Which is the optimum parenting for adolescents with low vs. high self-efficacy? Self-concept, psychological maladjustmentand academic performance of adolescents in the Spanish context / ¿Cuál es el estilo parental óptimo para adolescentes con baja vs. alta autoeficacia? Autoconcepto, desajuste psicológico y rendimiento académico de los adolescentes en el contexto español

El objetivo de este estudio es identificar qué estilo parental se asocia con resultados óptimos entre los adolescentes de familias españolas considerando aquellos con baja vs. alta autoeficacia. Los participantes fueron 1029 adolescentes españoles, 453 varones (44%), de 12 a 17 años. Aunque los estudios clásicos identifican el estilo autorizativo (basado en el afecto y la severidad) como la mejor estrategia socializadora, las investigaciones emergentes cuestionan seriamente los beneficios de la severidad parental. Además, el impacto de la socialización parental en la competencia psicosocial del adolescente se ha estudiado durante años, pero se sabe menos sobre si podría variar en función de las características individuales del adolescente (e.g., la autoeficacia). Las familias fueron clasificadas por estilo parental (autorizativo, autoritario, indulgente o negligente), y los adolescentes por baja vs. alta autoeficacia. La competencia psicosocial se examinó a través del autoconcepto emocional y académico, el desajuste psicológico (hostilidad/agresión, autoestima negativa, irresponsividad emocional, inestabilidad emocional y visión negativa del mundo) y el rendimiento académico (nota media y número de cursos repetidos). Se comprobaron los efectos principales y de interacción de estilo parental y autoeficacia. Los resultados de los efectos principales indicaron que los adolescentes con baja autoeficacia presentaban siempre la peor competencia psicosocial. También que los adolescentes de familias indulgentes y autorizativas presentaron mejores resultados que los de familias negligentes y autoritarias. Sin embargo, el estilo parental indulgente se asoció a los mejores resultados. El impacto de la socialización parental podría no ser igual en todos los contextos culturales. Frente a los resultados de los estudios clásicos, la severidad parental parece ser innecesaria o incluso perjudicial para los adolescentes con baja y alta autoeficacia.(AU)

The aim of this paper is to establish which parenting style is as-sociated with optimum outcomes among adolescents of Spanish families considering adolescents with low vs. high self-efficacy. Although classical studies identify the authoritative parenting style (based on warmth and strictness) as the best parental strategy, emerging research seriously ques-tions the benefits of parental strictness. Additionally, the impact of parent-ing on the adolescent’s psychosocial competence has been studied for years, but less is known about whether it might vary depending on individ-ual characteristics of the adolescent (e.g., self-efficacy). Participants were 1029 Spanish adolescents, 453 males (44%), aged 12-17 years. Families were classified in one of the parenting styles groups (authoritative, authori-tarian, indulgent, or neglectful), and adolescents were grouped by low vs. high self-efficacy. Adolescent psychosocial competence was examined through emotional and academic self-concept, psychological maladjust-ment (hostility/aggression, negative self-esteem, emotional responsivity, instability, and negative view of the world), and academic performance (grade point average and number of failing grades). Main and interaction effects of parenting style and adolescent self-efficacy were tested. Main ef-fect results indicated that adolescents with low self-efficacy were always as-sociated with the worst psychosocial competence. Consistently, the main effect findings indicated that adolescents from indulgent and authoritative families were associated with better results than those from neglectful and authoritarian families. However, the indulgent parenting style yielded the best results. The impact of parenting might not be the same for adoles-cents in all cultural contexts. Contrary to findings from classical studies, parental strictness seems to be unnecessary or even detrimental for adoles-cents with low and high self-efficacy.(AU)

Culpa y bienestar en cuidadores familiares de personas mayores dependientes institucionalizadas / Guilt and well-being in institutionalized family caregivers of dependent older adult people

Antecedentes y objetivo: La experiencia de los cuidadores familiares tras el ingreso en una residencia de personas mayores ha recibido escasa atención, probablemente porque muchos cuidadores experimentan una sensación inicial de alivio emocional inicial. Sin embargo, para algunos cuidadores el ingreso en una residencia de mayores es un factor de estrés a pesar de la reducción de la carga física de los cuidados. La angustia del cuidador tras la institucionalización se ha relacionado con las nuevas cargas y retos que se encuentran en la residencia de mayores. La ambivalencia y la culpa relacionados con la decisión de institucionalización se han identificado como fuentes de estrés. Por eso, este estudio examinó el efecto de la culpa y el bienestar en el estrés percibido de cuidadores familiares de personas dependientes institucionalizadas. Materiales y métodos: Participaron 201 cuidadores familiares de personas institucionalizadas en una residencia de mayores (La Rioja, España). Se evalúo el estrés percibido, la culpa para el cuidado y el bienestar subjetivo, variables sociodemográficas y relacionadas con el cuidado. Se realizaron análisis de regresión lineal y correlaciones entre las variables. Resultados: La culpa y 5 dimensiones de bienestar (ansiedad, vitalidad, autocontrol y depresión, excepto salud general) predijeron significativamente el estrés (R2adj=0,552 [F (6, 198)=41,71; p<0,001]). El tamaño del efecto fue grande (IC del 95%: 0,461). Conclusiones: Prestar atención a los sentimientos de culpa de los cuidadores familiares durante la institucionalización es fundamental. Ello permitirá diseñar e implementar intervenciones psicosociales que mejoren la adaptación del cuidador inmediatamente después de la institucionalización. (AU)

