Reduced Violence-Related Burden and Mortality at Higher Altitudes: Examining the Association between High Altitude Living and Homicide Rates in Ecuador.

Esteban Ortiz-Prado, Juan Sebastian Izquierdo-Condoy, María G. Dávila-Rosero, Jorge Vásconez-González, Ana M. Diaz, Carla E. Moyano, Vanessa Arcos-Valle, Ginés Viscor, and Joshua H. West. Reduced Violence-Related Burden and Mortality at Higher Altitudes: Examining the Association between High Altitude Living and Homicide Rates in Ecuador. High Alt Med Biol. 00:000-000, 0000. Background: Homicides are a major public health concern and a leading cause of preventable deaths worldwide. The relationship between altitude and homicides remains unclear, and evidence of the possible effects of living at high altitudes on homicide rates is limited. This research aimed to investigate the mortality rates resulting from various types of aggression that culminated in homicides in Ecuador and to explore potential differences associated with altitude. Methods: An ecological analysis of homicide rates in Ecuador was conducted from 2001 to 2022. Homicide cases and the population at risk were categorized based on their place of residence according to two altitude classifications: a binary classification of low (<2,500 m) and high altitude (>2,500 m), and a detailed classification according to criteria by the International Society for Mountain Medicine, which includes low (<1,500 m), moderate (1,500-2,500 m), high (2,500-3,500 m), and very high altitude (3,500-5,500 m) categories. Both crude and directly age-sex standardized mortality rates were calculated for each altitude category. Results: We analyzed a total of 40,708 deaths attributed to aggressions (ICD-10 codes X85-Y09). The total homicide rate for men was 21.29 per 100,000 (95% confidence interval [CI]: 9.55-32.37), whereas for women, it was 2.46 per 100,000 (95% CI: 1.44-3.27). Average rates across the 22 analyzed years were higher at low altitudes (men: 13.2/100,000 and women: 1.33/100,000) as compared with high altitudes (men: 5.79/100,000 and women: 1.05/100,000). Notably, the male-to-female rate difference was more pronounced at low altitudes (898%) than at high altitudes (451%). Conclusions: Our study revealed a higher prevalence of homicides in certain provinces and significant disparities in mortality rates between men and women. Although we cannot establish a direct relationship between altitude and homicide rates, further research is needed to explore potential confounding factors and a better understanding of the underlying causes for these variations.

Factors Affecting Sleep Quality among University Medical and Nursing Students: A Study in Two Countries in the Mediterranean Region.

Poor sleep quality, a global public health concern, poses a significant burden on individuals, particularly health care university students facing intense academic stress. A three-center cross-sectional study was conducted at the Higher Institute of Nursing and Health Sciences in Tetouan (Morocco), Faculty of Medicine in Tangier (Morocco) and Faculty of Nursing in Valencia (Spain). We collected various data using a sociodemographic questionnaire, the Pittsburgh sleep quality questionnaire, the international physical activity questionnaire (IPAQ) and the smartphone addiction questionnaire short-version (SAS-SV). A total of 1210 students were included in our study (mean age 20.4 years, 67.2% female, nursing students (66.2%) and medical students (33.8%), 76.1% students from Morocco and 33.9% from Spain). Analysis revealed a higher prevalence of poor sleep quality among Moroccans students compared to Spanish ones (p < 0.001), that nursing students showed less favorable sleep quality than medical students (p < 0.011) and that living with a chronic disease was linked to less favorable sleep quality (p < 0.001). Lastly, intense or weak physical activity and smartphone addiction were correlated with poor sleep quality (p < 0.001). In the multivariate analysis, an association persisted between poor sleep quality and factors such as the country of study (Odds ratio (OR): 6.25 [95% Confidence Interval (CI): 4.34-9.09]), involvement in nursing studies (OR: 3.50 [95% CI: 2.36-5.27]), and the presence of chronic diseases (OR: 2.70 [95% CI: 1.72-4.16]), (p < 0.01 each). Our findings highlight the multifaceted factors affecting sleep quality in young university students. The implications underscore the imperative of interventions tailored to this demographic group.

Nurse-Implemented Music Therapy to Reduce Anxiety in Community-Dwelling Individuals with Severe Mental Illness: A Pilot Study.

