Direct-to-consumer, store-and-forward teledermatology with dermoscopy using the pharmacist as patient point-of-contact.

OBJECTIVE(S): To evaluate the frequency of nonmelanoma skin cancer (NMSC), NMSC precursors, and melanoma on a store-and-forward dermatology model featuring the pharmacist as the patient's point-of-contact. The secondary objective was to define lesion changes and symptoms perceived by patients (clinical prediction rules by nonexpert observers) that can be predictive of malignity. METHODS: A cross-sectional study of teledermatology consultation was performed. All patients who underwent a teledermatology consultation between September 2018 and March 2020 were included. A patient could have more than 1 lesion per consultation. The object of the study was a defined dermatologic lesion. The differences between the variables were analyzed using a univariate model based on the chi-square test for independent qualitative variables and Fisher exact test in cases when the expected values in any of the cells of a contingency table were less than 5. Statistical significance was set at P < 0.05 (2-tailed). RESULTS: A total of 225 lesions in 218 patients were considered for this study; 53.8% (n = 121) of the lesions were classified as benign, 16.4% (n = 37) as dubious, 23.1% (n = 52) as NMSC precursors, 5.8% (n = 13) as NMSC, and 0.9% (n = 2) as melanomas. Of the reported clinical lesion changes, spontaneous pain, pruritus, surface texture changes, color changes, or form changes had no statistically significant relationship with the diagnostic group, whereas the presence of spontaneous bleeding (P = 0.015) and size changes (P = 0.026) were more frequently observed in the "dubious lesion" and "of oncological relevance lesion" groups. CONCLUSION: This "direct-to-consumer," store-and-forward teledermatology with dermoscopy model featuring the pharmacist as the patient's point-of-contact is useful for the diagnosis of melanoma, NMSC, and NMSC precursors when backed by a robust dermatology service.

Effectiveness of a chess-training program for improving cognition, mood, and quality of life in older adults: A pilot study.

BACKGROUND: Regular practice of a cognitively stimulating activity, such as chess, can help maintain a healthy cognitive, social, and psychological state during the aging process. OBJECTIVE: To evaluate the effects of a chess-training program on cognitive status, mood, and quality of life (QoL) in a sample of institutionalized and semi-institutionalized older adults. METHOD: A nonrandomized, controlled pilot study with repeated measures (pre- and post-intervention) was conducted. RESULTS: Analyses revealed a positive impact of the chess program on general cognitive status (p < 0.001) and promising evidence (p < 0.043) of an impact on attention, processing speed, and executive functions. The participants in the intervention group also showed significant improvement in QoL scores (p < 0.021). CONCLUSIONS: A 12-week chess-training protocol with two 60-minute sessions per week improved cognition and QoL in a sample of institutionalized and semi-institutionalized older adults. Further research with larger samples is needed to explore its effects in depth.

Dual and triple tasks performance in institutionalized prefrail and frail older adults.

OBJECTIVE: The aim of this pilot study was to investigate differences on dual- and triple-task performance in institutionalized prefrail and frail older adults. Performance on these tasks is relevant since many activities of daily living involve simultaneous motor and cognitive tasks. METHODS: We used a phenotypic description of frailty based on the presence or absence of five criteria related to physical fitness and metabolism (unintentional weight loss, self-reported exhaustion, muscle weakness, low gait speed, and low physical activity). Thirty-three institutionalized older adults (≥ 65 years, 78.8% females) were divided according to their frailty status. Participants completed cognitive tasks (a phonemic verbal fluency task and a visuospatial tracking task) while cycling on a stationary cycle (upper- and lower-extremity function was assessed). Cycling (number of arm and foot cycles) and cognitive (number of correct answers) performances were measured during single-, dual-, and triple-task conditions. Performances and costs of dual -and triple- tasking on cycling and cognitive performances were compared between prefrail and frail groups. RESULTS: Prefrail and frail older adults did not differ in their performance in dual-tasks; however, frail older adults showed a poorer performance in the triple-task. CONCLUSIONS: Although future studies need to confirm our observations in larger samples, this pilot study suggests that developing new tools based on triple tasking could be useful for the comprehensive assessment of frailty.

Application of light therapy in older adults with cognitive impairment: A systematic review.