Introduction and objective: The experience of family caregivers after nursing home admission has received much less attention, probably because many caregivers experience an initial sense of initial emotional relief. However, for some caregivers nursing home admission is a stressor despite the reduced physical burden of caregiving. Caregiver distress following institutionalization has been related to the new burdens and challenges encountered in the nursing home. Ambivalence and guilt related to the institutionalization decision have been identified as sources of stress. Therefore, this study examined the effect of guilt and well-being on the perceived stress of family caregivers of institutionalized dependent persons. Materials and methods: Two hundred and one family caregivers of institutionalized persons in a nursing home (La Rioja, Spain) participated. Perceived stress, caregiving guilt and subjective well-being, sociodemographic and caregiving-related variables were assessed. Linear regression analyses and correlations between variables were performed. Results: Guilt and five dimensions of well-being (anxiety, vitality, self-control and depression, except general health) significantly predicted stress (R2adj=.552 (F (6, 198)=41.71, P<.001)). The effect size was large (95% CI=.461). Conclusions: Paying attention to family caregivers’ feelings of guilt during institutionalization is important. This will enable the design and implementation of psychosocial interventions that improve caregiver adjustment immediately after institutionalization. (AU)

[Guilt and well-being in institutionalized family caregivers of dependent older adult people]. / Culpa y bienestar en cuidadores familiares de personas mayores dependientes institucionalizadas.

INTRODUCTION AND OBJECTIVE: The experience of family caregivers after nursing home admission has received much less attention, probably because many caregivers experience an initial sense of initial emotional relief. However, for some caregivers nursing home admission is a stressor despite the reduced physical burden of caregiving. Caregiver distress following institutionalization has been related to the new burdens and challenges encountered in the nursing home. Ambivalence and guilt related to the institutionalization decision have been identified as sources of stress. Therefore, this study examined the effect of guilt and well-being on the perceived stress of family caregivers of institutionalized dependent persons. MATERIALS AND METHODS: Two hundred and one family caregivers of institutionalized persons in a nursing home (La Rioja, Spain) participated. Perceived stress, caregiving guilt and subjective well-being, sociodemographic and caregiving-related variables were assessed. Linear regression analyses and correlations between variables were performed. RESULTS: Guilt and five dimensions of well-being (anxiety, vitality, self-control and depression, except general health) significantly predicted stress (R2adj=.552 (F (6, 198)=41.71, P<.001)). The effect size was large (95% CI=.461). CONCLUSIONS: Paying attention to family caregivers' feelings of guilt during institutionalization is important. This will enable the design and implementation of psychosocial interventions that improve caregiver adjustment immediately after institutionalization.

Genistein effect on cognition in prodromal Alzheimer's disease patients. The GENIAL clinical trial.

BACKGROUND: Delaying the transition from minimal cognitive impairment to Alzheimer's dementia is a major concern in Alzheimer's disease (AD) therapeutics. Pathological signs of AD occur years before the onset of clinical dementia. Thus, long-term therapeutic approaches, with safe, minimally invasive, and yet effective substances are recommended. There is a need to develop new drugs to delay Alzheimer's dementia. We have taken a nutritional supplement approach with genistein, a chemically defined polyphenol that acts by multimodal specific mechanisms. Our group previously showed that genistein supplementation is effective to treat the double transgenic (APP/PS1) AD animal model. METHODS: In this double-blind, placebo-controlled, bicentric clinical trial, we evaluated the effect of daily oral supplementation with 120 mg of genistein for 12 months on 24 prodromal Alzheimer's disease patients. The amyloid-beta deposition was analyzed using 18F-flutemetamol uptake. We used a battery of validated neurocognitive tests: Mini-Mental State Exam (MMSE), Memory Alteration Test (M@T), Clock Drawing Test, Complutense Verbal Learning Test (TAVEC), Barcelona Test-Revised (TBR), and Rey Complex Figure Test. RESULTS: We report that genistein treatment results in a significant improvement in two of the tests used (dichotomized direct TAVEC, p = 0.031; dichotomized delayed Centil REY copy p = 0.002 and a tendency to improve in all the rest of them. The amyloid-beta deposition analysis showed that genistein-treated patients did not increase their uptake in the anterior cingulate gyrus after treatment (p = 0.878), while placebo-treated did increase it (p = 0.036). We did not observe significant changes in other brain areas studied. CONCLUSIONS: This study shows that genistein may have a role in therapeutics to delay the onset of Alzheimer's dementia in patients with prodromal Alzheimer's disease. These encouraging results indicate that this should be followed up by a new study with more patients to further validate the conclusion that arises from this study. TRIAL REGISTRATION: NCT01982578, registered on November 13, 2013.

Impaired recollection and initially preserved familiarity in a patient with bilateral fornix transection following third ventricle colloid cyst removal: A two-year follow-up study.

OBJECTIVE: Recognition memory is widely accepted as a dual process-based model, namely familiarity and recollection. However, the location of their specific neurobiological substrates remains unclear. Similar to hippocampal damage, fornix damage has been associated with recollection memory but not familiarity memory deficits. To understand the neural basis of recognition memory, determining the importance of the fornix and its hippocampal connections is essential. METHODS: Recognition memory was examined in a 45-year-old male who underwent a complete bilateral fornix section following the removal of a third ventricle colloid cyst. The application of familiarity and recollection for recognition memory decisions was investigated via an immediate and delayed associative recognition test and an immediate and delayed forced-choice task in the patient and a control group (N = 15) over a two-year follow-up period. Complete demographic, neuropsychological, neuropsychiatric, and neuroradiological characterizations of this patient were performed. RESULTS: Persistent immediate and delayed verbal recollection memory deficits were observed in the patient. Moreover, delayed familiarity-based recognition memory declined gradually over the follow-up period, immediate familiarity-based recognition memory was unaffected, and reduced non-verbal memory improved. CONCLUSION: The present findings support models that the extended hippocampal system, including the fornices, does not appear to play a role in familiarity memory but is particularly important for recollection memory. Moreover, our study suggests that bilateral fornix transection may be associated with relatively functional recovery of non-verbal memory.