Anxiety is an important and recurrent problem in people with severe mental illness (SMI). The aim of this work is to measure the effectiveness of the Music Therapy nursing intervention in reducing anxiety in outpatients diagnosed with SMI (bipolar disorder and schizophrenia). The intervention was structured over five weeks (ten 1-h sessions, twice weekly). Objective measures (blood pressure, heart rate, and respiratory rate) and subjective measures (anxiety response and the subjective perception of relaxation) were taken before and after every session. Our results show that this nursing intervention entails an objective reduction of the respiratory rate ((-4.5, -0.5) breaths per minute), the heart rate ((-5.80, -2.13) bpm), and it evidences a reduction in the subjective perception of anxiety (16.08% mean reduction in state anxiety). Considering all the sessions, the subjective perception of relaxation increased 97.33% of the time. This study provides evidence that the Music Therapy intervention can effectively promote relaxation and reduce anxiety symptoms in people with SMI. This study was retrospectively registered at Clinical Trials with Protocol Identifier NCT06315049.

Salivary Brain-Derived Neurotrophic Factor and Cortisol Associated with Psychological Alterations in University Students.

INTRODUCTION: Recent evidence reported mental health issues in university students such as anxiety and depressive symptoms and poor sleep quality. Decreased plasma brain-derived neurotrophic factor (BDNF) levels have been proposed as a biomarker of depressive symptoms, whereas cortisol levels are an index of energy mobilization and stress and have been linked to sleep quality. Given that salivary biomarkers represent an interesting new field of research, the aim of this cross-sectional study was to evaluate salivary BDNF and cortisol levels in university students to assess whether they have associations with psychological disturbances such as anxiety and depressive symptoms, sleep quality, and stress level. METHODS: Salivary BDNF and cortisol levels were measured by specific immunoassays in 70 students whose mental health was also evaluated on the same day through the evaluation of anxiety and depression symptoms (Goldberg scale), sleep quality (Pittsburg Sleep Quality Index and Athens Insomnia Scale), and stress (self-perceived stress scale) and healthy lifestyle habits (alcohol consumption, smoking, regular exercise, and body mass index) were also measured. Multivariate regression analyses were performed in order to identify the strengths of associations between psychological alterations and the concentrations of BDNF, cortisol, and other variables. RESULTS: Salivary BDNF levels were significantly higher in students with more depressive symptoms, whereas no significant differences were found for cortisol levels. When performing the binary logistic regression model, BDNF levels are included as a predictor variable for a high-depressive-symptoms burden (p < 0.05). Students with worse sleep quality on the Pittsburg Scale had higher cortisol levels (p < 0.05). The subdomains of sleep latency and sleep medication were those significantly associated with salivary cortisol levels in logistic regression analyses (OR = 15.150, p = 0.028). Sleep medication only appeared to be related to cortisol levels (OR = 185.142, p = 0.019). Perceived stress levels and anxiety symptoms were not associated with BDNF or cortisol levels. CONCLUSIONS: BDNF could play a key role in the pathophysiology of mood-related disorders, and elevation of its peripheral levels could contribute to protecting neurons from the development of mental illness. Higher salivary cortisol levels measured in the morning are accompanied by poorer sleep quality. More research is needed, focusing on salivary biomarkers of disorders related to depressive symptoms and poor sleep quality as a potential tool for the diagnosis and prevention of mental illness.

Salivary Interleukin 1-Beta Concentration Associates With Sleep Quality in Older Individuals.

