Efficacy of a cognitive intervention program in patients with mild cognitive impairment.

BACKGROUND: Mild cognitive impairment (MCI) is a transitional state between normal aging and dementia. Identifying this condition would allow early interventions that may reduce the rate of progression to Alzheimer's disease (AD). We examined the efficacy of a six-month cognitive intervention program (CIP) in patients with MCI and to assess patients' condition at one-year follow-up. METHODS: Forty-six MCI participants assessed with neuropsychological, neurological, neuropsychiatry, and functional procedures were included in this study and followed up during a year. The sample was randomized into two subgroups: 24 participants (the "trained group") underwent the CIP during six months while 22 (control group) received no treatment. Sixteen participants dropped out of the study. The intervention focused on teaching cognitive strategies, cognitive training, and use of external aids, in sessions of two hours, twice per week for six months. Cognitive and functional measures were used as primary outcome and all were followed up at one year. RESULTS: The intervention effect (mean change from baseline) was significant (p < 0.05) on the Mini-Mental State Examination (1.74), the Clinical Dementia Rating Scale (0.14), the Boston Naming Test (2.92), block design (-13.66), matrix reasoning (-3.07), and semantic fluency (-3.071) tasks. Four patients (one trained and three controls) progressed to dementia after one year of follow-up. CONCLUSIONS: These results suggest that persons with MCI can improve their performance on cognitive and functional measures when provided with early cognitive training and it could persist in a long-term follow-up.

[Cognition in dysthymia]. / Cognición en distimia.

UNLABELLED: Depression is named as one of the most prevalent Mental Health problem, affecting almost 10 % of the population. According to Diagnostic and Statistical Manual of Mental Disorders (DSM-IV) different subtypes are included. Dysthymic Disorder is characterized by a depressed mood for most of the day, for more days than not, as indicated either by subjective account or observation by others, for at least 2 years. The aim of this study was to investigate the neuropsychological profile of dysthymic disorder. Ninety three patients fulfilling criteria for dysthymia were examined on a variety of cognitive tasks, neurological exam and a semi-structured psychiatric interview. Forty one non-depressed individuals served as controls. Significant differences between groups were found in digit span; immediate and delayed recall of a story; and semantic and phonologic fluency. Logic memory was worse than serial learning task, and has a correlation with attention deficit and depressive features. CONCLUSIONS: This results indicate that the neuropsychological performance of patients with dysthymic disorder exhibit impairments in attention and memory. Attentional deficits appear to be the key of cognitive deficits in dysthymia.

Programa de Acompañamiento en Salud Constante (PASC). Generando una red de voluntariado desde la participación comunitaria / Constant Health Accompaniment Programme. Involving the community to generate a network of volunteers

La soledad y el apoyo social deficiente están reconocidos como predictores de morbimortalidad. Cuando una persona mayor vive sola y no recibe soporte familiar ni social para corregir desviaciones en su autocuidado, se produce una sobreutilización de servicios sanitarios y, posiblemente, un aumento de los ingresos hospitalarios. En 2018, el Consell de Salut del Centro de Salud (CS) República Argentina de Valencia realizó un estudio piloto de detección y abordaje de soledad no deseada en las personas del barrio en el que se estableció que un 45% de las personas que vivían solas y eran mayores de 75 años tendrían un posible diagnóstico de aislamiento social. OBJETIVOS: implementar una red comunitaria de voluntariado de acompañamiento-vigilancia en autocuidados para personas mayores con aislamiento social en el área del CS República Argentina, con el soporte del «Programa de acompañamiento en salud constante» (PASC) de la Cruz Roja, en colaboración con el centro de salud, y estudiar la relación entre soledad y salud. MÉTODOS: mediante un diseño escalado de detección y diagnóstico de aislamiento social, con la participación de técnicos de la Cruz Roja, profesionales del centro de salud y la colaboración de voluntariado de acompañamiento a personas mayores participantes. RESULTADOS: en 7 meses 1.200 personas fueron sensibilizadas de forma directa sobre la soledad y 49 voluntarios del barrio desarrollaron labores de acompañamiento y asistencia a talleres formativos y lúdicos. Los profesionales sanitarios analizaron 216 casos: 149 (69%) no se sintieron solos y 67 (31%) fueron diagnosticados de aislamiento social (código correspondiente a V64.01 según CIE-9). Participaron en el proyecto 54 personas (25%). Existe asociación entre la escala de detección de la soledad existencial (EDSOL) y la participación en el proyecto. La sensación de soledad no deseada presenta correlación positiva con problemas de movilidad, cronicidad y una tendencia de asociación con otras variables de salud (consumo elevado de fármacos, percepción negativa de calidad de vida, etc.). CONCLUSIONES: las intervenciones comunitarias promovidas desde el centro de salud sobre personas que viven solas contribuyen al abordaje del aislamiento no deseado y a su vez generan un barrio más solidario

