Environmental exposure to pesticides and Amyotrophic Lateral Sclerosis in the South of Spain / Exposición ambiental a pesticidas y esclerosis lateral amiotrófica en el sur de España

Objective: To determine if there is a relationship between environmental exposure to pesticides and the prevalence of Amyotrophic Lateral Sclerosis (ALS) in Andalusia. Method: We carried out a case–control study using the logistic regression method to verify the relationship between the prevalence of ALS in the area exposed to pesticides versus the unexposed area, through the Odds Ratio statistical test. Results: The study population consisted of 519 individuals diagnosed with ALS between January 2016 and December 2018 according to the CMBD (Minimum Basic Data Set) as cases. In the control group, we have 8,384,083 individuals obtained from data from the National Institute of Statistics (INE). The Odds Ratio (OR) was used as a measure of association between cases and controls, obtaining an OR between 0.76 and 1.08 for the confidence interval of the CI (95%). Conclusions: Despite the existence of various studies that suggest a possible association between environmental exposure to pesticides and the risk of Amyotrophic Lateral Sclerosis, our analysis of the Andalusian population did not find significant evidence of this association.(AU)

Objetivo: Analizar si existe una relación entre la exposición ambiental a pesticidas y la prevalencia de esclerosis lateral amiotrófica (ELA) en Andalucía. Métodos: Realizamos un estudio de casos y controles con regresión logística para esclarecer la relación entre la prevalencia de ELA en el área expuesta a pesticidas vs. el área sin exposición, mediante el cálculo de razón de probabilidades (odds ratio [OR]). Resultados: Incluimos un grupo de casos, con 519 individuos diagnosticados de ELA entre enero de 2016 y diciembre de 2018, obtenidos del conjunto mínimo básico de datos, y un grupo control con 8.384.083 individuos obtenidos de la base de datos del Instituto Nacional de Estadística. Se utilizó la OR para medir la asociación entre casos y controles, con un intervalo de confianza del 95% de 0,76-1,08. Conclusiones: A pesar de que varios estudios sugieren una posible asociación entre la exposición ambiental a pesticidas y un aumento en el riesgo de ELA, nuestro estudio sobre la población andaluza no halló datos significativos en favor de dicha hipótesis.(AU)

Asociación entre sobrecarga del cuidador y presencia de alteraciones neurológicas en una población geriátrica peruana / Association between caregiver burden and the presence of neurological alterations in a Peruvian geriatric population

Objetivo: El objetivo del presente estudio es establecer la asociación entre cuidar adultos mayores con alteración neurológica y padecer sobrecarga del cuidador en el Centro Geriátrico Naval del Perú, desde noviembre del 2019 a enero del 2021. Metodología: Estudio analítico, observacional, tipo transversal realizado en el Centro Geriátrico del Centro Médico Naval. Se encuestaron 290 cuidadores que acudieron a consulta del adulto mayor cuidado. La sobrecarga del cuidador se midió con la escala de sobrecarga de Zarit. Resultados: Se halló una prevalencia de sobrecarga del cuidador del 52,76%. Los pacientes que padecían de alguna alteración neurológica fueron el 62,76%. Al ajustar por las variables sociodemográficas, ser cónyuge del paciente aumentó en 2,23 veces la probabilidad de padecer sobrecarga del cuidador. Al ajustar por las variables relacionadas con el cuidado, cuidar de un paciente con alteración neurológica y cuidar de un adulto mayor durante 1 o 2 años aumentaron en 1,86 y 1,91 veces, respectivamente, la probabilidad de padecer sobrecarga del cuidador, mientras que contar con el apoyo de otras personas disminuyó la probabilidad de padecerla en un 39%. Conclusiones: La sobrecarga del cuidador se encuentra asociada con cuidar de un adulto mayor con alteración neurológica, ser cónyuge del paciente, realizar el cuidado durante 1 o 2 años y contar con apoyo de otras personas (AU)