Background: Poor sleep quality is prevalent in older people and impairs their quality of life. Various studies show an association between sleep disorders and altered levels of inflammatory cytokines. The cytokine IL-1ß has been shown to display both somnogenic and insomnia-promoting effects in experimental animals. Objectives: to evaluate the relationship between insomnia and salivary IL-1ß concentration and the role of associated factors such as the symptoms of depression, use of hypnotics, intake of caffeinated beverages, smoking, and alcohol use in older individuals. An analytical, cross-sectional, observational research was carried out with a population of community-dwelling individuals over 60 years of age in Valencia (Spain). Sleep quality was measured with the Athens insomnia scale (AIS) and depressive symptoms with Geriatric Depression Scale (GDS). Results: 287 individuals participated in the study (mean age 74.08 years (76.7% women). 41.5% of the participants had insomnia, 36.9% took drugs for sleep problems, and 32.4% had relevant depressive symptoms. There was a significant inverse correlation between the IL-1ß and total AIS score (rho = -0.302, p < 0.001), the sleep difficulty subdomain (rho = -0.259, p < 0.001), and the daytime sleepiness subdomain (rho = -0.322, p < 0.001). No significant correlation was observed between GDS and salivary IL-1ß concentration. The IL-1ß concentration was significantly lower in individuals taking drugs for sleeping compared with those not taking those drugs (1.11 ± 0.09 and 1.48 ± 0.08, respectively; p = 0.001). Regarding the AIS score, there was no significant difference in marital status, smoking, or the number of cups of tea or cola drinks, but there was a significant association with alcohol intake (p = 0.019) and in the number of daily intakes of coffee (p = 0.030). The receiver operating characteristic (ROC) curve analysis of IL-1ß for diagnosis of moderate-severe insomnia showed an area under the curve (AUC) value of 0.78 (95% confidence interval 0.71-0.85). At the cut-off of 0.83 pg/µL of Il-1ß, it had a sensitivity of 70.3% and a specificity of 69.8%.

Increased Salivary IL-1 Beta Level Is Associated with Poor Sleep Quality in University Students.

Poor sleep quality is a major public health concern for all ages. In particular, university students often face stress levels and changes in social life habits that negatively influence their quality of sleep. This could be associated with psychological well-being in terms of anxiety and depressive symptoms, stress levels, and a poor self-perceived health status. The increases in the pro-inflammatory cytokine interleukin 6 (IL-6), IL-1 beta (IL-1ß), and tumor necrosis factor alpha (TNFα), in blood have been linked to poor sleep quality in many diseases, but data on salivary cytokine levels in students are missing or are seldom analyzed. In this study we determined the quality of sleep in a sample of university students and the role of psychological assessment and factors affecting sleep (alcohol intake, tobacco, consumption of stimulant drinks, exercise, and body mass index). We also aimed to shed new light on the associations between sleep quality and salivary inflammatory cytokines (IL-1ß, IL-6, and TNFα). Sleep quality was measured with the Athens Insomnia Scale (AIS) and Pittsburgh Sleep Quality Index (PSQI). Perceived stress was assessed using Cohen's Perceived Stress Scale (PSS), and the Goldberg Anxiety and Depression Scale (GADS) was used to assess the level of anxiety or depression. Perceived health status was measured with a visual analogue. Saliva samples was taken in the morning and the inflammatory cytokines was measured via enzyme-linked immunoassay. There was a direct and significant association between the salivary IL-1ß concentration and AIS score (r = 0.248; p = 0.038, Pearson correlation) and Pittsburgh scale score (r = 0.274; p = 0.022, Pearson correlation). The relationship between IL-1ß and AIS controlling for sex, age, and chronic disease, is still significant (r = 0.260; p = 0.033). The relationship between IL-1ß and PSQI controlling for the influence of these variables is also significant (r = 0.279; p = 0.022). Salivary IL-1ß concentrations were not significantly associated with any of the scores of the other psychological assessments (PSS, anxiety, depression symptoms, or self-perceived health). Salivary TNFα was significantly and inversely associated with self-perceived health (r = -0.259; p = 0.033, Pearson correlation), but the salivary IL-6 concentration was not associated with any of the sleep quality scale or psychological assessment scores. Our results provide a novel relationship between pro-inflammatory cytokine IL-1ß in saliva and poor sleep quality. However, the role of inflammation in poor sleep quality requires further study to identify strategies that could lower inflammation and thus, likely improve sleep quality.

Association between Depressive Symptoms and Adherence to the Mediterranean Diet in Nursing Students.

