Minerals and trace elements in pregnancy in women with previous bariatric surgery consequences on maternal and foetal health.

BACKGROUND: Bariatric surgery (BS) may decrease the risk of these obesity-related complications; however, due to its effect on nutrient intake and absorption, it can also have adverse consequences on maternal and foetal health. The aim of this study is to describe the evolution of electrolytes and trace elements serum levels throughout pregnancy after BS, according to the surgical technique and to evaluate the effect of nutritional deficiencies on the risk of maternal-foetal complications. METHODS: This is a retrospective observational study of the clinical evolution and maternal-foetal complications in a group of women with pregnancies that occurred after BS. Clinical evolution during pregnancy, body weight, and plasma electrolytes, vitamins, and trace elements, as well as their influence on maternal-foetal outcomes were evaluated. Composite neonatal variable (CNV) was defined to evaluate unfavourable foetal outcome. Published reference values for micronutrients during pregnancy have been used. RESULTS: The study includes data on 164 singleton pregnancies in 91 women. A hundred and twenty-seven pregnancies got to full term. The average birth weight was 2966 (546) g., 26.8% < P10 and 13.8% < P3 of a reference population. New-born of gestations after malabsorptive bariatric surgery had a higher risk of having a percentile of birth weight < P3. Plasma electrolytes, trace elements and vitamins throughout pregnancy showed differences depending on the surgical technique, with lower haemoglobin, ferritin, calcium, zinc, copper, vitamin A and vitamin E in the malabsorptive techniques. A high percentage of deficiency was observed, especially in the third trimester (Hb < 11 g/dl: 31.8%; ferritin < 30 mg/ml: 85.7%; zinc < 50 µg/dl: 32.4%, vitamin D < 30 ng/ml: 75.5% and < 20 ng/ml: 53.3%). A decreased plasma copper in the first trimester or zinc in the third trimester were associated with a lower percentile of new-born birth weight. A higher risk of CNV was observed in predominant malabsorptive BS and in pregnancies that had presented at least one vitamin D level lower than 20 ng/ml throughout pregnancy (30.4% vs. 7.1%, p=0.018). CONCLUSIONS: Trace elements and vitamin deficiencies are common in pregnant women after bariatric surgery, especially of iron, zinc, and vitamin D. These deficiencies might negatively affect foetal development. Further studies are needed to better define the role of micronutrients in maternal-foetal health after bariatric surgery.

Factores asociados a la progresión acelerada de la enfermedad renal crónica en pacientes provenientes de la costa Caribe colombiana

Contexto: la enfermedad renal crónica (ERC) es un problema de salud pública mundial, con una prevalencia creciente y una carga sustancial sobre los sistemas de salud. Las características de los pacientes progresores rápidos junto con los factores que podrían predecir la progresión acelerada requieren una mayor exploración, sobre todo porque en Colombia no hay estudios publicados de este tipo. Objetivo: identificar los factores clínicos y sociodemográficos asociados con la progresión rápida de la ERC en una gran cohorte de pacientes de la costa norte colombiana. Metodología: este estudio observacional retrospectivo incluyó dos cohortes de pacientes de la costa norte colombiana con estadios de G1 a G4 sin diálisis. El seguimiento se realizó durante 18 meses (n = 14.420) y 24 meses (n = 10.042) y los pacientes se dividieron en progresores rápidos y progresores estables, según la pendiente de la tasa de filtración glomerular (TFGe) < -5 ml/min/1,73 m2/año o ≥ -5 mL/min/1,73 m2/año, respectivamente. Resultados: el 37,68 % de la cohorte se clasificó como progresión rápida a los 24 meses y el 28,41 % a los 18 meses. Se encontró un R2 = 0,77 en ambas cohortes para las mediciones de la TFGe, lo que indica una tendencia hacia una pérdida lineal. Además, la progresión acelerada se observó en pacientes más jóvenes y con valores más altos de tensión arterial diastólica. Conclusiones: en dos grandes cohortes de pacientes renales, aproximadamente 4 de cada 10 pacientes se clasificaron como progresores rápidos a los 24 meses de seguimiento y 3 de cada 10 a los 18 meses de seguimiento. Es importante identificar a los pacientes con mayor riesgo de progresión acelerada de la ERC en el corto plazo, para brindarles una atención personalizada y efectiva.

