Inflammatory agents partially explain associations between cortical thickness, surface area, and body mass in adolescents and young adulthood.

BACKGROUND/OBJECTIVES: Excessive body mass index (BMI) has been linked to a low-grade chronic inflammation state. Unhealthy BMI has also been related to neuroanatomical changes in adults. Research in adolescents is relatively limited and has produced conflicting results. This study aims to address the relationship between BMI and adolescents' brain structure as well as to test the role that inflammatory adipose-related agents might have over this putative link. METHODS: We studied structural MRI and serum levels of interleukin-6, tumor necrosis factor alpha (TNF-α), C-reactive protein and fibrinogen in 65 adolescents (aged 12-21 years). Relationships between BMI, cortical thickness and surface area were tested with a vertex-wise analysis. Subsequently, we used backward multiple linear regression models to explore the influence of inflammatory parameters in each brain-altered area. RESULTS: We found a negative association between cortical thickness and BMI in the left lateral occipital cortex (LOC) and the right precentral gyrus as well as a positive relationship between surface area and BMI in the left rostral middle frontal gyrus and the right superior frontal gyrus. In addition, we found that higher fibrinogen serum concentrations were related to thinning within the left LOC (ß = -0.45, p < 0.001), while higher serum levels of TNF-α were associated to a greater surface area in the right superior frontal gyrus (ß = 0.32, p = 0.045). Besides, we have also identified a trend that negatively correlates the cortical thickness of the left fusiform gyrus with the increases in BMI. It was also associated to fibrinogen (ß = -0.33, p = 0.035). CONCLUSIONS: These results suggest that adolescents' body mass increases are related with brain abnormalities in areas that could play a relevant role in some aspects of feeding behavior. Likewise, we have evidenced that these cortical changes were partially explained by inflammatory agents such as fibrinogen and TNF-α.

Diagnósticos Enfermeros prevalentes en pacientes mayores con úlceras por presión: estudio transversal / Prevalent nursing diagnoses in elderly with pressure ulcers: cross-sectional study / Diagnósticos Enfermeiros prevalentes em pacientes idosos com úlceras por pressão: estudo transversal

Resumen Objetivo Determinar la prevalencia de los diagnósticos enfermeros en pacientes adultos mayores hospitalizados con úlceras por presión e identificar los diagnósticos enfermeros reales, potenciales, de salud y síndrome por patrón funcional de salud. Material y métodos Estudio Transversal, descriptivo conformado por una muestra de pacientes adultos mayores hospitalizados en diferentes servicios de un Hospital de Acapulco, Guerrero, México. Para su evaluación, se diseñó un instrumento de acuerdo con los patrones funcionales de Marjory Gordon. Se utilizó la plataforma de mejores prácticas de enfermería E-cuidados® para el análisis. Resultados El presente estudio identificó 36 diagnósticos relevantes, de los cuales 23 (63.9 %) fueron diagnósticos centrados en el problema, 10 (27.8 %) diagnósticos de riesgo y 3 (8.3 %) de promoción a la salud. Los patrones funcionales más afectados son; Actividad-Ejercicio, Nutricional-Metabólico y Valores-Creencias. Conclusiones El presente estudio ayuda a enfatizar la importancia de adoptar estrategias preventivas y de atención integral, así como la mejora de la planificación de la atención para evitar el deterioro de las condiciones en los pacientes adultos mayores.

Abstract Objective To determine the prevalence of diverse nursing diagnostics in hospitalized older patients with pressure ulcers, identifying the real, potential, and health-related ones, as well as syndrome by health functional pattern. Methods and material This is a transversal and descriptive study with a sample of older patients in different services in a hospital of Acapulco, Guerrero, Mexico. An assessment instrument was designed following the Functional Patterns of Marjory Gordon. The E-cuidados® best nursing practices platform was used for the analysis. Results 36 relevant diagnostics were identified: 23 (63.9 %) were problem-centered; 10 (27.8 %) were risk related; and 3 (8.3 %) were health promoting. The most affected functional patterns were: Activity-Exercise; Nutrition-Metabolism; and Values-Beliefs. Conclusions This study supports the need to highlight the importance of adopting preventive and integral attention strategies, as well as improving the attention planning process in order to avoid the deterioration of health conditions of older patients.

