Plain Language Summary of principles for improving the care of people with eosinophil-associated diseases.

WHAT IS THIS SUMMARY ABOUT?: Eosinophil-associated diseases (EADs) are a group of conditions in which eosinophils (a type of white blood cell) are thought to play a key role in the disease and how it develops. Some EADs are common, such as atopic dermatitis (also called eczema) and a subtype of asthma called eosinophilic asthma, while others are rare, such as hypereosinophilic syndrome (a condition in which a person has a very high number of eosinophils in both the blood and one or more organs). People with EADs face many problems related to their conditions. Symptoms such as severe abdominal pain, itch, or shortness of breath impact both the patient as well as their friends and family. Patients with EADs also experience delays to diagnosis and treatment as well as financial barriers. Healthcare professionals sometimes fail to recognize the complex set of symptoms that characterize an EAD, and this may cause delays in reaching a correct diagnosis. As a result, it may take longer for a patient to get the best care and the most effective treatments, which may contribute to poor health. The goal of this charter is to describe the key elements of good quality care, which all people with EADs deserve, as well as to present an action plan to improve health and overall well-being for people with EADs. Proposed use of this patient charter: The principles described in this charter (a written guide to achieve an outcome) show the core elements of quality care that people with EADs must receive. They also describe clear steps to reduce the burden on patients and their caregivers and to improve patient health outcomes. We urge healthcare professionals, hospitals, and policymakers around the world to adopt these principles quickly. By doing this, people with EADs will be more likely to receive an accurate and timely diagnosis and have access to quality care and treatment in the right setting.

Genetic Predictors of Change in Episodic Verbal Memory by Cognitive Intervention: ACT, PICALM, BDNF, NRG1, APOE Genes and Their Interactions in Situations of Cognitive Demand.

BACKGROUND: Cognitive interventions (CIs) in the elderly are activities that seek to improve cognitive performance and delay its deterioration. Our objectives were to study potential genetic predictors of how a CI program may influence immediate and delayed episodic verbal memory (EVM). METHODS: 162 participants were elderly individuals without dementia who were randomized into parallel control and experimental groups. Participants underwent genetic testing to analyze the PICALM, ACT, NRG1, BDNF and APOE genes. We performed a broad neuropsychological assessment before and 6 months after the CI. The CI involved multifactorial training (30 sessions). The control group undertook the centre's standard activities. The main outcome measures were the genotype studied as a predictor of post-intervention changes in EVM. RESULTS: We found the CI was associated with improvements in several cognitive functions, including immediate and delayed EVM. While no individual gene was associated with any such change, the interaction between PICALM/ACT (p = 0.008; Eta2 = 0.23) and PICALM/NRG1 (p = 0.029; Eta2 = 0.19) was associated with improved immediate EVM, and the NRG1/BDNF interaction was associated with improved delayed EVM (p = 0.009; Eta2 = 0.21). The APOEε4 genotype was not associated with any change in EVM. CONCLUSIONS: Our study shows that the participants' genotype can have an impact on the results of CIs. Cognitive stress may stimulate the interaction of various genes and as such, different types of CI should be established for distinct groups of people taking into account the individual's characteristics, like genotype, to improve the results of this type of health prevention and promotion activity.

Loneliness in the elderly: association with health variables, pain, and cognitive performance. A population-based study / La soledad en personas mayores: asociación con las variables de salud, el dolor y el rendimiento cognitivo. Estudio poblacional

The aim of this population-based study is to analyze the association of loneliness and physical health, pain, health-related quality of life, mental health, cognitive performance, morbidity, and use of health services. Based on the census, a stratified random sampling was chosen. A telephone interview was conducted with 2,060 people over 65 years old, using the GHQ-12 and the COOP-Wonca. An association of loneliness with General Mental Health (GHQ-12) was found, OR = 1.43 (1.34, 1.52) and depression, OR = 2.34 (1.54, 3.53). In cognitive performance the highest effect variable was “memory problems disturb your daily life”, OR = 3.11 (1.25, 7.72); illnesses-related variables: the highest effect variables were perception of health status, OR = 1.37 (1.13, 1. 67) and quality of life (COOP-Wonca), OR = 3.03 (2.32, 3.94); pain-related variables: the highest effect variables were non-localized pain, OR = 2.67 (1.87, 3.83) and arthritis/arthrosis, OR = 1.94 (1.38, 2.72); impaired vision, OR = 2. 62 (1.84, 3.73) and hearing, OR = 1.81 (1.21, 2.72). It is concluded that loneliness is a complex phenomenon associated with variables of different nature. This fact should be taken into account at the time of planning possible solutions. (AU)