Background: Chronic Kidney Disease (CKD) is a global public health problem with increasing prevalence and a substantial burden on healthcare systems. The characteristics of rapid progressors and factors that may predict accelerated CKD progression require further exploration, especially since there are no published studies about this topic in Colombia. Purpose: To identify the clinical and sociodemographic factors associated with the rapid progression of CKD in a large cohort of Colombian patients. Methods: This retrospective observational study included two cohorts of G1 to G4 stage CKD patients without dialysis from the Colombian North Coast. Follow-up was conducted for 18 months (n=14,420) and 24 months (n=10,042). Patients were divided into rapid progressors and stable progressors based on the glomerular filtration rate (GFR) slope <−5 mL/min/1.73m2/year or ≥-5 mL/min/1.73 m2/year, respectively. Results: 37.68% of the cohort was classified as rapid progressors at 24 months and 28.41% at 18 months. An R2=0.77 was found in both cohorts for GFR measurements, indicating a linear trend toward loss. Furthermore, accelerated progression was observed in younger patients and those with higher diastolic blood pressure values. Conclusion: In two large cohorts of renal patients, approximately 4 out of 10 patients were classified as rapid progressors at 24 months of follow-up and 3 out of 10 at 18 months of follow-up. It is important to identify patients at higher risk of accelerated CKD progression in the short term to provide them with personalized and effective care.

Adaptation of an evidence-based, fall-prevention, Tai Ji Quan exercise program for adults with traumatic brain injury: focus group results.

INTRODUCTION: Fall risk is increased in people with traumatic brain injury (TBI). PURPOSE: This study adapted an evidence-based fall-prevention program Tai Ji Quan: Moving for Better Balance (TJQMBB) for adults with TBI and convened an online focus group with the target population for input on its delivery, content/safety, and potential benefits. METHODS: Fall prevention and TBI experts adapted TJQMBB. Eight adults with TBI were recruited. Participants watched demonstrations of the adapted TJQMBB exercises online over ZOOM©. Themes, subthemes, and participant quotes were extracted. RESULTS: Five women (71%) and 2 men (29%) participated with a mean age of 45 years. Nine themes and 5 subthemes were identified. Participants recommended a learning sequence of exercise demonstration with verbal directions and visual cues, followed by simple written instructions. Participants identified physical and cognitive barriers to participation and recognized that possible balance loss during exercise was a safety issue. Potential benefits included improved balance, navigation of challenging terrain, quality of life, and social inclusion. CONCLUSION: Participants viewed the adapted program as safe and appropriate, given modifications for physical (e.g. balance) and cognitive impairments. The TJQMBB program may be underutilized in this population due to the complexity of the exercises, but is possible with modifications.

Manejo integral de sobrepeso y obesidad infantil y adolescente: Revisión sistemática de la literatura / Comprehensive management of childhood and adolescent overweight and obesity: Systematic review of the literature

Fundamentos: El estado nutricional de la población infantil está relacionado con el desarrollo de una naciónsiendo necesario implementar estrategias que permitan mejorar las condiciones de salud y nutrición de lapoblación, por ello el objetivo fue realizar una revisión documental y proponer estrategias para orientar lasintervenciones para el abordaje de las alteraciones nutricionales por exceso en los momentos de curso de vida,primera infancia, infancia y adolescencia.Métodos: Estudio de revisión sistemática de literatura estructurada bajo la declaración PRISMA, en el periodocomprendido entre enero de 2016 a noviembre de 2021. Las bases de datos establecidas para la búsquedafueron: SCOPUS, PUBMED, LILACS y SCIENCE DIRECT.Resultados: Fueron incluidos 74 artículos, que permitió categorizar las estrategias en cuatro ejes, actividadfísica, dietoterapia, conducta alimentaria e intervenciones en salud; de lo cual se pudo revisar las diversasrecomendaciones a la actualidad del manejo del sobrepeso y la obesidad infantil.Conclusiones: Se demostró la importancia de generar estrategias y recomendaciones para el abordaje de lasalteraciones nutricionales por exceso en niños, niñas y adolescentes, relacionadas con el diagnóstico oportunoy planes de tratamiento inter y transdisciplinarios. (AU)

