Implications of gut and oral microbiota in neuroinflammatory responses in Alzheimer's disease.

A diverse and stable microbiota promotes a healthy state, nevertheless, an imbalance in gut or oral bacterial composition, called dysbiosis, can cause gastrointestinal disorders, systemic inflammatory states and oxidative stress, among others. Recently, gut and oral dysbiosis has been linked to Alzheimer's disease (AD), which is considered the most common form of dementia and a public health priority due to its high prevalence and incidence. The aim of this review is to highlight the implications of gut and oral microbiota in the neuroinflammation characteristic of AD pathology and the subsequent cognitive impairment. It is a systematic review of the current literature obtained by searching the PubMed, Web of Science and Scopus databases. The characteristic intestinal dysbiosis in AD patients leads to increased permeability of the intestinal barrier and activates immune cells in the central nervous system due to translocation of microbiota-derived metabolites and/or bacteria into the circulation leading to increased neuroinflammation and neuronal loss, thus generating the cognitive impairment characteristic of AD. The presence in the central nervous system of Porphyromonas gingivalis can cause an increased neuroinflammation and beta-amyloid peptide accumulation.

Estrategias de desarrollo de competencias emocionales en estudiantes de ciencias de la salud: revisión integrativa / Strategies for the development of emotional competencies in health science students: integrative review

Además de habilidades clínicas, los estudiantes de ciencias de la salud precisan, en su proyecto formativo, lograr otras competencias de carácter psicoemocional como garantía de calidad de la asistencia prestada. Con el objetivo de analizar las diferentes estrategias llevadas a cabo a tal fin, se ha realizado una revisión integrativa de la literatura publicada en los últimos 10 años en las bases de datos científicas Web of Science, Scopus, PubMed, Cochrane, Joanna Briggs Institute, APA PsycNet Advanced Search, PsycINFO y en el Repositorio Científico de Acceso Abierto de Portugal. Se obtuvieron un total de siete publicaciones que cumplían con los criterios de inclusión establecidos. Para cada uno de los mismos se extrajeron como unidades de análisis principales el tipo de estudio, el objetivo, la muestra y la estrategia aplicada sobre la misma, las herramientas de medición de los resultados y sus principales hallazgos. Éstos muestran que las estrategias puestas en marcha en cada uno de los estudios fueron efectivas para mejorar los niveles de competencia emocional. No obstante, así mismo, se extraen como conclusiones la escasa evidencia científica disponible al respecto y la diversidad de objetivos, variables, metodologías e instrumentos de recogida de datos utilizados para el logro de tal competencia. La dificultad en el establecimiento de evidencias pone de manifiesto la necesidad de seguir profundizando para lograr el asentamiento de aquellas estrategias pedagógicas, que mejor sirvan para lograr la necesaria competencia emocional de los estudiantes y futuros profesionales en el ámbito de ciencias de la salud. (AU)

In addition to clinical skills, health science students need, in their training project, to achieve other competencies of a psychoemotional nature as a guarantee of the quality of the care provided. With the aim of analysing the different strategies carried out to this end, an integrative review of the literature published in the last 10 years in the scientific databases Web of Science, Scopus, PubMed, Cochrane, Joanna Briggs Institute, APA PsycNet Advanced Search, PsycINFO and the Portuguese Open Access Scientific Repository was carried out. A total of seven publications were obtained that met the established inclusion criteria. For each of them, the main units of analysis were extracted as the type of study, the objective, the sample and the strategy applied to it, the tools used to measure the results and the main findings. These show that the strategies implemented in each of the studies were effective in improving levels of emotional competence. However, the scarce scientific evidence available in this respect and the diversity of objectives, variables, methodologies and data collection instruments used for the achievement of such competence are also conclusions drawn. The difficulty in establishing evidence highlights the need for further research to establish those pedagogical strategies that best serve to achieve the necessary emotional competence of students and future professionals in the field of health sciences. (AU)

Impact of discontinuing non-pharmacological interventions on cognitive impairment in dementia patients by COVID-19 lockdown. A pilot observational, longitudinal, retrospective study carried out in an adult day center in Spain during the COVID-19 pandemic.