This systematic review aims to assess the efficacy of light therapy on behavioural and psychological symptoms of dementia (BPSD), cognition, functional status, and quality of life in older adults with cognitive impairment; and secondarily, to identify the optimal characteristics of light therapy to establish an adequate protocol for its clinical application. We searched Web of Science and Medline databases through December 2019, resulting in 36 included articles: 3 evaluated the effects on BPSD, 25 on sleep, 12 on agitation, 10 on mood, 4 on neuropsychiatric symptoms, 4 on cognition, 2 on quality of life and 2 on functional status. Literature has shown potential evidence for positive effects of light therapy on managing sleep, behavioural and mood disturbances in people with cognitive impairment, but a limited effect on cognition, quality of life and functional status. This review provides guidelines for intervention protocols with light therapy in older people with cognitive impairment.

Social factors and quality of life aspects on frailty syndrome in community-dwelling older adults: the VERISAÚDE study.

BACKGROUND: Frailty is a multidimensional clinical geriatric syndrome that may be reversed in its early stages. Most studies have paid attention to its physical or phenotypic boundaries, however, little is known about the social aspects surrounding this geriatric syndrome. The study examined the relationship between socio-demographic factors, social resources, quality of life and frailty in older adults. METHODS: This cross-sectional study included a representative sample (n = 749) of adults aged ≥65 years enrolled in forty-three senior centers located in North-West Spain. Socio-demographic data, social resources by the Older Americans Resources and Services Scale, quality of life by the World Health Organization's Quality of Life measure-brief version (WHOQOL-BREF), and frailty status diagnosed by the Frailty phenotype were measured. RESULTS: Female gender, age older than 75 years, single marital status, a poor quality of life, and low scores in the physical health domain of the WHOQOL-BREF were the main determinants of being non-robust. Together, these variables explained 24.4% of the variance. Age between 80 and 89 years, and a poor quality of life were the main determinants for non-robust men, whilst the physical health domain of the WHOQOL-BREF was the single main determinant for women. CONCLUSIONS: Our study found evidence that physical frailty is associated with social determinants and several quality of life domains. More research on this understudied topic is needed to avoid healthcare expenditures and improve the quality of life of non-robust elders.

Iatrogenic Calcinosis Cutis Successfully Treated with Topical Sodium Thiosulfate.

Calcinosis cutis is a term used to describe a group of disorders in which calcium salt deposits form in the skin and subcutaneous tissue. We report a 6-year-old boy with hypoparathyroidism after thyroidectomy who was admitted to the hospital for severe hypocalcemia being treated with calcium gluconate intravenous infusion through peripheral veins. Within a few days we made a diagnosis of iatrogenic calcinosis cutis and treatment with 10% topical sodium thiosulfate was prescribed; complete resolution of lesions was achieved after 6 months, with no local or systemic adverse effects. Because of the lack of noninvasive alternatives and the good tolerance of the treatment, especially in childhood, we suggest the topical use of this drug as an option for this condition.

Health determinants of nutritional status in community-dwelling older population: the VERISAÚDE study.

OBJECTIVE: Malnutrition is a common and relevant syndrome in elderly people due to its influence on quality of life. The main aim of the present study was to identify health determinants of malnutrition or risk of malnutrition. DESIGN: Cross-sectional study collecting information on sociodemographic and health factors (co-morbidity, cognitive or affective problems, prescription medication use, frailty status, self-rated health) as determinants of nutritional status, assessed by the short form of the Mini Nutritional Assessment. SETTING: Forty-three senior centres from Galicia (north-western Spain) participated to recruit participants. SUBJECTS: A representative community-dwelling sample of 749 elderly people aged ≥65 years. RESULTS: Of the total participants, 14·3 % were malnourished/at risk of malnutrition. Presence of overweight or obesity, depressive symptoms, polypharmacy (use of five or more prescription medications), presence of pre-frailty or frailty status and poor self-rated health showed the strongest relationship to malnutrition/risk of malnutrition. This model predicted 86·0 % of the cases correctly. The best determinants for women were polypharmacy and poor self-rated health, reaching 82·8 % of cases of malnourishment/risk of malnutrition predicted correctly. In men, the main determinants were overweight or obesity, depressive symptomatology and polypharmacy, with 89·8 % of cases of malnourishmen/risk of malnutrition predicted correctly. CONCLUSIONS: Screening for nutritional status and its determinant factors should be included as part of comprehensive assessments to ensure an early screening of malnutrition and to propose possible intervention strategies that would be important for both elderly people and the health-care system.

