Sleep disturbances in Alzheimer's disease are associated with neuropsychiatric symptoms and antidementia treatment.

Sleep disturbances (SDs) in Alzheimer's disease (AD) may significantly affect the behavioral, functional, and cognitive capacities of patients to the point of becoming a major determinant of caregiver burden. We conducted a cross-sectional study in 125 patients with probable AD to assess the association of SDs with neuropsychiatric symptoms, cognitive and functional status of patients, and severity and duration of dementia and to ascertain the role of antidementia drugs in the treatment of SD. SDs were assessed using the questionnaire on sleep disorders in the Neuropsychiatric Inventory. The prevalence of SDs in this sample was 36%. SDs in patients with AD are significantly associated with depression (Wald's test, 3.983; p < 0.05), disinhibition (Wald's test, 5.522; p < 0.05), and aberrant motor behavior (Wald's test, 7.430; p < 0.01). The patients treated with memantine presented lower mean SDs scores (t = 2.76; p < 0.001). These results highlight the need for a standardized and validated approach to the assessment of SDs in AD.

The experience of caregiving: the influence of coping strategies on behavioral and psychological symptoms in patients with Alzheimer's disease.

OBJECTIVES: To determine whether caregiver coping strategies are independently associated with behavioral and psychological symptoms (BPS) in Alzheimer's disease (AD) after accounting for patient characteristics. METHODS: Cross-sectional data analysis of 80 patients with AD and their primary caregivers. The presence of BPS was recorded using the Neuropsychiatric Inventory (NPI). The relationship between caregiver characteristics and BPS was assessed through one-way analysis of variance, two-tailed student t-tests or correlation coefficients. Multivariate linear regression was used to determine the combined effect of all caregiver factors that were significant on bivariate analysis regarding coping and BPS controlling for patient characteristics. RESULTS: Caregivers were on average 62 years old, 77% female, and most were the children or the spouse of the patient. Over 50% had significant depression or anxiety. Patients were on average 77 years old and 62% were female, and most had moderate to severe dementia. After adjusting for patient characteristics, patients cared for by more depressed, more burdened, or those using more disengagement coping strategies showed higher NPI mean composite scores. CONCLUSION: Coping strategies are associated with BPS regardeless of patient characteristics. Interventions to reduce BPS should focus on which psychological coping strategies caregivers use. Understanding how coping strategies influence BPS may help tailor specific interventions for caregivers.

Anxiety and depression are associated with coping strategies in caregivers of Alzheimer's disease patients: results from the MÁLAGA-AD study.

BACKGROUND: Caregiving for people with Alzheimer's disease (AD) is highly stressful and has significant negative consequences, such as anxiety and depression. Previous research offers conflicting findings as to whether coping strategies are associated with greater psychological distress or not. We conducted this study with a view to obtaining new data regarding the association of coping strategies and psychological distress in AD caregivers. METHODS: Eighty people with AD and their primary caregivers living in the community were recruited from local health services. Purposive recruitment was carried out to ensure that the sample was representative of people living with dementia in terms of dementia severity, gender, and care setting. We used the State-Trait Anxiety Inventory to measure anxiety, the Beck Depression Inventory to measure depression, and the Coping Strategies Inventory to measure coping strategies. RESULTS: Most caregivers reported higher anxiety and depression levels. Use of disengagement coping strategies (Wald = 3.35, p = 0.01) and higher caregiver burden (Wald = 4.83, p = 0.02) predicted anxiety on logistic regression. In turn, use of disengagement coping strategies (Wald = 12.48, p = 0.001) and higher caregiver burden (Wald = 6.91, p = 0.009) predicted depression on logistic regression. CONCLUSION: These results may be useful for designing treatment interventions that aim to modify the use of coping strategies and thus reduces caregiver anxiety and depression.

[New perspectives in the diagnosis and evolution of the consumption of tobacco: markers of susceptibility and damage]. / Nuevas perspectivas en el diagnóstico y la evolución del consumo de tabaco: marcadores de susceptibilidad y lesión.

The smoking represents a serious problem of public health. It is in and of itself high-priority to describe the genetic bases of the addiction, the susceptibility to begin the consumption, to be smoking and to develop pathologies related with the tobacco. Markers of susceptibility (I begin, consolidation, modulation and ceasing of the habit), of damage potential -chronic obstructive pulmonary disease (COPD), lung carcinoma-, and of valuation of the adverse goods of the exhibition. Dependence markers, motivation, depression, anxiety and stress are reviewed. As well as tests to value syndrome of abstinence, breathing analytic and functional parameters and quality of life.