Resumo Objetivo Determinar a prevalência dos diagnósticos enfermeiros em pacientes idosos hospitalizados com úlceras por pressão e identificar os diagnósticos enfermeiros reais, potenciais, de saúde e síndrome por padrão funcional de saúde. Material e métodos Estudo Transversal, descritivo conformado por uma amostra de pacientes idosos hospitalizados em diferentes serviços de um Hospital de Acapulco, Guerrero, México. Para sua avaliação, desenhou-se um instrumento conforme com os padrões funcionais de Marjory Gordon. Utilizou-se a plataforma de melhores práticas de enfermagem E-cuidados® para a análise. Resultados O presente estudo identificou 36 diagnósticos relevantes, dos quais 23 (63.9 %) foram diagnósticos centrados no problema, 10 (27.8 %) diagnósticos de risco e 3 (8.3 %) de promoção à saúde. Os padrões funcionais mais afetados são; Atividade-Exercício, Nutricional-Metabólico e Valores-Crenças. Conclusões O presente estudo ajuda a enfatizar a importância de adotar estratégias preventivas e de atenção integral, assim como a melhora da planificação da atenção para evitar a deterioração das condições nos pacientes idosos.

Allostatic load and executive functions in overweight adults.

BACKGROUND/OBJECTIVE: Overweight is linked to inflammatory and neuroendocrine responses potentially prompting deregulations in biological systems harmful to the brain, particularly to the prefrontal cortex. This structure is crucial for executive performance, ultimately supervising behaviour. Thus, in the present work, we aimed to test the relationship between allostatic load increase, a surrogate of chronic physiological stress, and core executive functions, such as cognitive flexibility, inhibitory control, and working memory. METHOD: Forty-seven healthy-weight and 56 overweight volunteers aged from 21 to 40 underwent medical and neuropsychological examination. RESULTS: Overweight subjects exhibited a greater allostatic load index than healthy-weight individuals. Moreover, the allostatic load index was negatively related to inhibitory control. When separated, the link between allostatic load index and cognitive flexibility was more marked in the overweight group. CONCLUSIONS: An overweight status was linked to chronic physiological stress. The inverse relationship between the allostatic load index and cognitive flexibility proved stronger in this group. Set-shifting alterations could sustain rigid-like behaviours and attitudes towards food.

Allostatic load and disordered white matter microstructure in overweight adults.

Overweight and stress are both related to brain structural abnormalities. The allostatic load model states that frequent disruption of homeostasis is inherently linked to oxidative stress and inflammatory responses that in turn can damage the brain. However, the effects of the allostatic load on the central nervous system remain largely unknown. The current study aimed to assess the relationship between the allostatic load and the composition of whole-brain white matter tracts in overweight subjects. Additionally, we have also tested for grey matter changes regarding allostatic load increase. Thirty-one overweight-to-obese adults and 21 lean controls participated in the study. Our results showed that overweight participants presented higher allostatic load indexes. Such increases correlated with lower fractional anisotropy in the inferior fronto-occipital fasciculi and the right anterior corona radiata, as well as with grey matter reductions in the left precentral gyrus, the left lateral occipital gyrus, and the right pars opercularis. These results suggest that an otherwise healthy overweight status is linked to long-term biological changes potentially harmful to the brain.

Affected connectivity organization of the reward system structure in obesity.

With the prevalence of obesity rapidly increasing worldwide, understanding the processes leading to excessive eating behavior becomes increasingly important. Considering the widely recognized crucial role of reward processes in food intake, we examined the white matter wiring and integrity of the anatomical reward network in obesity. Anatomical wiring of the reward network was reconstructed derived from diffusion weighted imaging in 31 obese participants and 32 normal-weight participants. Network wiring was compared in terms of the white matter volume as well as in terms of white matter microstructure, revealing lower number of streamlines and lower fiber integrity within the reward network in obese subjects. Specifically, the orbitofrontal cortex and striatum nuclei including accumbens, caudate and putamen showed lower strength and network clustering in the obesity group as compared to healthy controls. Our results provide evidence for obesity-related disruptions of global and local anatomical connectivity of the reward circuitry in regions that are key in the reinforcing mechanisms of eating-behavior processes.

