivers. Correlates with Distress during the COVID-19 Pandemic.

The COVID-19 pandemic added a new stress source for caregivers. Many aspects influence the potential depressive or anxiety symptomatology in caregivers. This study explored the association among COVID-19 related stressors, insomnia, leisure, and caregivers' depression and anxiety. 101 family caregivers of people with dementia were asked about COVID-19 related stressors, insomnia, leisure, depression and anxiety symptoms. Four regression models with caregivers' depression and anxiety symptoms as dependent variables were tested. Four potential mediation models were investigated. Two of them had insomnia as the independent variable and leisure as a mediator, and the other two had leisure as the independent variable and insomnia as a mediator. Regression models accounted for 48% and 40.6% of the variance in depressive and anxiety symptoms, respectively. The four mediator models were statistically significant. Findings suggest two potential mechanisms affecting caregivers' distress during the pandemic. Insomnia and leisure significantly contributed to explain caregivers' anxiety and depressive symptoms, even after controlling for COVID-19 related stressors. Provision of resources to increase the chances of caregivers engaging in leisure activities, alongside a reduction of barriers potentially limiting good sleep, may contribute significantly to improving the depression and anxiety symptoms of family caregivers.

Guilt Focused Intervention for Family Caregivers. Preliminary Results of a Randomized Clinical Trial.

OBJECTIVES: A pilot randomized controlled trial study was conducted for testing the efficacy of a novel Guilt Focused Intervention (GFI), that was compared with a Cognitive Behavioral Intervention (CBI) for caregivers of people with dementia with high levels of guilt and distress. METHODS: Participants were 42 caregivers who were randomized assigned to the intervention conditions. RESULTS: Participants in the GFI showed significant reductions in depression, anxiety, and guilt at posttreatment and follow-up. Participants in the CBI presented reductions in anxiety and guilt at posttreatment and follow-up. Clinically significant change for guilt was found in 62.5% in the GFI and 9.09% in the CBI group at posttreatment. At follow-up, 58.33% in GFI and 12.5% in the CBI group were recovered. CONCLUSIONS: The preliminary results of this pilot study suggest that caregivers with significant levels of guilt and distress might benefit from an intervention specifically designed to target guilt feelings. CLINICAL IMPLICATIONS: A novel and initial intervention approach specifically designed for targeting caregivers' feelings of guilt might have the potential to reduce caregiver's emotional distress.

Caring for Relatives with Dementia in Times of COVID-19: Impact on Caregivers and Care-recipients.

OBJECTIVES: To analyze caregivers' perceived impact of the pandemic in their mental health and the well-being of the care-recipients. METHODS: Caregivers (N = 88) were asked if they had COVID-19 and about their perceptions of change of care-recipients' health conditions as well as whether their own mental health, conflicts with care-recipients and other relatives, thoughts of giving up caregiving, and feelings of coping well with the situation. RESULTS: A large percentage of caregivers perceived a worsening of care-recipients' symptoms and of their own negative emotions, an increase in the number of conflicts and thoughts of needing to give up caregiving. Having had COVID-19 and reporting higher levels of distress as well as giving up caregiving were related to perceived worsening in care-recipients well-being. Perceived increases were mainly reported by younger caregivers, those who perceived to have not coped well, and those reporting an increase in conflicts. Some caregivers perceived an increase in positive emotions. CONCLUSIONS: The pandemic has a negative impact on caregivers' perceptions about the course of their own emotions and care-recipients' well-being. CLINICAL IMPLICATIONS: Interventions are needed to train caregivers in strategies to cope with the sources of stress caused by the pandemic and to promote social support.

Predictive value of the modified Bhalla score for assessment of pulmonary exacerbations in adults with cystic fibrosis.

OBJECTIVES: The objective of this study was to analyze the predictive value of the modified Bhalla score in high-resolution computed tomography (HRCT) for assessment of pulmonary exacerbations (PEx) in cystic fibrosis (CF) patients. We also describe the relationship between this score and pulmonary function test results. METHODS: We performed a multicenter and prospective study where adult patients with CF were included consecutively over 18 months. All patients underwent HRCT with acquisition in inspiration and expiration. The results were analyzed by an expert radiologist who assigned a modified Bhalla score value. Lung function was also assessed, and clinical variables were collected. Follow-up lasted approximately 1 year, and PEx were registered. RESULTS: The study population comprised 160 subjects selected from 360 CF patients monitored in the participating CF units. The mean age was 28 years, 47.5% were women, and mean forced expiratory volume in 1 s (FEV1) was 67.5%. The mean global modified Bhalla score was 14.5 ± 0.31 points. Pulmonary function test (PFT) results and the modified Bhalla score correlated well, mainly forced vital capacity (FVC) and FEV1. We constructed a statistical model based on the overall Bhalla score to predict the number of PEx. CONCLUSIONS: The overall modified Bhalla score can predict future PEx in CF patients. This useful tool can help to prevent PEx in higher risk patients. KEY POINTS: • Pulmonary function test results and the modified Bhalla score correlated well with FVC and FEV1. • The total modified Bhalla score can predict the number of exacerbations in adult CF patients. • Our findings highlight the need to establish a unified protocol for chest HRCT during the follow-up of adult patients with CF in order to anticipate possible complications and determine their impact on pulmonary function.

The Role of Caregivers' Sleep Problems in the Association between Behavioral Symptoms of Dementia and Caregiving Depression and Anxiety.

OBJECTIVES: Behavioral problems in people with dementia are a source of depression and anxiety for caregivers, who experience high levels of sleep problems. The present study aims to explore the role of sleep problems on the relationship between behavioral problems associated with dementias - considering its different dimensions - and family caregivers' depressive and anxious symptoms. METHOD: 264 family caregivers participated in the study. Through face-to-face interviews, sociodemographic and health variables, caregivers' depressive and anxious symptoms were measured, as well as their sleep problems. Data related to people with dementia symptoms and their level of independence in daily life activities were also collected. Data analysis consisted of simple mediational models using the PROCESS method for SPSS. RESULTS: the test for the indirect effect of disruptive behaviors on depression through sleep problems was statistically significant, as it was for disruptive behaviors on anxiety through sleep problems. The effect of sleep problems in the association between depressive and memory problems in the person with dementia, and caregivers' depression and anxiety were not statistically significant. CONCLUSIONS: Sleep problems are significantly and positively associated with care-recipients' disruptive behaviors, but not with depressive and memory problems. The indirect effect of disruptive behaviors on caregivers' mood through sleep problems suggests that disruptive behaviors seem to play an important role for understanding caregivers' sleep problems.

Guilt for perceiving oneself as a burden in healthy older adults. Associated factors.

METHODS: Participants were 317 community-dwelling people over 60 years without cognitive or functional limitations. A path model that explores the role of self-perceived burden in the relationship between negative self-perception of aging, perceived control, depressive symptoms and guilt associated with self-perception as a burden was analyzed. RESULTS: The model presented excellent fit to the data, explaining 41% of the depressive symptomatology and 45% of guilt for perceiving oneself as a burden. Negative self-perceptions of aging, lower sense of control, and a perception of being a burden were significantly associated with depressive symptoms and guilt for perceiving oneself as a burden. DISCUSSION: This study documents potential correlates of psychological distress in older adults with no explicit physical or cognitive problems, suggesting paths through which feelings of guilt for perceiving oneself as a burden may be reported by this population.