"With your age, what do you expect?": Ageism and healthcare of older adults in Spain.

INTRODUCTION: Ageism could influence the relationship between older patients' meeting needs and healthcare professionals' answers. AIMS: To highlight the experience of older adults with healthcare systems, how they perceive ageism from their healthcare providers, and to explore the relationship between perceived ageism and self-perception of aging (SPA). METHODS: We conducted an exploratory qualitative study. The participants were 14 women over 65 who lived alone in their homes. RESULTS: Professional responses ignored the expression of preferences of the older patients and excluded them from decision-making processes. These answers influenced older patients' use of health services. Moreover, the negative aspects predominated in a SPA influenced by the internalization of stereotypes and a relationship weighed down by ageist behaviors on the part of health professionals. CONCLUSION: Explicit situations of ageism influence an imbalance in power relations between older patients and healthcare professionals, a misuse of health services, and a negative SPA.

Moderate Beer Consumption Modifies Tumoral Growth Parameters and Pyrrolidone Carboxypeptidase Type-I and Type-II Specific Activities in the Hypothalamus-Pituitary-Mammary Gland Axis in an Animal Model of Breast Cancer.

AIMS: To determine the effect of moderate alcoholic and nonalcoholic beer consumption on tumoral growth parameters, the histopathology, pyrrolidone carboxypeptidase type I (Pcp I), and type II (Pcp II) specific activities in the hypothalamus-pituitary-mammary gland axis, and the circulating levels of estradiol (E2) and progesterone (P4) in rats with N-methyl-N-nitrosourea (NMU) induced mammary tumors. MATERIAL AND METHODS: Food and drink intake, weight gain and tumor growth parameters were collected. The malignant phenotype of the tumor was performed using the Scarff-Bloom-Richardson grading method. Pcp specific activities were fluorometrically analyzed using pyroglutamyl-ß-naphthylamide as substrate. Circulating steroid hormones were determined. RESULTS: Differences were found in tumoral parameters, depending on the drink. Animals that were given alcohol-containing beer (A/C) beer to drink showed the lowest values of hypothalamic Pcp I, in association with the lowest levels of circulating E2. The significant decrease in Pcp I activity in all NMU-treated groups suggest a clear role of the Pcp I in the tumoral process, and A/C beer interferes with it. DISCUSSION: Moderate consumption of alcoholic beer would have beneficial effects against mammary tumors through the modification of the endocrine status mediated by GnRH due to changes on Pcp I and II activities at different levels.

A deep learning model for Alzheimer's disease diagnosis based on patient clinical records.

BACKGROUND: Dementia, with Alzheimer's disease (AD) being the most common type of this neurodegenerative disease, is an under-diagnosed health problem in older people. The creation of classification models based on AD risk factors using Deep Learning is a promising tool to minimize the impact of under-diagnosis. OBJECTIVE: To develop a Deep Learning model that uses clinical data from patients with dementia to classify whether they have AD. METHODS: A Deep Learning model to identify AD in clinical records is proposed. In addition, several rebalancing methods have been used to preprocess the dataset and several studies have been carried out to tune up the model. RESULTS: Model has been tested against other well-established machine learning techniques, having better results than these in terms of AUC with alpha less than 0.05. CONCLUSIONS: The developed Neural Network Model has a good performance and can be an accurate assisting tool for AD diagnosis.

Impact of hyponatremia in patients hospitalized in Internal Medicine units: Hyponatremia in Internal Medicine units.

The aim of this study was to analyze the impact and the clinical and evolutionary characteristics of hypotonic hyponatremia in patients hospitalized in Internal Medicine units. Prospective multicenter observational study of patients with hypotonic hyponatremia (<135 mmol/L) in 5 hospitals in southern Spain. Patients were included according to point prevalence studies carried out every 2 weeks between March 2015 and October 2017, by assessing demographic, clinical, analytical, and management data; each patient was subsequently followed up for 12 months, during which time mortality and readmissions were assessed. A total of 501 patients were included (51.9% women, mean age = 71.3 ±â€…14.24 years), resulting in an overall prevalence of hyponatremia of 8.3%. The mean comorbidities rate was 4.50 ±â€…2.41, the most frequent diagnoses being heart failure (115) (23%), respiratory infections (65) (13%), and oncological pathologies (42) (6.4%). Of the total number of hyponatremia cases, 180 (35.9%) were hypervolemic, 164 (32.7%) hypovolemic, and 157 (31.3%) were euvolemic. A total of 87.4% did not receive additional diagnostic tests to establish the origin of the condition and 30% did not receive any treatment. Hospital mortality was 15.6% and the mean length of stay was 14.7 days. Euvolemic and admission hyponatremia versus hyponatremia developed during admission were significantly associated with lower mortality rates (P = .037). Mortality at 1 year and readmissions were high (31% and 53% of patients, respectively). Hyponatremia was common in Internal Medicine areas, with hypervolemic hyponatremia being the most frequent type. The mortality rate was high during admission and at follow-up; yet there is a margin for improvement in the clinical management of this condition.

