[Experiences of the family living with severe mental illness: a qualitative study in Navarre]. / Experiencias de la familia que convive con la enfermedad mental grave: un estudio cualitativo en Navarra.

BACKGROUND: It is estimated that 1% of the general population suffers from severe mental illness (SMI). In most cases, families are the ones providing support and direct care to the ill relative, which in turn results in the family being the unit that lives with the mental illness. In Spain, two key aspects have been barely explored: the relationship between the family and the mental health system; and the knowledge of families and the possible transfer of such knowledge to other families. The aim of this paper is to contribute to exploring these two aspects. METHODS: A qualitative study with a narrative approach was implemented in the Foral Community of Navarre (Spain). The study consisted of in-depth interviews with families living with SMI. Two interviews were conducted with each family (which included the individual diagnosed with a mental illness). A multimodal analysis (structural, thematic and dialogical) was conduc-ted with each family. Comparative analyses between families were also performed. RESULTS: A total of 6 families were interviewed with a total of 18 participants. Findings were grouped around two central catego-ries: requirements of families and family to family. The first category includes improving relationships with mental health provi-ders, medications, psychosocial rehabilitation centers and supporting families. The second category includes recommendations from the perspective of the relative with a SMI and those without it. CONCLUSIONS: Families would like to receive a higher degree of support from mental-health providers. At the same time, families should be considered as important sources of knowledge and support for the treatment of other families living with SMI.

Experiencias de la familia que convive con la enfermedad mental grave: un estudio cualitativo en Navarra / Experiences of the family living with severe mental illness: a qualitative study in Navarre

Fundamento: La enfermedad mental grave compromete al 1% de la población, siendo la familia, en gran parte de los casos, la que apoya, cuida y acompaña, y de esta forma convive con la enfermedad. La relación entre la familia y el sistema de salud ha sido poco explorada en España, así como los aprendizajes de la familia puestos al servicio de otras familias, de forma que el objetivo del presente artículo es aportar en estos dos aspectos. Material y métodos: En la Comunidad Foral de Navarra (España) se llevó a cabo un estudio cualitativo de tipo narrativo, realizando entrevistas a profundidad a familias que conviven con la enfermedad mental grave. Se realizaron dos entrevistas a cada familia (incluyendo a la persona con el diagnóstico de enfermedad mental) y posteriormente se realizó un análisis multimodal (estructural, temático y dialógico) de cada familia y un análisis entre familias. Resultados: Se entrevistaron seis familias y dieciocho participantes. Se encontraron dos categorías: requerimientos de las familias y de familia a familia. En los requerimientos se destacan la optimización de la relación con los profesionales de la salud, los medicamentos, los centros de rehabilitación psicosocial y el apoyo a las familias. En la segunda categoría se encuentran recomendaciones desde la perspectiva del familiar con enfermedad y de los familiares sin enfermedad. Conclusiones: Las familias desean mayor acompañamiento por los profesionales sanitarios, y a la vez son una fuente de aprendizajes que pueden ser utilizados para el proceso de recuperación de otras familias (AU)

Background: It is estimated that 1% of the general population suffers from severe mental illness (SMI). In most cases, families are the ones providing support and direct care to the ill relative, which in turn results in the family being the unit that lives with the mental illness. In Spain, two key aspects have been barely explored: the relationship between the family and the mental health system; and the knowledge of families and the possible transfer of such knowledge to other families. The aim of this paper is to contribute to exploring these two aspects. Methods: A qualitative study with a narrative approach was implemented in the Foral Community of Navarre (Spain). The study consisted of in-depth interviews with families living with SMI. Two interviews were conducted with each family (which included the individual diagnosed with a mental illness). A multimodal analysis (structural, thematic and dialogical) was conducted with each family. Comparative analyses between families were also performed. Results: A total of 6 families were interviewed with a total of 18 participants. Findings were grouped around two central categories: requirements of families and family to family. The first category includes improving relationships with mental health providers, medications, psychosocial rehabilitation centers and supporting families. The second category includes recommendations from the perspective of the relative with a SMI and those without it. Conclusions: Families would like to receive a higher degree of support from mental-health providers. At the same time, families should be considered as important sources of knowledge and support for the treatment of other families living with SMI (AU)

La familia como objeto de cuidado: hacia un enfoque integrador en la atención de enfermería / The family as the unit of care: toward an integrative approach in nursing care

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Non-infectious aortitis: a report of 32 cases from a single tertiary centre in a 4-year period and literature review.