Loneliness and poor social support are widely recognized as predictors of morbidity and mortality. When an elderly person lives alone and does not receive family or social support to correct minor deviations in basic self-care processes, this leads to overuse of health services and possibly, increased hospital admissions. In 2018, the Consell de Salut of the República Argentina Primary Health Centre in Valencia, began a pilot study to detect and tackle unwanted loneliness in people from the neighbourhood, in which it was established that 45% of people aged over 75 years old who lived alone may be diagnosed with social isolation. OBJECTIVES: To establish a community network of accompanying-surveillance volunteers in self-care for socially isolated elderly people in the area of the República Argentina Primary Care Centre with the support of the Red Cross Constant Health Accompaniment Programme. The specific objective is to study the relationship between loneliness and health. METHODS: Using a scaled design for the detection and diagnosis of social isolation, with the participation of the Red Cross technicians, professionals from the health center, and the collaboration of volunteer support for elderly participants. RESULTS: Over seven months a total of 1200 people have been directly made aware about loneliness and 49 volunteers from the neighbourhood performed accompaniment work and attended training and recreational workshops. Health professionals analyzed 216 cases, of which 149 (69%) did not feel alone and the remaining 67 (31%) were diagnosed with social isolation (code V64.01 according to ICD-9). A total of 54 (25%) agreed to take part in the project. An association was observed between the scale for detection of existential loneliness (EDSOL) and participation in the project. The feeling of unwanted loneliness correlates positively with mobility problems, chronicity and a tendency of association with other health variables such as high consumption of drugs and negative perception of quality of life. CONCLUSIONS: Community interventions promoted by the Primary Health Centre on people who live alone contribute to tackling unwanted isolation, which at the same time generates a more supportive neighbourhood

[Psychic change in schizophrenic patients produced group therapy]. / Cambio psíquico en pacientes esquizofrénicos en tratamiento grupal.

The objective of this paper is to analyze the effectiveness of group therapy to produce psychic change in patients with schizophrenia and other related psychosis. The experience took place in a Public Psychiatric Hospital. It involved 96 patients with this condition who entered different groups from 1998 up to the present. During the year 2000, 66 of them were asked to answer a questionnaire especially designed to investigate the changes that they thought they had gone through during this treatment. On one hand, the results show the high valorization of the group appliance, while on the other hand the most valued operational categories were the facilitation of interpersonal links, the valorization of listening and being listened, the recognition of improvement and the recognition of one's own characteristics in the other person. On account of these discoveries, the mechanisms of these group appliances to produce such changes are postulated. In conclusion, group treatment for schizophrenic patients and related psychosis turns out to be useful for producing psychic changes different from those achieved with psychopharmacological agents.

Estereologia do miocárdio em fetos humanos: estudo quantitativo das modificaçöes estruturais nos dois últimos trimestres de gestaçäo / Stereology of the Myocardium in Human Fetuses: Quantitative Study of the Structural Changes in the Last Two Trimesters of Gestation

Objetivo - Quantificar o miocárdio humano comparando o 2§ e 3§ trimestres gestacionais. Métodos - Fragmentos de miocárdio de 8 coraçöes de fetos humanos (sendo 4 do 2§ e 4 do 3§ trimestre) foram coletados e processados histologicamente. Quinze campos miocárdicos aleatórios de cada coraçäo foram quantificados para miócitos, tecido conjuntivo e vasos contando pontos-teste e intersecçöes . Resultados - As diferenças esterológicas para os miócitos, vasos e tecido conjuntivo, näo foram significantes comparando os 2 trimestres (p > 0,05). A densidade volumétrica foi: miócitos (núcleos inclusive) = 75,6// no 2§ trimestre e 67,7// no 3§ trimestre; vasos = 3,7// no 2§ trimestre e 6,4// no 3§ trimestre; tecido conjuntivo (substância intersticial excluindo os vasos) de 20,6 a 25,9// do 2§ para o 3§ trimestres, respectivamente. Entretanto, a diferença das densidades volumétricas dos núcleos dos miócitos foi significante (p=0,004) e indicou reduçäo do 2§ para o 3§ trimestres, de 15,2 para 8,1// respectivamente. Conclusäo - Esses resultados sugerem que há reduçäo gradativa da síntese protéica nos 2 últimos trimestres gestacionais, sem alteraçäo quantitativa importante na composiçäo do tecido cardíaco, provavelmente relacionada à simultânea diminuiçäo da multiplicaçäo celular miocárdica

Purpose - Quantitative study of the human myocardial comparing the2nd and 3rd trimesters of gestation. Methods - Fragments of the myocardium were collected from 8 fetal human hearts (4 from 2nd and 4 from 3rd trimesters) and prepared by histological methods. Fifteen random fields from each region were analyzed considering independently myocytes, connective tissue and vessels. Stereological determinations were possible by counting test-points and intersections on a multipurpose test lattice (M42). Results - Stereological differences between last 2 trimesters of gestation were not significant (p>0,05). The volume density was myocyte (including nucleus)=75.6% in 2nd trimester and 67.7% in 3rd trimester; vessels=3.7% in 2nd trimester and 6.4% in 3rd trimester; connective tissue (interstitial substance without vessels) = 20.6 to 25.9% for 2nd and 3rd trimesters respectively. However, considering the nuclei of the myocytes differences between last 2 trimesters were significant (p=0.004). The volume density of the nuclei had a reduction from 2nd to 3rd trimesters (from 15.2 to 8.1% respectively). Conclusion - This result suggests decreasing synthesis of proteins from nucleus of myocyte in the last 2 gestational trimesters, but without quantitative important changes in the cardiac tissue, probably in relation to the reduction of the myocardial cellular multiplication