Comparación de los libros de historia de vida digitales y convencionales sobre el estado de ánimo, la comunicación, la cognición y la calidad de vida en personas con demencia en residencias: un estudio piloto / Comparison of digital and conventional life story books on mood, communication, cognition and quality of life in people with dementia in nursing homes: A pilot study

Introducción: La atención centrada en la persona (ACP) incluye la historia de vida, una forma de terapia de reminiscencia que puede ser útil en el tratamiento de la demencia. Comparamos la eficacia de usar un libro de historia de vida (LHV) digital o convencional sobre los síntomas depresivos, la comunicación, la cognición y la calidad de vida. Material y métodos: Treinta y una personas con demencia que viven en 2 centros residenciales que siguen un modelo ACP fueron aleatorizadas para recibir terapia de reminiscencia basada en el LHV digital NeuralActions (n=16) o un LHV convencional (n=15). Ambos grupos realizaron 2 sesiones semanales de 45 minutos durante 5 semanas y fueron evaluadas inmediatamente antes y después de la intervención. Los síntomas depresivos se evaluaron con la escala de Cornell (CSDD); la comunicación con la escala de Holden (HCS), la cognición con el Mini Mental State Examination (MMSE) y la calidad de vida con la escala de calidad de vida para el Alzheimer (QoL-AD). Los resultados se analizaron mediante ANOVA de medidas repetidas con el programa jamovi 2.3. Resultados: Ambos LHV mejoraron las capacidades de comunicación (η2=0,115; p <0,001), sin diferencias entre grupos. No se encontraron efectos sobre la calidad de vida, la cognición, o el estado de ánimo. Conclusiones: En centros que siguen un modelo ACP, los LVH digitales o convencionales pueden ser útiles en el tratamiento de personas con demencia facilitando la comunicación. Su papel sobre la calidad de vida, cognición o estado de ánimo es incierto. (AU)

Introduction: Person-centered care (PCC) includes life story, a form of reminiscence therapy that can be useful in the treatment of dementia. We compared the efficacy of using a digital or conventional life story book (LSB) on depressive symptoms, communication, cognition, and quality of life. Material and methods: Thirty one persons with dementia living in 2 PCC nursing homes were randomly assigned to receive reminiscence therapy based on the Neural Actions digital LSB (n=16) or a conventional LSB (n=15). Both groups performed 2 weekly sessions of 45min for 5 weeks. Depressive symptoms were evaluated with the Cornell scale (CSDD); communication with the Holden scale (HCS), cognition with the Mini Mental State Examination (MMSE) and quality of life with the quality of life scale for Alzheimer's (QoL-AD). The results were analyzed using ANOVA of repeated measures with the jamovi 2.3 program. Results: Both LSB improved communication skills (η2=0.115; p<0.001), with no differences between groups. No effects on quality of life, cognition, or mood were found. Conclusions: In PCC centres digital or conventional LSB can be useful in the treatment of people with dementia by facilitating communication. Its role on quality of life, cognition or mood is uncertain. (AU)

[Comparison of digital and conventional life story books on mood, communication, cognition and quality of life in people with dementia in nursing homes: A pilot study]. / Comparación de los libros de historia de vida digitales y convencionales sobre el estado de ánimo, la comunicación, la cognición y la calidad de vida en personas con demencia en residencias: un estudio piloto.

INTRODUCTION: Person-centered care (PCC) includes life story, a form of reminiscence therapy that can be useful in the treatment of dementia. We compared the efficacy of using a digital or conventional life story book (LSB) on depressive symptoms, communication, cognition, and quality of life. MATERIAL AND METHODS: Thirty one persons with dementia living in 2 PCC nursing homes were randomly assigned to receive reminiscence therapy based on the Neural Actions digital LSB (n=16) or a conventional LSB (n=15). Both groups performed 2 weekly sessions of 45min for 5 weeks. Depressive symptoms were evaluated with the Cornell scale (CSDD); communication with the Holden scale (HCS), cognition with the Mini Mental State Examination (MMSE) and quality of life with the quality of life scale for Alzheimer's (QoL-AD). The results were analyzed using ANOVA of repeated measures with the jamovi 2.3 program. RESULTS: Both LSB improved communication skills (η2=0.115; p<0.001), with no differences between groups. No effects on quality of life, cognition, or mood were found. CONCLUSIONS: In PCC centres digital or conventional LSB can be useful in the treatment of people with dementia by facilitating communication. Its role on quality of life, cognition or mood is uncertain.