Background: The lockdown imposed during the COVID-19 pandemic led to social isolation and prevented patients with dementia from receiving a suite of non-pharmacological interventions (NPIs) that prevent cognitive decline. This discontinuation of NPIs could substantially affect the mental health status of people with dementia in social care settings, such as adult day care centers (ADCs). Propose: The study aimed to evaluate the effects of the COVID-19 lockdown on mental health and cognitive impairment in patients with dementia who could not attend their usual ADCs and did not receive our NPIs, based on World Health Organization (WHO) Guidelines. Methods: Observational, longitudinal, retrospective study carried out in an adult day center in Spain and reported it in accordance with the Strengthening Reporting of Observational Studies in Epidemiology (STROBE) statement. Cognitive status was assessed using the Mini-Mental State Examination (MMSE) in 80 patients attending the ADC of the "Leonese Association of Dementia Patients" (León, Spain), who had been evaluated with this instrument before the COVID-19 lockdown. Results: We observed a 0.4-point decrease in MMSE score/month (IQR = 1.4) during lockdown versus a 0.1-point decrease/month (IQR = 0.3) before this period (p = 0.038). Notably, this translated to >10-point decreases in MMSE score/year in 33.8% of participants during lockdown versus 5.5% earlier (p < 0.001). No statistically significant associations (p < 0.05) were found between the individual characteristics of the caregivers and the occurrence of the event. Conclusion: The reported declines in MMSE scores reveal a significant acceleration of cognitive decline during the period of inactivity. This could suggest that our NPIs, focused on slowing cognitive decline, are beneficial and, therefore, necessary in patients with dementia.

Analysis of Knowledge of Smoking-Related Diseases in Spanish Nursing Students.

Smoking causes significant morbidity and mortality worldwide, mainly in developed countries. In addition, it is the cause of numerous diseases in the body, despite the fact that the prevalence of tobacco use is decreasing. Nursing students, as future professionals, should be aware of action plans for cessation and information designed for smokers. To determine the level of knowledge among nursing students about smoking-related diseases and analyze the prevalence of student who smoke at the University of Leon, Spain, a descriptive cross-sectional study was carried out in which students were given an anonymous questionnaire, which was previously validated, during the 2021-2022 academic year. In a sample of 477 (79.5%) nursing students, a smoking prevalence of 17.6% was obtained. In addition, students' knowledge about the diseases directly caused by tobacco consumption and others associated with exposure to environmental smoke was assessed, and in both cases (8.03 points of 9 for consumption and 5.24 of 6 to exposure), scores were obtained that allow us to state that students do not know for sure the types of diseases that are related to tobacco use and passive smoking. In spite of this, it is necessary to continue to reduce the prevalence of smoking through different programs implemented in schools and universities, as it is also necessary to improve teaching plans when explaining smoking-related diseases, so that students, in the future, will be able to advise patients correctly.

La importancia de estar incluido en el Emerging sources Citation Index para las revistas y autores españoles / The importance of being included in the emerging sources citation index for spanish journals and authors

La evaluación de la actividad de los investigadores, de sus publicaciones y de las revistas donde se publican dichos trabajos, es un proceso continuo y necesario para poder valorar la calidad y el impacto de los mismos. Estas revistas están indexadas en diferentes bases de datos, siendo la Web Of Science una de las más importantes, junto con Scopus, debido a la cantidad de información que tiene recogida y a los rigurosos criterios que deben cumplir las revistas para ser incluidas en ella. Una nueva herramienta de esta base de datos es el Emerging Sources Citation Index, que contiene revistas que o bien están en proceso de evaluación, o bien son revistas que presentan una calidad científica acreditada en su disciplina, pero que nunca llegarán a integrarse en la Web of Science ya que su área de conocimiento es limitada y previsiblemente nunca llegaran a tener un factor de impacto suficientemente alto. El estar incluido en este recurso, como lo está ROL Revista de Enfermería, tiene un gran valor para las revistas y para los autores que publican sus trabajos en ellas ya que supone un mérito valorado en la mayoría de los procesos de evaluación de los investigadores, como por ejemplo en la Agencia Nacional de Evaluación de la Calidad y Acreditación (ANECA). (AU)

The evaluation of the activity of researchers, their publications and the journals where these works are published, is a continuous and necessary process to assess their quality and impact. These journals are indexed in different databases, being Web Of Science one of the most important, together with Scopus, due to the amount of information it has collected and the rigorous criteria that journals must meet to be included in it. A new tool of this database is the Emerging Sources Citation Index, which contains journals that are either in the process of evaluation, or are journals that have a proven scientific quality in their discipline, but that will never be included in the Web of Science because their area of knowledge is limited and they will probably never have a sufficiently high impact factor. Being included in this resource, as ROL Revista de Enfermería is, has a great value for the journals and for the authors who publish their work in them, since it is a merit valued in most of the evaluation processes of researchers, such as the National Agency for Quality Assessment and Accreditation (ANECA). (AU)

Implicaciones para la enfermería española del informe de referencia sobre la década del envejecimiento saludable 2021-2030 / Implications for spanish nursing of the reference report for a decade of healthy ageing 2021-2030