With university admission, there are major changes in students' daily habits that can lead to mental health problems. In this respect, adherence to a healthy diet, such as the Mediterranean diet (MD), can be very beneficial. The present study examines the associations between adherence to the MD and mental health among Spanish nursing students (n = 289). Sociodemographic data and life habits were collected electronically using a self-administered questionnaire. The participants also completed the Mediterranean Diet Adherence Screener (MEDAS-14) and the Goldberg Anxiety and Depression Scale (GADS). The percentage of anxiety and depression symptoms was high: 45.3% (n = 131) and 46.4% (n = 134), respectively. Only 35.6% reported good adherence to the MD (score ≥ 9). The statistical analysis showed poor adherence to the MD to be significantly and positively associated with depressive symptoms (p = 0.013) and the total score on the GADS (p = 0.039). A multivariable regression model analysis identified the depression subscale score as a predictor variable, with a mean risk of low adherence to the MD being 0.803 times (95%CI: 0.666-0.968, p = 0.021) among participants with greater depressive symptoms. These results support the implementation of prevention programs in universities focused on health and mental health issues.

Actigraphy Analysis of Sleep Associates with Salivary IL-6 Concentration in Institutionalized Older Individuals.

Sleep disorders are common in older individuals and are most prevalent in those who are institutionalized. Sleep complaints are often comorbid with medical and neuro-psychiatric illness and associated with polypharmacy. Various studies show an association between sleep disorders and altered levels of inflammatory cytokines, especially IL-6. In this study, an objective sleep analysis was performed using actigraphy, and IL-6 measurements in saliva in 61 older people residing in long-term nursing homes (72.1% women). Almost half (49.2%) of the people had no or mild cognitive impairment, and the rest suffered from moderate to severe dementia, mainly due to Alzheimer's disease (25 out of 31 individuals). A significant correlation was found between salivary IL6 and sleep parameters; e.g., less salivary IL-6 had significantly (p < 0.05) worse sleep efficiency and more night awakenings. In turn, actigraphy detected alterations in people with dementia in average sleep time, daily bedtime, and average daily time out of bed. There was no significant correlation between these sleep patterns and the total number of psychotropic drugs. No significant differences were found in salivary IL-6 between individuals with or without dementia. These results should be considered in future research with institutionalized people to detect sleep disturbances and to establish interventions aimed to improve sleep quality.

Social and Emotional Loneliness in Older Community Dwelling-Individuals: The Role of Socio-Demographics.

BACKGROUND: Social determinants have a major influence on individuals' health, and among them, loneliness has an important impact on the health of the elderly. OBJECTIVES: The aims were to determine loneliness and its social and emotional components in a sample of elderly people and to assess its prevalence and associations with sociodemographic variables. METHODS: Analytical, cross-sectional, observational research was carried out based on a population over 60 years of age in Valencia (Spain). Loneliness was assessed with the De Jong-Gierveld Loneliness Scale. RESULTS: Five-hundred and thirty community-dwelling individuals participated. The mean age of the sample was 72.7 years (84.2% women); 36.2% suffered from moderate loneliness and 6.6% suffered from extreme loneliness. The sociodemographic variables most significantly related to loneliness were being single, separated, or divorced (p < 0.01). Among widowers, loneliness was inversely associated with years of widowhood (p < 0.01). Having sons/daughters was a significant protective factor (p < 0.05), while having grandchildren or siblings did not have a significant influence. The ability to walk and smartphone and video call use were not associated with loneliness. CONCLUSIONS: There is a high prevalence of unwanted loneliness in community-dwelling individuals, and some social factors play an important role. Interventions against loneliness among older people are a priority for welfare and public health.

Salivary Biomarkers Associated with Psychological Alterations in Patients with Diabetes: A Systematic Review.

The care of individuals with diabetes needs a holistic perspective, taking into account both the physical disease and the mental health problems that may be associated. Different studies show a higher prevalence of depression or anxiety issues in diabetes patients than in the general population, which is why diabetes can be considered one of the chronic diseases in which psychological care is crucial to maintain quality of life. The objective of this review is to examine the published articles that relate the bidirectional associations between objective and subjective measures of anxiety, depressive symptomatology, stress, sleep quality, and salivary biomarkers in patients with diabetes. For this, a search was carried out in the electronic databases PubMed, Cochrane, and SCOPUS using the keywords "diabetes", "saliva", "sleep", "anxiety", "depression", and "stress" for works published up until May 2022 and limited to the English and Spanish languages. The sample comprised 14 articles, 5 of which analysed the associations between depressive symptomatology and salivary biomarkers in people with diabetes. Among the salivary biomarkers most frequently used to evaluate psychological alterations in persons with diabetes are cortisol and melatonin. Thus, significant changes in the levels of these biomarkers were observed in most studies. Four out of five studies reported a statistically significant relationship between increased salivary cortisol in the evening/midnight or the cortisol awakening response and depressive symptoms. In contrast, lower cortisol levels upon waking in the morning were observed when there was no depression or anxiety. Regarding the association between salivary cortisol values and sleep quality in patients with diabetes, lower morning cortisol values related to prolonged nighttime sleep were common in the analysed studies. Low melatonin concentrations showed a negative correlation with sleep quality. As it is an easy-to-apply and non-invasive method, the measurement of salivary biomarkers can be very useful for predicting psychological alterations in patients with diabetes. Further scientific studies are required to determine the sensitivity of these biological substances acting as biomarkers for detecting sleep disorders and psychological alterations.