Prevalencia, factores de riesgo y desenlace de delirium en la Unidad de Cuidados Intensivos del Hospital Ángeles del Carmen / Delirium prevalence, risk factors and outcome in the Intensive Care Unit at Hospital Ángeles del Carmen / Prevalência, fatores de risco e resultados do delirium na Unidade de Cuidados Intensivos Hospital Ángeles del Carmen

Resumen: Introducción: El delirium es común en pacientes críticos, se asocia con múltiples factores de riesgo, mal pronóstico y aumento de la mortalidad. Material y métodos: Se realizó un estudio observacional analítico en la Unidad de Cuidados Intensivos entre 2017 y 2018. Se documentó la prevalencia de delirium, los factores de riesgo y su asociación con mortalidad, tratamiento farmacológico y no farmacológico. Se utilizó el paquete estadístico IBM© SPSS© Statistics V24. Resultados: Se incluyeron 563 pacientes. La prevalencia fue de 14% (n = 79). Los factores de riesgo más significativos fueron demencia (OR 9.0), sedación (OR 6.7), etilismo (OR 5.0), EuroSCORE > 5% (OR 4.8), ingesta deficiente (OR 4.6), infección nosocomial (OR 3.2), ventilación mecánica no invasiva (OR 2.8) y edad > 67 años (OR 2.7). La mortalidad fue de 10.1% (13.9% con delirium, 10.3% con delirium hiperactivo/mixto y 23.8% con delirium hipoactivo, OR 1.93, IC 95% de 0.88-4.19, p = 0.12). La ausencia de tratamiento no farmacológico se asoció a mayor mortalidad (30.8 vs 10.6%, OR 2.74, IC 95% de 1.02-7.39, p = 0.05). Conclusión: La prevalencia de delirium en nuestra unidad es baja, con diferente proporción por tipo de delirium y diferentes factores de riesgo. El delirium hipoactivo y la omisión de tratamiento no farmacológico se asociaron a mayor mortalidad.

Abstract: Introduction: Delirium is a common condition in critical care patients, and is associated with multiple risk factors, poor prognosis and high mortality rate. Material and methods: An observational analytic study was conducted in a the Intensive Care Unit during 2017-2018, documenting delirium prevalence, risk factors and their association with mortality, pharmacological and non-pharmacological treatment, using IBM© SPSS© Statistics V24. Results: 563 patients were included, finding a prevalence of 14% (n = 79). The most significant risk factors were preexisting dementia (OR 9.0), sedation (OR 6.7), alcohol abuse (OR 5.0), non-invasive mechanical ventilation (OR 2.8) and age > 67 years (OR 2.7). The general mortality rate was 10.1% (13.9% in patients with delirium, 10.3% in hyperactive/mixed delirium and 23.8% in hypoactive delirium, OR 1.93, CI 95% 0.88-4.19, p = 0.12). Absence of non-pharmacological treatment was associated with higher mortality (30.8 vs 10.6%, OR 2.74, CI 95% 1.02-7.39, p = 0.05). Conclusion: There is a low prevalence of delirium in our unit, with differences in delirium types and risk factors. Hypoactive delirium and absence of non-pharmacological treatment were associated with higher mortality.

Resumo: Antecedentes: Delirium é comum em pacientes críticos e está associado a múltiplos fatores de risco, mau prognóstico e aumento da mortalidade. Material e métodos: Realizou-se um estudo observacional analítico na unidade de terapia intensiva entre 2017 e 2018. Foram documentadas a prevalência de delirium, fatores de risco e sua associação com mortalidade, tratamento farmacológico e não farmacológico. Utilizou-se o pacote estatístico IBM©SPSS©Statistics V24. Resultados: Incluíram-se 563 pacientes. A prevalência foi de 14% (n = 79). Os fatores de risco mais significativos foram demência (OR 9.0), sedação (OR 6.7), alcoolismo (OR 5.0), Euroscore > 5% (OR 4.8), má ingestão (OR 4.6), infecção hospitalar (OR 3.2), ventilação mecânica não invasiva (OR 2.8) e idade > 67 anos (OR 2.7). A mortalidade foi de 10.1% (13.9% com delirium, 10.3% com delirium hiperativo/misto e 23.8% com delirium hipoativo, OR 1.93, IC 95% 0.88-4.19, p = 0.12). A ausência de tratamento não farmacológico foi associada a maior mortalidade (30.8 vs 10.6%, OR 2.74, IC 95% 1.02-7.39, p = 0.05). Conclusão: A prevalência de delirium em nossa unidade é baixa, com proporção diferente por tipo de delirium e diferentes fatores de risco. Delirium hipoativo e omissão de tratamento não farmacológico foram associados a maior mortalidade.

Factors associated with satisfaction and depressed mood among nursing home workers during the covid-19 pandemic.