OBJECTIVES: Non-infectious aortitis often presents with non-specific symptoms leading to inappropriate diagnostic delay. We intend to describe the clinical spectrum and outcome of patients with aortitis diagnosed at a single centre. METHODS: We reviewed the clinical charts of patients diagnosed with non-infectious aortitis between January 2010 and December 2013 at the Rheumatology Division from a 1.000-bed tertiary teaching hospital from Northern Spain. The diagnosis of aortitis was usually based on FDG-PET-CT scan, and also occasionally on CT or MRI angiography or helical CT-scan. RESULTS: During the period of assessment 32 patients (22 women and 10 men; mean age 68 years [range, 45-87]) were diagnosed with aortitis. The median interval from the onset of symptoms to the diagnosis was 21 months. FDG-PET CT scan was the most common tool used for the diagnosis of aortitis. The underlying conditions were the following: giant cell arteritis (n=13 cases); isolated polymyalgia rheumatica (PMR) (n=11); Sjögren's syndrome (n=2), Takayasu arteritis (n= 1); sarcoidosis (n=1), ulcerative colitis (n=1), psoriatic arthritis (n=1), and large-vessel vasculitis that also involved the aorta (n=2). The most common clinical manifestations at diagnosis were: PMR features, often with atypical clinical presentation (n=23 patients, 72%); diffuse lower limb pain (n=16 patients, 50%); constitutional symptoms (n=12 patients, 37%), inflammatory low back pain (n=9 patients, 28%) and fever (n=7 patients, 22%). Acute phase reactants were increased in most cases (median erythrocyte sedimentation rate 46 mm/1st hour, and a median serum C-reactive protein 1.5 mg/dL). CONCLUSIONS: Aortitis is not an uncommon condition. The diagnosis is often delayed. Atypical PMR features, unexplained low back or limb pain, constitutional symptoms along with increased acute phase reactants should be considered 'red flags' to suspect the presence of aortitis.

Sobre los cuidadores de personas dependientes / On carers of dependent people

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Relationship between fragmented QRS complexes and left ventricular systolic and diastolic functions.

BACKGROUND: Fragmented QRS complexes (fQRS) have been associated with increased morbidity and mortality, sudden cardiac death, and recurrent cardiovascular events. The association between left ventricular systolic and diastolic functions and presence of fragmented QRS has not been comprehensively studied to date. We tested the hypothesis that the presence of fragmented QRS is associated with left ventricular systolic and diastolic dysfunction. METHODS: The study included 259 patients who were consecutively admitted to our outpatient clinic for cardiovascular risk factor management. Extensive echocardiographic parameters were obtained from all patients and these were compared with the presence and number of fQRS. RESULTS: Patients with fQRS were of older age (58 ± 12 vs. 55 ± 13 years, p = 0.03) and had prolonged QRS time (105 ± 12 vs. 93 ± 10 ms, p < 0.001) and a higher rate of Q waves on ECG (36% vs. 11%, p < 0.001). In addition, they had worse systolic (lower LVEF%, 44 ± 17 vs. 61 ± 12, p < 0.001) and diastolic functions (DT, 177 ± 77 vs. 211 ± 59 ms, p < 0.001; IVRT, 81 ± 27 vs. 92 ± 22 ms, p = 0.001; Em, 9 ± 4 vs. 10 ± 4 cm/s, p = 0.008; E/Em ratio, 11 ± 5 vs. 8 ± 4, p < 0.001) in comparison to patients with nonfragmented QRS. There was a significant negative correlation between the number of fQRS and left ventricle systolic functions (for LVEF%, r = - 0.595, p < 0.001). After adjustment for age and gender, the number of fQRS remained significantly negatively associated with left ventricular systolic and diastolic functions. CONCLUSION: We found that fQRS is related to left ventricular systolic dysfunction and diastolic dysfunction. fQRS, which may be the result of myocardial ischemia or scar on myocardial electrical parameters at the cellular level, may represent inadequate systolic and diastolic functions.

Increased serum resistin levels in patients with coronary slow-flow phenomenon.