The BAT: A videotaped battery to assess theory of mind in schizophrenia.

The ability of attributing mental states to oneself and to the others (theory of mind, ToM) is impaired in schizophrenia. ToM is not a monolithic function, it includes different capacities: some implies the decoding of affective states, others the reasoning about mental states. We have developed the BAT, a Battery to Assess Theory of mind abilities in adult psychotic subjects in an ecological audiovisual format. The performance on the BAT and three other test of social cognition was compared in a sample of schizophrenic patients with a control group. The samples were matched in terms of age and premorbid IQ. The BAT was sensitive to detect the ToM impairments in schizophrenia, showed good internal consistency and concurrent validity. The area under the ROC curves established a cutoff point that would correctly classify controls and patients in a 96.6% of cases. The factorial analysis isolated two factors: empathy and reasoning, with a good adjustment. Our results showed that the BAT could be a valid, ecological and usable tool to assess ToM in psychotic patients, with good psychometric properties, that would allow obtaining a more complete profile of their impairment.

[Local and citizen participation and representation strategies in Healthcare Administration]. / Las estrategias de participación y representatividad local y ciudadana en la Administración Sanitaria.

The public as a whole are the rightful owners and beneficiaries of the public healthcare system in our country. As such, they collaborate in its maintenance and upkeep through payment of taxes. The government is accountable to the public as to how the ever-scarce resources are allocated. When it comes to the area of healthcare, this represents an added factor of complexity and specificity which makes the issue a particularly sensitive one. In the field of healthcare, both the General Health Law and the Law of Catalan Healthcare Code define the actors responsible for the public representation of its citizens. Nevertheless, their inclusion does not necessarily guarantee the perception of participation by its citizens or that of a greater democratic quality. The model must be understood as the intermediary link between a legally regulated framework and the actual debate, which in a globalized world with such an immense volume of information available to citizens and with the current online social networking sites, occurs at the heart of society in general, even though government has no such incorporation channel. The system will need to be developed as new technologies enable this, towards a more direct and more global models for participation. Participation is a flexible concept which, as far as possible, needs to adapt to the different problems as well as the different regions. Legislative regulation must therefore provide the mechanisms and stable frameworks for participation. In turn however, it must also establish dynamic systems capable of adapting to and incorporating the varying demands and methods of participation coming from the public in response to disparate processes.

Las estrategias de participación y representatividad local y ciudadana en la Administración Sanitaria / Local and citizen participation and representation strategies in Healthcare Administration

Los ciudadanos son los propietarios y beneficiarios del sistema sanitario público de nuestro país. Como tales colaboran en su mantenimiento a través de los impuestos. Los gobernantes tienen la obligación de rendir cuentas a la ciudadanía de cómo se utilizan los recursos, siempre escasos y que, en materia de sanidad, tienen un suplemento de complejidad y especificidad que los hacen especialmente sensibles. En el ámbito de la salud, tanto la Ley General de Sanidad como la Ley de Ordenación Sanitaria de Cataluña determinan los actores en los que recae la representación de los ciudadanos. Sin embargo, su incorporación no necesariamente garantiza la percepción de participación por parte de la ciudadanía ni una mayor calidad democrática. El modelo debe entenderse como el eslabón intermedio entre un marco regulado legalmente y el debate real que, en un mundo globalizado con gran volumen de información a disposición del ciudadano y con las actuales redes sociales electrónicas, se produce en el seno de la población, aunque no exista un cauce de incorporación por parte de la administración. Será necesario evolucionar el sistema, a medida que las nuevas tecnologías lo permitan, hacia formas de participación más directas y más globales. La participación es un concepto líquido que, en la medida de lo posible, es necesario adaptar, tanto a las diferentes problemáticas como a los distintos ámbitos territoriales. La regulación legislativa debe proveer de mecanismos y marcos estables de participación; pero, a su vez, ha de prever mecanismos ágiles que permitan adaptarse e incorporar las distintas demandas y formas de participación emanadas de la ciudadanía ante procesos dispares (AU)