Female homicides and femicides in Ecuador: a nationwide ecological analysis from 2001 to 2017.

BACKGROUND: Gender-based violence is a major public health concern arising from the structural discrimination of women and girls. In 2014, Ecuador criminalized acts of femicide in response to a growing crisis across the region. As no epidemiological studies on the state of female homicides and femicides have been published, we estimated patterns of female homicides and femicides nationally and the burden through economic cost per years of life lost, between 2001 and 2017. METHODS: Using aggregated data from the National Institute of Census and Statistics and police records we estimated the annual mortality rates, cumulative incidence and prevalence odds ratios for female homicides and femicides, from 2001 to 2017. The impact of aggressions, assaults and violence on years of life lost due to premature mortality was estimated using the Human Capital method. RESULTS: Over the period, at least 3236 cases of female homicides and femicides were reported. The highest murder rate occurred in the province of Sucumbíos (6.5 per 100,000) and in the Putumayo canton (12.5 per 100,000). The most common way to murder their victims was using firearms (38%). The highest odds ratio was estimated for women aged between 25 and 29, at 4.5 (3.9-5.1), of primary school attainment at 17.2 (14.6-20.3) and of Afro-Ecuadoran descent 18.1 (10.5-30.9). Female homicide-related costs reached, on average, $35 million per year and more than $500 million lost from 2001 to 2017. CONCLUSIONS: The high rates, distribution and cost indicate that investments are urgently needed to address the structural causes and reduce the impact of female homicides and femicides in Ecuador; thereby protecting the livelihood and well-being of their women and girls.

Clinical Outcomes and Qualitative Perceptions of In-person, Hybrid, and Virtual Cardiac Rehabilitation.

PURPOSE: Cardiac rehabilitation (CR) is evolving to include both in-person and virtual delivery. Our objective was to compare, in CR patients, the association of in-person, hybrid, and virtual CR with change in performance on the 6-min walk test (6MWT) between enrollment and completion. METHODS: Patients enrolled in CR between October 22, 2019, and May 10, 2021, were categorized into in-person, hybrid, or virtual groups by number of in-person and virtual visits. All patients received individualized exercise training and health behavior counseling. Cardiac rehabilitation was delivered to patients in the hybrid and virtual cohorts using synchronous video exercise and/or asynchronous telephone visits. Measurements at CR enrollment and completion included the 6MWT, blood pressure (BP), depression, anxiety, waist-to-hip ratio, and cardiac self-efficacy. RESULTS: Of 187 CR patients, 37/97 (38.1%) were in-person patients and 58/90 (64.4%) were hybrid/virtual patients ( P = .001). Compared to in-person (51.5 ± 59.4 m) improvement in the 6MWT was similar in hybrid (63.4 ± 55.6; P = .46) and virtual (63.2 ± 59.6; P = .55) compared with in-person (51.5 ± 59.4). Hybrid and virtual patients experienced similar improvements in BP control and anxiety. Virtual patients experienced less improvement in depression symptoms. There were no statistically significant changes in waist-to-hip ratio or cardiac self-efficacy. Qualitative themes included the adaptability of virtual CR, importance of relationships between patients and CR staff, and need for training and organizational adjustments to adopt virtual CR. CONCLUSIONS: Hybrid and virtual CR were associated with similar improvements in functional capacity to in-person. Virtual and hybrid CR have the potential to expand availability without compromising outcomes.

Personal and Social Consequences of Psychotropic Substance Use: A Population-Based Internet Survey.

