Prediction of caregiver psychological distress in amyotrophic lateral sclerosis: A cross-sectional study.

PURPOSE/OBJECTIVE: To propose a predictive model for caregivers' psychological distress (including anxiety, depression, and cognitive overload) based on different data gathered from amyotrophic lateral sclerosis (ALS) patients (cognitive level, psychological distress, type of ALS, and sex). RESEARCH METHOD/DESIGN: A cross-sectional study with a sample of 51 ALS patients and their respective main carers. Various instruments were used such as the Beck Anxiety Inventory, ALS Depression Inventory-12, and the Edinburgh Cognitive and Behavioral ALS Screen, Zarit Burden Interview, Self-Rating Depression Scale, and Self-Rating Anxiety Scale for caregivers. RESULTS: ALS type, sex, and cognition were predictive variables for caregiver distress, with the main explanatory variable being the distress of the patients themselves. Spinal ALS led to higher psychological distress in caregivers (ß = .38), as did male patients with ALS and preserved cognition. CONCLUSIONS/IMPLICATIONS: The proposed confirmatory model demonstrates that patients' psychological distress is the best predictor of psychological distress in their caregivers. (PsycInfo Database Record (c) 2024 APA, all rights reserved).

Analysis of Heart Rate Variability in Individuals Affected by Amyotrophic Lateral Sclerosis.

INTRODUCTION: Amyotrophic lateral sclerosis (ALS) produces alterations in the autonomic nervous system (ANS), which explains the cardiac manifestations observed in patients. The assessment of heart rate variability (HRV) is what best reflects the activity of the ANS on heart rate. The Polar H7 Bluetooth® device proves to be a non-invasive and much faster technology than existing alternatives for this purpose. OBJECTIVE: The goal of this study is to determine HRV using Polar H7 Bluetooth technology in ALS patients, comparing the obtained measurements with values from healthy individuals. METHOD: The sample consisted of 124 participants: 68 diagnosed with ALS and 56 healthy individuals. Using Polar H7 Bluetooth technology and the ELITE HRV application, various HRV measurements were determined for all participants, specifically the HRV index, RMSSD, RMSSD LN, SDNN index, PNN50, LF, HF, LF/HF ratio, HR average, and HF peak frequency. RESULTS: Statistically significant differences were observed between ALS patients and healthy individuals in the HRV index, RMSSD, RMSSD LN, SDNN index, PNN50, HF, and LF, where healthy individuals exhibited higher scores. For the HR average, the ALS group showed a higher value. Values were similar when comparing men and women with ALS, with only a higher HF peak frequency observed in women. CONCLUSION: The Polar H7 Bluetooth® device is effective in determining heart rate variability alterations in ALS, being a promising prognostic tool for the disease.

Predictive Model of Anxiety and Depression Perception in Multiple Sclerosis Patients: Possible Implications for Clinical Treatment.

Multiple Sclerosis (MS) is a neurodegenerative disease characterized by motor and non-motor symptoms, including emotional distress, anxiety, and depression. These emotional symptoms currently have a pharmacological treatment with limited effectiveness; therefore, it is necessary to delve into their relationship with other psychological, functional, or prefrontal alterations. Additionally, exploring non-pharmacological therapeutic alternatives that have shown benefits in addressing emotional distress in MS patients is essential. AIM: To establish a predictive model for the presence of anxiety and depression in MS patients, based on variables such as psychological well-being, functional activity, and prefrontal symptoms. Additionally, this study aimed to propose non-pharmacological therapeutic alternatives based on this model. MATERIALS AND METHODS: A descriptive, observational, and cross-sectional study was conducted with a sample of 64 diagnosed MS patients who underwent functional and cognitive assessments using the following questionnaires and scales: Functional Activities Questionnaire (FAQ), Acceptance and Action Questionnaire (AAQ-II), Experiences Questionnaire (EQ), Self-Compassion Scale Short Form (SCS-SF), Beck Depression Inventory II (BDI-II), State-Trait Anxiety Inventory (STAI), and Prefrontal Symptoms Inventory (PSI). RESULTS: The model showed an excellent fit to the data and indicated that psychological well-being was the most significant predictor of the criteria (ß = -0.83), followed by functional activity (ß = -0.18) and prefrontal symptoms (ß = 0.15). The latter two are negatively related to psychological well-being (ß = -0.16 and ß = -0.75, respectively). CONCLUSIONS: Low psychological well-being is the variable that most significantly predicts the presence of anxiety and depression in MS patients, followed by functional activity and prefrontal alterations. Interventions based on mindfulness and acceptance are recommended, along with nutritional interventions such as antioxidant-enriched ketogenic diets and moderate group physical exercise.