The public as a whole are the rightful owners and beneficiaries of the public healthcare system in our country. As such, they collaborate in its maintenance and upkeep through payment of taxes. The government is accountable to the public as to how the ever-scarce resources are allocated. When it comes to the area of healthcare, this represents an added factor of complexity and specificity which makes the issue a particularly sensitive one. In the field of healthcare, both the General Health Law and the Law of Catalan Healthcare Code define the actors responsible for the public representation of its citizens. Nevertheless, their inclusion does not necessarily guarantee the perception of participation by its citizens or that of a greater democratic quality. The model must be understood as the intermediary link between a legally regulated framework and the actual debate, which in a globalized world with such an immense volume of information available to citizens and with the current online social networking sites, occurs at the heart of society in general, even though government has no such incorporation channel. The system will need to be developed as new technologies enable this, towards a more direct and more global models for participation. Participation is a flexible concept which, as far as possible, needs to adapt to the different problems as well as the different regions. Legislative regulation must therefore provide the mechanisms and stable frameworks for participation. In turn however, it must also establish dynamic systems capable of adapting to and incorporating the varying demands and methods of participation coming from the public in response to disparate processes (AU)

Intestinal intraepithelial lymphocyte cytometric pattern is more accurate than subepithelial deposits of anti-tissue transglutaminase IgA for the diagnosis of celiac disease in lymphocytic enteritis.

BACKGROUND & AIMS: An increase in CD3+TCRγδ+ and a decrease in CD3- intraepithelial lymphocytes (IEL) is a characteristic flow cytometric pattern of celiac disease (CD) with atrophy. The aim was to evaluate the usefulness of both CD IEL cytometric pattern and anti-TG2 IgA subepithelial deposit analysis (CD IF pattern) for diagnosing lymphocytic enteritis due to CD. METHODS: Two-hundred and five patients (144 females) who underwent duodenal biopsy for clinical suspicion of CD and positive celiac genetics were prospectively included. Fifty had villous atrophy, 70 lymphocytic enteritis, and 85 normal histology. Eight patients with non-celiac atrophy and 15 with lymphocytic enteritis secondary to Helicobacter pylori acted as control group. Duodenal biopsies were obtained to assess both CD IEL flow cytometric (complete or incomplete) and IF patterns. RESULTS: Sensitivity of IF, and complete and incomplete cytometric patterns for CD diagnosis in patients with positive serology (Marsh 1+3) was 92%, 85 and 97% respectively, but only the complete cytometric pattern had 100% specificity. Twelve seropositive and 8 seronegative Marsh 1 patients had a CD diagnosis at inclusion or after gluten free-diet, respectively. CD cytometric pattern showed a better diagnostic performance than both IF pattern and serology for CD diagnosis in lymphocytic enteritis at baseline (95% vs 60% vs 60%, p = 0.039). CONCLUSIONS: Analysis of the IEL flow cytometric pattern is a fast, accurate method for identifying CD in the initial diagnostic biopsy of patients presenting with lymphocytic enteritis, even in seronegative patients, and seems to be better than anti-TG2 intestinal deposits.

Proximal disinsertion of the common extensor tendon for lateral elbow tendinopathy.