Effectiveness of Multicomponent Interventions and Physical Activity in the Workplace to Reduce Obesity: A Systematic Review and Meta-Analysis.

BACKGROUND: Overweight and obesity are public health problems that affects the workplace. This paper aims to analyse the effectiveness of workplace health promotion interventions in reducing Body Mass Index (BMI); Methods: Following PRISMA guidelines, a systematic review was conducted using PubMed, MEDLINE, and SCOPUS databases. The inverse variance statistical method was used for the meta-analysis with a random effects analysis model and standardised means. The results have been represented by Forest Plots and Funnel Plots graphs; Results: The multicomponent approach had the best results for reducing BMI (-0.14 [-0.24, -0.03], 95% CI; p = 0.009) compared to performing physical activity only (-0.09 [-0.39, 0.21], 95% CI; p = 0.56). However, both methods resulted in positive changes in reducing BMI in the general analysis (-0.12 [-0.22, -0.02], 95% CI; p = 0.01). The GRADE evaluation showed low certainty due to the high heterogeneity between interventions (I2 = 59% for overall analysis). CONCLUSIONS: The multicomponent approach could be an effective intervention to reduce obesity in the working population. However, workplace health promotion programs must be standardised to conduct quality analyses and highlight their importance to workers' well-being.

Aging, depression and dementia: The inflammatory process.

Population aging that we are currently witnessing has led to an increase in chronic age-related diseases, with dementia and depression being highlighted. Several studies establish a relationship between dementia and depression, although without defining the mechanism that links them. Some studies establish depression as a prodrome of dementia, while others consider it a risk factor for dementia. One of the events that is common between dementia and depression is the inflammatory process. In depression, an increase in inflammatory cytokines has been described, which would justify the serotonergic, noradrenergic and dopaminergic dysfunction of depression. This increase entails altering the activity of the hypothalamic-pituitary-adrenal (HPA) axis, thus linking chronic stress to depression, and the consequent weakening of the blood-brain barrier (BBB), facilitating the passage of pro-inflammatory factors. In this line, recent studies suggest that inflammation could direct the development of the pathogenesis of dementia, particularly Alzheimer's disease (AD), once the pathology has begun. In addition, sustained exposure to pro-inflammatory cytokines characteristic of aging could alter the microglial function and the expression of enzymes responsible for amyloid peptide metabolism, aggravating the pathological process. In view of the involvement of the inflammatory process in both conditions, it is necessary to investigate the events which both conditions share, such as the inflammatory process, to know the involvement of the inflammatory process in both dementia and depression, possible relationship of these 2 conditions, and consequently, to establish the clinical approach to both conditions.

Care and Rearing of Institutionalized Girls in Arequipa, Peru: An Ethnographic Approach.

INTRODUCTION: Institutional care for children is a global phenomenon. Despite its advantages, common threats have been described. In Peru, more than 70% of institutionalized children/adolescents have living parents who cannot take care of them. The study aims to understand the care/rearing of institutionalized girls in Arequipa, Peru. METHODOLOGY: Ethnographic design, with a sample integrated by 27 institutionalized girls. Data collected based on participant observation and semi-structured interviews. The analysis followed the Method of Constant Comparisons. RESULTS: Five main themes were found: (a) The little house (foster home) is better than my house; (b) They take care of me-even when I am sick-; (c) But . . .; (d) What I have lived is what I am; (e) Happiness fits in this little house. DISCUSSION: An ethnography of care/rearing practices could be helpful for a better understanding of the dimensions of the life of institutionalized girls living in developing countries.

Conditions for Feasibility of a Multicomponent Intervention to Reduce Social Isolation and Loneliness in Noninstitutionalized Older Adults.