Background: The nutritional status of the child population is related to the development of a nation and it isnecessary to implement strategies to improve the health and nutritional conditions of the population.Therefore, the objective was to conduct a documentary review and propose strategies to guide interventionsto address nutritional disorders due to excess in the moments of the life course, early childhood, infancy andadolescence.Methods: Systematic literature review study structured under the PRISMA statement, in the period fromJanuary 2016 to November 2021. The databases established for the search were: SCOPUS, PUBMED, LILACS,and SCIENCE DIRECT.Results: 74 articles were included, which allowed categorizing the strategies in four axes, physical activity, diettherapy, eating behavior and health interventions; from which it was possible to review the variousrecommendations on the current management of childhood overweight and obesity.Conclusions: The importance of generating strategies and recommendations for the approach to nutritionalalterations due to excess in children and adolescents, related to timely diagnosis and inter and transdisciplinarytreatment plans, was demonstrated. (AU)

Do alcohol and cannabis substitute or complement each other? Analysis from behavioral economics for formulating public policy on substance use in Colombia.

After alcohol and tobacco, cannabis is the third most used substance among young Colombian adults, and many consume alcohol and cannabis concomitantly. However, academics have debated whether these substances substitute or complement each other among consumers. Understanding the relationship between the price and demand for psychoactive substances can clarify consumption patterns and help to develop strategies to reduce harmful consumption. This paper summarizes worldwide evidence of both complementary and substitution relationships and discusses the most probable relationship types in Colombia based on its substance use patterns and current regulations. Like other countries, Colombia is considering legalizing recreational cannabis use. However, there is a growing concern that legalization would increase the negative impacts of cannabis and increase alcohol use among the young adult population. The lack of Colombian empirical studies about the impacts of legal changes on the cannabis market makes it difficult to predict how such changes would affect demand and price elasticities.

Diets for inflammatory bowel disease: What do we know so far?

In recent years, the role of diet in the pathogenesis of inflammatory bowel disease (IBD) has gained great interest within the scientific community. Eating habits from industrialised countries (the so-called western diet or WD) have been associated with a higher incidence of IBD in observational studies, although the dietary factors responsible for the development of the disease are still to be elucidated. Some components of the diet with proinflammatory potential may cause changes in immunity and intestinal microbiota, leading to the inflammatory reaction that causes IBD-related lesions. The quality of available evidence is low, due to methodological issues, such as the lack of intervention studies, small sample size and heterogeneity of studies. For this reason, scientific societies have offered their recommendations using clinical practice guidelines and consensus documents, in order to establish a common criterion in the nutritional treatment of patients with IBD. The objective of this review was to summarise the data published regarding diet in IBD and review the recommendations given by scientific societies.

Impact of COVID-19 in nutritional and functional status of survivors admitted in intensive care units during the first outbreak. Preliminary results of the NUTRICOVID study.

BACKGROUND & AIMS: COVID-19 patients present a high hospitalization rate with a high mortality risk for those requiring intensive care. When these patients have other comorbid conditions and older age, the risk for severe disease and poor outcomes after ICU admission are increased. The present work aims to describe the preliminary results of the ongoing NUTRICOVID study about the nutritional and functional status and the quality of life of adult COVID-19 survivors after ICU discharge, emphasizing the in-hospital and discharge situation of this population. METHODS: A multicenter, ambispective, observational cohort study was conducted in 16 public hospitals of the Community of Madrid with COVID-19 survivors who were admitted to the ICU during the first outbreak. Preliminary results of this study include data retrospectively collected. Malnutrition and sarcopenia were screened at discharge using MUST and SARC-F; the use of healthcare resources was measured as the length of hospital stay and requirement of respiratory support and tracheostomy during hospitalization; other study variables were the need for medical nutrition therapy (MNT); and patients' functional status (Barthel index) and health-related quality of life (EQ-5D-5L). RESULTS: A total of 176 patients were included in this preliminary analysis. Most patients were male and older than 60 years, who suffered an average (SD) weight loss of 16.6% (8.3%) during the hospital stay, with a median length of stay of 53 (27-89.5) days and a median ICU stay of 24.5 (11-43.5) days. At discharge, 83.5% and 86.9% of the patients were at risk of malnutrition and sarcopenia, respectively, but only 38% were prescribed MNT. In addition, more than 70% of patients had significant impairment of their mobility and to conduct their usual activities at hospital discharge. CONCLUSIONS: This preliminary analysis evidences the high nutritional and functional impairment of COVID-19 survivors at hospital discharge and highlights the need for guidelines and systematic protocols, together with appropriate rehabilitation programs, to optimize the nutritional management of these patients after discharge.