BACKGROUND: Slow coronary flow (SCF) is an angiographic finding characterized by delayed opacification of the epicardial coronary arteries without obstructive coronary disease. Resistin, an adipocytokine, plays a major role besides low-grade inflammation in atherosclerotic vascular processes and may be of importance in other coronary pathologies such as SCF. METHODS: The present study was cross-sectional and observational, consisting of 70 individuals who underwent coronary angiography and had angiographically normal coronary arteries of varying coronary flow rates. The study included 50 patients with isolated SCF and 20 control participants with normal coronary flow (NCF). RESULTS: There were no statistically significant differences between the SCF and NCF groups with respect to age, gender, presence of hypertension or diabetes mellitus, and smoking habit, except for increased creatinine levels (p = 0.014). The serum resistin level was significantly higher in the SCF group than in the NCF group (8.4 ± 7.2 vs. 5.4 ± 2.6 ng/ml, p = 0.014). Ln-transformed resistin levels correlated positively with left anterior descending (LAD) coronary artery TIMI frame count (TFC) (r = 0.408, p < 0.001) as well as with glucose (r = 0.340, p = 0.004), creatinine (r = 0.248, p = 0.044), and C-reactive protein (CRP; r = 0.283, p = 0.023) levels, and negatively with LAD coronary flow velocity (r = - 0.314, p = 0.009). When multivariate analyses were performed, in linear regression analysis, ln-resistin was associated with a longer TFC [beta (standardized regression coefficient): 0.404, p = 0.001] and lower coronary flow velocity (beta: - 0.280, p = 0.035); in logistic regression analysis, ln-resistin was an independent predictor of the presence of SCF (OR: 6.692, 65 %CI: 1.117-40.1, p = 0.037). CONCLUSION: We demonstrated, for the first time, a significant increase in serum resistin levels in patients with SCF compared to subjects with NCF. We believe that further studies are needed to clarify the role of resistin in patients with SCF.

Aortic valve sclerosis is a high predictive marker of systemic endothelial dysfunction in hypertensive patients.

BACKGROUND: Aortic valve sclerosis (AVS) is closely related to hypertension and is an important predictor of coronary artery disease as well as cardiovascular morbidity and mortality. However, the mechanisms causing AVS have not yet been clarified. Therefore, we planned to investigate the influence of atherosclerosis-related risk factors including C-reactive protein (CRP), epicardial adipose tissue (EAT), carotid intima-media thickness (CIMT), pulse wave velocity (PWV), left ventricular hypertrophy, and the conventional risk parameters as well as endothelial dysfunction in untreated hypertensive patients. METHODS AND RESULTS: Our study was cross-sectional and observational, and included 107 consecutive untreated hypertensive patients. All patients underwent vascular evaluation by CIMT, PWV, flow-mediated dilation (FMD%), as well as echocardiographic examinations. Age (OR = 1.180, p < 0.001), male sex (OR = 3.056, p = 0.019), waist circumference (OR = 1.082, p = 0.004), EAT (OR = 1.419, p = 0.001), smoking status (OR = 3.161, p = 0.014), FMD% (OR = 0.649, p < 0.001), mean CIMT (OR = 2.481, P < 0.001), and carotid plaque (OR = 4.692, P = 0.001) were associated with AVS in univariate analyses. Multivariate analyses revealed only age (OR = 1.144, P = 0.006) and FMD% (OR = 0.691, 0.001) as independent predictors of AVS. The presence of AVS had a high positive predictive value (100 %) but a low negative predictive value (51 %) for endothelial dysfunction (FMD < 12 %) in hypertensive patients. CONCLUSION: Our study supports the theory that systemic endothelial dysfunction has an initial and independent effect on AVS pathogenesis. Moreover, we demonstrated that the presence of AVS in patients with hypertension predicts endothelial dysfunction, with a high positive predictive value. Thus, AVS in hypertensive patients may urge clinicians toward aggressive risk factor modification and intensive treatment.

Comparision of inflammatory biomarkers for detection of coronary stenosis in patients with stable coronary artery disease.