Background and objectives: Drug abuse has become a major worldwide health concern among all age groups. The present study analyses substance misuse and its social and personal consequences using a population-based internet survey in Spain. Materials and Methods: Screening for drug abuse (of alcohol, marijuana/hashish and psychostimulants) and its related risks and problems was performed using the Car, Relax, Alone, Forget, Friends, Trouble (CRAFFT) score. Socio-demographic factors, depressive, anxiety and stress symptoms as well as health habits were also evaluated. We used Linear regression methods to compare each variable's individual contribution so as to determine which one best explains the results. Results: In this population-based study, 1224 people completed and returned the online survey. Of all participants, 57% reported consuming at least one substance based on the CRAFFT scale. While increasing age reduces the probability of personal and social consequences of consumption, people who smoke receive up to three times more (OR = 3.370) recommendations from family and friends to reduce their consumption. As for the type of substance, the consumption of marijuana increases the risk of forgetting (OR = 2.33) and the consumption of other psychostimulant substances almost triples the risk of consuming alone (OR = 2.965). Combining substances can increase the rate of driving a vehicle after consumption by 3.4 times. Conclusions: Although age, smoking and the type of substances used increase the risk of suffering from social and personal consequences of the use or abuse of substances, future studies are needed to determine the influence of new variables as a potential tool for treating and minimizing the adverse consequences of drug abuse.

Using the Reflective Journal to Improve Practical Skills Integrating Affective and Self-Critical Aspects in Impoverished International Environments. A Pilot Test.

The reflective practice journal is a teaching methodology that facilitates the acquisition of professional, attitudinal values and skills, affording comprehensive training by reflecting on experiences that have been lived and showing feelings that, a priori, would be hidden. Our aim was to implement it in the international practicum in impoverished environments as a facilitating instrument of meaningful learning and the acquisition of professional skills, integrating affective and self-critical aspects. The project was developed with Nursing students at Catholic University of Valencia, in an impoverished environment. Qualitative reflections increased, highlighting humanity, closeness and attention focused on health promotion. The quality of the experience was 9.46/10. The mean score in self-criticism and expression was 4.57/5, and the self-evaluation of the acquisition of skills was 9.55/10. The double-blind peer evaluation of the performance of their practices in the international context was 9.68/10. The trust of the students with the teachers was evaluated as 10/10. The reflective practice journal facilitated the progression of learning, self-criticism, and the acquisition of values such as hospitality, the quality of care offered, and respect for customs and beliefs, as well as responsibility in the distribution of available resources and interventions.

Salivary Inflammatory Molecules as Biomarkers of Sleep Alterations: A Scoping Review.

Poor sleep quality and sleep disorders are the most common problems in people, affecting health-related quality of life. Various studies show an association between sleep disorders and altered levels of stress hormones and inflammatory cytokines measured in saliva. The main objective of this article is to provide an analysis of the current evidence related to changes in inflammatory markers in the saliva and their associations with sleep quality measurement (both objective and subjective methods) in healthy subjects and in sleep-related disorders. To that end, a scoping review was carried out, following the PRISMA criteria in the bibliographic search in several databases: PubMed, EBSCO, and SCOPUS. Eleven of the articles are from the adult population and two from the child-youth population. They mainly measure the relationship between sleep and interleukin-1ß (IL-1ß), interleukin-6 (IL-6), and tumor necrosis factor alpha (TNFα) alpha, as well as other inflammatory markers such as myeloperoxidase (MPO) and prostaglandin-endoperoxide synthase 2. An analysis shows the relationship between these salivary biomarkers and sleep quality, especially in the case of IL-6 in both healthy subjects and several pathologies associated with sleep-disorders. The results for TNFα and IL-1ß measurements are still inconclusive and the difference with IL-6 was assessed. Two studies reported interventions that result in sleep improvement and are accompanied by the normalization of inflammatory changes detected in the saliva. As it is an easy-to-apply and non-invasive method, the measurement of salivary cytokines can be very useful in chronobiology studies. Further studies are required to determine the sensitivity of salivary inflammatory markers in monitoring biological rhythms and acting as biomarkers in the detection of sleep disorders and sleep interventions.

Subjective and objective sleep quality in elderly individuals: The role of psychogeriatric evaluation.