AIMS: To identify the factors conditioning the feasibility of an intervention to reduce social isolation and loneliness in noninstitutionalized older adults from the perspective of the intervention agents. DESIGN: A Dimensional Grounded Theory study conducted from December 2019 to January 2020. METHODS: Twelve participants were recruited from an experimental study developed in a health district of a southern Spanish city. Data were collected through focus group meetings, individual interviews, biograms, anecdote notebooks, and the field diaries of two participants not included in the other techniques. Transcripts were analyzed using thematic analysis. FINDINGS: Findings were divided into three themes: (a) the elderly between the walls of loneliness, economic difficulties, losses, and the past; (b) intervention agents/volunteers between the walls of inexperience in the management of psychological/emotional processes, lack of moral authority, and difficulty in planning results adapted to the (elderly) person; and (c) intervention between the walls of (interest in) company and assistance at home, lack of involvement ("waiting for you to save them"), and withdrawal/"abandonment". CONCLUSION: A profile of the specialized intervention agent, professionalized (or at least a mentored agent), with both technical and relational competencies; a clear understanding of the purposes of the intervention (empowerment, as opposed to having company or being helped with household chores) and the commitment to active participation by the elder; or adequate management of the completion of the intervention (flexibility, attachment management) are some of the main factors contributing to the feasibility of these approaches. IMPACT: The findings have potential implications in the field of primary healthcare because primary and community healthcare services can implement corrections to the proposed intervention and ensure its effectiveness under feasible conditions. The nurse is shown as the most appropriate profile to conduct this intervention, although more research is needed to analyze the feasibility of this type of intervention in the daily practice of community nurses.

Lifestyle, Type of Work, and Temporary Disability: An Incidence Study of the Working Population.

The objective of the study was to identify lifestyles associated with loss of health among workers. A retrospective longitudinal incidence study was carried out over a three-year period (2015, 2016, and 2017) among the working population. A total of 240 workers were analysed using information from occupational health assessments. The outcome variable was loss of health due to common illness or workplace injury, quantified by the number of days each episode lasted. Predictor variables were age, gender, type of work, tobacco use, alcohol consumption, physical activity (IPAQ), and adherence to the Mediterranean diet (AMD). An adjusted multiple linear regression was performed, determining the goodness of fit of the final model using the coefficient of determination adjusted r2. During the study, 104 men (58.8%) and 25 women (39.7%) suffered an episode of illness or workplace injury (p < 0.05). The overall incidence was 17.9% people/year 95% CI [15, 21.3]. 4.6% of the workers were sedentary or engaged in light physical activity, and 59.2% maintained an adequate AMD. Workers who engaged in high levels of physical activity had an average of 36.3 days of temporary disability compared to 64.4 days for workers with low-moderate levels of physical activity (p < 0.01).

Relationships between work, lifestyles, and obesity: cross-sectional study based on the 2017 Spanish National Health Survey.

AIMS: Overweight and obesity are affected by factors such as dietary transgressions and lack of exercise, as well as less obvious factors such as shift work and sedentary working. (i) To explore the associations between overweight and obesity (O/O) with working conditions such as type of job position, and work shifts; (ii) to know the associations between O/O with lifestyles (physical activity, eating habits, and tobacco and alcohol consumption). METHODS AND RESULTS: A cross-sectional, population-based design was used based on the Spanish National Health Survey. The final sample consisted of 9097 workers aged between 18 and 65. The influence of the explanatory variables on the outcome variable (body mass index) was examined using logistic regression. The prevalence of O/O increased by 4% for every additional year of age (P < 0.001) and was 3.1 times more frequent among men (P < 0.001). It also was 20% higher in night work or rotating shifts (P < 0.01), and 14.9% lower in sedentary job positions (P < 0.05). Low consumption of the following foods was significantly associated with a reduction in O/O: meat (16.2%), fish (75.4%), cured meats (35.1%), dairy products (33.3%), and snacks (47.1%). CONCLUSION: Age, men, engaging in moderate or low levels of physical activity, being an ex-smoker, working during the night or rotating shifts, holding a non-sedentary job position, having a low to moderate consumption of pasta, potatoes, and rice, a moderate consumption of bread and cereals, as well as dairy products, vegetables, sugary foods, and fast food, have been significantly associated with a higher prevalence of O/O. No relationships were identified between the consumption of alcohol, fruit, eggs, pulses, and sugary soft drinks.

Emotional Universe of Nurse Case Managers Regarding Care for Elderly at Risk in Spain: A Hermeneutical Study.