La Década del Envejecimiento Saludable reabre oportunidades para invertir en entornos adaptados a las personas mayores y en sistemas integrados de atención sanitaria y social. El objetivo de este trabajo es analizar esas ventanas de oportunidad para Enfermería. El envejecimiento saludable implica que las personas mayores contribuyen a la sociedad durante más tiempo, con oportunidades para gozar de buena salud, y para mantener y desarrollar las capacidades, y que está determinado por la capacidad funcional, la capacidad intrínseca y el entorno físico y social. Para ello, son precisos sistemas sociales y de salud integrados, transformadores y centrados en las personas, en lugar de sistemas basados únicamente en la enfermedad. Enfermería puede contribuir cambiando la forma de pensar, de sentir y de actuar con respecto a la edad y el envejecimiento, ofreciendo una atención integrada y centrada en las personas, adaptando el modelo de cuidados, con el foco en la promoción de la salud y la prevención de la enfermedad, y la atención de las personas mayores potenciando sus capacidades y su autonomía, en especial desde la Atención Primaria. Luchar contra el edadismo, formar a enfermeras en competencia de práctica avanzada, mejorar la accesibilidad, formar a las personas mayores y sus familias en materia digital, investigando sobre estos factores, son oportunidades que vuelve a abrir el Informe sobre la Década del Envejecimiento Saludable para Enfermería. (AU)

The Decade of Healthy Ageing reopens opportunities to invest in age-friendly environments and integrated health and social care systems. The aim of this paper is to analyse these windows of opportunity for Nursing. Healthy ageing implies that older people contribute to society for longer, with opportunities to have good health, and to maintain and develop capabilities, and that it is determined by functional ability, intrinsic capacity and the physical and social environment. This requires integrated, transformative and people-centred health and social systems, rather than systems based on disease. Nursing can contribute by changing the way we think, feel and act about age and ageing, offering integrated and person-centred care, adapting the model of care, with a focus on health promotion and disease prevention, and care for older people by enhancing their capabilities and autonomy, especially in primary care. Fighting against ageism, training nurses in advanced practice competency, improving accessibility, training older people and their families in digital matters, researching on these factors, are opportunities that the Decade of Healthy Ageing Report reopens for Nursing. (AU)

[Analysis of Bullying and Harassment Experienced by Fourth-Year Nursing Students in their Clinical Practice.] / Análisis de la intimidación y acoso experimentado por estudiantes de Enfermería de cuarto curso durante sus prácticas clínicas.

OBJECTIVE: Nursing students, with their inexperience and the frequent challenge of encountering new environments, are a potentially vulnerable group for bullying and harassment in the work setting. The aim of this study was to analyze the bullying and/or harassment experienced by Nursing students during their clinical practice. METHODS: A descriptive cross-sectional study was carried out at the University of León and the study population was fourth-year nursing students. The measurement instrument was a 24-item questionnaire approved by the University Ethics Committee. The chi-square test, Student's t-test and Mann Whitney U test were used for statistical analysis. RESULTS: A prevalence of 26.5% (22/83) of students who suffered episodes of bullying and/or harassment was observed; younger students suffered these events from physicians, patients and family members and/or companions to a greater extent. This produced an impact on the psychological well-being of the students, who felt depressed, humiliated and incapable, which negatively affected the level of care provided to patients. CONCLUSIONS: The overall problem studied presents a lower prevalence than that obtained in other work carried out in the rest of the world; as a consequence, there is an impact on the psychological well-being of the students that affects their level of attention to the tasks they are carrying out and their way of working with others.

OBJETIVO: Los estudiantes de Enfermería, con su inexperiencia y el desafío frecuente de encontrarse con nuevos entornos, son un grupo potencialmente vulnerable para sufrir intimidación y acoso en el ámbito del trabajo. El objetivo de este trabajo fue analizar la intimidación y/o acoso padecidos por los estudiantes de Enfermería durante sus prácticas clínicas. METODOS: Se realizó un estudio descriptivo transversal en la Universidad de León. La población a estudio fueron los estudiantes del Grado en Enfermería de cuarto curso. El instrumento de medida fue un cuestionario que constó de 24 items y que se aprobó por el Comité de Ética de la Universidad. Para el análisis estadístico se utilizó la prueba de chi-cuadrado, t de Student y la U de Mann Whitney. RESULTADOS: Se observó una prevalencia del 26,5% (n=83) de estudiantes que sufrieron episodios de intimidación y/o acoso; los estudiantes de menor edad padecieron estos hechos por parte de los médicos, pacientes y familiares y/o acompañantes en mayor medida. Esto produjo un impacto en su bienestar psicológico e hizo que se sintieran deprimidos, humillados e incapaces, lo que afectó negativamente al nivel de atención prestado a los pacientes. CONCLUSIONES: El problema global estudiado presenta una prevalencia inferior a la obtenida en otros trabajos llevados a cabo en el resto del mundo. Como consecuencia, existe un impacto en el bienestar psicológico de los estudiantes que afecta a su nivel de atención en las tareas que están llevando a cabo y a su forma de trabajar con los demás.