Aging affects sleep and sleep problems are common in older individuals. However, the relationship between objective and subjective tools for analysing sleep and psycho-geriatric variables have not been tested in institutionalised older individuals. This work analyses sleep quality by using actigraphy as an objective tool and validates the Athens and Oviedo sleep questionnaires in octogenarian elderly individuals as subjective scales of sleep perception. All patients wore an actigraph device for one week and then completed the Athens and Oviedo clinical sleep-evaluation questionnaires. Morning cortisol levels in blood plasma and saliva samples were also measured to assess the association between objective and reported sleep patterns. Age, gender, and psycho-geriatric evaluations, including Barthel, Tinetti, and Mini-Mental scale measurements were analysed as variables with the potential to confound the strength of any such associations. There was a significant inverse correlation between the number of awakenings and the time spent awake during night assessed by actigraphy and the total Oviedo questionnaire score, but no significant associations for the other parameters. The blood cortisol concentration appears to be a marker of insomnia related to sleep times of less than four hours and diagnosis of insomnia based on Athens scale and thus, represents a potential marker for sleep interventions.

Sleep Alterations in Non-demented Older Individuals: The Role of Cortisol.

BACKGROUND: Sleep alterations can impair quality of life and contribute to disease progression but they, and their features and contributing factors, are rarely analysed in institutionalised older individuals. In this study, we investigated sleep alterations, the factors involved, and the role of cortisol in sleep-related problems in institutionalised individuals. METHODS: We conducted a descriptive cross-sectional study in participants living in nursing homes in Valencia (Spain); sleep alterations were determined based on two validated tools: the Athens insomnia scale and Oviedo sleep questionnaire. Plasma cortisol was measured in the morning and determined by high performance liquid chromatography-mass spectroscopy, along with other blood analytical parameters. We also analysed any confounding factors (sleep duration, morning awakening time, intake of hypnotic and psychotropic medication, and cognitive function). RESULTS: The mean age was 82.5 years (range: 65-99); approximately 80% were women and sleep alterations were present in 25-60% of the population, depending on the scale used or type of sleep disorder considered. There was no significant correlation between morning cortisol concentrations and sleep disorders, sex, age, or psychotropic drug ingestion (including hypnotic drugs). However, there was a significant correlation between cortisol and an Oviedo questionnaire subscale for evaluating insomniarelated adverse events, which remained significant after adjusting for multiple potentially confounding factors. CONCLUSION: Sleep disorders are common in institutionalised older individuals and are not related to sleep duration or decreased by ingestion of hypnotic medications. There is a significant relationship between morning cortisol levels in blood and insomnia-related sleep disorders (e.g. snoring with awakenings, nightmares, restless legs syndrome, etc.) but not directly with insomnia or hypersomnia.

[Current diagnosis and treatment of acromegaly]. / Diagnóstico y tratamiento actual de la acromegalia.

Acromegaly is a rare condition characterized by the excessive secretion of growth hormone (GH), usually by a pituitary adenoma. The clinical manifestations of acromegaly include enlarged hands, feet and face, headaches, arthralgias, fatigue and hyperhydrosis. This condition is also associated with comorbidities such as hypertension and diabetes in a significant proportion of patients and frequently compromises life quality and life expectancy. The biochemical diagnosis of acromegaly rests on the demonstration of an autonomous secretion of GH by means of the measurement of glucose-suppressed GH levels and the serum concentration of insulin like growth factor type 1 (IGF-1). The localizing method of choice is magnetic resonance image of the selar area, which in 70 % of the cases reveals the presence of a macroadenoma. Even though the primary treatment is usually the transsphenoidal resection of the adenoma, the majority of patients require a multimodal intervention that includes radiotherapy, as well as pharmacological therapy with somatostatin analogs and dopamine agonists. The latter approach has resulted in a significant reduction in mortality and in an improvement in the quality of life.