Predictors of Functional Outcome in a Cohort of Hispanic Patients Using Exoskeleton Rehabilitation for Cerebrovascular Accidents and Traumatic Brain Injury.

Traumatic brain injury (TBI) and cerebrovascular accidents (CVA) are two of the leading causes of disability in the United States. Robotic exoskeletons (RE) have been approved for rehabilitation by the Federal Drug Administration (FDA) for use after a CVA, and recently received approval for use in patients with TBI. The aim of the study was to determine which factors predict the improvement in functional independence measure (FIM) score after using RE rehabilitation in a population of patients with CVA or TBI. We carried out a retrospective chart-review analysis of the use of the RE (Ekso® GT) in the rehabilitation of patients with TBI and CVA using data from a single, private rehabilitation hospital for patients admitted and discharged between 01/01/2017 and 04/30/2020. From the medical records, we collected presentation date, Glasgow Coma Scale score (GCS) on the date of injury, rehabilitation start date, age, diabetes status on presentation (Yes or No), injury category (TBI or CVA), and both admission and discharge FIM scores. Matching algorithms resulted in one TBI patient matched to three CVA patients resulting in a sample size of 36. The diabetic and non-diabetic populations showed significant differences between age and days from injury to the start of rehabilitation. A multivariate linear regression assessed predictors for discharge motor FIM and found admission motor FIM score and total RE steps to be statistically significant predictors. For each point scored higher on the admission motor FIM the discharge FIM was increased by 1.19 FIM points, and for each 1,000 steps taken in the RE, the discharge motor FIM increased by three points. The type of acquired brain injury (CVA or TBI) was not found to affect functional outcome. The presented results show that key clinic-biologic factors including diabetic status, together with start to rehabilitation play key roles in discharge FIM scores for patients using RE. Clinical Trial Registration: ClinicalTrials.gov, NCT04465019.

Conocimientos, experiencias y actitudes sobre derechos sexuales y derechos reproductivos en adolescentes y jóvenes / Knowledge, experiences and attitudes about sexual rights and reproductive rights in adolescents and young people / Conhecimentos, experiências e atitudes sobre direitos sexuais e direitos reprodutivos em adolescentes e jovens

Resumen El Modelo de los Servicios de Salud Amigables para Adolescentes y Jóvenes (SSAAJ) corresponde a un proceso creado para garantizar que las instituciones de salud generen espacios y formas de atención integral y diferencial para la población entre 10 y 29 años, permitiendo que se garanticen los Derechos Sexuales y Derechos Reproductivos (DSDR) acorde a las necesidades y expectativas en salud que les afectan. Objetivo: indagar los conocimientos, actitudes y experiencias en DSDR en un grupo de adolescentes y jóvenes vinculados a los SSAAJ. Materiales y métodos: mediante un estudio cualitativo con diseño fenomenológico se realizaron 13 entrevistas semiestructuradas a los adolescentes y jóvenes entre los 13 y 21 años. Resultados: en conocimientos frente a los DSDR los adolescentes hombres tienen algunas nociones sobre derechos humanos, pero desconocen los diferentes DSDR que existen, en las mujeres predomina mayor conocimiento sobre los DSDR. Las actitudes de los adolescentes frente a los DSDR son favorables una vez identifican lo que representan en el abordaje de la sexualidad, sin embargo, consideran que sus experiencias sobre el ejercicio de los DSDR se ven limitadas para su exigibilidad y garantía por el desconocimiento que tienen de ellos. Conclusiones: se encontró que los conocimientos, actitudes y experiencias de los adolescentes y jóvenes sobre los DSDR están influenciados por factores familiares y culturales que impactan sus trayectorias de vida.