Análisis de la intimidación y acoso experimentado por estudiantes de Enfermería de cuarto curso durante sus prácticas clínicas / Analysis of Bullying and Harassment Experienced by Fourth-Year Nursing Students in their Clinical Practice

FUNDAMENTOS:Los estudiantes de Enfermería, con su inexperiencia y el desafío frecuente de encontrarse con nuevos entornos, son un grupo potencialmente vulnerable para sufrir intimidación y acoso en el ámbito del trabajo. El objetivo de este trabajo fue analizar la intimidación y/o acoso padecidos por los estudiantes de Enfermería durante sus prácticas clínicas. MÉTODOS: Se realizó un estudio descriptivo transversal en la Universidad de León. La población a estudio fueron los estudiantes del Grado en Enfermería de cuarto curso. El instrumento de medida fue un cuestionario que constó de 24 items y que se aprobó por el Comité de Ética de la Universidad. Para el análisis estadístico se utilizó la prueba de chi-cuadrado, t de Student y la U de Mann Whitney. RESULTADOS: Se observó una prevalencia del 26,5% (n=83) de estudiantes que sufrieron episodios de intimidación y/o acoso; los estudiantes de menor edad padecieron estos hechos por parte de los médicos, pacientes y familiares y/o acompañantes en mayor medida. Esto produjo un impacto en su bienestar psicológico e hizo que se sintieran deprimidos, humillados e incapaces, lo que afectó negativamente al nivel de atención prestado a los pacientes. CONCLUSIONES: El problema global estudiado presenta una prevalencia inferior a la obtenida en otros trabajos llevados a cabo en el resto del mundo. Como consecuencia, existe un impacto en el bienestar psicológico de los estudiantes que afecta a su nivel de atención en las tareas que están llevando a cabo y a su forma de trabajar con los demás.(AU)

BACKGROUND: Nursing students, with their inexperience and the frequent challenge of encountering new environments, are a potentially vulnerable group for bullying and harassment in the work setting. The aim of this study was to analyze the bullying and/ or harassment experienced by Nursing students during their clinical practice. METHODS: A descriptive cross-sectional study was carried out at the University of León and the study population was fourth-year nursing students. The measurement instrument was a 24-item questionnaire approved by the University Ethics Committee. The chi-square test, Student’s t-test and Mann Whitney U test were used for statistical analysis. RESULTS: A prevalence of 26.5% (22/83) of students who suffered episodes of bullying and/or harassment was observed; younger students suffered these events from physicians, patients and family members and/or companions to a greater extent. This produced an impact on the psychological well-being of the students, who felt depressed, humiliated and incapable, which negatively affected the level of care provided to patients. CONCLUSIONS: The overall problem studied presents a lower prevalence than that obtained in other work carried out in the rest of the world; as a consequence, there is an impact on the psychological well-being of the students that affects their level of attention to the tasks they are carrying out and their way of working with others.(AU)

Avances en el manejo de la fragilidad en personas mayores. Implicaciones para atención primaria / Advances in management of frailty in the elderly. Implications for primary health care

El concepto teórico de fragilidad está ampliamente aceptado, pero su aplicación a la práctica presenta algunas limitaciones debido a la existencia de múltiples herramientas para su detección precoz y propuestas de intervención. En esta breve revisión de situación, se pretende resumir las últimas evidencias respecto a la detección precoz y el abordaje de la fragilidad en Atención Primaria. El cribado se basa en la detección oportunista de casos mediante búsqueda activa a partir de los 70 años, usando como herramientas una prueba de ejecución y la escala FRAIL. Se aconseja confirmación con el Frailty Index. Su abordaje debe ser multidimensional centrado en el entrenamiento de fuerza muscular, suplementos proteicos y la revisión de la medicación. La fragilidad es evitable, y se necesita poner el foco en la detección precoz. A pesar de los avances en los últimos años, es necesaria más investigación en busca del modelo de atención más eficaz. (AU)

Although the theoretical concept of frailty is widely accepted, its practical application is somehow limited due to the existence of multiple tools related to its early detection and intervention proposals. In this brief review of the situation, the aim is to summarize the latest evidence regarding early detection and management of frailty in Primary Health Care. The screening is based on opportunistic case detection by active search from the age of 70, using a performance test and the FRAIL scale as tools. Confirmation using the Frailty Index is recommended. Its approach should be multidimensional and focusing on muscle strength training, protein supplementation and medication review. Frailty is preventable, and emphasis should be placed on early detection. Despite advances in recent years, more research is needed in order to find the most effective healthcare model. (AU)

Tasa de retorno y características asistenciales de pacientes mayores de 65 años en un servicio de Urgencias en Atención Primaria / Return rate to the Primary Care Emergency Service for elderly patients over 65 years old and their assistance requirements