Analysis of a global random stratified sample of nurse legislation.

AIM: To identify, compare and contrast the major component parts of heterogeneous stratified sample of nursing legislation. BACKGROUND: Nursing legislation varies from one jurisdiction to another. Up until now no research exists into whether the variations of such legislation are random or if variations are related to a set of key attributes. METHODS: This mixed method study used a random stratified sample of legislation to map through documentary analysis the content of 14 nursing acts and then explored, using quantitative techniques, whether the material contained relates to a number of key attributes. These attributes include: legal tradition of the jurisdiction; model of regulation; administrative approach; area of the world; and the economic status of the jurisdiction. FINDINGS: Twelve component parts of nursing legislation were identified. These were remarkably similar irrespective of attributes of interest. However, not all component parts were specified in the same level of detail and the manner by which the elements were addressed did vary. A number of potential relationships between the structure of the legislation and the key attributes of interest were identified. CONCLUSIONS AND IMPLICATIONS FOR POLICY: This study generated a comprehensive and integrated map of a global sample of nursing legislation. It provides a set of descriptors to be used to undertake further quantitative work and provides an important policy tool to facilitate dialogue between regulatory bodies. At the individual nurse level it offers insights that can help nurses pursue recognition of credentials across jurisdictions.

A systematic review of nurse-related social network analysis studies.

BACKGROUND: Nurses frequently work as part of both uni- and multidisciplinary teams. Communication between team members is critical in the delivery of quality care. Social network analysis is increasingly being used to explore such communication. AIM: To explore the use of social network analysis involving nurses either as subjects of the study or as researchers. METHODS: Standard systematic review procedures were applied to identify nurse-related studies that utilize social network analysis. A comparative thematic approach to synthesis was used. Both published and grey literature written in English, Spanish and Portuguese between January 1965 and December 2013 were identified via a structured search of CINAHL, SciELO and PubMed. In addition, Google and Yahoo search engines were used to identify additional grey literature using the same search strategy. RESULTS: Forty-three primary studies were identified with literature from North America dominating the published work. So far it would appear that no author or group of authors have developed a programme of research in the nursing field using the social network analysis approach although several authors may be in the process of doing so. LIMITATIONS: The dominance of literature from North America may be viewed as problematic as the underlying structures and themes may be an artefact of cultural communication norms from this region. CONCLUSIONS: The use of social network analysis in relation to nursing and by nurse researchers has increased rapidly over the past two decades. The lack of longitudinal studies and the absence of replication across multiple sites should be seen as an opportunity for further research. IMPLICATION FOR NURSING AND HEALTH POLICY: This analytical approach is relatively new in the field of nursing but does show considerable promise in offering insights into the way information flows between individuals, teams, institutions and other structures. An understanding of these structures provides a means of improving communication.

Reward processing in obesity, substance addiction and non-substance addiction.

Similarities and differences between obesity and addiction are a prominent topic of ongoing research. We conducted an activation likelihood estimation meta-analysis on 87 studies in order to map the functional magnetic resonance imaging (fMRI) response to reward in participants with obesity, substance addiction and non-substance (or behavioural) addiction, and to identify commonalities and differences between them. Our study confirms the existence of alterations during reward processing in obesity, non-substance addiction and substance addiction. Specifically, participants with obesity or with addictions differed from controls in several brain regions including prefrontal areas, subcortical structures and sensory areas. Additionally, participants with obesity and substance addictions exhibited similar blood-oxygen-level-dependent fMRI hyperactivity in the amygdala and striatum when processing either general rewarding stimuli or the problematic stimuli (food and drug-related stimuli, respectively). We propose that these similarities may be associated with an enhanced focus on reward--especially with regard to food or drug-related stimuli--in obesity and substance addiction. Ultimately, this enhancement of reward processes may facilitate the presence of compulsive-like behaviour in some individuals or under some specific circumstances. We hope that increasing knowledge about the neurobehavioural correlates of obesity and addictions will lead to practical strategies that target the high prevalence of these central public health challenges.

Defining nurse regulation and regulatory body performance: a policy Delphi study.