Disengagement coping partially mediates the relationship between caregiver burden and anxiety and depression in caregivers of people with Alzheimer's disease. Results from the MÁLAGA-AD study.

BACKGROUND: Caring for people with Alzheimer's disease can be considered stressful and demand adjustment strategies. While various variables have been associated with caregiver anxiety and depression, a possible mediator role of coping strategies adopted by caregivers between caregiver burden and anxiety and depression is still unclear. We hypothesized that caregivers with clinically significant anxiety and depression were more likely to use disengagement coping strategies that non-anxious and non-depressed caregivers. METHODS: This study involved 80 Alzheimer disease patients and their primary caregivers. Patients were evaluated using the Mini Mental State Examination, the Bayer Activities of Daily Living Scale, the Global Deterioration Scale and the Neuropsychiatric Inventory. Caregivers were evaluated with the Caregiver Burden Interview, the Beck Depression Inventory, the State-Trait Anxiety Inventory and the Coping Strategies Inventory. We conducted a series of multiple linear regressions to determine the relationship between caregiver burden and caregiver anxiety and depression, and if the coping strategies mediated this relationship. RESULTS: Using more disengagement (ß=0.270, p<0.001) and less engagement coping (ß=-0.310, p<0.001) were predictors for anxiety scores. Using more disengagement (ß=0.250, p<0.001) and less engagement coping (ß=-0.261, p<0.001) were predictors for depression scores. LIMITATIONS: This study was a cross-sectional design, so the direction of causality should be strengthened by a longitudinal study. CONCLUSIONS: Most caregivers reported higher anxiety and depression levels and this was partially mediated by their dysfunctional coping strategies.

Can impairment in memory, language and executive functions predict neuropsychiatric symptoms in Alzheimer's disease (AD)? Findings from a cross-sectional study.

The authors performed a cross-sectional study to examine the relationship between specific cognitive domains and behavioral and psychological symptoms in dementia (BPSD) in 125 patients with probable AD. Cognitive deficits were evaluated with the mini mental state examination (MMSE), trail-making test (TMT), Rey auditory verbal learning test (RAVLT), and semantic fluency test (SFT) and phonemic fluency test (PhFT), whereas the neuropsychiatric inventory (NPI) was used to rate BPSD. Patients' performance in cognitive tests significantly correlated with total NPI scores (p<0.0001). After controlling for demographic and clinical characteristics, cognitive impairments in memory, executive function, and language (RAVLT, TMT, PhFT, SFT) importantly estimated total NPI scores (p<0.001, multivariate regression models). These findings suggest that the evaluation of cognitive domains may have a predictive value for the occurrence of BPSD.

Usos y actitudes de los pacientes ostomizados en España (Estudio U&A en Ostomía) / Uses and attitudes of ostomy patients in Spain (U&A Study on Ostomy)

Objetivo: conocer la práctica habitual de los profesionales expertos en ostomías en España. Explorar los usos y las actitudes del paciente ostomizado, así como su calidad de vida (CdV). Método: estudio retrospectivo nacional (U&A en Ostomía) con 148 participantes que recogieron datos clínicos sobre pacientes ostomizados. El estudio estuvo abierto al empleo de cualquier dispositivo comercial. Los profesionales registraron datos demográficos, características de ostomía y dispositivo, escala DET para evaluación de la piel periestomal (0-15), estado anímico del paciente (0-10), escala Stoma-QoL (0-100) y cambios de hábitos. También se evaluaron las características más valoradas del dispositivo, así como la atención recibida y las sugerencias de mejora por los pacientes. Resultados: se incluyeron 871 pacientes (64% hombres, 36% mujeres; 57,5% colostomía, 28,6% ileostomía y 13,9% urostomía; 68,5% definitiva, 31,5% temporal; 75% neoplasia, 13,2% enfermedad inflamatoria intestinal y 11,8% causa no filiada). En el 55,35% se realizó y respetó el marcado preoperatorio. La puntuación media DET fue 1,7±2,7 (rango 0-13), la satisfacción global con el dispositivo 8,1±1,3 (rango 1-10) y la puntuación Stoma-QoL 57,8±10,3 (rango 11,5-100). El uso de dispositivos Coloplast se asoció a menor frecuencia de fugas (p< 0,036). El 89% de los pacientes acudió regularmente a la consulta de Enfermería experta en ostomía y valoró con 9,4 (0-10) la atención recibida. Conclusiones: U&A en Ostomía es el primer estudio a gran escala que evalúa la realidad clínica del paciente con ostomía en España. Se describen los usos y las actitudes de los pacientes hacia su condición. Se confirma la importancia del marcado preoperatorio y sus repercusiones en la CdV