Abstract The Model of Friendly Health Services for Adolescents and Young People (SSAAJ for its acronym in Spanish) corresponds to a process created to guarantee that health institutions generate spaces and forms of comprehensive and differential care for the population between 10 and 29 years of age, allowing the Sexual Rights and Reproductive Rights (DSDR for its acronym in Spanish) according to the health needs and expectations that affect them. Objective: to investigate the knowledge, attitudes and experiences in DSDR in a group of adolescents and young people linked to the SSAAJ. Materials and methods: through a qualitative study with a phenomenological design, 13 semi-structured interviews were conducted with adolescents and young people between 13 and 21 years of age. Results: regarding knowledge about DSDR, male adolescents have some notions about human rights, but are unaware of the different DSDR that exist. In women there is more knowledge about DSDR. The attitudes of adolescents towards DSDR are favorable once they identify what they represent in the approach to sexuality. However, they consider that their experiences regarding the exercise of DSDR are limited for their enforceability and guarantee due to the lack of knowledge they have from them. Conclusions: it was found that the knowledge, attitudes and experiences of adolescents and young people about DSDR are influenced by family and cultural factors that impact their life trajectories.

Resumo O Modelo dos Serviços de Saúde Amigáveis para Adolescentes e Jovens (SSAAJ) corresponde a um processo criado para garantir que as instituições de saúde gerem espaços e formas de atenção integral e diferencial para a população entre 10 e 29 anos, permitindo que se garantam os Direitos Sexuais e Direitos Reprodutivos (DSDR) de acordo com as necessidades e expectativas em saúde que os afetam. Objetivo: indagar os conhecimentos, atitudes e experiências em DSDR em um grupo de adolescentes e jovens vinculados aos SSAAJ. Materiais e métodos: mediante um estudo qualitativo com desenho fenomenológico se realizaram 13 entrevistas semiestruturadas aos adolescentes e jovens entre os 13 e 21 anos. Resultados: em conhecimentos perante os DSDR os adolescentes homens têm algumas noções sobre direitos humanos, mas desconhecem os diferentes DSDR que existem, nas mulheres predomina maior conhecimento sobre os DSDR. As atitudes dos adolescentes frente aos DSDR são favoráveis assim que identificam o que representam na abordagem da sexualidade. No entanto, consideram que suas experiências sobre o exercício dos DSDR se veem limitadas para sua exigibilidade e garantia pelo desconhecimento que têm deles. Conclusões: Encontrou-se que os conhecimentos, atitudes e experiências dos adolescentes e jovens sobre os DSDR estão influenciados por fatores familiares e culturais que impactam suas trajetórias de vida.

Design and Development of a Risk Classification Instrument for Virological Failure in HIV, Using Psychosocial Determinants of Health: Preliminary Evidence from a South American Country.

Predictive approaches in HIV to estimate a patient's risk to present with relevant health outcomes, such as hospitalizations and AIDS-related death, long before they happen, could be highly useful. We aimed to develop a risk classification instrument for virological failure through a scoring system that identifies patients with a low, medium, and high risk after six months of ART treatment. A case-control design was implemented through 355 HIV-positive Colombian adults who were assessed using the designed instrument. The variables with independent predictive values were selected using logistic regression analysis, and the diagnostic performance of the prediction score was evaluated using the area under the curve. The prediction score included relevant psychosocial and biological risk factors, some of them modifiable variables like substance use and low health literacy. The area under the curve value for the total prediction score was 0.85 (CI 0.80-0.90). Therefore, this instrument could be a valuable tool to identify at-risk patients of virological failure. In low and middle-income countries, the associated risk factors of virological failure are little known. Assessing such risk would lead to make individualized decisions regarding the patient's management and minimize the chance of non-desirable outcomes.