El objetivo de este estudio poblacional es analizar la asociación de la soledad no deseada (SND) con salud física, dolor, calidad de vida relacionada con la salud, salud mental, rendimiento cognitivo, morbilidad y uso de servicios de salud. Recurriendo al censo, se realizó un muestreo aleatorio estratificado en Madrid. Se llevó a cabo una entrevista telefónica a 2,060 mayores de 65 años utilizando el GHQ-12 y el COOP-Wonca. Encontramos asociación de la SND y la salud mental general (GHQ-12), OR = 1.43 (1.34, 1.52) y depresión, OR = 2.34 (1.54, 3.53). En rendimiento cognitivo, la variable de mayor efecto fue “los problemas de memoria alteran su vida cotidiana”, OR = 3.11 (1.25, 7.72); variables relacionadas con enfermedad: las de mayor efecto fueron “percepción del estado de salud”, OR = 1.37 (1.13, 1.67) y calidad de vida (COOP-Wonca), OR = 3.03 (2.32, 3.94); variables de dolor: dolor general, OR = 2.67 (1.87, 3.83) y artritis/artrosis, OR = 1.94 (1.38, 2.72); dificultades para ver, OR = 2.62 (1.84, 3.73) y oír, OR = 1.81 (1.21, 2.72). Se concluye que la SND es una situación compleja, lo que debe considerarse al programar soluciones que sean efectivas. (AU)

Improving Care in Eosinophil-Associated Diseases: A Charter.

Eosinophil-associated diseases (EADs) are a range of heterogeneous conditions in which eosinophils are believed to play a critical pathological role. EADs include common illnesses such as eosinophilic asthma and chronic rhinosinusitis and rare conditions such as hypereosinophilic syndromes (HES) and eosinophilic gastrointestinal disorders (EGIDs). EADs are associated with substantial burdens for the patient, including chronic, debilitating symptoms, increased financial burden, decreased health-related quality of life, and the need for repeated visits to multiple different healthcare professionals (HCPs), emergency departments, and/or hospitals. Poor EAD recognition by HCPs often contributes to delayed diagnoses, which further delays patient access to appropriate care and effective treatments, contributing to poor health outcomes. The objective of this charter is to outline key patient rights and expectations with respect to the management of their condition(s) and to set forth an ambitious action plan to improve health outcomes for patients with EADs: (1) people with EADs, their caretakers, HCPs, and the public must have greater awareness and education about EADs; (2) people with EADs must receive a timely, accurate diagnosis; (3) all people with EADs must have access to an appropriate multidisciplinary team, when necessary; and (4) people with EADs must have access to safe and effective treatment options without unnecessary regulatory delays. The principles described in this charter demonstrate the core elements of quality care that people with EADs must receive, and they represent clear steps by which to reduce patient and caregiver burden and improve patient outcomes. We urge HCPs, healthcare systems, and policymakers worldwide to swiftly adopt these principles to ensure patients with EADs have an accurate diagnosis in a timely manner and access to high-level care and treatment in an appropriate setting.

Subjective Memory Complaints in healthy older adults: Fewer complaints associated with depression and perceived health, more complaints also associated with lower memory performance.

OBJECTIVES: (i) To analyze if general cognitive performance, perceived health and depression are predictors of Subjective Memory Complaints (SMC) contrasting their effect sizes; (ii) to analyze the relationship between SMC and objective memory by comparing a test that measures memory in daily life and a classical test of associated pairs; (iii) to examine if different subgroups, formed according to the MFE score, might have different behaviors regarding the studied variables. METHODS: Sample: 3921 community-dwelling people (mean age 70.41±4.70) without cognitive impairment. Consecutive non-probabilistic recruitment. ASSESSMENT: Mini Cognitive Exam (MCE), daily memory Rivermead Behavioural Memory Test (RBMT), Paired Associates Learning (PAL), Geriatric Depression Scale (GDS), Nottingham Health Profile (NHP). Dependent variable: Memory Failures Everyday Questionnaire (MFE). RESULTS: Two different dimensions to explain SMC were found: One subjective (MFE, GDS, NHP) and other objective (RBMT, PAL, MCE), the first more strongly associated with SMC. SMC predictors were NHP, GDS, RBMT and PAL, in this order according to effect size. Considering MFE scores we subdivided the sample into three groups (low, medium, higher scores): low MFE group was associated with GDS; medium, with GDS, NPH and RBMT, and higher, with age as well. Effect size for every variable tended to grow as the MFE score was higher. CONCLUSION: SMC were associated with both health profile and depressive symptoms and, in a lesser degree, with memory and overall cognitive performance. In people with fewer SMC, these are only associated with depressive symptomatology. More SMC are associated with depression, poor health perception and lower memory.