AIMS AND OBJECTIVES: This paper aims to examine the satisfaction and depressed mood experienced by nursing home workers during the COVID-19 pandemic and associated variables. Specifically, to analyse the factors that may contribute to nursing home workers developing adaptive behaviours that promote satisfaction or, on the contrary, show characteristics associated with a negative mood. BACKGROUND: Nursing homes have faced unprecedented pressures to provide appropriately skills to meet the demands of the coronavirus outbreak. DESIGN: A cross-sectional survey design using the STROBE checklist. METHODS: Professionals working in nursing homes (n = 165) completed an online survey measuring sociodemographic and professional characteristics, burnout, resilience, experiential avoidance, satisfaction with life and depression. Data were collected online from April to July 2021, the time in which Spain was experiencing its fifth wave of COVID-19. Two multiple linear regression models were performed to identify salient variables associated with depressive mood and satisfaction. RESULTS: Resilience, personal accomplishment and satisfaction had a significant and negative relationship with depression and emotional exhaustion, depersonalisation and experiential avoidance had a positive relationship with depression. However, emotional exhaustion, depersonalisation and experiential avoidance had a negative and significant relationship with satisfaction and personal accomplishment, and resilience had a positive and significant relationship with satisfaction. In addition, it was found that accepting thoughts and emotions when they occur is beneficial for developing positive outcomes such as satisfaction. CONCLUSIONS: Experiential avoidance was an important predictor of the effects that the COVID-19 pandemic can have on nursing home workers. RELEVANCE TO CLINICAL PRACTICE: Interventions focusing on resources that represent personal strengths, such as acceptance, resilience and personal accomplishment, should be developed. NO PATIENT OR PUBLIC CONTRIBUTION: The complex and unpredictable circumstances of COVID's strict confinement in the nursing home prohibited access to the centres for external personnel and family members. Contact with the professionals involved could not be made in person but exclusively through online systems. However, professionals related to the work environment have subsequently valued this research positively as it analyses 'How they felt during this complicated process'.

Sense of coherence and burnout in nursing home workers during the COVID-19 pandemic in Spain.

Care staff in nursing homes work in a challenging environment, and the COVID-19 pandemic has exacerbated those challenges in an unprecedented way. On the other hand, the sense of coherence (SOC) is a competence that could help these professionals perceive the situation as understandable, manageable and meaningful. This study aims to analyse the extent to which potential risk and protective factors against burnout have affected nursing home workers during the COVID-19 pandemic and to assess the contribution of these factors to their burnout. Three hundred forty professionals who worked in nursing homes in Spain completed a survey and reported on their sociodemographic characteristics and their organisational characteristics of the job related to COVID-19, SOC and burnout. Multiple linear regression analyses were performed. The results showed that the SOC is highly related to the dimensions of burnout and is a protective factor against this. In addition, the increase in hours has a negative effect, facilitating inadequate responses to stressful situations; and whereas perceived social support and availability of resources have a protective effect, the deterioration in mental and physical health is the most important risk factor. This study could help better understand the psychological consequences of the effort that nursing home workers and can also help design mental health prevention and care interventions for workers that provide them with resources and supports that foster their coping skills.

Sensibilidad antimicrobiana y mortalidad intrahospitalaria de infecciones comunitarias y nosocomiales en la Unidad de Cuidados Intensivos del Hospital Ángeles del Carmen / Antimicrobial susceptibility and mortality of community and nosocomial acquired infections in the Intensive Care Unit at Hospital Ángeles del Carmen / Susceptibilidade antimicrobiana e mortalidade hospital por infecções comunitárias e nosocomiais na Unidade de Terapia Intensiva do Hospital Ángeles del Carmen

Resumen: Introducción: el manejo de antibióticos en las unidades de cuidados intensivos (UCI) es un tema prioritario. Conocer la epidemiología bacteriana y su sensibilidad es fundamental para aumentar la sobrevida de nuestros pacientes. Material y métodos: se realizó un estudio tipo cohorte retrospectiva en la Unidad de Cuidados Intensivos del Hospital Ángeles del Carmen durante el periodo de 2018 a 2020 en pacientes con infección documentada y con cultivo positivo. Se obtuvo el patrón de sensibilidad antimicrobiana y se analizó de acuerdo al origen Gram, tipo de infección, reactantes de fase aguda y mortalidad. Se realizó comparación de medias y proporciones con χ2, t de Student y ANOVA. Se obtuvieron razones de desventajas (OR) para identificar variables asociadas a resolución. Se consideró un valor de p < 0.05 para significancia estadística. Resultados: se analizaron 308 cultivos bacterianos obtenidos de 188 pacientes, principalmente de origen respiratorio, urinario y torrente sanguíneo (76.7%), de origen nosocomial (65.3%), con predominio de gram-negativos (65%) multidrogorresistentes. La procedencia comunitaria se asoció más a infección que la nosocomial (85 versus 61.7%, OR 3.5, IC 95% 1.93-6.45, p < 0.001). El porcentaje de infección fue mayor en gram-negativos (71.8 versus 66%, OR 1.10, IC 95% de 0.91-1.32, p = 0.297). Las infecciones por gram-positivos tuvieron menor porcentaje de mortalidad que aquéllas por gram-negativos (17.9 versus 30.7%, OR 0.49, IC 95% de 0.27-0.88, p = 0.016) así como las infecciones comunitarias en comparación con nosocomiales (17.8 versus 30.8%, OR 0.48, IC 95% de 0.27-0.86, p = 0.013). Conclusión: las bacterias predominantes en nuestra unidad de cuidados críticos son bacilos gram-negativos multidrogorresistentes, provenientes de infecciones respiratorias, urinarias y de torrente sanguíneo. Las infecciones por gram-positivos y adquiridas en la comunidad se asociaron a menor riesgo de mortalidad.