Social and economic costs of home parenteral nutrition.

BACKGROUND AND AIMS: Home parenteral nutrition (HPN) is a lifesaving treatment for people with chronic intestinal failure. Although HPN has been studied from an economic point of view, the categories of costs usually included direct costs, frequently excluding personal costs and productivity costs. The purpose of the present paper was to study the total costs of HPN from a societal perspective. METHODS: Observational, retrospective, transverse study of all adult patients who were on HPN for more than 3 months and were treated at Gregorio Marañón University Hospital (Madrid, Spain), from June 2018-2019. Data on personal costs and productivity costs were collected from questionnaires completed by patients receiving HPN. We also updated the direct healthcare and non-healthcare costs studied by our group previously to Euros (€) for the year 2019. RESULTS: Twenty-two patients were included. Personal costs were €729.49 per patient (€3.45 per patient per day) and productivity costs were €256.39 per patient (€1.21 per patient per day). Total HPN costs amounted to €14,460.87 per patient (€131.58 per patient per day). The direct healthcare and non-healthcare costs accounted for 96.46% of overall costs, the personal costs for the patients receiving HPN accounted for 2.62% and productivity costs for 0.92%. CONCLUSIONS: From a societal perspective, the direct healthcare and non-healthcare costs accounted for the majority of HPN expenditure, followed by personal costs and productivity costs.

Analysis of Motor Intervention Program on the Development of Gross Motor Skills in Preschoolers.

This study aimed to investigate the influence of a structured movement activity program on the motor development of children aged three to five years attending preschool. Participants were 136 preschool students with normative development at three to four years old who lived in the Region of Murcia (Spain). The McCarthy Children's Psychomotricity and Aptitude Scales (MSCA) battery of psychomotor tests was used to evaluate the motor development profiles of preschoolers before and after the intervention. The sample was divided into two groups: an intervention group (28 students) and a comparison group (108 students). A structured 24 week physical education program was used in the intervention group. An experiential program based on free play was used in the comparison group during the same period. Preschoolers in both groups got a significant improvement in the contrast of pre-intervention with post-intervention in limb coordination. Statistically significant differences in the post-intervention measurements between the comparison group and the intervention group on arm and leg coordination were observed, whereby the intervention group presented higher arm coordination values (F1,134 = 14,389, p = 0.000, η2 = 0.097) and higher leg coordination values (F1,134 = 19,281, p = 0.000, η2 = 0.126) than the comparison group. It was pointed out that structured physical activity education is better educational methodology than free play to achieve adequate motor development in preschool children.

Afrontamiento y viudez en la vejez: Estudio mixto en población colombiana / Coping and widowhood in the older adulthood: Mixed methods study in Colombian population

Resumen La viudez está catalogada como uno de los eventos de vida adversos más estresantes. El cambio de estado civil genera un cambio de rol e implica una resignificación de la vida. El presente estudio tuvo como objetivo comprender la forma en que las personas mayores viven y afrontan la viudez y determinar cuál es la relación entre las respuestas psicológicas, el sexo y los estilos de afrontamiento. Se utilizó metodología mixta con un diseño CUALI-cuanti a partir de la teoría fundamentada y análisis log lineal. La muestra estuvo compuesta por 29 personas mayores viudas residentes en Bogotá. Este estudio reporta las respuestas psicológicas de un grupo de personas mayores viudas que facilitan el afrontamiento exitoso a la pérdida de la pareja y aquellas que lo dificultan. Los resultados en la fase cualitativa mostraron que el afrontamiento a la viudez se enmarca en siete factores: sentido de vida, apoyo social, relación previa, satisfacción con el matrimonio, participación en actividades, consecuencias generadas por la pérdida y fortalezas personales. En la fase cuantitativa se encontró una interacción significativa entre respuesta psicológica y afrontamiento, lo que reveló que algunas respuestas psicológicas en particular llevan a un afrontamiento activo o por el contrario, lo dificultan. Las respuestas que se encontraron significativas fueron aislamiento, soledad, seguir adelante y participación en actividades. Los resultados demuestran que el afrontamiento es producto de las interacciones entre los sistemas macro y micro y muestra a la viudez como una transición multifacética. Se discuten las similitudes con estudios anteriores y limitaciones.