Dysphagia and its association with other health-related risk factors in institutionalized older people: A systematic review.

BACKGROUND: Dysphagia is considered a geriatric syndrome that is characterized by inability to or difficulty in safely and effectively forming or moving the food bolus toward the esophagus. This pathology is very common and affects approximately 50% of institutionalized older people. Dysphagia is often accompanied by high nutritional, functional, social, and emotional risks. This relationship implies a higher rate of morbidity, disability, dependence, and mortality in this population. This review is aimed at studying the relationship between dysphagia and different health-related risk factors in institutionalized older people. METHOD: We conducted a systematic review. The bibliographic search was performed in the Web of Science, Medline, and Scopus databases. Data extraction and methodological quality were evaluated by two independent researchers. RESULTS: Twenty-nine studies met the inclusion and exclusion criteria. A clear relationship between the development and progression of dysphagia and a high nutritional, cognitive, functional, social, and emotional risk in institutionalized older adults was found. CONCLUSIONS: There is an important relationship between these health conditions that shows the need for research and new approaches to considerations such as their prevention and treatment as well as the design of protocols and procedures that will help reduce the percentage of morbidity, disability, dependence, and mortality in older people.

Low-volume cycling training improves body composition and functionality in older people with multimorbidity: a randomized controlled trial.

Physical exercise, when practiced regularly and in adequate doses, is a proven nonpharmacological measure that helps to prevent and reverse noncommunicable diseases, as well as reduce mortality rates from any cause. In general, older adults perform insufficient physical activity and do not meet the doses recommended by the World Health Organization for the improvement of health through physical activity. However, there is little evidence on adequate doses of exercise in older people, especially in those with multimorbidity. Our main aim was to evaluate the effect of a 6-week intervention on health-related outcomes (body composition, hemodynamic and functionality changes) in 24 individuals aged 65 and older with multimorbidity in a randomized controlled trial. The intervention consisted of a very low volume (60 min per week) of low-to-moderate intensity exercise training (perception of effort from 3 to 6 on an 11-point scale). After the intervention, blood pressure was significantly (p = 0.038) reduced in the exercise group (EG), with a higher reduction in men. Furthermore, the EG decreased their waist circumference (p = 0.005), a proxy of abdominal adiposity, and demonstrated an increased likelihood (73%) that a randomly selected change in muscle mass score from the EG would be greater than a randomly selected change score from the control group. The exercise intervention was particularly effective in enhancing the functionality of older adults with multimorbidity, especially in walking speed and balance skills. Perceptually regulated intensity during exercise training seemed to be a very interesting strategy to train individuals with low physical fitness and comorbidities. This study is registered with Clinicaltrials.gov (NCT04842396).

Bright Light Therapy in Older Adults with Moderate to Very Severe Dementia: Immediate Effects on Behavior, Mood, and Physiological Parameters.

Bright light therapy (BLT) has demonstrated positive short- and long-term effects in people with cognitive impairment or dementia; however, the immediate impact of BLT sessions has been scarcely investigated. In this study, we aimed to explore the immediate effects of BLT on behavior, mood, and physiological parameters (oxygen saturation/heart rate) in a sample of institutionalized older adults with moderate to very severe dementia, with a median age of 85.0 (interquartile range, IQR, 82.0-90.0), being higher in men (87.0 years, IQR 80.0-94.0) than in women (84.5 years, IQR 82.0-89.5). The BLT protocol consisted of 30-min morning sessions of 10,000 lux, Monday through Friday, for 4 weeks. The physiological parameters were recorded immediately before and after each session by pulse oximetry. Mood and behavior were assessed before, after, and during the sessions using the Interact scale. Post-session Interact scores showed a significant decrease in the items Tearful/sad and Talked spontaneously, and a significant increase in the items Enjoying self, active or alert, and Relaxed, content or sleeping appropriately. Interact scores during the sessions reflected a significant decrease in the speech-related items. Both physiological parameters changed positively from before to after sessions. Our results suggest that BLT provides immediate positive effects on mood, stimulation level, and physiological parameters, as well as a trend toward decreased speech. More robust research is needed to further explore the immediate impact of BLT. This study is registered with Clinicaltrials.gov (NCT04949984).