CONTEXT: Professional self-regulation is a privilege and needs to deliver against the underpinning social contract between the professional and citizens who are receiving care and services. AIMS: The aims of this study were to generate, international consensus on a contemporary definition of professional nurse regulation; and to articulate the key features of a highly performing regulatory body, and postulate which regulatory model and administrative arrangements are best suited to attain the key features. METHOD: A highly diverse and globally recruited random stratified sample of 75 experts was approached to participate in a classic three-round policy Delphi study. Quantitative and qualitative data were generated and subjected to thematic and statistical analysis. Both non-parametric and descriptive statistical techniques were used in relation to quantitative data. RESULTS: Consensus on a revision of the current International Council of Nurses definition of professional nurse regulation was developed and a set of 47 key features of high-performing regulatory bodies was agreed. Although a strong preference for the delegated self-regulatory model (43%) and single-board administrative approach (48%) was expressed the underlying rationale for such a preference was unclear. CONCLUSION: The research makes an important contribution to an underdeveloped field of study. The case for conducting more quantitative investigations to ascertain the best regulatory model and associated administrative approach has been made.

Nurse faculty migration: a systematic review of the literature.

BACKGROUND: To undertake a systematic review of English and Spanish literature relating to nurse faculty migration. METHODS: A systematic review of both published literature, using CINAHL, EMBASE, ERIC and MEDLINE, and grey literature, using Google and Yahoo search engines, utilizing a defined search strategy with key terms, wild card strings and logical operators, was undertaken. An initial limitation of searching for material published in the last ten years was removed due to the poor yield of relevant papers. In total, 18 research-based studies were identified, retrieved and reviewed. Finally, the retrieved material was reviewed and augmented by a group of nurse faculty and migration experts, who offered comments and proposed additional grey literature. With increased globalization, the impact of mutual recognition agreements and associated modes of supply of services as well as those factors influencing clinical nurse migration was also considered. RESULTS: Studies on clinical nurse migration and general academic faculty provided some insights, but nursing faculty differ in a number of key ways and this needs to be considered when interpreting the results. Based on this systematic review, the paper concludes that nurse faculty migration is a neglected topic and one that warrants urgent investigation if health systems redesign and the associated scale-up of nurses are to be achieved. Particular gaps in knowledge relate to nurse faculty workforce planning, and understanding the dynamics and flows of faculty both across and within countries. It is unclear as to the extent to which our knowledge of push and pull factors relating to clinical nurse migration can be used in understanding nurse faculty migration. CONCLUSION: The current policy position of organizations such as the World Health Organization and individual governments to increase nursing numbers is incomplete without due consideration of faculty migration.

A structured policy review of the principles of professional self-regulation.

BACKGROUND: The International Council of Nurses (ICN) has, for many years, based its work on professional self-regulation on a set of 12 principles. These principles are research based and were identified nearly three decades ago. ICN has conducted a number of reviews of the principles; however, changes have been minimal. In the past 5-10 years, a number of authors and governments, often as part of the review of regulatory systems, have started to propose principles to guide the way regulatory frameworks are designed and implemented. These principles vary in number and content. OBJECTIVES: This study examines the current policy literature on principle-based regulation and compares this with the set of principles advocated by the ICN. DESIGN AND DATA SOURCES: A systematic search of the literature on principle-based regulation is used as the basis for a qualitative thematic analysis to compare and contrast the 12 principles of self-regulation with more recently published work. RESULTS: A mapping of terms based on a detailed description of the principles used in the various research and policy documents was generated. This mapping forms the basis of a critique of the current ICN principles. A professional self-regulation advocated by the ICN were identified. CONCLUSIONS: A revised and extended set of 13 principles is needed if contemporary developments in the field of regulatory frameworks are to be accommodated. These revised principles should be considered for adoption by the ICN to underpin their advocacy work on professional self-regulation.

Neural responses to visual food cues: insights from functional magnetic resonance imaging.

The aim of this paper is to describe the patterns of functional magnetic resonance imaging activation produced by visual food stimuli in healthy participants, as well as in those with anorexia nervosa, bulimia nervosa, binge eating disorder and obesity. We conducted a systematic review of studies published in the last decade on normal and abnormal eating. This review suggested the existence of neural differences in response to the sight of food between healthy individuals, those with an eating disorder and obese subjects. Differences were identified in two brain circuits: (i) limbic and paralimbic areas associated with salience and reward processes and (ii) prefrontal areas supporting cognitive control processes.