PURPOSE: To evaluate surgical outcomes of disinsertion of the common extensor tendon for lateral elbow tendinopathy. METHODS: Records of 277 men and 128 women who underwent surgery for lateral elbow tendinopathy were reviewed. The indication for surgery was insufficient improvement of pain and inability to return to work after 3 weeks of physiotherapy (stretching, ultrasound) and local corticosteroid injections. According to the Tavernier technique, the origin of the tendons of the extensor carpi radialis brevis and extensor digitorum communis was located, and proximal disinsertion of the common extensor tendon was performed. RESULTS: Outcome was excellent in 344 (85%) of the patients, good in 46 (11.5%), regular in 9 (2%), and poor in 2 (0.5%). The mean time to return to work was 29 (range, 5-93) days. Immediate complications included infection (n=1), seroma (n=1), cicatricial fibrosis (n=10), radial neuritis (sensory) [n=4], and reactive dermatitis (n=2). Late complications included Frohse's arcade syndrome (n=1) and carpal tunnel syndrome (n=2). CONCLUSION: Disinsertion of the proximal common tendon is a good option for treating lateral elbow tendinopathy.

Prevalence and clinical relevance of enteropathy associated with systemic autoimmune diseases.

OBJECTIVE: To assess whether systemic autoimmune diseases are a risk group for coeliac disease and if there is a systemic autoimmune diseases-associated enteropathy. METHODS: 183 patients with systemic autoimmune diseases were included. Duodenal biopsy was carried out on patients with positive coeliac genetics (HLA-DQ2-DQ8) and/or serology and/or symptoms of the coeliac disease spectrum. When enteropathy was found, causes, including gluten sensitivity, were investigated and categorized according to a sequentially applied treatment. Results were analysed with Chi-square or Fisher exact tests. RESULTS: The prevalence of coeliac disease with atrophy was 0.55% (1 of 183 patients). Thirty-eight of the 109 patients (34.8%) who underwent duodenal biopsy had lymphocytic enteropathy (8 infectious, 5 due to gluten sensitive enteropathy, 5 HLA-DQ2/DQ8 who did not accept gluten-free diet and 20 of unknown aetiology). Lymphocytic enteropathy was unrelated to disease activity or immunosuppressants. HLA-DQ2 was more frequent in connective tissue disease (41.5%) compared with systemic vasculitis and autoinflammatory diseases (17.9%) (p=0.02), whereas a lower percentage of lymphocytic enteropathy was observed in the former (20.2% vs. 41.6%). Lymphocytic enteropathy was clinically irrelevant in cases with no definite aetiology. DISCUSSION: One third of systemic autoimmune diseases patients had enteropathy of uncertain clinical meaning in the majority of cases, which was rarely due to gluten sensitive enteropathy.

Are positive serum-IgA-tissue-transglutaminase antibodies enough to diagnose coeliac disease without a small bowel biopsy? Post-test probability of coeliac disease.

BACKGROUND: It has been suggested that high titres of tTG are associated with elevated positive predictive values (PPV) for celiac disease. However, the PPV of a strongly positive tTG will depend on the celiac disease prevalence in the different risk groups of the disease AIMS: To assess the PPV of a strongly positive tTG for celiac disease. In addition, to calculate the post-test probability for celiac disease of a strongly positive tTG in a setting of routine clinical practice. METHODS: 145 consecutive celiac disease patients with positive tTG, and with a small bowel biopsy were included. The PPV for different cut-off points of tTG levels for the diagnosis of celiac disease was assessed. In addition, the cut-offs associated with higher PPV were used to calculate the positive likelihood ratio. A simulation in a setting of routine clinical practice was performed to calculate the post-test probability of celiac disease. RESULTS: No cut-off level was associated with a PPV of 100%. A cut-off of 80 U/mL (11.4×upper normal limit) was associated with the higher PPV value of 98.6%. In the most frequent clinical situations, which in general have a pre-test probability <10%, the post-test probability after having a strongly positive tTG was 90% or less. CONCLUSIONS: A strongly positive tTG should not be enough to diagnose celiac disease in the most frequent clinical situations, small bowel biopsy remaining as the gold standard in these cases.