[Dermatological reactions secondary to the use of personal protective equipment]. / Reacciones dermatológicas secundarias al uso de equipo de protección personal.

BACKGROUND: During the COVID-19 pandemic, healthcare professionals use personal protective equipment (PPE) on a constant basis and for extended periods, leading to adverse dermatological reactions, a situation little known and studied despite its relevance. OBJECTIVE: To determine the risk factors associated with the development of adverse dermatological reactions in health workers using PPE during the COVID-19 pandemic. MATERIAL AND METHODS: An observational, cross-sectional, analytical study conducted through an online survey that evaluated the association between dermatological reactions and the use of PPE through a descriptive and inferential statistical analysis. RESULTS: There was a sample of 171 healthcare professionals. It was reported a high prevalence of adverse reactions (59%) and the most affected sites were the facial region and hands. The use of PPE > 6 hours, a history of dermatological disease, female gender, use of plastic overalls and the use of a respirator were documented as risk factors. CONCLUSIONS: Being an infectious disease, COVID-19 forces healthcare professionals to use accessories as a form of personal protection, implying potential health risks; for this, effective preventive strategies and treatment are required.

INTRODUCCIÓN: durante la pandemia por COVID-19, los trabajadores de la salud utilizan equipos de protección personal (EPP) de forma constante y por periodos prolongados, lo cual propicia reacciones adversas dermatológicas, situación poco conocida y estudiada a pesar de su relevancia. OBJETIVO: determinar los factores de riesgo asociados al desarrollo de reacciones adversas dermatológicas en trabajadores de la salud que utilizan EPP durante la pandemia por COVID-19. MATERIAL Y MÉTODOS: estudio observacional, transversal, analítico, realizado mediante una encuesta en línea, que evaluó la asociación entre reacciones dermatológicas y el uso de EPP a partir de un análisis estadístico descriptivo e inferencial. RESULTADOS: se recabó una muestra de 171 trabajadores de la salud. Se reportó una alta prevalencia de reacciones adversas (59%) y los sitios más afectados fueron la región facial y las manos. El uso de EPP > 6 horas, el antecedente de enfermedad dermatológica, el género femenino, el uso de overol de plástico y el uso de respirador se documentaron como factores de riesgo. CONCLUSIONES: al ser una enfermedad infectocontagiosa, la COVID-19 condiciona que los trabajadores de salud utilicen aditamentos para su protección personal, lo cual implica potenciales riesgos para la salud; por tanto, se requieren estrategias preventivas y tratamientos eficaces.

Clinical and Neuropsychological Correlates of Prefrailty Syndrome.

Physical frailty is closely associated with cognitive impairment. We aim to investigate the neuropsychological profiles of prefrail and non-frail dementia-free community-dwelling older adults using a comprehensive neuropsychological evaluation, and to examine the association between specific frailty criteria and clinical and neuropsychological scores. Participants completed a comprehensive standardized neuropsychological evaluation (covering cognitive domains such as memory, executive functions, language and attention), and frailty assessment. Frailty was assessed according to biological criteria: unintentional weight loss, exhaustion, low physical activity, slowness, and weakness. The sample comprised 60 dementia-free community-dwelling adults, aged 65 years or older (range 65-89 years; 60.0% women). Forty-two participants were classified as robust (no frailty criteria present), and 18 as prefrail (1 or 2 frailty criteria present). We explored neurocognitive differences between the groups and examined the association between specific criteria of frailty phenotype and clinical and neuropsychological outcomes with bivariate tests and multivariate models. Prefrail participants showed poorer cognitive performance than non-frail participants in both memory and non-memory cognitive domains. However, delayed episodic memory was the only cognitive subdomain that remained significant after controlling for age, gender, and educational level. Gait speed was significantly associated with general cognitive performance, immediate memory, and processing speed, while grip strength was associated with visual episodic memory and visuoconstructive abilities. Both gait speed and grip strength were negatively associated with depressive scores. Our results suggest that prefrailty is associated with cognitive dysfunction. The fact that specific cognitive domains may be susceptible to subclinical states of physical frailty may have important clinical implications. Indeed, early detection of specific cognitive dysfunctions may allow opportunities for reversibility.