Objective: The objective of this study is to establish the association between caring for older adults with neurological disorders and suffering from caregiver burden at the Naval Geriatric Center of Peru, from November 2019 to January 2021. Methodology: Analytical, observational, cross-sectional study carried out at the Geriatric Center of the Naval Medical Center. A total of 290 older adult’s caregivers who went to medical consultation were surveyed. Caregiver burden was measured with the Zarit burden scale. Results: A prevalence of caregiver burden of 52.76% was found. The patients that suffered some neurological alteration were 62.76%. When adjusting for sociodemographic variables, being the patient’s spouse increased the probability of suffering from caregiver burden by 2.23 times. When adjusting for the variables related to care, caring for a patient with neurological disorder and caring for an older adult for 1 or 2 years increased the probability of suffering caregiver burden by 1.86 and 1.91 times, respectively, while having the support of other people decreased the probability of suffering it by 39%. Conclusions: Caregiver overload is associated with caring for an older adult with neurological disorder, being the patient’s spouse, caring for 1 or 2 years and having the support of other people (AU)

Early path nursing improves neurological function recovery in patients with intracerebral hemorrhage: Protocol for a randomized controlled trial.

BACKGROUND: To explore the influence of the early path nursing on life quality and the neurological function recovery in the intracerebral hemorrhage (ICH) patients. METHODS: The experiment was implemented from January 2018 to October 2020 at the First Affiliated Hospital of Soochow University. The experiment was granted through the Research Ethics Committee of the First Affiliated Hospital of Soochow University (2017033). In this experiment, the criteria for inclusion includes: hemorrhagic stroke diagnosed via the MRI or head CT; over 18 years of age; patients with motor dysfunction; The Glasgow Coma Scale > 12. The patients with these symptoms will be excluded: severe cognitive impairment; ischemic stroke; onset time > 3 days; and severe complications. The scale used for the evaluation the neurological function is the American Stroke Scale. This scale contains a total of eleven items, that is, the movements of upper and lower limb, the consciousness level, gaze, visual field, etc. Other outcomes include patient satisfaction and complications. RESULTS: Evaluation the neurological function and quality of life will be shown in Table 1. CONCLUSION: The early path nursing can promote the neurological function recovery in the ICH patients. TRIAL REGISTRATION NUMBER: researchregistry6327.

The effect of neuropalliative care on quality of life and satisfaction with quality of care in patients with progressive neurological disease and their family caregivers: an interventional control study.

BACKGROUND: It is recommended that patients with progressive neurological disease (PND) receive general and specialized palliative care. The purpose of this study was to determine the effect of neuropalliative care on quality of life (QoL) and satisfaction with provided care in both patients with PND in advanced stages of disease and their family caregivers. METHODS: The sample consisted of 151 patients with PND and 140 family caregivers. The PNDQoL questionnaire was used for data collection. Patients and family caregivers completed the questionnaires both before and 3 months after the intervention. RESULTS: Before intervention, there were no statistically significant differences in the individual domains of QoL in patients and family caregivers in either the intervention or the control group. After intervention, differences were identified in the sample of patients in the domains of symptoms burden (p < 0.001), emotional (p < 0 .001), social functioning (p = 0.046), spiritual area (nonreligious) (p = 0.050), and in QoL. In the sample of family caregivers, there were differences in the domains of symptoms burden (p < 0.001), emotional functioning (p = 0.016), spiritual area (nonreligious) (p = 0.042), and in the assessment of health (p = 0.002), and QoL (p = 0.002). Patients and family caregivers from the intervention group evaluated their satisfaction with the quality of care provided significantly more positively in all five analyzed domains. CONCLUSION: The provision of neuropalliative care to patients with advanced stages of PND helped to maintain and slightly improve their QoL, and symptoms burden, and resulted in a more positive assessment of satisfaction with the quality of care provided.

A Case Report: The CSF Characteristics of HaNDL Syndrome.