BACKGROUND: The objective of the current study was to evaluate the role of various inflammatory biomarkers in detection of coronary stenosis in patients with stable coronary artery disease (CAD) and healthy people. METHODS: A total of 111 patients with stable coronary artery disease, and 66 healthy subjects were enrolled in the study. Serum levels of lipoprotein-associated-phospholipase A2 (Lp-PLA2), high-sensitivity C-reactive protein (hs-CRP), and myeloperoxidase (MPO) were measured to compare patient and control groups. RESULTS: Baseline characteristics were similar between healthy and patient groups, with the exception of age. ANCOVA and log-transformed data of inflammatory biomarkers revealed that, Lp-PLA2 (p < 0.001) and hs-CRP (p < 0.05) levels in all patient groups were significantly higher than in the control group. Conversely, there was no significant difference in MPO levels among groups. CONCLUSIONS: In stable CAD patients, serum Lp-PLA2 levels are more compatible than hs-CRP and MPO levels in the detection of coronary stenosis.      

Elevated serum YKL-40 level predicts myocardial reperfusion and in-hospital MACE in patients with STEMI.

BACKGROUND: Macrophages in atherosclerotic plaques secrete YKL-40, a new biomarker of acute and chronic inflammation in patients with stable CAD. We hypothesized that YKL-40 may be a specific marker reflecting the burden of localized inflammation in myocardium and a predictor in patients with STEMI. In this study, we investigated the relationship of YKL-40 to in-hospital major adverse cardiac events (MACE), reperfusion parameters and its predictors in patients with STEMI. METHODS: In total, 80 patients with STEMI and no history of prior coronary artery disease (CAD), who underwent primary percutaneous coronary intervention (p-PCI), were enrolled consecutively. In addition, 30 patients with normal coronary arteries (NCA) were enrolled as a control group. Cardiac biomarker levels including creatinine kinase-MB fraction (CK-MB), troponin-I, admission glucose and inflammatory markers including leukocytes and YKL-40 levels were measured as admission values. RESULTS: In our study, YKL-40 levels correlated to high-sensitivity CRP levels (r = 0.333, p = 0.003), TIMI risk score (r = 0.445, p < 0.001), age (r = 0.477, p < 0.001), pain to balloon time (r = 0.432, p < 0.001), leukocyte and neutrophil count (r = 0.386, p < 0.001 and r = 0.430, p < 0.001, respectively), hemoglobin (r = - 0.345, p = 0.002), admission and fasting blood glucose (r = 0.388, p < 0.001 and r = 0.427, p < 0.001), creatinine levels (r = 0.395, p < 0.001) and myocardial blush grade (r = - 0.334, p = 0.004). When the patients were divided into two groups determined by presence or absence of MACE, the patients with MACE had significantly higher levels of YKL-40 in comparison to the patients without MACE and the control group (194 ± 104, 114 ± 61 and 110 ± 53 µg/L, p < 0.001, respectively). In multivariate logistic regression analysis in STEMI patients, only YKL-40 level (OR: 1.011, 95%CI: 1.002-1.019, p = 0.011) and leukocyte count (OR: 1.264, 95%CI: 1.037-1.540, p = 0.020) were the independent predictors for MACE. Sensitivity and specificity of YKL-40 to predict MACE, when 125 µg/l was accepted as a cut-off value, were 84% and 70%, respectively. CONCLUSION: We found that serum YKL-40 is related to older age, increased admission glucose levels, leukocyte counts and decreased hemoglobin levels; YKL-40 level and leukocyte count independently predicted MACE.

Extra-label use of ivermectin in some minor ruminant species: pharmacokinetic aspects.

The characterisation of ivermectin pharmacokinetics can be used to predict and to ensure an optimal activity in the target species and for designing programmes aimed for parasite control. Ivermectin pharmacokinetic studies performed in several minor ruminant species are reviewed in this paper with the aim of facilitating the adoption of rational basis for the establishment of appropriate dosage schedules.

Ivermectin residue depletion in food producing species and its presence in animal foodstuffs with a view to human safety.