Sex-Differences in Health-Related Characteristics of Senior Center Users: The VERISAÚDE Study.

BACKGROUND: We explored sex-related differences in sociodemographic, medical, psychological, and functional conditions in older adults attending to senior citizens' centers. MATERIALS AND METHODS: An exploratory study was conducted as part of the VERISAÚDE project, a cross-sectional population-based study of individuals aged ≥65 years enrolled in senior community centers located in Galicia, Northwest of Spain (n = 749). A comprehensive gerontological evaluation was used to assess the social, medical, psychological, and functional characteristics of the sample. RESULTS: Women presented a higher prevalence of frailty (p = 0.017), a higher risk of malnutrition (p = 0.029), more medication consumption (p = 0.002), and polypharmacy (p = 0.008), higher depressive scores (p = 0.007), and lower cognitive scores (p = 0.045) than men, who showed a higher prevalence of hearing impairment (p = 0.034), toxic habits (all ps = 0.0001), and comorbidity (p = 0.002), and better quality of life (p = 0.030), and social resources (p = 0.002). Participants considered that attending and being involved in senior centers has a positive influence on their health and promotes successful aging. DISCUSSION: Important differences were found between women and men in health variables, suggesting that sex exerts a powerful influence on health status in older age. These differences should be identified and taking into account when designing interventions to promote active aging and to improve the quality of life of older adults. Taking a sex perspective during the evaluation process could lead to a higher number of older people being effectively treated in clinical practice.

Changes in frailty status in a community-dwelling cohort of older adults: The VERISAÚDE study.

OBJECTIVES: Greater understanding of changes in the degree of frailty is important for clarifying the natural history of frailty and may help clinical decision-making regarding preventive interventions. The objectives of this study were to explore natural frailty transition rates at 1-year follow-up and to identify the main determinants of such transitions. STUDY DESIGN: Prospective longitudinal study covering a representative sample of community-dwelling older adults aged ≥65 years (n = 749) at baseline, and transition information at 1-year follow-up (n = 537). MEAN OUTCOME MEASURES: The assessment of frailty status was based on phenotypic criteria (unintentional weight loss, weakness, exhaustion, slow walking speed, low physical activity). Frailty transitions (progressed, regressed, no change, or death) and associated factors were assessed. RESULTS: Most participants remained unchanged from their baseline status (57.1% non-frail, 83.4% pre-frail, 66.7% frail). Regarding frailty transitions, 42.9% of non-frail older adults at baseline had progressed to a pre-frail status by the 1-year follow-up, and 7.9% of pre-frail older adults had become frail. Importantly, 33.3% of frail older adults regressed to a pre-frail status and 8.7% of pre-frail adults had regressed to a non-frail status. Non-frail females tended to progress to pre-frailty significantly more than males (p = 0.006), and mortality was higher among participants classified as frail at baseline (10.7%). Logistic regression showed that the main determinants of worsening frailty were hearing impairment (OR 3.180; 95% CI 1.078-9.384), congestive heart failure (OR 10.864; 95% CI 1.379-85.614), and polypharmacy (OR 2.572, 95% CI 1.096-6.037). CONCLUSION: Our results confirm the dynamic of frailty and the bidirectional nature of frailty transitions, and indicate the need for preventing and treating these conditions in later life in order to minimize the burden of frailty.

Quality of life, functional impairment and social factors as determinants of nutritional status in older adults: The VERISAÚDE study.