Objetivo: Determinar la tasa de retorno inesperado a las 72 h y las características clínico- asistenciales de los mayores de 65 años que retornan. Diseño: Estudio epidemiológico observacional retrospectivo. Emplazamiento: Servicio Urgencias Atención Primaria (SUAP) Cotolino en Cantabria, España. Participantes: Se incluyó a 1.940 pacientes mayores de 65 años que acudieron al SUAP durante el año 2016. Mediciones principales: La variable dependiente fue el retorno y las independientes las variables sociodemográficas, clínicas y asistenciales. Los datos fueron suministrados por la Gerencia de Atención Primaria. Se analizaron las variables mediante el test de la chi al cuadrado de Pearson y el test exacto de Fisher utilizando como nivel de significación p ≤ 0,05. Resultados:Tasa de retorno inesperado 2,3%. Edad media 77,4 años (DE 8,4), siendo el 37,6% varones. El grupo etario más frecuente de retorno fue el de 75 a 84 años. Se detectó polifarmacia en el 54,4% y un riesgo cardiovascular medio. Al 42,2% lo asistió el personal de enfermería (p <0,001). Los pacientes con disnea (p=0,015), cura programada o inyección programada regresan con mayor frecuencia (p <0,001). Se detectó una mayor probabilidad de retorno en el mes de diciembre y enero (p <0,001). Conclusiones: El retorno inesperado del total de asistencias es bajo. El retornado precisa cuidados urgentes fundamentalmente por problemas generales inespecíficos o enfermedades del aparato respiratorio. Proponemos desarrollar protocolos en todos los servicios de Urgencias de Atención Primaria que integren a los profesionales de Geriatría y Gerontología, con el fin de mejorar la atención urgente a este grupo poblacional.(AU)

Objective: To determine the unexpected return rate to the Primary Care Emergency Service of elderly patients over 65 years old within the following 72h of a previous visit, as well as to determine the clinical and assistance requirements of these patients. Procedure: Retrospective and observational epidemiologic study. Location: Cotolino's Primary Care Emergency Service in Cantabria, Spain. Participants: 1940 elderly patients over 65 years old were included. These patients returned to the Primary Care Emergency Service in 2016.Main data for the study: The dependent variable was the return rate to the Primary Care Emergency Service. The independent variables were socio-demographic characteristics, health details and medical assistance information. All data was collected from the Primary Care Emergency Service Management Office database. All variables were analysed applying Pearson's chi-squared test and Fisher's exact test, with statistical significance P≤.05. Results: The rate of unexpected return was 2.3%. The average age was 77.4 years old (standard deviation (SD): 8.4), of which the 37.6% were male. The most frequent range of age was from 75 to 84 years old, with males being the predominant group. A history of polymedication was detected in 54.4% of the cases, as well as a medium cardiovascular risk within this group. Nursing professionals attended the 42.2% of these return cases (P<.001). Patients with dysnea (P=.015), scheduled care or scheduled injection returned with a higher frequency (P<.001). It was as well noticed a higher frequency of return for subsequent attention during the months of December and January (P<.001). Conclusions: The rate of unexpected return is low. The main causes why elderly patients returned to the service requiring urgent assistance were issues categorised as unspecific general health indicators and/or respiratory system illnesses.(AU)

The Influence of Nutrition in Alzheimer's Disease: Neuroinflammation and the Microbiome vs. Transmissible Prion.

Alzheimer's disease (AD) is a primary, progressive, neurodegenerative disorder. Many risk factors for the development of AD have been investigated, including nutrition. Although it has been proven that nutrition plays a role in AD, the precise mechanisms through which nutrition exerts its influence remain undefined. The object of this study is to address this issue by elucidating some of the mechanisms through which nutrition interacts with AD. This work is a qualitative systematic bibliographic review of the current literature searchable on various available databases, including PubMed, Web of Science, and Google Scholar. Our evidence comprises 31 articles selected after a systematic search process. Patients suffering with AD present a characteristic microbiome that promotes changes in microglia generating a proinflammatory state. Many similarities exist between AD and prion diseases, both in terms of symptoms and in the molecular mechanisms of pathogenesis. Changes in the composition of the gut microbiome due to dietary habits could be one of the environmental factors affecting the development of AD; however, this is probably not the only factor. Similarly, the mechanism for self-propagation of beta-amyloid seen in AD is similar to that seen in prions.

[Return rate to the Primary Care Emergency Service for elderly patients over 65 years old and their assistance requirements]. / Tasa de retorno y características asistenciales de pacientes mayores de 65 años en un servicio de Urgencias en Atención Primaria.