BACKGROUND: Headache and Neurologic Deficits with cerebrospinal fluid Lymphocytosis (HaNDL) is a rare and underdiagnosed syndrome that mimics recurrent stroke, migraine with aura, and encephalitis. OBJECTIVE: Describe the presentation, clinical characteristics, and cerebrospinal fluid (CSF) findings in a patient with HaNDL and provide insight into the importance of the recognition of this syndrome. METHODS: The authors describe a unique case of (HaNDL) during which the patient underwent three lumbar punctures over 26 days. RESULTS: The authors demonstrate the natural course of CSF characteristics of a patient with HaNDL, with rising and falling lymphocyte counts. Additionally, the authors provide an example of the clinical presentation of HaNDL, with episodic attacks over the course of 1 month of migraine headache, hemibody paresthesias, hemibody weakness, and encephalopathy. CONCLUSIONS: HaNDL is a headache syndrome mimicking viral encephalitis, migraine with aura, and recurrent cerebral ischemic events. While HaNDL is a diagnosis of exclusion, the syndrome's association with characteristic clinical and laboratory findings are important to recognize. Furthermore, a monophasic pattern of CSF lymphocytosis in HaNDL may be observed. IMPLICATIONS FOR NURSING: Increased recognition of this syndrome may help prevent unnecessary tests and treatments when patients present with recurrent episodes.

Managing health changes for people with a learning disability in a residential care home setting.

BACKGROUND: People with learning disability (LD) have complex comorbidities that develop at an earlier age than the general population and with which they are now living longer. Identification, assessment and management of these conditions is important but challenging. AIM: To develop resources with care staff to enable them to recognise and manage changes and decline in the health of a person with a LD. METHODS: Two resources (PIP-LD and CIRC) were developed through undertaking a literature review; networking with experts; and collaborating with staff in the care homes for people with a LD. Care staff then used these resourcesto review their residents. FINDINGS: The PIP-LD and CIRC were used in 39 care homes. The PIP-LD empowered staff to meet people's immediate health needs, and the CIRC helped them to recognise changes or a decline. CONCLUSIONS: The combined use of the PIP-LD and the CIRC enabled care staff to recognise the signs and symptoms of each person's comorbidities early, and to identify and manage changes when their health declined.

Effects of the caregiver burden perceived by caregivers of patients with neurological disorders on caregiver wellbeing and caregiver stress.

PURPOSE: The present study was conducted to determine the effects of the caregiver burden perceived by caregivers of patients with neurological disorders on caregiver wellbeing and stress. DESIGN AND METHODS: The study was designed as a descriptive, cross-sectional, and correlational study. FINDINGS: In the study, it was determined that the care burden is related to a caregiver's wellbeing and stress level and that the caregivers' levels of performing activities of living decreased and their stress levels increased as their perceived burden of care increased. IMPLICATIONS FOR PRACTICE: Determining caregivers' difficulties in providing care and providing them with professional support will contribute to reducing the burden of care.

Support for people with long-term neurological conditions in rural English communities.

Almost one-fifth of the population in England lives in rural areas. Compared to urban populations, the rural population is older and faces greater difficulties in accessing medical services. At the same time, healthcare teams in rural areas face particular challenges in recruiting and retaining staff, travelling between patients and keeping specialised knowledge up-to-date. Drawing upon a recent health needs assessment for people living with long-term neurological conditions in a rural English county, as well as a broader review of the literature, this paper considers the challenges of rurality and discusses potential solutions. Technological and community-based responses have often been suggested as responses to challenges of rurality. However, there is likely to be a need for up-front investment of resources and careful consideration of individual and community needs before these solutions can be applied to rural neurological care.

Early Identification of Pediatric Neurology Patients With Palliative Care Needs: A Pilot Study.

Palliative care services are beneficial for pediatric neurology patients with chronic, life-limiting illnesses. However, timely referral to palliative care may be impeded due to an inability to identify appropriate patients. The aim of this pilot case-control study was to test a quantitative measure for identifying patients with unmet palliative care needs to facilitate appropriate referrals. First, a random subset of pediatric neurology patients were screened for number of hospital admissions, emergency center visits, and problems on the problem list. Screening results led to the hypothesis that having six or more hospital admissions in one year indicated unmet palliative care needs. Next, hospital admissions in the past year were counted for all patients admitted to the neurology service during a six-month period. Patients with six or more admissions as well as age- and gender-matched controls were assessed for unmet palliative care needs. In hospitalized pediatric neurology patients, having six or more admissions in the preceding year did not predict unmet palliative care needs. While this pilot study did not find a quantitative measure that identifies patients needing a palliative care consultation, the negative finding highlights an important distinction between unmet social needs that interfere with care and unmet palliative care needs. Further, the method of screening patients used in this study was simple to implement and provides a framework for future studies.