BACKGROUND & AIMS: Malnutrition is an important and growing health problem in elderly people. The main aim of this research was to examine the relationship between socio-demographic factors, social resources, functional status and quality of life and malnutrition or risk of malnutrition in elders. METHODS: A cross-sectional study was conducted with a representative sample of 749 community-dwelling elders aged 65 years and over. A comprehensive assessment was carried out, including the collection of socio-demographic factors, social resources by the Older Americans Resources and Services Scale, nutritional status by the Mini-Nutritional Assessment-Short Form, functional status by the Lawton's instrumental activities of daily living scale and quality of life by the World Health Organizations's Quality of Life measure-brief version (WHOQOL-BREF). RESULTS: Being female, the presence of totally impaired social resources and low scores in the physical health domain of the WHOQOL-BREF were the strongest determinants of malnutrition/risk of malnutrition. This model predicted 85.7% of the cases correctly. In men, the best determinants were being unmarried and having poor satisfaction with their health, with a percentage of 89.8% of cases of poor nutritional status correctly predicted. The best determinant for women was also the physical health domain of the WHOQOL-BREF, reaching a correct prediction of 83.0% of malnutrition/risk of it. CONCLUSIONS: Nutritional status assessment and potential determinant factors should be incorporated as part of comprehensive assessments for early identification of malnutrition and to determine appropriate intervention strategies to address this public health problem in older adults.

Effects of Degree of Urbanization and Lifetime Longest-Held Occupation on Cognitive Impairment Prevalence in an Older Spanish Population.

Our aim was to estimate the prevalence of cognitive impairment in rural and urban elderly populations and to examine the relationship between lifetime occupation and general cognitive performance. A cross-sectional study was carried out covering a representative sample (n = 749) of adults aged ≥65 years. Two categories were created to define the degree of urbanization using a criterion of geographical contiguity in combination with a minimum population threshold: densely populated (urban) areas and intermediate-thinly populated (rural) areas. Occupational histories were ranked by skill level requirements according to the Spanish National Classification of Occupations. Prevalence estimates of cognitive impairment were measured with the Mini-Mental State Examination. Results show that rural residence was not significantly associated with higher risk of cognitive impairment. A protective effect of cognitive demands at work against age-related cognitive decline was observed. However, this effect was not independent of confounder factors, such as age and education. A low overall prevalence of cognitive impairment was observed (6.5%), compared with previous estimates, possibly due to the sample selection in senior centers. Occupation during active life is not an isolated protective factor against cognitive impairment, and it is closely related to educational level. In future geriatric programs, description of both factors should be taken into consideration in screening older adults at increased risk of cognitive impairment and dementia.

Realidad virtual como herramienta de prevención, diagnóstico y tratamiento del deterioro cognitivo en personas mayores: revisión sistemática / Virtual reality as a tool for the prevention, diagnosis and treatment of cognitive impairment in the elderly: a systematic review

INTRODUCCIÓN: En las últimas décadas, se ha incrementado exponencialmente la investigación sobre los efectos de la realidad virtual en diferentes trastornos neurológicos. Sin embargo, la bibliografía centrada en los beneficios de la realidad virtual sobre el deterioro cognitivo en personas mayores es limitada. OBJETIVO: Explorar la aplicación de la realidad virtual como herramienta preventiva, diagnóstica o de tratamiento del deterioro cognitivo en personas mayores. PACIENTES Y MÉTODOS: Se llevó a cabo una búsqueda bibliográfica en las bases de datos Medline y Web of Science, incluyendo toda la bibliografía publicada desde sus inicios hasta diciembre de 2019. RESULTADOS: De las 270 publicaciones encontradas, 15 cumplieron los criterios de inclusión: dos examinaron el efecto de la realidad virtual como herramienta de prevención del deterioro cognitivo; seis, su aplicabilidad diagnóstica; y siete, su efectividad como tratamiento. CONCLUSIONES: Existe evidencia del potencial efecto de la realidad virtual como estrategia preventiva frente al desarrollo de deterioro cognitivo en personas mayores. Existe también evidencia de su aplicabilidad como herramienta diagnóstica de detección de desarrollo de deterioro cognitivo leve o demencia, y de su efectividad como tratamiento, ya que mejora el funcionamiento cognitivo de personas mayores con deterioro cognitivo. Son necesarios futuros estudios metodológicamente más robustos y con amplios tiempos de seguimiento para examinar el impacto real de la realidad virtual y poder generalizar su aplicación en los diferentes ámbitos de manejo del deterioro cognitivo