Spanish adaptation and validation of the ALS Depression Inventory-12 (ADI-12) in patients with Amyotrophic Lateral Sclerosis.

BACKGROUND: Patients with Amyotrophic Lateral Sclerosis (ALS) have a higher prevalence of mood disorders, including depression, than the general population. Non-specific measurement instruments have been used to evaluate depression in these patients, which complicates accurate diagnosis. The ALS Depression Inventory (ADI-12) exclusively assesses depressive symptoms in patients with ALS. AIM: To adapt and validate the ADI-12 in a Spanish sample. METHODS: A selective design was used with 74 patients with ALS, using the ADI-12 questionnaire. The original instrument was translated and back-translated into Spanish. The internal structure, temporal stability, convergent, and discriminant validity of the instrument were analyzed. RESULTS: Two confirmatory models showed internal validity (p = 0.502 for the one-factor model, p = 0.507 for the two-factor model). The Cronbach's alpha (0.900 in the first measurement and 0.889 in the second one) indicated a high internal consistency of the test. The Pearson correlation (0.90) indicated high temporal stability. In terms of convergent validity, the ADI-12 showed moderate correlations with the Beck Anxiety Inventory (BAI) (0.51-0.58), and low correlations with time since ALS diagnosis (-0.26 to -0.27). LIMITATIONS: The main limitation of the present study was the small sample size. CONCLUSIONS: The ADI-12 is fitted to a single general factor of depression, and the scale shows high internal consistency and high temporal stability, therefore, its use is recommended for the diagnosis of depression in patients with ALS.

Fear of Falling Score Is a Predictor of Falls in Community-Dwelling Pre-Frail and Frail Older People.

Identifying frail older people at risk of falling is a priority in order to apply preventive strategies. This cross-sectional study included community-dwelling pre-frail and frail people (Fried's criteria) aged 70 years and older to assess the prevalence of falls and identify screening strategies based on comprehensive geriatric assessments to detect an increased risk of falling and recurrent falling in community-dwelling frail and pre-frail old people. Of the 229 participants, 121 (54.9%) had fallen in the previous 12 months, and 20 of these (16.5%) were recurrent fallers (≥2 falls). A score of 20 points or more on the Falls Efficacy Scale International was predictive of falling (area under the receiver-operating characteristics curve 0.67, 95% confidence interval: 0.61-0.74, p < 0.001) with a sensitivity of 51.7% and a specificity of 73.9%. Polypharmacy, Short Physical Performance Battery score of 8 points or less, and Falls Efficacy Scale International score of 20 points or more show an area under the curve of 0.78 (95% confidence interval: 0.67-0.89, p < 0.001) for recurrent falling.

Impact of Family Function on the Quality of Life and Health Perception of Non-Institutionalized Dementia Patients.

BACKGROUND: Dementia is one of the pathologies that has increased the most among the older population (mainly Alzheimer's disease), and it has a direct impact on the quality of life (QoL), cognitive performance, and health of these patients. Family functionality can play a role in this QoL if these patients are not institutionalized. OBJECTIVE: To analyze the role of family function in the QoL and health perception of non-institutionalized dementia patients, as well as related variables such as anxiety, depression, optimism, or pessimism. METHODS: Cross-sectional study with a sample of 54 patients diagnosed with some type of dementia, non-institutionalized, or in outpatient care, from different centers in the province of Valencia (Spain). The EQ-5D, MMSE, Apgar Family or general health, and Goldberg anxiety and depression questionnaires were utilized. RESULTS: The correlation of the Apgar Family with the General Health Questionnaire-new onset problems variable (GHQ) and Chronicity and General Health Questionnaire-chronic problems (CGHQ) of the Goldberg Quality of Life questionnaire was statistically significant and negative (GHQ r = -0.310; p = 0.034. CGHQ r = -0.363; p = 0.012); as well as between Apgar Family and Anxiety-Depression (r = -0.341; p = 0.020). The correlation of the Apgar Family with the Life Orientation Test-Pessimism variable (LOT) was statistically significant and negative (r = -0.270; p = 0.061). Finally, severe dysfunction of Apgar Family has a negative correlation with self-perception of health (p = 0.036 B = -16.589) determined by the Visual Analogue Scale (VAS). CONCLUSION: Family functionality directly influences anxiety, depression, optimism, and pessimism. This could explain why family function is related to the QoL of patients and their self-perception of health.