OBJECTIVE: To determine the unexpected return rate to the Primary Care Emergency Service of elderly patients over 65 years old within the following 72h of a previous visit, as well as to determine the clinical and assistance requirements of these patients. PROCEDURE: Retrospective and observational epidemiologic study. LOCATION: Cotolino's Primary Care Emergency Service in Cantabria, Spain. PARTICIPANTS: 1940 elderly patients over 65 years old were included. These patients returned to the Primary Care Emergency Service in 2016. MAIN DATA FOR THE STUDY: The dependent variable was the return rate to the Primary Care Emergency Service. The independent variables were socio-demographic characteristics, health details and medical assistance information. All data was collected from the Primary Care Emergency Service Management Office database. All variables were analysed applying Pearson's chi-squared test and Fisher's exact test, with statistical significance P≤.05. RESULTS: The rate of unexpected return was 2.3%. The average age was 77.4 years old (standard deviation (SD): 8.4), of which the 37.6% were male. The most frequent range of age was from 75 to 84 years old, with males being the predominant group. A history of polymedication was detected in 54.4% of the cases, as well as a medium cardiovascular risk within this group. Nursing professionals attended the 42.2% of these return cases (P<.001). Patients with dysnea (P=.015), scheduled care or scheduled injection returned with a higher frequency (P<.001). It was as well noticed a higher frequency of return for subsequent attention during the months of December and January (P<.001). CONCLUSIONS: The rate of unexpected return is low. The main causes why elderly patients returned to the service requiring urgent assistance were issues categorised as unspecific general health indicators and/or respiratory system illnesses. Our proposal is to develop specific protocols combining the work from both Geriatrics and Gerontology professionals, in order to improve the support to this group of population at every Primary Care Emergency Service.

Prevalence of Comorbidities in Individuals Diagnosed and Undiagnosed with Alzheimer's Disease in León, Spain and a Proposal for Contingency Procedures to Follow in the Case of Emergencies Involving People with Alzheimer's Disease.

Background: Alzheimer's disease (AD) which is the most common type of dementia is characterized by mental or cognitive disorders. People suffering with this condition find it inherently difficult to communicate and describe symptoms. As a consequence, both detection and treatment of comorbidities associated with Alzheimer's disease are substantially impaired. Equally, action protocols in the case of emergencies must be clearly formulated and stated. Methods: We performed a bibliography search followed by an observational and cross-sectional study involving a thorough review of medical records. A group of AD patients was compared with a control group. Each group consisted of 100 people and were all León residents aged ≥65 years. Results: The following comorbidities were found to be associated with AD: cataracts, urinary incontinence, osteoarthritis, hearing loss, osteoporosis, and personality disorders. The most frequent comorbidities in the control group were the following: eye strain, stroke, vertigo, as well as circulatory and respiratory disorders. Comorbidities with a similar incidence in both groups included type 2 diabetes mellitus, glaucoma, depression, obesity, arthritis, and anxiety. We also reviewed emergency procedures employed in the case of an emergency involving an AD patient. Conclusions: Some comorbidities were present in both the AD and control groups, while others were found in the AD group and not in the control group, and vice versa.

Responsabilidad profesional en el manejo de úlceras por presión: análisis de la jurisprudencia / Professional liability in the handling of bed sores: case-law analysis

OBJETIVO: establecer los principales determinantes de la estimación de las demandas interpuestas por usuarios del sistema sociosanitario en relación con la aparición de úlceras por presión. MÉTODO: análisis de resoluciones judiciales obtenidas a través de una búsqueda exhaustiva en bases de datos especializadas del sistema jurisprudencial en España entre los años 2007 y 2017 en los órdenes civil, penal y contencioso-administrativo. RESULTADOS: se obtuvieron un total de 22 pronunciamientos, 10 estimatorios y 12 desestimatorios, de los que se extrajeron como principales conclusiones la necesidad de cumplir con la "Lex Artis ad hoc" a través de la aplicación de medidas preventivas y terapéuticas adecuadas, para lo que resulta conveniente el seguimiento de protocolos o guías de práctica clínica, y la relevancia del registro de las intervenciones llevadas a cabo en la historia clínica de los pacientes, documento probatorio de la diligencia de los profesionales en los diferentes procesos judiciales. CONCLUSIONES: además de como medio de aseguramiento de los derechos de los pacientes, el cumplimiento de la "Lex Artis ad hoc", y el registro de la actividad de los profesionales sanitarios en la historia clínica, sirve de defensa de los intereses de los propios profesionales, porque toda actuación ajustada a la "Lex Artis", que conste debidamente diligenciada en la historia clínica, se erige en salvaguarda frente a las demandas judiciales por mala praxis tal y como viene poniendo de manifiesto la jurisprudencia analizada al respecto