Functional connectivity in obesity during reward processing.

Obesity is a health problem that has become a major focus of attention in recent years. There is growing evidence of an association between obesity and differences in reward processing. However, it is not known at present whether these differences are linked exclusively to food, or whether they can be detected in other rewarding stimuli. We compared responses to food, rewarding non-food and neutral pictures in 18 young adults with obesity and 19 normal-weight subjects using independent component analysis. Both groups modulated task-related activity in a plausible way. However, in response to both food and non-food rewarding stimuli, participants with obesity showed weaker connectivity in a network involving activation of frontal and occipital areas and deactivation of the posterior part of the default mode network. In addition, obesity was related with weaker activation of the default mode network and deactivation of frontal and occipital areas while viewing neutral stimuli. Together, our findings suggest that obesity is related to a different allocation of cognitive resources in a fronto-occipital network and in the default mode network.

Impact of diabetic foot related complications on the Health Related Quality of Life (HRQol) of patients--a regional study in Spain.

The diabetic foot reduces the health-related quality of life (HRQoL) in patients with diabetes mellitus. This study aims at ascertaining the impact of the etiological factors of the diabetic foot on the various aspects of HRQoL. This is a comparative study involving type 1 or type 2 (n = 421) diabetic patients divided into 2 groups. Group 1 (n = 258) includes diabetic patients without foot lesions and group 2 (n = 163) includes patients suffering from a diabetic foot ulcer. The HRQoL of the sample was assessed by using the SF-36 Health Questionnaire. The overall HRQoL score was 68.58 ± 18.24 in group 1 and 50.99 ± 18.98 in group 2 (P < .001). The diabetic foot-related etiological factors that significantly reduce these patients' HRQoL are neuropathy, amputation history, and poor metabolic control (P < .001). Quality of life was lower in women with diabetic foot than in men. Neuropathy--regarded as the main etiological factor in the diabetic foot--also proved to be a variable that reduces the HRQoL. Paradoxically, peripheral vascular disease did not prove to have a negative impact on the quality of life.

Inter-observer reproducibility of probing to bone in the diagnosis of diabetic foot osteomyelitis.

AIMS: The objectives of our study were (i) to analyse the inter-observer reproducibility or diagnostic variability of the probing-to-bone test, depending on the training of the professional involved, and (ii) to assess whether the probing-to-bone test can be extrapolated to any professional specialty that deals with these patients. METHODS: This was a cross-sectional study, involving 75 patients with diabetic foot ulcer and clinical suspicion of osteomyelitis. A registration sheet was completed for all patients involved in the research study, gathering data relative to the results of the probing-to-bone test performed by three observers. Observer 1 was a very experienced professional with several years of experience in the treatment of the diabetic foot; observer 2 was a medium-experienced professional whose experience ranges from 6 to 12 months in the treatment of the diabetic foot; observer 3 was a healthcare professional without experience in the treatment of the diabetic foot. Data were gathered confidentially by a fourth researcher. RESULTS: The results showed a kappa index of 0.593 (95% CI 0.407-0.778) between observer 1 and observer 2, 0.397 (95% CI 0.188-0.604) between observer 1 and observer 3 and 0.53 (95% CI 0.335-0.725) between observer 2 and observer 3. CONCLUSIONS: The probing-to-bone test demonstrated moderate to fair concordance with an experienced examiner, although the degree of concordance is not significant between groups.

[Metabolic syndrome and ageing: cognitive impairment and structural alterations of the central nervous system]. / Síndrome metabólico y envejecimiento: déficit cognitivo y alteraciones estructurales del sistema nervioso central.