Abstract: Introduction: local identification of antimicrobial susceptibility and resistance patterns must be a priority in intensive care units. Material and methods: a cohort study was conducted in the intensive care unit from 2018 to 2020, identifying patients with an infectious diagnosis and a positive culture, with prospective clinical and laboratory follow-up. Antimicrobial resistance patterns were analyzed according to source, gram, type of infection, acute phase reactants and outcome, comparing means and proportions with χ2, Student t and ANOVA. OR were obtained to identify resolution-associated variables. A p < 0.05 value was considered as statistically significant. Results: 308 cultures were analyzed, obtained from 188 patients. Primary souces were respiratory, urinary and bloodstream (76.7%), 65.3% were from in-hospital infections, and 65% were caused by gram-negative multi-drug resistant bacteria. Community cultures were more associated with infection compares with in-hospital cultures (85 vs 61.7%, OR 3.5, 95% CI 1.93-6.45, p < 0.001). Gram-negative bacteria had a greater association with infection compared with gram-positive (71.8 vs 66%, OR 1.10, 95% CI 0.91-1.32, p = 0.297), but infections caused by gram-positive bacteria had a greater association with resolution (82.1 vs 68.8%, OR 2.07, 95% CI 1.16-3.70, p = 0.019), as well as community infections (82.2 vs 68.7%, OR 2.11, 95% CI 1.18-3.77, p = 0.016). Conclusion: multi-drug resistant gram-negative bacteria were the principal isolates found in respiratory, urine and bloodstream infections in our intensive care unit. Community infections and gram-positive isolates were associated with greater resolution rates.

Resumo: Introdução: a gestão de antibióticos em Unidades de Cuidados Intensivos é uma questão prioritária. Conhecer a epidemiologia bacteriana e sua suscetibilidade é essencial para aumentar a sobrevida de nossos pacientes. Material e métodos: foi realizado um estudo de coorte retrospectivo na Unidade de Terapia Intensiva do Hospital Ángeles del Carmen durante o período de 2018 a 2020, em pacientes com infecção documentada e com cultura positiva. O padrão de sensibilidade antimicrobiana foi obtido e analisado segundo origem, grama, tipo de infecção, reagentes de fase aguda e mortalidade. A comparação de médias e proporções foi feita com χ2, teste t de Student e ANOVA. Razões de desvantagem (OR) foram obtidas para identificar variáveis ​​associadas à resolução. Um valor de p < 0.05 foi considerado para significância estatística. Resultados: foram analisadas 308 culturas bacterianas obtidas de 188 pacientes, principalmente de origem respiratória, urinária e sanguínea (76.7%), de origem nosocomial (65.3%), com predominância de gram-negativos (65%) multirresistentes. A origem comunitária foi mais associada à infecção do que a nosocomial (85 vs 61.7%, OR 3.5, IC 95% 1.93-6.45, p < 0.001). A porcentagem de infecção foi maior para gram-negativos (71.8 vs 66%, OR 1.10, IC 95% 0.91-1.32, p = 0.297). As infecções Gram-positivas tiveram uma taxa de mortalidade menor do que as infecções Gram-negativas (17.9 vs 30.7%, OR 0.49, IC 95% de 0.27-0.88, p = 0.016), bem como infecções comunitárias em comparação com as nosocomiais (17.8 vs 30.8%, OR 0.48, IC 95% de 0.27-0.86, p = 0.013). Conclusão: as bactérias predominantes em nossa unidade de terapia intensiva são bacilos gram-negativos multirresistentes, originários de infecções respiratórias, urinárias e de corrente sanguínea. As infecções gram-positivas e adquiridas na comunidade foram associadas a um menor risco de mortalidade.

Colitis por cytomegalovirus en trasplante renal: Presentación de 2 casos / Cytomegalovirus colitis in kidney transplant recipients: presentation of two cases

Resumen La infección por citomegalovirus (CMV) es un riesgo latente en pacientes inmunocomprometidos por trasplante renal, asociándose con aumento del riesgo de rechazo del injerto y muerte. La infección por CMV puede manifestarse como infección activa o enfermedad por CMV (dividida en síndrome por CMV y enfermedad tisular invasiva por CMV). Presentamos dos casos de enfermedad tisular invasiva por CMV, la cual se presentó entre los primeros siete meses posteriores al trasplante. Ambos casos eran D+/R-; recibieron agentes depletores de linfocitos y micofenolato y profilaxis para CMV de acuerdo con las guías de práctica clínica. Los criterios para enfermedad por CMV incluyeron replicación viral detectable en sangre, hallazgos endoscópicos clásicos y confirmación histopatológica. Hacemos énfasis en la necesidad de identificar los factores de riesgo para la infección por CMV en pacientes con trasplante renal, especialmente el seroestatus donador/receptor y los medicamentos inmunosupresores. Aun cuando las guías de práctica clínica sugieren de uno a tres meses de profilaxis para CMV en casos de alto riesgo, debería considerarse la profilaxis extendida y el ajuste de los medicamentos inmunosupresores.

Abstract Cytomegalovirus infection is a latent risk among immunocompromised kidney transplant recipients and is associated with increased risk of allograft failure and death. CMV infection can manifest as active infection or as CMV disease (divided in CMV syndrome and CMV tissue-invasive disease). We present two cases of tissue invasive CMV disease, presenting within 7 months after kidney transplantation. Both cases were D+/R-, received lymphocyte-depleting agents and mycophenolate, and both received CMV prophylaxis according to General Practice Guidelines. CMV disease criteria included detectable viral replication in blood, classical endoscopic findings and histopathological confirmation. We emphasize the need of categorical identification of CMV infection risk factors among kidney transplantation recipients, specially CMV donor/recipient serostatus and immunosuppressive medication. Although clinical practice guidelines suggest 1 to 3 months CMV prophylaxis in high-risk cases, extended prophylaxis and immunosuppressive medication adjustment should be considered.

Big Five and psychological and subjective well-being in Colombian older adults.