INTRODUCTION: In recent decades, research into the effects of virtual reality on different neurological disorders has increased exponentially. Yet, the literature focused on the beneficial effects of virtual reality on cognitive impairment in elderly people is limited. AIM: To explore the application of virtual reality as a preventive, diagnostic or therapeutic tool for cognitive impairment in elderly people. PATIENTS AND METHODS: A literature search was conducted in the Medline and Web of Science databases, including all the literature published from their inception up until December 2019. RESULTS: Of the 270 publications found, 15 met the inclusion criteria: two examined the effect of virtual reality as a tool for the prevention of cognitive impairment, six looked at its possible applications in diagnosis, and seven explored its effectiveness as a form of treatment. CONCLUSIONS: There is evidence of the potential effect of virtual reality as a preventive strategy against the development of cognitive impairment in elderly people. There is also evidence of its applicability as a diagnostic tool for detecting the development of mild cognitive impairment or dementia, and of its effectiveness as a treatment, since it improves the cognitive functioning of elderly people with cognitive impairment. Further studies are needed that are more methodologically robust and have long follow-up times in order to examine the real impact of virtual reality and to be able to generalise its application in different areas of the management of cognitive impairment

[Seroprevalence of antinuclear antibodies in blood donors in the Yaqui Valley]. / Seroprevalencia de anticuerpos antinucleares en donadores de sangre del valle del Yaqui.

BACKGROUND: Antinuclear antibodies are immunoglobulins that recognize autologous nuclear and cytoplasmic cellular components. In healthy persons they are not associated with autoimmune disease. However, they may be related to an immune risk phenotype that has not been sufficiently studied. We undertook this study to examine the presence of antinuclear antibodies in serum from blood donors. METHODS: Cross-sectional study on 379 blood donors between 18 and 65 years old. Serum for the presence of antinuclear antibodies by indirect immunofluorescence in HEp-2 cells was analyzed. The prevalence and pattern of expression were compared with age, gender, and history of rheumatic or thyroid disease. RESULTS: Prevalence of antinuclear antibodies in the study population was 13%. Most of the positive subjects were between 21 and 40 years old. Male gender expressed a greater proportion of positivity (11%) than females (2%). Likewise, 82% of males had low titers (1:80) and nucleolar type in 66% of cases (OR = 10.66 [1.83 to 62.18], p = 0.007). CONCLUSIONS: The presence of antinuclear antibodies in healthy individuals at low levels may not mean an autoimmune condition; however, it could reflect exposure to environmental factors that have not been sufficiently studied. New studies of healthy individuals are necessary in order to explain the association between the presence of these antibodies and toxic and environmental factors and their effects on health.

Antecedentes: los anticuerpos antinucleares son inmunoglobulinas que reconocen componentes celulares nucleares y citoplasmáticos autólogos. En personas sanas no se relacionan con alguna enfermedad autoinmune; sin embargo, pueden estar vinculados con un fenotipo inmunológico de riesgo que no ha sido suficientemente estudiado. Objetivo: examinar la existencia de anticuerpos antinucleares en el suero de donadores de sangre. Material y métodos: estudio transversal y analítico en búsqueda de anticuerpos antinucleares en suero mediante inmunofluorescencia indirecta en células HEp-2. La prevalencia y patrón de expresión se contrastaron con la edad, el género y los antecedentes de enfermedad reumática o tiroidea. Resultados: se estudiaron 379 donadores de sangre con límites de edad entre 18 y 65 años. La prevalencia de anticuerpos antinucleares en la población estudiada fue de 13%. La mayoría de los sujetos positivos tenía entre 21 y 40 años de edad. El género masculino expresó mayor proporción de positividad (11%) en comparación con las mujeres (2%). De la misma forma, 82% de los hombres tenía títulos bajos (1:80) y en 66% eran de tipo nucleolar (RM = 10.66 [1.83 a 62.18]; p = 0.007). Conclusiones: en individuos sanos, la existencia de anticuerpos antinucleares a títulos bajos puede no significar un estado de autoinmunidad; sin embargo, podría ser el reflejo de una exposición a factores ambientales que no han sido lo suficientemente estudiados. Es necesario realizar nuevos estudios en población sana que permitan explicar la asociación entre estos anticuerpos y los factores tóxicoambientales, así como sus efectos en la salud.