Importance of Soft Skills in Health Sciences Students and Their Repercussion after the COVID-19 Epidemic: Scoping Review.

Soft skills (SKs) are skills related to the interaction among people and their way of dealing with tasks. Increasingly valued in the workplace, they are especially relevant in health professionals due to the importance of the relationship among them and their patients and families. Given their importance, the university training of healthcare professionals must promote the development of SKs. The COVID-19 pandemic has been a turning point in many areas, changing the learning process and, even more, the use of these soft skills as a fundamental ingredient in human relationships. The aim of this study was to analyse the available evidence regarding SKs in health science students, specifically nursing students, and to describe whether there is a worsening in the development of such skills after the COVID-19 pandemic. According to the PRISMA-ScR methodology for systematic reviews, this study included articles on social skills and possible changes in these skills as a consequence of the pandemic in health sciences students The results highlight the importance of these emotional competences for future nurses, being particularly relevant for communication and emotional self-awareness and showing their influence on academic aspects, such as academic performance or mental health and coping skills. A major limitation of the present study was not considering aspects such as compassion or empathy. However, the novelty provided by this work is the analysis of the changes in SKs produced as a consequence of the pandemic. It is definitely clear that there is a need to enhance emotional intelligence, and thus soft skills, in future health professionals.

In Situ Simulation: A Strategy to Restore Patient Safety in Intensive Care Units after the COVID-19 Pandemic? Systematic Review.

BACKGROUND: Patient safety is a public health problem worldwide. In situ simulation (ISS) arises as a learning strategy that allows health professionals to immerse themselves in a real environment without endangering the patients until they have learned the skills needed, thus increasing the quality of care. This systematic review aimed to verify the efficacy of the use of "in situ simulation" as a method that will allow health professionals to increase patient safety in Intensive Care Units after the situation experienced during the pandemic caused by the COVID-19 virus. METHODS: Seven studies were reviewed using the PRISMA methodology for systematic reviews. The CASPe guide was used to assess the quality of the manuscripts. RESULTS: The main topics that emerged from this review in relation to in situ simulation were as follows: looking at aspects such as patient self-perception of safety, adverse events, interprofessional communication and health system organization in relation to in situ simulation. CONCLUSIONS: The adequate implementation of in situ simulation after the COVID-19 pandemic in ICU services is shown to be an efficient and effective strategy to promote improvement in the attitudes on a culture of safety and teamwork of professionals.

Relationship of Motor Impairment with Cognitive and Emotional Alterations in Patients with Multiple Sclerosis.

Introduction. Multiple sclerosis (MS) is a neurodegenerative disease that, despite mainly affecting women, is more severe in men and causes motor, cognitive and emotional alterations. The objective of this study was to determine the possible relationship between motor, cognitive and emotional alterations. Materials and Methods. This is a descriptive, observational and cross-sectional study, with 67 patients with MS (20 men and 47 women), who were given the following questionnaires: Expanded Disability Status Scale (EDSS), Two-Minute Walk Test (2MWT), Berg Balance Scale, Beck's Depression Inventory (BDI-II), State-Trait Anxiety Inventory (STAI) and Prefrontal Symptoms Inventory (PSI) to analyze their cognitive level, body mass index (BMI) and percentage of muscle mass. In addition, regression analysis was conducted to study the relationship among variables. Results. No significant differences were found between men and women in any of the variables. Regarding the relationship between parameters, the regression analysis was statistically significant, showing an effect of age on the walking and balance performance (ß â‰… −0.4, p < 0.05); in addition, there was a relationship between 2MWT and STAI A/S, indicating that both older age and a high anxiety state could impact walking performance. On the other hand, prefrontal symptoms showed moderate relationships with both anxiety and depression (ß â‰… 0.6, p < 0.05); thus, high levels of anxiety and depression could increase prefrontal alterations. Conclusions. There is a relationship between motor and emotional variables. Specifically, state anxiety is related to walking resistance. No relationship was found between depression and cognitive alteration and balance or walking ability. Only age has an effect in these relationships.