Large Evaluation of Anti-Cardiolipin and anti-Beta2Glycoprotein I Assays: Results from the AutoimmunityWorkshop of the Spanish Society of Immunology

Despite their clinical utility and the importance that laboratory testshave in APS diagnosis, probably the most important drawback of suchtests is the elevated intra- and inter-laboratory variation. The aim of thepresent work was to assess the multilaboratory performance of aCL (..) (AU)

A pesar de la indudable utilidad clínica y de la importancia de laspruebas de laboratorio en el diagnóstico del síndrome antifosfolípido(APS), probablemente el mayor defecto de dichas pruebas es su elevadavariabilidad intra- e inter-laboratorio. El objetivo del presente trabajo fueevaluar el comportamiento de los ensayos (..) (AU)

Impact of mass screening for gluten-sensitive enteropathy in working population.

AIM: To assess: (1) frequency and clinical relevance of gluten sensitive enteropathy (GSE) detected by serology in a mass screening program; (2) sensitivity of antitransglutaminase (tTGA) and antiendomysium antibodies (EmA); and (3) adherence to gluten-free diet (GFD) and follow-up. METHODS: One thousand, eight hundred and sixty-eight subjects recruited from an occupational health department underwent analysis for tTGA and EmA and, if positive, duodenal biopsy, DQ2/DQ8 genotyping, clinical feature recording, blood tests, and densitometry were performed. Since > 98% of individuals had tTGA < 2 U/mL, this value was established as the cut-off limit of normality and was considered positive when confirmed twice in the same sample. Adherence to a GFD and follow up were registered. RESULTS: Twenty-six (1.39%) subjects had positive tTGA and/or EmA, and 21 underwent biopsy: six Marsh III (one IIIa, four IIIb, one IIIc), nine Marsh I and six Marsh 0 (frequency of GSE 1:125). The sensitivity of EmA for GSE was 46.6% (11.1% for Marsh I, 100% for Marsh III), while for tTGA, it was 93.3% (88.8% for Marsh I, 100% for Marsh III). All 15 patients with abnormal histology had clinical features related to GSE. Marsh I and III subjects had more abdominal pain than Marsh 0 (P = 0.029), and a similar trend was observed for distension and diarrhea. No differences in the percentage of osteopenia were found between Marsh I and III (P = 0.608). Adherence to follow-up was 69.2%. Of 15 GSE patients, 66.7% followed a GFD with 80% responding to it. CONCLUSION: GSE in the general population is frequent and clinically relevant, irrespective of histological severity. tTGA is the marker of choice. Mass screening programs are useful in identifying patients who can benefit from GFD and follow-up.

Systemic expression of cytokine production in patients with severe pneumococcal pneumonia: effects of treatment with a beta-lactam versus a fluoroquinolone.

Bacterial alveolar invasion is followed by an inflammatory response. A systemic extension of the compartmentalized immune response has been described in patients with severe pneumonia. The data suggest that some antimicrobials may induce a differential release of cytokines. We conducted a prospective, randomized study in adult patients with severe pneumococcal pneumonia to measure the effects of ceftriaxone and levofloxacin in the systemic cytokine expression over time. Demographic, clinical characteristics, and severity scores were recorded. The serum concentrations of tumor necrosis factor alpha (TNF-alpha), interleukin-1beta (IL-1beta), IL-6, IL-8, IL-10, and IL-1 receptor agonist were measured at 0, 24, 72, and 120 h. A total of 32 patients were included in the study. Both groups were homogeneous in terms of age, comorbidities, severity of disease, and corticosteroid or statin use. With the single exception of IL-1beta, all cytokines were detected in venous blood. All of the cytokines studied showed a similar pattern of progressive decrease over time. No significant differences in the concentrations of any of the cytokines studied were found, with the exception of TNF-alpha, for which lower concentrations were obtained at 120 h in the levofloxacin group (P = 0.014). Basal oxygen saturation (P = 0.034) and heart rate (P = 0.029) returned to normal values earlier in the levofloxacin arm. We demonstrated that in patients with severe pneumococcal pneumonia pro- and anti-inflammatory responses could be detected in venous blood, representing a systemic extension of the compartmentalized response. Treatment with a beta-lactam agent or a fluoroquinolone has different effects on cytokine production and its systemic expression, impacting the clinical course of the disease.