The goal of the current study was to investigate the relationships between the Five Factor Model of personality and the dimensions of subjective well-being (positive affect, negative affect, and life satisfaction), and psychological well-being (self-acceptance, personal growth, environmental mastery, autonomy, positive relations with others, and purpose in life). Participants included 618 Colombian adults aged 60-92 years. Multiple linear regression analyses were conducted. Regarding the subjective well-being, neuroticism was associated with lower scores on life satisfaction, and positively associated with negative affect, whereas extroversion and conscientiousness were associated with higher scores on life satisfaction and positive affect. For psychological well-being, neuroticism showed a negative and significant association with all of the psychological well-being dimensions, except purpose in life, whereas extroversion and conscientiousness showed a significant and positive relationship with the six dimensions. Neuroticism, extraversion, and conscientiousness represent personality predispositions for general well-being. Extraversion and conscientiousness are predictors of optimal aging. Neuroticism was the only significant predictor of negative affect.

Tubo endotraqueal con aspiración subglótica y riesgo de neumonía asociada a ventilador / Subglottic secretion drainage tracheal tube and risk of ventilator-associated pneumonia / Tubo endotraqueal com aspiração subglótica e risco de pneumonia associada AO ventilador

Resumen: Introducción: El principal factor de riesgo para neumonía asociada a ventilador (NAV) es el tubo endotraqueal. Objetivo: Documentar la efectividad del tubo endotraqueal con aspiración subglótica (TEAS) en la reducción de NAV. Metodología: Estudio de casos y controles de mayo de 2012 a diciembre de 2015 en una unidad de cuidados intensivos. En muestra por conveniencia, con relación control:caso 3:1, con nivel de significancia α de 95% y poder β de 80%, fueron necesarios 18 casos y 54 controles. Se utilizó BMI® SPSS® Statistics v21. 72. Resultados: 277 (18.5%) de 1,492 pacientes recibieron asistencia mecánica ventilatoria, AMV (2,040 días ventilador); se obtuvo una tasa de 12.3 NAV por 1,000 días de ventilación. Se incluyeron 23 casos en el grupo de NAV y 67 controles. Once (18.3%) con TEAS y doce (40%) sin TEAS desarrollaron NAV (OR 0.33, IC 95% de 0.12-0.89). NNT = 4.6. Se encontró correlación significativa entre NAV y apego al protocolo de reducción de riesgos (r = 0.223, p = 0.036), días de ventilación mecánica (r = -0.51, p < 0.0001) y estancia en la unidad de cuidados intensivos, UCI (r = 0.42, p < 0.0001). Conclusión: El TEAS y el apego al protocolo de reducción de riesgos disminuyen el riesgo de NAV en pacientes con AMVI en la UCI, además de reducir los días de ventilación mecánica y la estancia hospitalaria.

Abstract: Background: Traqueal tube is the main risk factor for ventilator-associated pneumonia (VAP). Objective: Efficacy documentation of VAP reduction with endotracheal tube with subglottic secretion suction (ETSS). Methods: A case-control study from May 2012 to December 2015 in an intensive care unit. Patients who met the definition for VAP were considered as cases, and the exposition factor was the use of ETSS. Using a convenience sample with case:control rate of 1:3, α = 95% and β = 80%, a total of 18 cases and 54 controls were required. BMI® SPSS® Statistics v21 was used for the statistical analysis. Results: A total of 1,492 patients received attention in the ICU during the study period, with 277 (18.5%) requiring mechanical ventilation (2,040 ventilator-days). We included 23 cases in the VAP group and 67 controls. The rate of VAP was 12.3/1000 ventilator-days. Eleven patients (18.3%) with ETSS and twelve (40%) without it developed VAP (OR 0.33, IC 95% 0.12-0.89; NNT = 4.6). A significant correlation was found between VAP and bundle care adherence (r = 0.223, p = 0.036), days on mechanical ventilation (r = -0.51, p < 0.0001), and length of stay in the ICU (r = 0.42, p < 0.0001). Conclusions: ETSS use and care bundles adherence significantly reduced VAP risk in the intensive care unit, and shortened the days on mechanical ventilation and the length of stay.

Resumo: Introdução: O principal fator de risco para a pneumonia associada ao ventilador (PAV) é o tubo endotraqueal. Objetivo: Documentar a eficácia do tubo endotraqueal com aspiração subglótica (TEAS) na redução do PAV. Metodologia: Estudo de casos e controles durante maio de 2012 a dezembro de 2015 do Hospital. Na amostra por conveniência, com relação de controle:caso de 3:1, com nível de significância α de 95% e potência β de 80%, foram necessários 18 casos e 54 controles. Utilizou-se BMI® SPSS® Statistics v21. 72 Resultados: 277 (18.5%) de 1492 pacientes receberam AMV (2040 dias de ventilador), obtendo taxa de 12.3 PAV por 1000 dias de ventilação. Foram incluídos 23 casos no grupo de PAV e 67 controles. Onze (18.3%) com TEAS e doze (40%) sem TEAS desenvolveram PAV (OR 0.33, IC 95% de 0.12-0.89). NNT = 4.6. Uma correlação significativa foi encontrada entre PAV e a adesão ao protocolo de redução de risco (r = 0.223, p = 0.036), dias de ventilação mecânica (r = -0.51, p < 0.0001) e permanência na UTI (r = 0.42, p < 0.0001). Conclusão: El TEAS e a adesão ao protocolo de redução de riscos diminue o risco de PAV em pacientes com AMVI na UTI, além de reduzir os dias de ventilação mecânica e a estadia hospitalária.

Idle minds are the devil's tools? Coping, depressed mood and divergent thinking in older adults.