Educational Needs in Oncology Nursing: A Scoping Review.

Care in oncology requires both technical and psychosocial skills by nursing staff, so continuous learning is necessary. Evidence suggests there are some educational gaps in oncology nursing staff, and continuing educational interventions have been effective in overcoming these deficiencies. Aim: to determine the basic educational lines that a continuous training program should have for oncology nurses. A bibliographic review study was carried out in two phases from October 2020 to January 2021. In a first phase, the main databases were analyzed: PubMed, Web of Science, Dialnet and Medline, following the PRISMA methodology; and subsequently, an analysis of the most important thematic nuclei that a training program in cancer nursing should contain. The DAFO matrix and the Hanlon prioritization method were used. Four competencies that every oncology nurse should have were described: communication, coping, self-direction of learning and technical health. The thematic contents that a training program should contain were then determined, and aspects such as stress prevention and burnout, adequate communication with patient and family, and continuous educational and technical skills were considered. The results found suggest that there are deficiencies in the education of nursing staff. Continuing education programs are effective in supplementing them. They should develop the four skills described in the results section.

Patrón de uso del teléfono móvil e Internet en adolescentes de entre 11 y 15 años / Pattern of mobile phone and internet use among 11–15-years-old

Objetivo: Valorar el patrón de uso de Internet y del teléfono móvil para conocer un posible abuso, y describir los factores relacionados con este patrón en adolescentes de 11-15 años. Método: Estudio descriptivo transversal en 8 centros de educación primaria y secundaria adscritos a un centro de salud semirrural. Muestreo bietápico, por conglomerados y sistemático, con un tamaño final de la muestra de 446 participantes. Se contemplaron variables sociodemográficas y aquellas relacionadas con el Cuestionario de experiencias relacionadas con el móvil (CERM) y el Cuestionario de experiencias relacionadas con Internet (CERI). Resultados: Se obtuvieron 446 encuestas válidas, 228 niños (51,1%) y 218 niñas (48,9%) de 11 a 15 años. Tenían móvil propio 418 (93,7%). La mediana de uso del móvil fue de 12horas entre semana y 10 el fin de semana. Lo más usado fue WhatsApp (53,6%) y redes sociales (31,4%). Se observaron criterios de uso problemático de Internet (CERI≥26) en un 15,7%, especialmente en 2.o y 3.o de ESO. Las niñas presentaron mayores valores de CERI-conflictos interpersonales (p=0,04). Respecto al uso del móvil, las niñas presentaron mayor puntuación en CERM total (p=0,001) y CERM-uso comunicacional y emocional (p=0,001). Conclusiones: Los resultados obtenidos sitúan un inicio precoz de los problemas por uso de Internet y el móvil probablemente relacionado con la accesibilidad a las nuevas tecnologías. Se ha observado ausencia de control parental, más uso problemático de móvil e Internet en 2.o y 3.o de ESO y en las niñas mayores puntuaciones relacionadas con uso comunicacional, emocional y conflictos interpersonales. Los hallazgos del estudio pueden ayudar a incrementar la concienciación sobre este problema, así como detectarlo de forma precoz y prevenir los efectos de la adicción a las tecnologías en adolescentes.(AU)