Objectives: to understand the daily practice of those professionals who are ostomy experts in Spain. To explore the uses and attitudes of the ostomy patients and their quality of life (QoL). Method: a national retrospective study (U&A on Ostomy), with 148 participants who collected clinical data about ostomy patients. The study was open for the use of any marketed device. Professionals collected demographical data, characteristics of ostomy and device, the DET score for evaluating the peristomal skin (0-15), the mood of the patient (0-10), the Stoma-QoL scale (0-100), and changes of habits. There was also an assessment of the most highly valued characteristics of the device, care received and improvement suggestions by patients. Results: the study included 871 patients (64% male, 36% female; 57.5% with colostomy, 28.6% with ileostomy and 13.9% with urostomy; 68.5% were permanent and 31.5% temporary; 75% for neoplasia, 13.2% for inflammatory bowel disease, and 11.8% with undetermined causes). Pre-surgical markings were conducted and observed in 55.35% of cases. The mean DET score was 1.7±2.7 (range 0-13), overall satisfaction with the device was of 8.1±1.3 (range 1-10), and the Stoma-QoL score was 57.8±10.3 (range 11.5-100).The use of Coloplast devices was associated with a lower frequency of leaks (p< 0.036). Overall, 89% of patients attended regularly their appointments with the Ostomy Nurse, and their score for the care received was 9.4 (0-10). Conclusions: U&A in Ostomy is the first large-scale study evaluating the clinical reality of the ostomy patient in Spain. It describes the uses and patients attitudes towards their condition. The importance of pre-surgical marking was confirmed, as well as its impact on QoL

Evaluación clínica de los nuevos dispositivos de tres piezas para ostomías Alterna® Confort / No disponible

OBJETIVO: evaluar la flexibilidad y seguridad de los nuevos dispositivos para ostomías de la gama Alterna® Confort tres piezas, así como el grado de satisfacción global de los pacientes con el nuevo dispositivo. MÉTODO: estudio observacional, abierto y multicéntrico en condiciones asistenciales reales para estudiar la nueva y mejorada gama de productos Alterna® Confort tres piezas con enganche mecánico clic. Consta de dos visitas donde profesional y paciente cumplimentan un cuestionario basal el día de la inclusión y otro final después de una semana de prueba del producto en estudio.RESULTADOS: datos recogidos de 283 pacientes. Un 36,5% colostomizados, 47,5% ileostomizados y 16% urostomizados. Relativo a las mejoras del disco, un 87,2% opina que la adhesividad es muy buena o buena, un 85% está muy satisfecho o satisfecho con la flexibilidad, un 83,9% dice estar muy satisfecho o satisfecho respecto a la seguridad. Un 87,3% están muy satisfechos o satisfechos con el nuevo cierre clic. Los pacientes valoran de manera global el dispositivo con una nota de 8,32 puntos sobre 10; además el nuevo disco mejora la piel en aquellos casos donde hay problemas periestomales, existiendo para ambas premisas una diferencia estadísticamente significativa frente a la valoración del dispositivo anterior. CONCLUSIONES: solo tras una semana de estudio, los dispositivos Alterna® Confort tres piezas demuestran un alto grado de flexibilidad y seguridad en pacientes ostomizados, así como una valoración muy positiva por parte de los profesionales sanitarios en cuanto a su adaptabilidad a pliegues y zonas difíciles, por lo que se confirma que este nuevo dispositivo es una buena alternativa terapéutica para aquellos ostomizados que precisen de un dispositivo múltiple

OBJECTIVE: to assess the flexibility and safety of the new improved devices in the three-piece Alterna® Confort range, as well as the level of overall satisfaction of patients with the new device. METHOD: an observational, open and multicenter study in a real patient care scenario, in order to study the new and improved range of three-piece Alterna® Confort devices with mechanical click fastening. The study involved two visits, where the professional and the patient completed a basal questionnaire on the day of inclusion, and a final one after one week of trying the product studied. Outcomes: data were collected from 283 patients: 36.5% with colostomy, 47.5% with ileostomy, and 16% with urostomy. Regarding the improvements in the flange, 87.2% of patients believed that adhesion was very good or good, 85% of patients were very satisfied or satisfied with its flexibility, and 83.9% stated that they were very satisfied or satisfied in terms of its safety. An 87.3% of patients were very satisfied or satisfied with the new click fastening. Patients evaluated the device in general with an 8.32 score out of 10; besides, the new flange improved the skin in cases of peristomal problems, and there was a statistically significant difference for both premises compared with the value assigned to the former device. CONCLUSIONS: after one single week of study, the three-piece Alterna® Confort devices demonstrated a high level of flexibility and safety in ostomized patients, as well as a very positive evaluation by healthcare professionals regarding its adaptability to folds and difficult areas. Therefore, it was confirmed that this new device is a good therapeutical alternative for those patients who require a multiple device