Top Ten Tips Palliative Care Clinicians Should Know About Caring for Patients with Neurologic Illnesses.

Patients with neurologic illnesses are commonly encountered by palliative care (PC) clinicians though many clinicians feel uncomfortable caring for these patients. Understanding how to diagnose, treat, communicate with, and prognosticate for neurology patients will improve the confidence and competence of PC providers in the neurology setting. This article offers PC providers 10 useful tips that neurologists with PC training think all PC providers should know to improve care for patients with neurologic illness.

Transitioning the Treatment Paradigm: How Early Palliative Care Service Involvement Affects the End-of-Life Course for Critically Ill Patients in the Neuro-Intensive Care Unit.

Background: Involvement of the palliative care service has potential for patient and family benefit in critically ill patients, regardless of etiology. Anecdotally, there is a lack of involvement of the palliative care (PC) service in the neuro-intensive care unit (neuro-ICU), and its impact has not been rigorously investigated in this setting. Objective: This study aims at assessing the effect of early involvement of the PC service on end-of-life care in the neuro-ICU. Design: Demographic variables and elements pertaining to the end-of-life care were obtained retrospectively via the electronic medical record from patients receiving their care at the University of Alabama at Birmingham Hospital neuro-ICU. The patient population was divided into two cohorts: patients who received PC services and patients who did not. Contingency analysis was performed to assess for associations with PC service involvement. Results: A total of 149 patients were included in the study. PC services were included in 56.4% of the cases. Involvement of the PC service led to more code status changes to comfort care-do-not-resuscitate p = 0.0021. This was more often a decremental change to less invasive measures rather than a direct change from full code to comfort care measures (p = 0.026). When PC specialists were involved, medications to treat anxiety/agitation, dyspnea/pain, and respiratory secretions were utilized more frequently (p < 0.001) and fewer procedures were performed on these critically ill patients within 48 hours of death (p < 0.001). Conclusion: Early involvement of the PC service has an impact on adjusting the treatment paradigm for patients suffering from devastating neurologic injuries. We recommend the creation of a standardized protocol to ensure early PC consultation in the neuro-ICU based on initial patient presentation parameters, imaging characteristics, and prognosis.

The Unmet Needs of Patients With Progressive Neurological Diseases in the Czech Republic: A Qualitative Study.

AIM:: The aim of our research was to explore the unfulfilled needs of patients with a progressive neurological disease in advanced stage of the illness within the current system of health and social care in the Czech Republic. DESIGN AND SETTING:: Qualitative research (grounded theory) was used to conceptualize the patterns of unmet palliative care needs in Czech Republic. METHODS:: The data collection method comprised individual, in-depth interviews (n = 19) and focus groups (n = 4) where a total of 52 respondents participated (patients with progressive neurological diseases [PNDs], family members, and professionals). RESULTS:: Two main categories of unfulfilled needs were determined (life with the disease, professional help), and they were described in the context of the 3 crucial themes identified in the study-the symptoms of the advanced stage of the disease resulted in substantial reduction of physical self-sufficiency, loss of autonomy, and social isolation; the level of dependence on the support and help of others increased; the patients also highlighted several problems related to health-care services. CONCLUSION:: The unmet needs should be taken into consideration when creating the concept of the neuropalliative and rehabilitation care, including the mental health support plan, because of the emotional, behavioral, and cognitive disorders that frequently occur in the lives of a substantial amount of patients with PND.

Complications of Solid Organ Transplantation: Cardiovascular, Neurologic, Renal, and Gastrointestinal.