Objective: To assess the pattern of problematic internet and mobile use in a sample of adolescents. Method: Cross-sectional descriptive study in 8 primary and secondary education centres attached to a semi-rural health centre serving 21,000 inhabitants. Two-stage, cluster and systematic sampling, with a final sample size of 446 participants. Sociodemographic variables and data related to the questionnaire for mobile phone-related experiences (CERM) and questionnaire on internet-related experiences (CERI) were collected. Results: 446 valid surveys were obtained, 228 boys (51.1%) and 218 girls (48.9%) 11 to 15 years old. A total of 418 (93.7%) had their own mobile. Median mobile usage was 12hours on weekdays and 10 at weekends. The most used platforms were WhatsApp (53.6%) and social media (31.4%). Criteria for problematic internet use (CERI>26) were observed in 15.7%, more in 2nd and 3rd ESO. Girls had higher CERI -interpersonal conflict scores (p=.04). Regarding mobile use, girls had higher scores in total CERM (p=.001) and CERM-communicative and emotional use (p=.001). Conclusions: The results indicate early onset of problems with internet and mobile use, probably related to the accessibility of the new technologies. No parental control was observed. More problematic use of mobile and internet in second and third compulsory secondary education and higher scores in the group of girls related to communication, emotional use and interpersonal conflicts were observed. The findings can help to raise awareness of this problem, detect it early and prevent the effects of addiction to technologies in adolescents.(AU)

Pattern of mobile phone and internet use among 11-15-years-old.

OBJECTIVE: To assess the pattern of problematic internet and mobile use in a sample of adolescents. METHOD: Cross-sectional descriptive study in 8 primary and secondary education centres attached to a semi-rural health centre serving 21,000 inhabitants. Two-stage, cluster and systematic sampling, with a final sample size of 446 participants. Sociodemographic variables and data related to the questionnaire for mobile phone-related experiences (CERM) and questionnaire on internet-related experiences (CERI) were collected. RESULTS: 446 valid surveys were obtained, 228 boys (51.1%) and 218 girls (48.9%) 11-15 years old. A total of 418 (93.7%) had their own mobile. Median mobile usage was 12h on weekdays and 10 at weekends. The most used platforms were WhatsApp (53.6%) and social media (31.4%). Criteria for problematic internet use (CERI>26) were observed in 15.7%, more in 2nd and 3rd ESO. Girls had higher CERI -interpersonal conflict scores (p=.04). Regarding mobile use, girls had higher scores in total CERM (p=.001) and CERM-communicative and emotional use (p=.001). CONCLUSIONS: The results indicate early onset of problems with internet and mobile use, probably related to the accessibility of the new technologies. No parental control was observed. More problematic use of mobile and internet in second and third compulsory secondary education and higher scores in the group of girls related to communication, emotional use and interpersonal conflicts were observed. The findings can help to raise awareness of this problem, detect it early and prevent the effects of addiction to technologies in adolescents.

Perdón y gratitud como predictores de bienestar psicológico / Forgiveness and gratitude as predictors of psychological wellbeing

Objetivo: analizar los constructos de perdón y gratitud como predictores del bienestar psicológico. Método: se realizó una revisión narrativa, mediante revisión bibliográfica en las bases de datos Pubmed, ScienceDirect, Biblioteca Virtual de Salud, Scielo y Embase. Periodo: de diciembre de 2020 a marzo de 2021. Los términos empleados para la búsqueda fueron: “psichologycal well-being”, “forgiveness”, “gratitude”. Eran artículos originales, en inglés o español. Resultados: se obtuvo un total de 284 artículos, de los cuales se seleccionaron ocho trabajos. La gratitud y el perdón están correlacionados con el bienestar psicológico, aunque pocos estudios han examinado los mecanismos por los que la gratitud ejerce estos efectos beneficiosos. Respecto del perdón, diversos autores proponen que el beneficio redunda mayormente en quien lo ejercita, más que en aquella persona que lo recibe. Conclusiones: las intervenciones de gratitud proporcionan una nueva dimensión psicológica para buscar formas de reducir el estrés y mejorar el bienestar psicológico de las personas, y pueden ser útiles como una terapia de promoción de la salud psicológica.(AU)

Objective: to analyse the forgiveness and gratitude constructs as predictors of psychological wellbeing. Method: a narrative review was conducted, through bibliographic review in the following databases: Pubmed, ScienceDirect, Biblioteca Virtual de Salud, Scielo and Embase. Period: From December 2020 to March 2021. The terms used in the search were: “psychological wellbeing”, “forgiveness”, “gratitude”. Original articles, in English or Spanish. Results: in total, 284 articles were retrieved, and eight articles were selected out of these. Gratitude and forgiveness are correlated with psychological wellbeing, although few studies have examined the mechanism through which gratitude has these beneficial effects. Regarding forgiveness, different authors suggest that there is benefit mostly for the person granting it, rather than for the person receiving it. Conclusions: gratitude interventions provide a new psychological dimension to search for ways of reducing stress and improving the psychological wellbeing of people, and they can be useful as a therapy to promote psychological health.(AU)