OBJECTIVE: to establish the main determining factors used to estimate claims brought by socio-healthcare patients with bed sores. METHOD: analysis of judicial resolutions obtained through an exhaustive search conducted in specialised databases in the Spanish case-law system, between 2007 and 2017, in civil, criminal and contentious-administrative jurisdictions. RESULTS: a total of 22 pronouncements were obtained, 10 ruling in favour and 12 against; the main conclusions drawn included the need to follow "lex artis ad hoc" by applying adequate preventive and therapeutic measures, for which clinical practice protocols or guides are recommended, and the relevance of entering any procedures into each patient's medical records, constituting proof of professional care in various judicial proceedings. CONCLUSIONS: in addition to guaranteeing patient rights, compliance with "lex artis ad hoc" and the entry of healthcare professionals' activity into medical records has become a safeguard to fight malpractice claims in court, as evidenced by the case-law analysed on the matter

Canine-Assisted Therapy and Quality of Life in People With Alzheimer-Type Dementia: Pilot Study.

BACKGROUND: With the aim of improving the quality of life of people with Alzheimer's disease, primarily as regards behavioral and psychological symptoms, we implemented canine-assisted therapy in a group of people with this disease. METHODS: We conducted a quasi-experimental study, with a simple pre-post case series design. Participants comprised 10 Alzheimer's day care center users presenting severe or very severe cognitive decline. The measurement instrument employed was the Quality of Life in Late-Stage Dementia (QUALID) scale. RESULTS: By the end of the therapy, 100% of participants showed an improvement in physical, behavioral, and psychological aspects. The total scores of the QUALID scale for the three different evaluation times (before the therapy and 6 and 12 months after starting) after the canine-assisted therapy intervention were smaller and less dispersed. The total score for the QUALID scale decreased significantly (p < 0.05) at 6 and 12 months after starting therapy. An analysis by item revealed that the scores of all of them fell during the course of the therapy. DISCUSSION: Our study provides evidence of the significant benefits of canine-assisted therapy for quality of life in people with Alzheimer's disease.

Medicamentos genéricos, ¿equivalentes a los de referencia? ¿qué está sucediendo? / Generic drugs, equivalent to reference drugs? What is happening?

La Agencia Española de Medicamentos y Productos Sanitarios (AEMPS) ha emitido en los últimos meses una serie de alertas sanitarias retirando del mercado diversos lotes de medicamentos genéricos que contenían el principio activo valsartán, y más recientemente al irbesartán, debido a la presencia de una impureza, la N-nitrosodimetila-mina (NDMA), una sustancia tóxica para el hígado y probablemente carcinogénica. Como consecuencia de esta situación, se ha avivado la polémica que las diferencias entre medicamentos genéricos e innovadores despierta en la opinión pública y en algunos ámbitos profesionales. Los medicamentos genéricos con-tienen los mismos principios activos y se presentan en la misma forma farmacéutica, comparten calidad, seguridad y eficacia, y están sometidos a los mismos controles que los de referencia. Sin embargo, mientras que para acreditar la eficacia y la seguridad de un medicamento de referencia es necesario realizar ensayos clínicos, los genéricos pueden hacerlo demostrando su bioequivalencia con un medicamento ya autorizado. Las alertas emitidas demuestran que el sistema de control rutinario de fármacos funciona bien, pero también ha servido para dar un aviso a las administraciones públicas, quienes deben comprender que no se puede centrar la política de medicamentos únicamente en el ahorro y en precios bajos, ya que esto muchas veces conlleva riesgos para los con-sumidores. Sin duda, deben intensificarse tan-to las regulaciones sanitarias como la farmacovigilancia, para poder identificar a tiempo este tipo de riesgos sanitarios y prevenirlos o, al menos, reducirlos

The Spanish Agency for Medicines and Health Products (AEMPS) has issued a series of health alerts in the last few months removing from the market several batches of generic medicines containing the active ingredient valsartan, and more recently irbesartan, due to the presence of an impurity, N-nitrosodimethylamine (NDMA), toxic to the liver and probably carcinogenic. As a result of this situation, the controversy that the differences between generic and innovative medicines arouse in public opinion and in some professional fields has been stoked. Generic medicines contain the same active ingredients and are presented in the same pharmaceutical form, share quality, safety and efficacy, and are subject to the same controls as the reference ones. However, while accrediting the efficacy and safety of a reference medicine requires clinical trials, generics can do so by demonstrating their bioequivalence with an already authorized medicine. The warnings issued show that the routine drug control system works well, but it has also served to give notice to public administrations, who must understand that the drug policy can not be focused solely on savings and low prices, since that this often entails risks for consumers. Undoubtedly, both sanitary regulations and pharmacovigilance must be intensified in order to identify these types of health risks in time and prevent them or, at least, reduce them

Improving Engagement of Mild to Moderate Dementia Alzheimer's Disease Patients Using Evidence-Based Visual Cognitive Stimulation Exercises.