Abstract Widowhood is cataloged as one of the most stressful adverse life events; the change of civil status generates a change of role and implies a resignification of life. The aim of this study was to understand how older people experience and cope with widowhood. The research used mixed methods approach with a QUALI- quanti design, through grounded theory and log lineal analysis, with a sample of 29 elderly widows and widowers living in Bogotá. This study reports the psychological responses of a group of elderly widows that facilitate successful coping with the loss of the couple, and the responses that make it difficult. The results in the qualitative stage showed that coping with widowhood is framed in seven factors: sense of life, social support, previous relationship, satisfaction with marriage, participation in activities, consequences generated by the loss and personal strengths. In the quantitative stage a significant interaction between psychological response and coping was found, which revealed that some psychological responses in particular lead to an active coping or, on the contrary, made coping difficult. The answers that were significant were isolation, loneliness, moving forward and participation in activities. The results revealed that coping is a product of the interactions between macro and micro systems and showed widowhood as a multifaceted transition. Similarities with previous studies and limitations are discussed.

Impact of the caregiver burden on the effectiveness of a home-based palliative care program: A mediation analysis.

OBJECTIVE: The growing aging population and the high prevalence of several concomitant chronic diseases have contributed to the elevated rates of caregiver burden and suffering in patients. In turn, intending to relieve unnecessary pain in patients, there has been a rapid growth of outpatient palliative care programs. However, little has been studied about caregiver burden as a relevant factor potentially affecting the effectiveness of these programs. This study aimed to determine the extent of caregiver burden as a possible mediator on the effectiveness of a home-based palliative care program. METHOD: Sixty-six palliative patients (56% women; mean age + SD = 71, 6 ± 17.7) and their caregivers were assessed with measures for physical, emotional, and psychological symptoms before and 1 month after the start of a home-based palliative care program. RESULTS: The association between caregiver burden and palliative outcomes was corroborated with a categorical regression model (p < 0.01). Caregiver burden was found to be a significant mediator in the relationship between outcome measures for palliative care at baseline and after 1 month of enrollment in the program. SIGNIFICANCE OF RESULTS: To our knowledge, this is the first study to assess the role of caregiver burden in the effectiveness of a home-based palliative care program. Although further work is required, the results indicate that a patient-focused intervention does not have the same beneficial effect if the caregiver burden is not addressed. Future home-based palliative care programs should focus on caregivers as well as patients, with particular attention to psychosocial intervention on caregivers.

Mismatch between perceived family and individual chronotype and their association with sleep-wake patterns.

While social zeitgebers are known to shape diurnal preference, little research has been devoted to determining the contribution of the familiar group chronotype as social zeitgeber on individual circadian rhythms and sleep-wake patterns in adult subjects. The current study aimed to examine the matching between perceived family chronotype and individual chronotype and their relationship with sleep-wake patterns on weekdays and weekends, diurnal subjective somnolence, and substance consumption. Nine hundred and forty-two Colombian adults completed the Composite Scale of Morningness, the Epworth Sleepiness Scale, and responded to a questionnaire about circadian preferences of their family nucleus. We found evidence of a mismatch between perceived family and individual chronotype, mainly for morning-type individuals (Cohen's Kappa = -0.231; p < 0.001). This mismatch was associated with diurnal subjective somnolence (ß = 0.073; p < 0.001) and specific sleep-wake patterns (p < 0.01). In addition, subjects with evening-type families showed higher caffeine and alcohol consumption (p < 0.001). To our knowledge, this is the first study to assess and report the mismatching between perceived family and individual chronotypes, and it adds to the existing body of knowledge regarding the influence of social zeitgebers on circadian rhythms. This is particularly relevant since mismatching between circadian physiology and environmental cues have been shown to lead to diverse pathologies.

Psychological distress among undergraduate medical students: the influence of excessive daytime sleepiness and family functioning.