Relevancia de la Evitación Experiencial en la Esclerosis Múltiple y rol de enfermería / Relevance of Experiential avoidance in Multiple sclerosis and nursing rol

Objetivo: Describir los niveles de Evitación experiencial (EE) en pacientes con Esclerosis Múltiple (EM) y establecer los principales diagnósticos enfermeros. Metodología: Estudio transversal y analítico realizado con 51 pacientes de dos asociaciones de EM. Se utilizó la escala autoaplicada Acceptance and Action Questionnaire-II (AAQ-II). Resultados: Se obtuvo una media para la evitación experiencial de 23,84. El análisis por factores evidenció mayores puntuaciones para el factor desbordamiento emocional (46,02 %). Conclusión: La evitación experiencial constituye una respuesta de afrontamiento ineficaz ante la esclerosis múltiple, y se ha constatado una mayor prevalencia entre el sexo femenino. Se propone la inclusión de herramientas que permitan el diagnóstico precoz de alteraciones cognitivas relacionadas con esta patología desde la Atención Primaria de salud. (AU)

Objective: To describe the levels of Experimental avoidance (EA) in patients with Multiple sclerosis (MS) and establish the main nursing diagnoses. Methods: cross-sectional study carried out with 51 patients in two MS associations The self-applied scale Acceptance and Action Questionnaire-II was used. Results: The average score for the experiential avoidance was 23.84. The analysis by factors shows higher scores for emotional overflow (46.02 %). Conclusion: Experience avoidance is an ineffective coping response to multiple sclerosis, and there has been a higher prevalence among the female sex. It is proposed to include tools that allow the early diagnosis of cognitive alterations related to this pathology from Primary Health Care. (AU)

Possible Role of Butyrylcholinesterase in Fat Loss and Decreases in Inflammatory Levels in Patients with Multiple Sclerosis after Treatment with Epigallocatechin Gallate and Coconut Oil: A Pilot Study.

(1) Background. Multiple sclerosis (MS) is characterised by the loss of muscle throughout the course of the disease, which in many cases is accompanied by obesity and related to inflammation. Nonetheless, consuming epigallocatechin gallate (EGCG) and ketone bodies (especially ß-hydroxybutyrate (ßHB)) produced after metabolising coconut oil, have exhibited anti-inflammatory effects and a decrease in body fat. In addition, butyrylcholinesterase (BuChE), seems to be related to the pathogenesis of the disease associated with inflammation, and serum concentrations have been related to lipid metabolism. Objective. The aim of the study was to determine the role of BuChE in the changes caused after treatment with EGCG and ketone bodies on the levels of body fat and inflammation state in MS patients. (2) Methods. A pilot study was conducted for 4 months with 51 MS patients who were randomly divided into an intervention group and a control group. The intervention group received 800 mg of EGCG and 60 mL of coconut oil, and the control group was prescribed a placebo. Fat percentage and concentrations of the butyrylcholinesterase enzyme (BuChE), paraoxonase 1 (PON1) activity, triglycerides, interleukin 6 (IL-6), albumin and ßHB in serum were measured. (3) Results. The intervention group exhibited significant decreases in IL-6 and fat percentage and significant increases in BuChE, ßHB, PON1, albumin and functional capacity (determined by the Expanded Disability Status Scale (EDSS)). On the other hand, the control group only exhibited a decrease in IL-6. After the intervention, BuChE was positively correlated with the activity of PON1, fat percentage and triglycerides in the intervention group, whereas these correlations were not observed in the control group (4). Conclusions. BuChE seems to have an important role in lipolytic activity and the inflammation state in MS patients, evidenced after administering EGCG and coconut oil as a ßHB source.

The Impact of Epigallocatechin Gallate and Coconut Oil Treatment on Cortisol Activity and Depression in Multiple Sclerosis Patients.