INTRODUCTION: Different studies have proven the effectiveness of cognitive stimulation (CS) for people with mild to moderate dementia, but further research is needed to gain insight into how CS interventions should be designed and developed. OBJECTIVES: The objective of this study was to gather and analyze data about the development of a series of CS sessions with Alzheimer's disease (AD) patients, to gain insight into how different individuals engage to different CS activities. METHODS: 24 AD patients with mild to moderate dementia (GDS = 4 and 5) participated in the study. Twelve different sessions were held with a different stimulation exercise each. Information about the achievement and engagement for each of the exercises were recorded for each patient. RESULTS: A significant correlation was found between the global engagement and the GDS level, and between engagement and gender (and also with educational level) for one of the exercises. These results may be useful for designing CS sessions depending on the composition of the group. For example, five exercises got very different engagement results when comparing patients with GDS = 4 and GDS = 5; if the session group consists of patients with both GDS levels, these kinds of exercises should be avoided to gain homogeneity in the engagement and prevent discouragement. CONCLUSIONS: The type and characteristics of CS exercises have an impact on the engagement level of AD patients with mild to moderate dementia. Further studies are necessary to better understand which characteristics of the exercises affect the engagement of the patient according to their particularities. This kind of study may help the design of CS sessions and improve the results obtained.

A Semantic Social Network Analysis Tool for Sensitivity Analysis and What-If Scenario Testing in Alcohol Consumption Studies.

Social Network Analysis (SNA) is a set of techniques developed in the field of social and behavioral sciences research, in order to characterize and study the social relationships that are established among a set of individuals. When building a social network for performing an SNA analysis, an initial process of data gathering is achieved in order to extract the characteristics of the individuals and their relationships. This is usually done by completing a questionnaire containing different types of questions that will be later used to obtain the SNA measures needed to perform the study. There are, then, a great number of different possible network-generating questions and also many possibilities for mapping the responses to the corresponding characteristics and relationships. Many variations may be introduced into these questions (the way they are posed, the weights given to each of the responses, etc.) that may have an effect on the resulting networks. All these different variations are difficult to achieve manually, because the process is time-consuming and error-prone. The tool described in this paper uses semantic knowledge representation techniques in order to facilitate this kind of sensitivity studies. The base of the tool is a conceptual structure, called "ontology" that is able to represent the different concepts and their definitions. The tool is compared to other similar ones, and the advantages of the approach are highlighted, giving some particular examples from an ongoing SNA study about alcohol consumption habits in adolescents.

Situación actual de la prescripción enfermera en España / Current situation of the nursing prescription in Spain

La prescripción enfermera es un tema que ha generado controversia en los últimos años. Desde hace tiempo, se viene reclamando un apoyo legal para esta tarea que las enfermeras asumen de manera habitual en su práctica clínica. Las enfermeras realizan tareas asistenciales relacionadas con pacientes crónicos, cuidados paliativos, de atención domiciliaria o de otros procesos y, en muchas ocasiones, deben tomar decisiones sin ningún respaldo legal. La primera regulación en España que hace referencia a la capacidad de las enfermeras para indicar, usar y dispensar determinados medicamentos y productos sanitarios de forma autónoma aparece en la Ley 28/2009, que modificaba la ley de garantías y uso racional de los medicamentos. En ella, también se hacía referencia a que el gobierno regularía esta competencia. El desarrollo de esta normativa no se produjo hasta el año 2015 con el Real Decreto 954/2015, que niega la posibilidad de la prescripción enfermera autónoma y genera de nuevo controversia. En los últimos meses se ha llegado a un acuerdo para modificar este real decreto, de manera que, una vez que se publique en el BOE, las enfermeras podrán prescribir en el ámbito de sus competencias, lo que supondrá el reconocimiento de sus competencias en la práctica profesional y un beneficio tanto para los pacientes como para el sistema sanitario

The nursing prescription is a subject that has generated controversy in recent years. For some time now, legal support has been demanded for this task which nurses usually assume in their clinical practice. The nurses perform care tasks related to chronic patients, palliative care, home care or other processes, and in many cases, they must make decisions without any legal backing. The first regulation in Spain that refers to the ability of nurses to indicate, use and dispense certain medicines and health products autonomously appears in Law 28/2009, which modified the law on guarantees and rational use of medicines. In it, reference was also made to the fact that the government would regulate this competence. The development of this regulation does not occur until 2015 with Royal Decree 954/2015, which denies the possibility of autonomous nurse prescription and generates new controversy. In recent months, an agreement has been reached to modify this royal decree so that, once it is published in the BOE, nurses may prescribe within the scope of their competences, which will mean the recognition of their skills in professional practice and a benefit for both patients and the health system