OBJECTIVES: The main aim was to test a causal relations model of the problem-focused and emotion-focused coping styles, depressed mood, and divergent thinking (DT) in older adults. It was hypothesized that both forms of coping would have a significant effect on predicting depressed mood, and that problem-focused coping and depressed mood would have a significant effect on DT. METHOD: Participants were 135 subjects with ages ranging between 55 and 84 years old, who took part in a personal interview and filled out several questionnaires. The statistical analysis included structural equations models (SEM). RESULTS: The initial model led to a final model endorsed by the goodness of fit, composite reliability, and discriminant validity indexes. This model confirms a direct relationship between the two types of coping strategies and depressed mood (with the opposite sign), but not between rational coping and DT. Finally, depressed mood was also confirmed as a mediator variable between coping and DT. CONCLUSION: The type of coping is a clear predictor of mood in older adults. Advanced age decline is not necessarily translated into inefficacy in everyday problem solving especially in those who, through proble-focused coping, avoid depressed moods and maintain good levels of DT.

False memories in Lewy-body disease.

Recently, de Boysson, Belleville, Phillips et al. (2011) found that patients with Lewy-body disease (LBD) showed significantly lower rates of false memories than healthy controls, using the Deese-Roediger-McDermott (DRM) experimental procedure. Given that this result could be explained by the practically null rate of true recognition in the LBD group (0.09), we decided to replicate the study by de Boysson et al. (2011), but including a new condition that would maximize the true recognition rate (and analyze its effect on the rate of false memories). Specifically, in a DRM experiment, we manipulated (within subjects) two study and recognition conditions: in the "immediate" condition, both the LBD patients and the control group of healthy older people received a different recognition test after each study list (containing twelve words associated with a non-presented critical word), while in the "delayed" condition (similar to the one in de Boysson et al., 2011), the participants received the entire series of study lists and then took only one recognition test. The results showed that, in both samples, the "immediate" condition produced higher corrected rates of both true and false recognition than the "delayed" condition, although they were both lower in the LBD patients, which shows that these patients are capable of encoding and recognizing the general similitude underlying information (gist memory) in the right conditions.

Repetition increases false recollection in older people.

Aging is accompanied by an increase in false alarms on recognition tasks, and these false alarms increase with repetition in older people (but not in young people). Traditionally, this increase was thought to be due to a greater use of familiarity in older people, but it was recently pointed out that false alarms also have a clear recollection component in these people. The main objective of our study is to analyze whether the expected increase in the rate of false alarms in older people due to stimulus repetition is produced by an inadequate use of familiarity, recollection, or both processes. To do so, we carried out an associative recognition experiment using pairs of words and pairs of images (faces associated with everyday contexts), in which we analyzed whether the repetition of some of the pairs increases the rate of false alarms in older people (compared to what was found in a sample of young people), and whether this increase is due to familiarity or recollection (using a remember-know paradigm). Our results show that the increase in false alarms in older people due to repetition is produced by false recollection, calling into question both dual and single-process models of recognition. Also, older people falsely recollect details of never studied stimuli, a clear case of perceptual illusions. These results are better explained in terms of source-monitoring errors, mediated by people's retrieval expectations.

Intervención fisioterápica preventiva del deterioro de la musculatura respiratoria en ancianas institucionalizadas con limitación funcional / Physiotherapy Intervention for Preventing the Respiratory Muscle Deterioration in Institutionalized Older Women with Functional Impairment

Introducción: En el anciano de edad avanzada (> 80 años) la función respiratoria puede verse afectada cuando a la presencia de comorbilidad y la pérdida de movilidad se suma el descenso de la fuerza de la musculatura respiratoria (MR). La literatura médica ha mostrado que el entrenamiento de la MR puede ser una intervención efectiva para mejorar la funcionalidad y prevenir el deterioro clínico, especialmente en la población con debilidad de la MR. El objetivo del estudio fue evaluar la efectividad del entrenamiento de la MR en la fuerza y resistencia de esta musculatura, en ancianas institucionalizadas con limitación funcional. Método: Se asignaron aleatoriamente 54 residentes con limitación para deambular (media 85 años, DE 6,7) a un grupo control (n = 27) y entrenado (n = 27). Se desarrolló un programa de entrenamiento supervisado, mediante Threshold ®IMT, 5 días por semana durante 6 semanas. Las variables principales fueron: la presión inspiratoria máxima (PImáx), la presión espiratoria máxima (PEmáx) y la ventilación voluntaria máxima (MVV), medidas en las semanas 0, 4, 7 y 10.ResultadosLos análisis estadísticos no revelaron cambio en la PImáx (F3,114 = 1,04, p = 0,368, R2 = 0,027), PEmáx (F3,114 = 1,86, p = 0,14, R2 = 0,047) y MVV (F3,114 = 1,74, p = 0,162, R2 = 0,044) entre ambos grupos tras la intervención. No obstante, la carga de trabajo mejoró significativamente con el entrenamiento (F5,100 = 72,031, p < 0,001, R2 = 0,791). Conclusión: El dispositivo de entrenamiento umbral en un programa interválico de 6 semanas no produce una mejora significativa de los parámetros relacionados con la fuerza y la resistencia de la MR, en la población estudiada(AU)

Introduction: In elderly seniors (>80 years), respiratory function may be compromised when, in addition to the presence of comorbidity and loss of mobility, there is also reduced respiratory muscle (RM) strength. The literature has shown that RM training could be an effective method to improve RM function and prevent clinical deterioration, particularly in population with RM weakness. The main purpose of this paper was to assess the effectiveness of RM training on the respiratory muscle strength and endurance of institutionalized elderly women with functional impairment. Method: Fifty-four residents (mean=85 years, SD=6.7) were randomly assigned to either a control (n=27) or training (n=27) group. A supervised training program was developed with Threshold®IMT, five times per week for 6-weeks. The main variables of the intervention were: maximum inspiratory pressure (PImax), maximum expiratory pressure (PEmax) and maximal voluntary ventilation (MVV), all of which were measured at weeks 0, 4, 7 and 10.ResultsStatistical analysis revealed no significant differences in PImax (F3,114=1.04, p=0.368, R2=0.027), PEmax (F3,114=1.86, p=0.14, R2=0.047) and MVV (F3,114=1.74, p=0.162, R2=0.044) between the two groups after the intervention. However, the workload significantly improved with the training sessions (F5,100=72.031, p<0.001, R2=0.791). Conclusion: In a 6-week interval-based training program, the threshold loading device does not significantly improve parameters related to RM strength and endurance of the study population(AU)

Physiotherapy intervention for preventing the respiratory muscle deterioration in institutionalized older women with functional impairment.