(1) Background: Multiple sclerosis (MS) is pathogenically characterized by high oxidative stress and symptomatically by progressive muscle loss and increased body fat associated with the presence of depression. Epigallocatechin gallate (EGCG) (particularly present in green tea) and ketone bodies (in particular beta-hydroxybutyrate (BHB)), whose main source is coconut oil, have shown emotional benefits and body fat loss. The aim of this study was to assess the impact of EGCG and coconut oil on cortisol activity related to fat loss and depression in MS patients. (2) Methods: The study involved 51 MS patients who were randomly divided into an intervention group or a control group. The intervention group received 800 mg of EGCG and 60 mL of coconut oil, which were included in their daily diet for four months. The control group received placebo and all patients followed an isocaloric diet. A blood sample was collected before and after the four-month period, and levels of cortisol, albumin and BHB were measured in serum. In addition, immediately before and after the intervention, anthropometric variables were measured: waist-to-hip ratio (WHR), body fat mass percentage, fat weight, total weight, and muscle mass percentage. Depression was assessed with the Beck Depression Inventory II (BDI-II). (3) Results: No significant changes were obtained in cortisol levels in any of the groups, and there was a significant increase in albumin in the blood of the intervention group only that could lead to a decrease in serum free cortisol. In addition, it was observed a significant decrease in levels of depression and abdominal fat. (4) Conclusions: EGCG combined with coconut oil increase the concentration of albumin in blood and produce less depression in MS patients.

Reporting of workplace violence towards nurses in 5 European countries - a cross-sectional study.

OBJECTIVES: This study aimed to assess country-specific evidence of physical and non-physical acts of workplace violence towards nurses working in the health sector in 5 European countries, and then to identify reasons for not reporting violence experienced at work. MATERIAL AND METHODS: This retrospective cross-sectional study was conducted in 5 participating countries (Poland, the Czech Republic, the Slovak Republic, Turkey, and Spain). All registered nurses working in selected healthcare settings for at least 1 year were invited to participate in the study. A questionnaire adapted from the Workplace Violence in the Health Sector Country Case Study - Questionnaire, developed jointly by the International Labour Office, the International Council of Nurses, the World Health Organization and Public Services International, was used. The selection of healthcare settings and the distribution of the questionnaire were conducted according to the recommendations of the questionnaire authors. RESULTS: In total, 1089 nurses submitted completed questionnaires which could be included in the study. Of these, 54% stated that they had been exposed to non-physical violence and 20% had been exposed to physical violent acts. A total of 15% of the surveyed nurses experienced both forms of workplace violence. In addition, 18% of the respondents confirmed having witnessed physical violence in their workplace. The most common perpetrators were patients and patients' relatives. In about 70% of these cases, no actions were taken after the act of violence to investigate its causes. About half of the study group did not report workplace violence as they believed it was useless or not important. The most common consequences of workplace violence included being "superalert" or watchful and on guard. CONCLUSIONS: Nurses internationally are both victims of and witnesses to workplace violence. Workplace violence is often seen by nurses as an occupational hazard and, as such, it remains not reported. The first step in preventing workplace violence is not only to acknowledge its existence but also to ensure the appropriate reporting of violent acts. Int J Occup Med Environ Health. 2020;33(3):325-38.

Percepción de la población inmigrante sobre el sistema nacional de salud español / Perception of immigrant people about Spanish national system of health / Percepção da população imigrante no sistema nacional de saúde espanhol

Objetivo principal: Conocer la percepción actual que tienen los inmigrantes de origen marroquí sobre el Sistema Nacional de Salud, en el departamento de salud de Xativa-Ontinyent. METODOLOGÍA: estudio cualitativo fenomenológico mediante entrevistas semi-estructuradas llevadas a cabo durante los meses de octubre de 2017 a mayo de 2018. Resultados principales: Casi la totalidad de los entrevistados refiere haberse sentido discriminado/a en alguna ocasión. Según apuntan, el color de piel, el no dominar el idioma a la perfección y el hecho de ser de otro país culturalmente distinto son motivos de discriminación. Conclusión principal: El sistema sanitario español retrocede en cuanto a derechos humanos tras la implantación del Real Decreto Ley 16/2012, de 20 de abril, donde la asistencia gratuita y universal desaparece, quedando los más desfavorecidos y sin recursos excluidos de recibir atención sanitaria de calidad y aumentando las diferencias sociales entre personas