From a human safety perspective, the administration of ivermectin to food producing animal species entails potential risks related to the presence of drug residues in edible tissues, milk, and other derived products. The European Medicines Agency has established the maximum residue limits for ivermectin in the European Union, with values of 100 µg·kg(-1) in fat and liver and 30 µg·kg(-1) in kidney for all mammalian food producing species, in order to ensure that the amount of ivermectin that can be found in animal foodstuff is below dangerous levels for the consumers. According to these values, withdrawal periods after subcutaneous injection were recently established in the European Union (2009), in 49 days for products containing ivermectin as a single active substance or in combination with closantel, and in 66 days when combined with clorsulon. The marker residue for ivermectin was found to be H(2)B(1a), which is the major component of the parent compound. The tissue distribution of residues and the overall ratios of marker to total residues were generally similar in most species, and the highest concentrations of ivermectin residues were found in fat and liver with high levels also detected in injection site muscles. Ivermectin is not licensed for use in animals from which milk is produced for human consumption, however its extra-label use should be considered regarding human safety, due to its long persistence in milk and milk-derived products.

Dependencia y familia cuidadora: reflexiones para un abordaje familiar / Dependence and the caring family: reflections for a family approach

El envejecimiento y la dependencia, estrechamente asociados, están poniendo a prueba el “potencial familiar de cuidados” y plantean el dilema de si la familia puede dar respuesta a estas nuevas situaciones de demanda de asistencia. Las necesidades de cuidados prolongados que tienen las personas mayores dependientes son, en ocasiones, de gran complejidad. Para desarrollarlos de manera correcta es preciso contar con formación suficiente, y hacerlo bajo la supervisióny con el apoyo de profesionales adecuados. Si no es así,las consecuencias sufridas por el cuidado constituyen un factor de tensión adicional sobre el modelo familiar de atención. La llamada “carga” del cuidador tiene incidencia sobre los familiares que cuidan, sobre el entorno familiar, económico, laboral y sobre su propia salud. Un enfoque integrado de cuidados, con una atención centrada en la familia, podría aumentar la autonomía de estas familias cuidadoras y paliar, en algúnmodo, sus limitaciones o sufrimientos (AU)

Ageing and dependence, which are closely interrelated, are currently challenging the “family potential forcare” and posing the dilemma of whether the family canprovide an answer to these new situations where assistanceis called for. Elderly dependants have long-termcare needs, which are sometimes of great complexity. In order to correctly carry out this care it is necessary to have the necessary training, and this must be done under the supervision and with the support of suitable professionals. Other wise, the consequences for the person receiving the care will be an additional factor of tension placed on the family model of care. The socalled “caregiver burden” has an impact on the family care givers and on the family, social and economic environment, as well as on their own health. An integrated approach to care, focused on the family, could enhance the autonomy of these caring families and to some extent alleviate their limitations and suffering (AU)

Dietary fiber and its interaction with drugs.

As the intake of purified dietary fibers is increasing in the society, it is necessary to know how these fibers interact with simultaneously administered drugs, in order to ensure adequate therapeutic effects, minimizing the risk for adverse effects. This paper reviews the literature on the interactions between different types of purified fibers and several drugs.

Dietary fiber and its interaction with drugs / La fibra dietética y su interacción con los fármacos

As the intake of purified dietary fibers is increasing in the society, it is necessary to know how these fibers interact with simultaneously administered drugs, in order to ensure adequate therapeutic effects, minimizing the risk for adverse effects. This paper reviews the literature on the interactions between different types of purified fibers and several drugs (AU)

El uso, cada vez más frecuente, de distintos tipos de fibra dietética en la población hace necesario conocer cómo interaccionan dichas fibras con los fármacos empleados simultáneamente, para garantizar un adecuado efecto terapéutico y minimizar la posibilidad de aparición de efectos adversos. En el presente trabajo se revisan las publicaciones relativas a las interacciones entre distintos tipos de fibras dietéticas purificadas y fármacos (AU)

Association of cytosine-adenine repeat polymorphism of the estrogen receptor-beta gene with rheumatoid arthritis symptoms.

The influence of the polymorphism of the estrogen receptor-beta gene, cytosine-adenine (CA) dinucleotide repeat in intron 6, in the occurrence of rheumatoid arthritis (RA) was investigated. Forty-seven RA patients and 36 control subjects with osteoarthritis (OA) were recruited. CA repeat polymorphism was examined using denaturing high-performance liquid chromatography (WAVE DNA Fragment Analysis System). The mean number of CA repeats was significantly higher in RA than in OA patients. Two groups were established: or=22 repeats (long L); and 3 kinds of genotypes (SS, SL, LL) were found. In RA patients, the L allele frequency was higher (OR = 2.03; P