INTRODUCTION: In elderly seniors (>80 years), respiratory function may be compromised when, in addition to the presence of comorbidity and loss of mobility, there is also reduced respiratory muscle (RM) strength. The literature has shown that RM training could be an effective method to improve RM function and prevent clinical deterioration, particularly in population with RM weakness. The main purpose of this paper was to assess the effectiveness of RM training on the respiratory muscle strength and endurance of institutionalized elderly women with functional impairment. METHOD: Fifty-four residents (mean=85 years, SD=6.7) were randomly assigned to either a control (n=27) or training (n=27) group. A supervised training program was developed with Threshold(®)IMT, five times per week for 6-weeks. The main variables of the intervention were: maximum inspiratory pressure (PI(max)), maximum expiratory pressure (PE(max)) and maximal voluntary ventilation (MVV), all of which were measured at weeks 0, 4, 7 and 10. RESULTS: Statistical analysis revealed no significant differences in PI(max) (F(3,114)=1.04, p=0.368, R(2)=0.027), PE(max) (F(3,114)=1.86, p=0.14, R(2)=0.047) and MVV (F(3,114)=1.74, p=0.162, R(2)=0.044) between the two groups after the intervention. However, the workload significantly improved with the training sessions (F(5,100)=72.031, p<0.001, R(2)=0.791). CONCLUSION: In a 6-week interval-based training program, the threshold loading device does not significantly improve parameters related to RM strength and endurance of the study population.

How we compensate for memory loss in old age: adapting and validating the Memory Compensation Questionnaire (MCQ) for Spanish populations.

Compensating entails using external strategies and mechanisms that help overcome or alleviate the decreasing memory function that comes with age. This study aims to adapt and validate the MCQ in the elderly Spanish population. A total of 403 elderly people aged between 65 and 92 in the city of Valencia (Spain) completed the questionnaire for the validation process. The factorial validity of the scale was tested using confirmatory factor analysis. The result showed a first order five-factor model with 23 items that met the criteria for model fit according to multiple fit indices. As a general conclusion, the adaptation into Spanish provided a reliable and valid measure of compensation in the elderly population, and it could potentially be useful in both clinical practice and research in the elderly.

Coping strategies: gender differences and development throughout life span.

Development during life-span implies to cope with stressful events, and this coping may be done with several strategies. It could be useful to know if these coping strategies differ as a consequence of personal characteristics. This work uses the Coping with Stress Questionnaire with this aim using a sample of 400 participants. Specifically, the effects of gender and age group (young people, middle age and elderly), as well as its interaction on coping strategies is studied. With regard to age, on one hand, it is hypothesised a decrement in the use of coping strategies centred in problem solving and social support seeking as age increases. On the other hand, the use of emotional coping is hypothesised to increase with age. With respect to gender, it is hypothesised a larger use of emotional coping and social support seeking within women, and a larger use of problem solving within men. A MANOVA found significant effects for the two main effects (gender and age) as well as several interactions. Separate ANOVAs allowed us to test for potential differences in each of the coping strategies measured in the CAE. These results partially supported the hypotheses. Results are discussed in relation to scientific literature on coping, age and gender.

Coping strategies: gender differences and development throughout life span

Development during life-span implies to cope with stressful events, and this coping may be done with several strategies. It could be useful to know if these coping strategies differ as a consequence of personal characteristics. This work uses the Coping with Stress Questionnaire with this aim using a sample of 400 participants. Specifically, the effects of gender and age group (young people, middle age and elderly), as well as its interaction on coping strategies is studied. With regard to age, on one hand, it is hypothesised a decrement in the use of coping strategies centred in problem solving and social support seeking as age increases. On the other hand, the use of emotional coping is hypothesised to increase with age. With respect to gender, it is hypothesised a larger use of emotional coping and social support seeking within women, and a larger use of problem solving within men. A MANOVA found significant effects for the two main effects (gender and age) as well as several interactions. Separate ANOVAs allowed us to test for potential differences in each of the coping strategies measured in the CAE. These results partially supported the hypotheses. Results are discussed in relation to scientific literature on coping, age and gender (AU)

El desarrollo a lo largo del ciclo vital implica afrontar situaciones estresantes, lo que puede hacerse mediante diversas estrategias de afrontamiento. Los tipos de estrategias empleadas pueden diferir en función de características personales. Este trabajo estudia estas potenciales diferencias en algunas de estas características empleando como medida de afrontamiento el CAE. Específicamente se han probado los efectos de la edad, del género y de su interacción en las estrategias empleadas por una muestra de 400 adultos españoles. En relación a la edad, se hipotetiza que habrá una disminución en la aplicación de las centradas en la solución de problemas y búsqueda de apoyo social al aumentar la edad y un aumento de las centradas en la emoción. En relación al género, se hipotetiza que los hombres usarán más frecuentemente estrategias de solución de problemas, y las mujeres de las centradas en la emoción y búsqueda de apoyo social. Se empleó MANOVA para evaluar estos tanto los efectos principales como los de interacción. Los ANOVAs de continuación permitieron contrastar las potenciales diferencias en cada una de las distintas estrategias de afrontamiento, que apoyaban parcialmente las hipótesis planteadas. Se discuten los resultados encontrados relacionándolos con la literatura científica (AU)