Despite improvements in overall graft function and patient survival rates after solid organ transplantation, complications can lead to significant morbidity and mortality. Cardiovascular complications include heart failure, arrhythmias leading to sudden death, hypertension, left ventricular hypertrophy, and allograft vasculopathy in heart transplantation. Neurologic complications include stroke, posterior reversible encephalopathy syndrome, infections, neuromuscular disease, seizure disorders, and neoplastic disease. Acute kidney injury occurs from immunosuppression with calcineurin inhibitors or as a result of graft failure after kidney transplantation. Gastrointestinal complications include infections, malignancy, mucosal ulceration, perforation, biliary tract disease, pancreatitis, and diverticular disease. Immunosuppression can predispose to infections and malignancy.

Sharing expertise: when immunology meets psychiatry and neuroscience.

A radio programme investigating how a 'rogue' immune system could affect mental health led second-year nursing student at Kingston and St George's University Leo Honey to research the subject further, leohoney3@gmail.com.

Resiliency is independently associated with greater quality of life among informal caregivers to neuroscience intensive care unit patients.

OBJECTIVE: Every year, millions of Americans become informal caregivers to loved ones admitted to Neuroscience Intensive Care Units (Neuro-ICU), and face challenges to Quality of Life (QoL). This study sought to identify associations between resiliency, distress, and caregiver QoL at time of Neuro-ICU admission. METHODS: Informal caregivers (N = 79, Mage = 53, 64% female) of Neuro-ICU patients were recruited and completed self-report questionnaires during the hospitalization. We used hierarchical regression to test relative contributions of caregiver mindfulness, perceived coping abilities, and preparedness for caregiving to caregiver QoL, above-and-beyond non-modifiable patient and caregiver factors (e.g., gender) and caregiver psychological distress (i.e., anxiety, depression, history of mental health conditions). RESULTS: Preparedness for caregiving was uniquely and positively associated with Physical Health QoL (sr2 = 0.07, p = 0.001), Social QoL (sr2 = 0.05, p = 0.021), and Environmental QoL (sr2 = 0.14, p < 0.001), even after accounting for psychological distress. Mindfulness was uniquely and positively associated with Physical Health QoL (sr2 = 0.12, p < 0.001) and Psychological QoL (sr2 = 0.07, p = 0.004), above-and-beyond variance accounted for by psychological distress. CONCLUSIONS: Mindfulness and preparedness for caregiving emerged as consistent, unique resiliency factors associated with greater caregiver QoL across QoL dimensions. Results highlight the importance of resiliency factors in QoL among Neuro-ICU caregivers and the need for early interventions to support resiliency.

[Applicability of the Therapeutic Nursing Theory in Neurological (Early-) Rehabilitation into Nursing Practice - A Case Study]. / Übertragbarkeit der Theorie "Therapeutische Pflege in der neurologischen (Früh-)Rehabilitation" in die pflegerische Versorgungspraxis ­ Eine Fallstudie.

PURPOSE: The objective of the study is to describe how the theory of therapeutic nursing in neurological (early) rehabilitation can be transferred into nursing practice. MATERIALS AND METHODS: The theory was developed using the method of grounded theory by Glaser and Strauss. Open participatory observations (n=92) and episodic interviews (n=10) with nursing professionals and nursing auxiliaries were conducted in 5 inpatient rehabilitation clinics. Data analysis was performed using the constant comparative method by Glaser and Strauss. RESULTS: By means of a case study, the applicability of the theory into nursing practice with regard to the following care situations is described: (1) training for personal care, (2) therapeutic positioning, (3) oral hygiene, (4) training of sensory-motor perception and (5) counseling relatives. Consequently, the categories of the theory: (1) nursing care, (2) observation/perception, (3) communication, (4) autonomy and individual needs of patients and their relatives, (5) multi-professional team and (6) prerequisites are transferred into the case scenario. CONCLUSIONS: The case study demonstrates how the therapeutic nursing theory in neurological (early-) rehabilitation can be transferred into nursing practice and reveals the complexity of nursing interventions.