The main objective is to know the current perception of moroccan'simmigrants about the national system of health, at the Department of health of Xativa Ontinyent. As to the methodology it's a qualitative phenomenological stydy using semi-structured interwiews between October 2017 to may 2018. The main results contribute that almost all of those interviewed referred to have been sometimes discriminated. According to target, the color of skin, do not master the language perfectly and the fact of being from another country culturally distinct are grounds for discrimination. In conclusion, the Spanish health system back on human rights after the implementation of Royal Decree-Law 16/2012, April 20, on urgent measures to ensure the sustainability of the national health system and improve the quality and safety of their performance, where the free and universal assistance disappears, leaving the poor and without resources excluded from receiving quality health care and increasing social differences between people

O objetivo principal é conhecer a percepção atual de imigrantes de origem marroquina sobre o Sistema Único de Saúde, no departamento de saúde da Xativa-Ontinyent. Sobre a metodología, é um estudo fenomenológico qualitativo, por meio de entrevista semiestruturada, realizada durante os meses de outubro de 2017 a maio de 2018. Os principais resultados contribuem que quase todos os entrevistados relataram ter se sentido discriminados ocasionalmente.como eles apontam, a cor da pele, a falta de domínio da língua à perfeição e o fato de que eles são de outro país culturalmente diferente são motivos de discriminação. Em conclusão, o sistema de saúde espanhol recua em termos de direitos humanos após a implementação do Real Decreto-Lei 16/2012, de 20 de abril, onde desaparece a assistência gratuita e universal, deixando os mais desfavorecidos e sem recursos excluídos de receber cuidados de saúde qualidade e aumento das diferenças sociais entre as pessoas

Violence against nurses working in the health sector in five European countries-pilot study.

AIM: To provide initial data regarding country-specific evidence of workplace violence towards nurses working within the health sector in five European countries. METHODS: This is a descriptive and cross-sectional pilot study, conducted in June 2016. The sample consisted of 260 nurses working in selected health care settings in five participating countries (Poland, Czech Republic, Slovakia, Turkey, and Spain). The questionnaire used was adapted from the International Labour Office/International Council of Nurses/World Health Organisation/Public Services International Workplace Violence in the Health Sector Country Case Study-Questionnaire. RESULTS: A large number of participants confirmed that they had been physically attacked or verbally abused in the workplace in the last 12 months. In most cases, the physical and verbal abuse was inflicted by patients and to a lesser degree by relatives of patients, staff members, or managers/supervisors. In the majority of cases, no action was taken to investigate the causes of the incidents. In most cases, participants believed there was no point in reporting the incidents. However, the reasons for not reporting or discussing incidents of workplace violence varied depending on the country. CONCLUSION: Workplace violence towards nurses is a serious problem internationally, and violence prevention strategies need to be implemented.

Improvement of Main Cognitive Functions in Patients with Alzheimer's Disease after Treatment with Coconut Oil Enriched Mediterranean Diet: A Pilot Study.

BACKGROUND: Alzheimer's disease (AD) is the most prevalent neurodegenerative disorder (mainly in women), and new therapies are needed. In this way, ketone bodies are a direct source of cellular energy and can be obtained from coconut oil, postulating that coconut oil could be a new non-pharmacological alternative in AD patients. OBJECTIVE: The aim of this study is to detect changes in the main cognitive functions of patients with AD after following a coconut oil enriched Mediterranean diet, and to determine whether there are differences in function of stage or sex. METHODS: A prospective, longitudinal, qualitative, analytic, experimental study was carried out in 44 patients with AD, who were randomly divided into two homogenous groups of 22 patients each: an experimental group of patients who followed a coconut oil enriched Mediterranean diet for 21 days and a control group. In order to determine the cognitive changes after the intervention, we carried out the 7 Minute Screen, which analyses temporal orientation, visuospatial and visuoconstructive abilities, and semantic and episodic memory. RESULTS: After intervention with coconut oil, improvements in episodic, temporal orientation, and semantic memory were observed, and it seems that the positive effect is more evident in women with mild-moderate state, although other improvements in males and severe state were also shown. CONCLUSIONS: The isocaloric coconut oil enriched Mediterranean diet seems to improve cognitive functions in patients with AD, with differences according to patient sex and degree of severity of the disease, although more studies in this line are needed.