Systematic evaluation of the causes of chronic watery diarrhea with functional characteristics.

UNLABELLED: BACKGROUND Causes of chronic watery diarrhea are multiple. There is not definite scientific evidence about AND AIMS: which are the recommended explorations to be performed in the diagnostic workup of patients with functional diarrhea. The aim was to assess prospectively the presence of gluten-sensitive enteropathy, bile acid malabsorption, and sugar malabsorption in consecutive patients with chronic watery diarrhea of obscure origin fulfilling Rome II criteria of functional disease. METHODS: A total of 62 patients with chronic watery diarrhea, defined as more than 3 loose or liquid bowel movements a day for at least 4 wk and a stool weight >200 g/day were included. The following tests were performed: (a) HLA-DQ2/DQ8 genotyping, and if positive, endoscopic biopsies from distal duodenum were obtained, and intestinal damage assessed; (b) SeHCAT (Se-homotaurocholate) abdominal retention test; (c) small bowel follow-through; and (d) hydrogen breath test (lactose, fructose + sorbitol). Gluten- or sugar-free diet, or cholestyramine was administered according to results. Functional disease was diagnosed if all tests performed were normal or if either there was no response to specific therapy or diarrhea relapsed during a 12-month follow-up. RESULTS: Bile acid malabsorption was considered to be the cause of diarrhea in 28 (45.2%) patients, sugar malabsorption in 10 (16.1%), gluten-sensitive enteropathy in 10 (16.1%), and both bile acid and sugar malabsorption in 2 patients. Twelve (19.4%) patients remained without a specific diagnosis and were considered as functional bowel disease. Diarrhea stopped in the 50 patients after specific treatment, decreasing the daily stool number from 5.4 +/- 0.3 to 1.5 +/- 0.1 (P < 0.0005), without relapse after the 12-months follow-up. CONCLUSIONS: The diagnosis of functional disease in patients with chronic watery diarrhea should be performed with caution since in most cases there is an organic cause that justifies diarrhea.

Predisposing HLA-DQ2 and HLA-DQ8 haplotypes of coeliac disease and associated enteropathy in microscopic colitis.

OBJECTIVE: To assess the presence of both genetic and serological markers of coeliac disease in patients with microscopic colitis, and whether there was associated enteropathy. METHODS: HLA-DQ2, HLA-DQ8, serum immunoglobulin A-antiendomysial and immunoglobulin A-anti-tissue transglutaminase antibodies were investigated in 59 patients with microscopic colitis. Seventy healthy subjects acted as the control group. Endoscopic biopsies from the distal duodenum were obtained in DQ2-positive or DQ8-positive patients. Patients with histological changes compatible with gluten-sensitive enteropathy were started on a gluten-free diet. RESULTS: Seventeen of 70 (24.3%) healthy controls were DQ2-positive. Twelve of 25 (48%) patients with lymphocytic colitis (P = 0.027 versus controls), and 11 of 34 (32.3%) with collagenous colitis (P = 0.38 versus controls) were DQ2-positive. There were no differences in the frequency of DQ8-positivity. The coeliac serology was positive in one patient. Duodenal biopsies were performed in 23 DQ2-positive and/or DQ8-positive patients. None had villous atrophy (Marsh III lesion) (0%; 95% confidence interval, 0-6.1). A Marsh type I lesion was found in four patients. Three of these patients were put on a gluten-free diet with disappearance of diarrhoea. CONCLUSIONS: The results suggest that there is an association of lymphocytic colitis with HLA-DQ2 genes, which might be relevant in the pathogenesis of this disease. The association of microscopic colitis with Marsh type III coeliac disease seems to be rare, making it unnecessary to routinely screen for coeliac disease in microscopic colitis patients.