INTRODUCTION: The metabolic syndrome is a cluster of vascular risk factors, including: hypertension, insulin resistance, low levels of high density lipoproteins, high levels of triglycerides and obesity. Nowadays the prevalence of the syndrome in the developmental societies increases and it is related to aging. AIM: To review the relation of metabolic syndrome to the cognitive impairment and cerebrovascular alterations during the aging. DEVELOPMENT: The syndrome involves higher risk of vascular pathologies and recently has been related to the pathological aging, including cognitive impairment and structural damage in the central nervous system. Specifically the studies about metabolic syndrome have described a profile of higher general cognitive impairment and higher risk of dementia, as well as concrete neuropsychological deficits probably related to white matter alterations. The independent effects of vascular risk factors in cognition have been studied before as well as their influences in structural integrity of the brain. CONCLUSION: Nowadays further research is necessary to know if the metabolic syndrome effects on cognition and brain are greater than the sum of the effect of his components. In the future the knowledge about the cognitive and structural damage due to the syndrome could be useful to design prevention programs and promote the healthy aging.

Microstructural white matter changes in metabolic syndrome: a diffusion tensor imaging study.

BACKGROUND: Although metabolic syndrome is associated with cardiovascular disease and stroke, limited information is available on specific brain damage in patients with this syndrome. We investigated the relationship of the syndrome with white matter (WM) alteration using a voxel-based approach with diffusion tensor imaging (DTI). METHODS: We compared fractional anisotropy (FA) and apparent diffusion coefficient (ADC) measurements of DTI in 19 patients with metabolic syndrome aged between 50 and 80 years and 19 age-matched controls without any vascular risk factors for the syndrome. RESULTS: Patients with metabolic syndrome showed an anterior-posterior pattern of deterioration in WM with reduced FA and increased ADC values compared with controls. WM changes were not related to any isolated vascular risk factor. CONCLUSION: Although the mechanism of this damage is not clear, the results indicate microstructural white matter alterations in patients with metabolic syndrome, mainly involving the frontal lobe.

Obsessive-compulsive disorder (OCD) patients are impaired in remembering temporal order and in judging their own performance.

Obsessive-compulsive disorder (OCD) has been related to frontostriatal dysfunction, but some inconsistencies between studies and a relative paucity of neuropsychological research still characterizes the study of OCD. We compared 28 patients with OCD and matched healthy controls on two neuropsychological tests sensitive to frontal dysfunction: temporal ordering and a "feeling-of-doing" (FOD) judgment about ordering. The OCD group performed significantly worse than controls in the temporal ordering task despite showing normal recognition memory. Patients were also impaired in "feeling-of-doing" judgments suggesting they have a lack of self-awareness of their performance. Thus, the results of the current study reinforces previous research that indicates that OCD patients fail on tasks that require adequate functioning of the frontal-striatal pathways.

Impairment of incidental memory for frequency in patients with obsessive-compulsive disorder.

The aim of our study was to investigate whether patients with obsessive-compulsive disorder (OCD) have impaired incidental memory for frequency. Fifty-four subjects (27 OCD patients and 27 matched control subjects) performed a task assessing estimation of occurrence of previously heard words. Performance on this task was compared with other intentional verbal memory tasks (recognition, recall and learning of common words). We also correlated memory for frequency with frontal lobe tests (Wisconsin Card Sorting Test, Trail Making Tests A and B, and verbal fluency). Performance on incidental learning of frequency was significantly worse in the OCD group than in control subjects. Other verbal memory measures did not show significant differences. Performance in the frequency task correlated with verbal fluency. Although intentional verbal memories are normal in OCD patients, incidental memory for frequency is impaired, suggesting that prefrontal systems are involved in OCD.

Correlation of atrophy measures on MRI with neuropsychological sequelae in children and adolescents with traumatic brain injury.

To examine the relationship between neuropsychological sequelae and atrophy parameters from magnetic resonance imaging (MRI) following paediatric moderate-to-severe traumatic brain injury (TBI), 19 head injured children and adolescents were studied at least 6 years after injury. Three-dimensional MRI scans were obtained. A semi-automatic computerized method was used to estimate ventricular volumes and the corpus callosum area. Tests of intellectual, memory, visuospatial, frontal lobe, and motor speed functioning were administered to all patients and to 19 matched normal control subjects. Patients' performance significantly differed from controls in general intellectual function, visual memory, visuospatial and frontal lobe tests. The corpus callosum area correlated strongly with several measures involving processing speed and visuospatial function. Ventricular enlargement was less related to neuropsychological outcome. In conclusion, quantitative measurement of the corpus callosum on MRI reflects neuropsychological outcome better than ventricular dilation in paediatric patients.