Mental health problems among undergraduate medical students is a well-known issue; however, their associated risk factors have been poorly studied. We aimed to assess the hypothesis that medical students have a higher prevalence of psychological distress and to explain this prevalence considering common risk factors for mental disorders. This was a cross-sectional, questionnaire-based descriptive study conducted with 467 Colombian undergraduate medical students from different years of training. Validated and widely used self-report questionnaires of psychological distress, daytime sleepiness, and family functioning were included. In addition, measurements of smoking, alcohol, and caffeine intake were used. We found a prevalence of psychological distress, depressive symptoms and anxiety symptomatology of 65.9%, 75.3%, and 50.5%, respectively. Furthermore, 20.6% showed both psychological distress and excessive daytime sleepiness. Adjusted risk ratio analysis showed that poor family functioning, the presence of excessive daytime sleepiness, and caffeine consumption were significant risk factors for high levels of psychological distress. Additionally, psychological distress and daytime sleepiness were related to the year of training. Our results replicate in part previous findings of poor mental health among undergraduate medical students compared with mental health in general population and provide novel findings that family functioning plays a significant role as an important explanatory factor. The current study has high relevance for future research and interventions focused on prevention of medical errors, conflicts in the physician-patient relationship and the personal safety of undergraduate medical students.

Telomere length and childhood trauma in Colombians with depressive symptoms

Objective: Childhood trauma and telomere length (TL) are important risk factors for major depressive disorder. We examined whether there was an association between childhood trauma and TL in a sample of Colombians who were assessed for depressive symptoms. Methods: We applied the Center for Epidemiologic Studies Depression scale, the Patient Health Questionnaire-9, the Hospital Anxiety and Depression scale and the Childhood Trauma Questionnaire to 92 Colombian subjects (mean age = 21). TL was measured with quantitative PCR. Spearman's correlation coefficient (rs) was used to analyze the relationship between childhood trauma scores and TL. Results: We found a significant correlation between TL and sexual abuse scores (rs = 0.428, p = 0.002) in individuals with higher depressive symptom scores. Conclusion: This is the first report of a significant association between TL and sexual abuse in a Latin American sample and provides additional evidence about the role of childhood trauma and TL in neuropsychiatric disorders.

Network analysis of multiple risk factors for mental health in young Colombian adults.

BACKGROUND: A considerable proportion of young adults are affected by psychological distress at any time and an important fraction of them may develop mental disorders. Use of novel approaches for the analysis of data from multiple psychological scales might facilitate the identification of key indicators of mental health. AIMS: The aim of current study was to examine the relationship between multiple risk factors for mental illness, using a network analysis perspective. METHODS: A sample of 334 young Colombian adults (mean age = 21.7) were evaluated with validated scales measuring several psychosocial factors previously associated with mental health (e.g. worry, sleep problems, suicidal ideation, childhood abuse, alcohol related-problems and personality traits). A total of 24 nodes were included in the network analysis and topology, centrality, and stability of the networks were studied. RESULTS: Specific nodes that occupied critical positions in the network were identified, with worry, perceived distress and low energy being the most central nodes. CONCLUSIONS: Our explorative findings suggest that a network analysis might identify risk factors that have a central role in the multiple dimensions of emotional health in young adults. These novel analyses could have important applications for the understanding of the psychological functioning affecting mental health.

Telomere length and childhood trauma in Colombians with depressive symptoms.

OBJECTIVE: Childhood trauma and telomere length (TL) are important risk factors for major depressive disorder. We examined whether there was an association between childhood trauma and TL in a sample of Colombians who were assessed for depressive symptoms. METHODS: We applied the Center for Epidemiologic Studies Depression scale, the Patient Health Questionnaire-9, the Hospital Anxiety and Depression scale and the Childhood Trauma Questionnaire to 92 Colombian subjects (mean age = 21). TL was measured with quantitative PCR. Spearman's correlation coefficient (rs) was used to analyze the relationship between childhood trauma scores and TL. RESULTS: We found a significant correlation between TL and sexual abuse scores (rs = 0.428, p = 0.002) in individuals with higher depressive symptom scores. CONCLUSION: This is the first report of a significant association between TL and sexual abuse in a Latin American sample and provides additional evidence about the role of childhood trauma and TL in neuropsychiatric disorders.