La acromegalia es una entidad rara que se caracteriza por un incremento en la secreción de hormona de crecimiento (GH), generalmente resultado de un adenoma hipofisiario. Las manifestaciones clínicas incluyen acrocrecimiento de manos, pies y cara, cefalea, artralgias, fatiga e hiperhidrosis. Esta condición se asocia a comorbilidades como la hipertensión y la diabetes en una proporción importante de pacientes y resulta en una disminución en la esperanza y la calidad de vida. El diagnóstico bioquímico se basa en la demostración de una hipersecreción autónoma de GH mediante la prueba de supresión con glucosa y en la presencia de niveles elevados de factor de crecimiento insulinoide tipo 1 (IGF-1). El método de imagen de elección es la resonancia magnética nuclear (RMN) de silla turca, la cual muestra un macroadenoma en el 7 % de los casos. Si bien el tratamiento de elección es la cirugía transefenoidal, la mayoría de los pacientes requiere de un abordaje multimodal, que incluye radioterapia y manejo farmacológico con agonistas dopaminérgicos y análogos de la somatostatina. Este abordaje multimodal, aunado al tratamiento específico de las distintas comorbilidades ha resultado en una disminución significativa en la mortalidad y en una importante mejoría en la calidad de vida de estos pacientes.

Manifestación del liderazgo transformacional en un grupo de supervisores de Puerto Rico / Transformational leadership manifestation in a group of puertorrican supervisors

Esta investigación se realizó con el propósito de identificar el estilo de liderazgo que mayormente se atribuye utilizar un grupo de supervisores puertorriqueños. De igual forma, deseamos comparar si estas atribuciones presentaban diferencias significativas entre mujeres y hombres. Un total de 200 supervisores/ as participaron en este estudio, 112 mujeres y 88 hombres. Los resultados apoyan la aplicabilidad de la teoría de rango completo de liderazgo en los líderes puertorriqueños. Se identificaron diferencias significativas al comparar las atribuciones de los supervisores/as, presentando las mujeres niveles de liderazgo transformacional y transaccional superiores al compararlas con los hombres. No se encontraron diferencias significativas al considerar otras variables demográficas relevantes, como tampoco una interacción de éstas con el género del supervisor. Estos resultados se discuten de acuerdo a los hallazgos en otros estudios fuera de Puerto Rico y sus implicaciones para el manejo de este tema en nuestro país(AU)

This research was carried out to identify the leadership style which is largely self-attributed by a group of Puertorrican supervisors. Similarly, we would compare if these self- attributions were significantly different between women and men. A total of 200 supervisors participated in this study, 112 women and 88 men. The results support the applicability of the full-range theory of leadership in the Puertorrican leaders. We identified significant differences when comparing the self-attributions of supervisors, showing women higher levels of transformational and transactional leadership when compared with men. No significant differences were found when considering other relevant demographic variables, nor an interaction of these with the gender of the supervisor. These results are discussed according to findings in other studies outside of Puerto Rico and its implications in our country(AU)

El cine como herramienta didáctica para familiares de pacientes con trastorno bipolar / Informative movies as an educational for the relatives of patients with bipolar disorder

Los estudios realizados con familias de pacientes con trastornobipolar sugieren que la intervención familiar acompañadade tratamiento farmacológico permite la reduccióndel número de recaídas y hospitalizaciones. De este modo,se consigue una mejora del clima familiar y del funcionamientoocupacional y social del paciente. En este sentido,el papel de la enfermera especialista en salud mental resultaclave para actuar como “cuidador de cuidadores”.En este artículo se propone la utilización del cine como herramientacomunicativa y formativa dentro de un programade atención de Enfermería dirigido a las familias de pacientescon trastorno bipolar. Con ello se pretende mejorarel clima familiar y optimizar el proceso enfermero para laadquisición de conocimientos por parte del familiar acercade la enfermedad; además, se espera un aumento del gradode satisfacción del usuario con la intervención enfermera

Studies carried out on the families of patients with bipolardisorder suggest that family intervention, accompanied bydrug therapy, reduces the number of relapses and hospitalisations.In this manner, the family environment is improvedand the social and occupational functioning of thepatient is enhanced. In this regard, the role of mental healthnurse specialist is vital to act as the “Carer of Carers”.This paper proposes the use of informative movies as a communicationand information tool within the programme ofnursing aimed at the relatives of patients suffering frombipolar disorder The aim of this initiative is to improve thehome environment and to optimise the nursing process toteach the relative about the disease; furthermore, an increasein the level of satisfaction on the part of the user isexpected as a result of the nursing intervention (AU)