Burden assessment in caregivers of patients with home artificial nutrition: a need and a challenge.

BACKGROUND/OBJECTIVES: Caregiving can be a stressful task with severe consequences on caregivers' health. Our aim was to evaluate the profile and the burden of caregivers of patients with home artificial nutrition (HAN) in our area. SUBJECTS/METHODS: We conducted a prospective observational study of patients who had started HAN over a period of a year (n=573) and their home caregivers (n=103). Epidemiological characteristics of the patients and the type of HAN were registered. Caregivers' profile data (gender, age and degree of kinship) and Zarit Burden Assessments were recorded. RESULTS: Care recipients had a median age of 79.0 (IQR 87) years, neurological and oncological diseases in 50% and a high rate of mobility limitations (80%). Oral supplements with high-calorie formulas were predominant (60%). The usual caregiver profile was a patient's daughter with a mean age of 53.1 (s.d. 13.4) years acting as the primary caregiver. Burden was absent in 49.5%, light in 18.4% and intense in 32% of caregivers. Intense burden was more frequent in oral over enteral nutrition (42% versus 22.6%; P=0.036). Supplementary nutrition was also associated with higher caregiver burden scores compared with complete diets. In patients with functional limitations, a tendency toward a slightly higher burden was observed. No differences in caregiver burden were detected according to other patient or caregiver characteristics. CONCLUSIONS: HAN type appears to be a factor influencing caregiver burden and therefore, evaluation of caregiver burden should be part of HAN programs.

Etiología y patogenia de la acromegalia / Etiology and pathogenesis of acromegaly

La acromegalia es una enfermedad producida por la hipersecreción crónica e inapropiada de la hormona del crecimiento (GH) que se inicia después del cierre de los cartílagos de crecimiento. La función hipofisaria normal está sometida a un estrecho control hipotalámico y de retroalimentación negativa que comprende la propia GH, el factor de crecimiento similar a la insulina tipo I y las hormonas hipotalámicas: la hormona liberadora de GH, que potencia la secreción de GH y su transcripción génica, y la somatostatina, que inhibe su secreción y tiene escaso efecto en su síntesis. El papel de la nueva hormona ghrelina está aún por dilucidar. La acromegalia está causada en el 98% de los casos por un tumor secretor de GH localizado en la hipófisis, mientras que las causas extrahipofisarias son muy raras. La patogenia de estos tumores hipofisarios sigue siendo en gran parte desconocida y en su origen se han incluido tanto un defecto primario de la célula somatotropa hipofisaria como alteraciones en el control hipotalámico de la secreción de GH. A pesar de que se han descrito defectos moleculares asociados a estos adenomas, la base molecular de la tumorogenia hipofisaria está por definir (AU)

Acromegaly is a disease due to an inadequate and chronical hypersecretion of growth hormone initiated after epiphyseal fusion. Normal pituitary function is subjected to a strict hypothalamic control and negative feedback including GH, IGF-I and hypothalamic hormones: GH-RH improves GH secretion and its gene transcription while somatostatin inhibits its secretion and has a limited effect on its synthesis. The role of the new hormone, ghrelin, is yet to be clarified. In 98% of cases acromegaly is due to a GH- secreting tumour located in the pituitary gland. Extrapituitary causes are very uncommon. The pathogenesis of these pituitary tumours is, in its majority, unknown, involving in its origin a primary defect of pituitary somatotroph cell and also disturbances in the hypothalamic control of GH secretion. Despite the fact that molecular defects associated with these adenomas have been described, the molecular basis of pituitary tumorigenesis remains to be elucidated (AU)