Calidad de atención y relaciones familiares en la asistencia a los controles del servicio de consulta externa / Quality of care and family relations in assisting controls outpatient service

Para recolectar la información se realizaron 100 visitas domiciliarias; se aplicaron 2 instrumentos para c/u, (calidad de atención y apgar familiar); para la tabulación, se utilizaron tablas de contingencia; la información se presento a razón de disparidad, determinando la fuerza de asociación entre los factores de riesgo estudiados, de acuerdo con las hipótesis planteadas. Se pudo determinar que la insatisfacción de los usuarios para la calidad de los servicios ofertados por el H.M.R.S. es un factor predisponente para inasistencia a los controles por consulta externa. Se identificó que no hay evidencia estadísticamente, que el presentar insatisfacción, representa un factor asociado para la inasistencia a tratamiento por consulta externa. Para la funcionalidad familiar, se demostró que el 96.7% de cada 100 casos presentan disfuncionalidad familiar, y un 89.7% de cada 100 controles también presentan disfunción familiar, demostrando que esta variable es una característica principal de los pacientes mentales en general. Para concluir, la calidad de atención como la funcionalidad familiar, representan un factor predisponente a presentar inasistencia, pero no son la principal causa por la cual los usuarios del Hospital Mental Rudesindo Soto ( HMRS) no acuden a los controles programados por consulta externa de acuerdo a lo investigado.

For the harvesting of the information 100 domiciliary visits were realised; 2 instruments for c/u were applied, (quality of attention and to apgar familiar); for the tabulation, contingency tables were used, and the information I appear at the rate of disparity, determining the force of association between the studied factors of risk, in agreement with the raised hypotheses. With the investigation it was possible to be determined that the dissatisfaction of the users for the quality of the services supplied by the H.M.R.S is a factor prearranger for inasistencia to the controls by external consultation. I identify myself that there is no evidence statistically, that presenting/displaying dissatisfaction, represents a factor associated for the inasistencia treatment by external consultation. For the familiar functionality, one demonstrated that the 96,7% of each 100 cases present/display familiar disfunctionality, and 89,7% of each 100 controls also present/display familiar dysfunction, demonstrating that this variable is a basic characteristics of the mental patients generally. In order to conclude, the quality of attention like the familiar functionality, represents a factor prearranger to present/display inasistencia, but they are not the main cause by which the users of the HMRS do not go to the controls.

Nuevas perspectivas en el diagnóstico y la evolución del consumo de tabaco: marcadores de susceptibilidad y lesión / New perspectives in the diagnosis and evolution of the consumption of tobacco: markers of susceptibility and damage

El tabaquismo representa un grave problema de salud pública. Resulta por ello prioritario describir las bases genéticas de la adicción y la susceptibilidad para iniciar el consumo, ser fumador y desarrollar enfermedades relacionadas con el tabaco, así como buscar marcadores de susceptibilidad (inicio, consolidación, modulación y cese del hábito), de daño potencial ­enfermedad pulmonar obstructiva crónica (EPOC) o carcinoma pulmonar­ y de valoración de los efectos adversos de la exposición. Se repasan los marcadores de dependencia, motivación, depresión, ansiedad y estrés, además de los tests para valorar el síndrome de abstinencia, los parámetros analíticos y funcionales respiratorios y la calidad de vida

The smoking represents a serious problem of public health. It is in and of itself high-priority to describe the genetic bases of the addiction, the susceptibility to begin the consumption, to be smoking and to develop pathologies related with the tobacco. Markers of susceptibility (I begin, consolidation, modulation and ceasing of the habit), of damage potential ­chronic obstructive pulmonary disease (COPD), lung carcinoma­, and of valuation of the adverse goods of the exhibition. Dependence markers, motivation, depression, anxiety and stress are reviewed. As well as tests to value syndrome of abstinence, breathing analytic and functional parameters and quality of life