Adherencia al taatamiento de pacientes hipertenos atendidos en assbasalud ese,, manizales (Colombia) 2011 / Treatment adherence of hypertensive patients' being attended by Assbasalud ESE, Manizales (Colombia) 2011

Antecedentes. Por ser la enfermedad hipertensiva de carácter asintomático, el problema de la adherencia al tratamiento de pacientes hipertensos puede ser grave. Objetivo. Estudiar la adherencia al tratamiento de los pacientes hipertensos atendidos en la ciudad de Manizales (Colombia) por el programa ASSBASALUD E.S.E en el año 2011. Materiales y métodos. Estudio de corte transversal en el cual se empleó una población de 200 personas hipertensas (73,5% femenino, edad media 63,76 años) atendidas en ASSBASALUD ESE, Manizales, en el segundo semestre de 2011. Se empleó el cuestionario Martín-Bayarre-Grau (MBG) y el cuestionario de Morinsky-Green para evaluar la red de apoyo social y se empleó el cuestionario Medical OutcomesStudy (MOS). Resultados. Adherentes totales 45% según Morinsky-Green, adherentes totales 51% según MBG, respecto al cuestionario MOS se tiene, 12,29 personas en promedio en su red de apoyo social, apoyo emocional de 74,83%, ayuda material 80,45%, relaciones sociales de ocio y distracción de 78,61%, apoyo afectivo de 83,28%, el fármaco más empleado fue enalapril 17,9%, seguido de verapamilo 10,1%. La adherencia según el cuestionario MBG mostró dependencia significativa entre variables como: educación (p=0,000), conocimientos de la patología (p=0,032), y con los resultados del cuestionario de apoyo social, MOS (p=0,000). La adherencia según Morinsky-Green mostró muy pocas relaciones significativas. Conclusión. La población en estudio presenta bajos niveles de adherencia asociada a baja educación, bajos conocimientos de la patología, bajo apoyo social, se hace necesario una intervención efectiva de ASSBASALUD ESE, a través de su personal de salud. El cuestionario MBG mostró mayor consistencia en la descripción de la adherencia que el cuestionario de Morinsky-Green.

Background. Difficulties regarding patient adherence when treating hypertension could be extremely serious as one is dealing with an asymptomatic hypertensive disease. Objective. Studying adherence to treatment concerning hypertensive patients being attended in Manizales, Colombia, by the state-run Assbasalud programme in 2011. Materials and Methods. This was a cross-sectional study involving a population of 200 hypertensive people (73.5% were female, average age was 63.76 years) being attended by the state-run Assbasalud ESE, Manizales, during the second half of 2011. The Martín-Bayarre-Grau (MBG) and Morisky-Green (MG) questionnaires were used for evaluating the social support network, as well as the Medical Outcomes Study (MOS) questionnaire. Results.45% of patients were totally adherent according to MG and 51% totally adherent according to MBG. Regarding the MOS questionnaire, 12.29 people on average were in a patient's social support network, 74.83% received emotional support, 80.45% material aid, 78.61% were involved in leisure and entertainment-related activities, 83.28% were receiving affective support and enalapril was the drug most used in treatment (17.9%), followed by verapamil (10.1%). According to the MBG questionnaire, adherence significantly depended on variables such as education (p=0.000), knowledge about the disease (p=0.032) and MOS social support questionnaire results (p=0.000). The MG questionnaire revealed very few significant relationships for treatment adherence. Conclusion. The study revealed low adherence levels associated with having a low educational level, poor knowledge regarding the disease and poor social support, thereby making it necessary that Assbasalud ESE take more effective action, especially through its healthcare personnel. The MBG questionnaire had greater consistency regarding a description of adherence than the MG questionnaire.