Health-related quality of life in stroke patients questionnaire, short version (HRQOLISP-40): validation for its use in Colombia.

BACKGROUND: The health-related quality of life in stroke patients (HRQOLISP-40, short version) survey was developed in Nigeria and constitutes a 40-item, multidimensional, self-administrated questionnaire. We assessed the validity and reliability of the HRQOLISP-40 Spanish version for stroke patients in Colombia. METHODS: The analysis included factor analysis, confirmatory factor analysis, Rasch analysis, convergent validity, internal consistency (261 stroke patients), test-retest reliability (73 patients assessed at two different times) and sensitivity to change (46 patients assessed before and after a rehabilitation intervention). RESULTS: We found an 8-domain structure. None of the items had a significant impact on the global alpha value in order to be removed. Lin's concordance correlation coefficient indicated test-retest reliability (Rho IC: 0.76 to 0.95), suggesting an adequate stability of the instrument. Regarding sensitivity to change differences, they were only significant in the psychological and eco-social domains (p <0.05). When comparing SF-36 with HRQOLISP-40, all the correlation coefficients values were significantly different from zero, except those related to vitality. The highest scores were found in the physical and physical functioning domains, with a value of 0.722. CONCLUSIONS: The HRQOLISP-40 scale is valid and reliable for assessing patients' quality of life after a stroke. Validating quality of life assessment instruments is necessary in order to improve the effectiveness of rehabilitation programs for Colombian stroke patients.

Fast-food and commercial baked goods consumption and the risk of depression.

OBJECTIVE: Whereas the relationship between some components of diet, such as n-3 fatty acids and B-vitamins, and depression risk has been extensively studied, the role of fast-food or processed pastries consumption has received little attention. DESIGN: Consumption of fast food (hamburgers, sausages, pizza) and processed pastries (muffins, doughnuts, croissants) was assessed at baseline through a validated semi-quantitative FFQ. Participants were classified as incident cases of depression if they reported a physician diagnosis of depression or the use of antidepressant medication in at least one of the follow-up questionnaires. Cox regression models were fit to assess the relationship between consumption of fast food and commercial baked goods and the incidence of depression. SETTING: The SUN (Seguimiento Universidad de Navarra - University of Navarra Follow-up) Project, Spain. SUBJECTS: Participants (n 8964) from a Spanish cohort. RESULTS: After a median follow-up of 6·2 years, 493 cases of depression were reported. A higher risk of depression was associated with consumption of fast food (fifth (Q5) v. first quintile (Q1): hazard ratio (HR) = 1·36; 95 % CI 1·02, 1·81; P trend = 0·003). The results did not change after adjustment for the consumption of other food items. No linear relationship was found between the consumption of commercial baked goods and depression. Participants belonging to consumption quintiles Q2-Q5 showed an increased risk of depression compared with those belonging to the lowest level of consumption (Q1; HR = 1·38; 95 % CI 1·06, 1·80). CONCLUSIONS: Fast-food and commercial baked goods consumption may have a detrimental effect on depression risk.

Factors associated to institutionalization and mortality over three years, in elderly people with a hip fracture-An observational study.

OBJECTIVE: To identify the factors associated to institutionalization and mortality in elderly patients with hip fractures (HF). DESIGN: Thirty-six months observational study. SETTING: A post-acute rehabilitation ward. PARTICIPANTS: subjects living in the community or in nursing-home, above the age of 65, with HF. MEASUREMENTS: The following were registered: comorbidity, intra-hospital complications, Barthel index, walking ability and Mini Mental State Examination, as well as blood samples upon admission and discharge. Destination upon discharge was recorded as well as mortality during hospital stay and over the three-year follow up. RESULTS: a total of 430 subjects were included in the study. Twenty-three patients (5.3%) died during their stay in hospital and 152 (35.3%) during follow up after discharge. Forty-five patients (10.5%) were institutionalized upon discharge. In adjusted analysis, the factors that predict intra-hospital mortality are higher comorbidity (OR, 1.46; 95%CI, 1.06-2.01), and the number of complications (OR, 1.71; 95%CI, 1.16-2.64). Factors that predict mortality in the long term are age (HR 1.04; 95%CI, 1.01-1.06), comorbidity (HR 1.19, 95% CI, 1.09-1.30), the number of complications (HR 1.17, 95%CI, 1.05-1.31). The factors that predicted new institutionalization were age (OR 1.04, 95%CI, 0.98-1.09), living alone (OR 3.95, 95%CI, 1.38-11.3), and length of hospital stay (OR 1.02 95%CI, 1.00-1.03). CONCLUSIONS: Mortality 3 years after a hip fracture and institutionalization are associated to age, the loss of autonomy in walking, a worse cognitive status and living alone before the fracture. Identification of and, when possible, intervention upon these factors can improve care of elderly people with hip fractures.

Tratar la depresión en el anciano, ¿hasta cuándo? / No disponible

La depresión es la enfermedad psiquiátrica más frecuente en los pacientes de edad avanzada. Supone la primera causa entre los pacientes que se suicidan a esta edad, genera gran sufrimiento en el propio paciente y en su familia, y es fuente de importante discapacidad por la propia enfermedad y por la repercusión en la evolución de otras enfermedades comórbidas. Una vez diagnosticada y tratada, la evolución de la enfermedad puede ser a una recuperación completa del paciente, tanto en lo sintomático como en lo funcional. Sin embargo, es frecuente, en este periodo de la vida, que la enfermedad depresiva sea recurrente y que por tanto haya que mantener el tratamiento antidepresivo durante varios años o de manera continuada. También resulta habitual que algunos de los síntomas no respondan de la misma manera al tratamiento farmacológico o de psicoterapia. En este caso, pueden hacerlo más tarde que los síntomas nucleares o quedar como síntomas residuales. Estos síntomas pueden tener tanta importancia y repercutir de tal manera en la vida de los pacientes que condicionen el pronóstico de la enfermedad que padecen. Los síntomas cognitivos, la ansiedad y las alteraciones de los ritmos biológicos, sobre todo el sueño, son los que requieren una mayor atención, pero las ideas de muerte y de suicidio, los síntomas somáticos y la apatía constituyen también síntomas para tener en cuenta. En este artículo se pretende revisar las posibles evoluciones y sus opciones terapéuticas, abordar si existe riesgo de encarnizamiento terapéutico, y finalizar con algunas cuestiones de la vida de estos pacientes que influyen en el afrontamiento de la enfermedad

Depression is the most frequent psychiatric illness in elderly patients. It is the first cause among patients who commit suicide at this age, generates great suffering in the patients and in their family, and is a source of significant disability due to the disease itself and the impact on the evolution of other comorbid diseases. Once diagnosed and treated, the evolution of the disease can be to a complete recovery of the patient, symptomatic and functional recovery. However, it is frequent, in this period of life, that the depressive illness would be recurrent and that therefore it would be necessary to maintain the antidepressant treatment for several years or continuously. It is also common that some of the symptoms do not respond in the same way to the pharmacological treatment or psychotherapy. In this case, they can do it later than core symptoms do, or remain as residual symptoms. These symptoms can be so important and affect in such a way the life of the patients that condition the prognosis of the disease they suffer. Cognitive symptoms, anxiety and alterations of biological rhythms, especially sleep, are those that require more attention, but the ideas of death and suicide, somatic symptoms and apathy are also symptoms to be taken into account. Finally, some patients have resistant forms and do not respond to the treatment used, or they do it very partially. This article aims to review possible evolutions, to approach therapeutic harassment possibilities, and, finally, to examine some issues in the lives of these patients that could influence the coping of the disease

Adaptación transcultural al español de la escala Health-Related Quality of Life In Stroke Patients HRQOLISP-40 / Spanish Cross-cultural adaptation of the scale Health-Related Quality of Life in Stroke Patients (HRQOLISP-40)

Antecedentes. La medición de calidad de vida en pacientes con accidente cerebrovascular es importante, ya que puede orientar el manejo de los procesos de rehabilitación. En Colombia no existen instrumentos de medición de calidad de vida validados para pacientes con este tipo de afección. Objetivo. Realizar la adaptación transcultural de la escala Health-Related Quality of Life In Stroke Patients HRQOLISP-40 para su uso en Colombia. Materiales y métodos. Se siguieron las recomendaciones metodológicas del grupo de calidad de vida EORTC: traducción inicial, traducción inversa y estudio piloto. Resultados. Las traducciones directas fueron similares en 24/40 ítems; en 12 ítems hubo variaciones en redacción sin cambio de palabras; en las instrucciones, una opción de respuesta y en 4 ítems se requirió escoger la mejor opción de traducción de una palabra. Las traducciones inversas fueron similares entre sí y a la versión original de la escala. Por otra parte, en la prueba piloto se observó cierta dificultad de comprensión en 3 ítems, se adoptaron las sugerencias del autor respecto a las inquietudes de los pacientes, no hubo dificultades por molestia ni se sugirió un nuevo parafraseo. Conclusión. Al terminar esta fase se cuenta con la versión en español (de Colombia) de la escala HRQOLISP-40 para ser sometida a una validación previa a su uso en la evaluación de calidad de vida en pacientes con accidente cerebrovascular.

Background. The measurement of quality of life in patients with stroke is important because it can guide the management of rehabilitation processes. In Colombia there are no instruments for measuring quality of life in stroke patients. The objective was to perform the cross-cultural adaptation of Health-Related Quality of Life In Stroke Patients HRQLISP-40 scale for use in Colombia. Objective. To make a transcultural adaptation to the Health-Related Quality of Life In Stroke Patients HRQOLISP-40 scale in order to use it in Colombia. Materials and Methods. The methodological recommendations by EORTC quality of life group were taken: initial translation, back translation and pilot study. Results. Direct translations were similar in 24/40 items; in 12 items there were variations in writing without changing the words; in the instructions, an option of choices and 4 items were required to choose the best translation of a word. The reverse translations were similar to each other and with the original version of the scale; in the pilot test there were difficulty in comprehension understanding 3 items and were adopted the author's suggestions concerns the patients, there was no trouble or non-comfortableness nor any paraphrase were suggested. Conclusion. To finish this phase it is the Colombian Spanish version of HRQLISP-40 scale to be submitted for validation prior to use in assessing quality of life in stroke patients.