The role of nurse case managers (NCM) involves a rarely visible emotional labor, even more when their role focuses on the care of elders at risk (EAR). Motivated by the lack of qualitative research on the emotional universe of NCM, this study explores the emotional universe (EU) of NCM regarding the care they provide to EAR in primary health care as well as the reasons that generate these emotions. An interpretative-phenomenological approach was implemented in southern Spain, with a purposive sampling that included nurses playing the NCM role for at least three years. Data collection was conducted in two periods (between September 2019 and July 2022). The primary collection tool was the semi-structured individual interview, with starting categories based on Bisquerra's EU taxonomy. The analysis followed Ricoeur's considerations, using the Nvivo software. In the NCM's EU, the recognition of the social phenomena stands out, with an open feeling of empathy regarding the desire of the EAR to continue living at home. However, there was also helplessness, resignation, disappointment, and frustration when EAR rejected their proposals. Furthermore, the system's limitations aroused compassion in the NCM and made them go beyond the limits of their role. This EU requires that their role be valued more, and higher responsiveness must be enforced to improve EAR care.

Spanish adaptation and validation of the Pain Assessment Scale in Advanced Dementia (PAINAD) in patients with dementia and impaired verbal communication: cross-sectional study.

OBJECTIVES: The aim of this study was to adapt and validate the Pain Assessment in Advanced Dementia (PAINAD) scale in Spanish. DESIGN: Cross-sectional observational study. SETTING: Two health districts of Andalusian provinces, located in the south of Spain, through the Andalusian network of Primary Healthcare centres and four institutions dedicated to the care of patients with dementia. PARTICIPANTS: A total of 100 older people, with a medical diagnosis of dementia and a score on the Global Deterioration Scale between 5 and 7 were assessed using the PAINAD scale. PRIMARY AND SECONDARY OUTCOME MEASURES: Psychometric properties including content validity, construct validity and reliability of the scale have been tested. RESULTS: The overall Item Content Validity Index was excellent (0.95). Regarding construct validity, it was confirmed that a lower use of analgesics implied a lower score on the PAINAD scale (p<0.05). The internal consistency of the scale was 0.76 and it increases to 0.81 if we remove the breathing item. Furthermore, the intraclass correlation coefficient (ICC) used to assess interobserver reliability was 0.94, whereas the ICC used to assess temporary stability was 0.55. CONCLUSIONS: The Spanish version of the PAINAD scale is a valid tool to assess pain in patients with dementia and inability to communicate verbally.

Putative Involvement of Endocrine Disruptors in the Alzheimer's Disease Via the Insulin-Regulated Aminopeptidase/GLUT4 Pathway.

It has been well established that there is a connection between type II diabetes (DMTII) and Alzheimer's disease (AD). In fact, the increase in AD incidence may be an emerging complication of DMTII. Both pathologies are related to estradiol (E2) exposure; on the one hand, estrogen receptors (ER) are emerging as important modulators of glucose homeostasis through ß-pancreatic cell function; on the other hand, brain bioenergetic and cognitive deficits have been related to the down regulation of brain ERs, contributing to women ageing and AD susceptibility, both related to the reduction in estradiol levels and the deficits in brain metabolism. Here we discuss that environmental contaminants with estrogenic capacity such as bisphenol A (BPA) could develop pharmacological effects similar to those of E2, which could affect ß-pancreatic cell function by increasing the biosynthesis of glucose-induced insulin after extranuclear ER binding. BPA-induced hyperinsulinemia would promote the translocation of glucose transporter 4 (GLUT4), which is located next to insulin-regulated aminopeptidase (IRAP) in intracellular vesicles. In insulin-responsive tissues, IRAP and GLUT 4 are routed together to the cell surface after insulin stimulation. IRAP is also the angiotensin IV (AngIV) receptor, and AngIV associates the brain renin-angiotensin system (bRAS) with AD, since AngIV is related to learning, memory, emotional responses, and processing of sensory information not only through its inhibitory effect on IRAP but also through the stimulation of glucose uptake by increasing the presence of IRAP/GLUT4 at the cell surface. Thus, the IRAP/GLUT4 pathway is an emerging target for pharmacological intervention against AD.

Correlation between Biomarkers of Pain in Saliva and PAINAD Scale in Elderly People with Cognitive Impairment and Inability to Communicate.

The pain assessment in advanced dementia (PAINAD) appears to be a clinically useful tool. However, the salivary determination of tumor necrosis factor receptor type II (sTNF-RII) and secretory IgA (sIgA) as pain biomarkers is still incipient. The aim was to correlate the PAINAD score with sTNF-RII and sIgA biomarker levels in the saliva of patients with advanced dementia. In this regard, a cross-sectional study was conducted. The sample consisted of 75 elderly patients with a clinical diagnosis of dementia and a global deterioration scale (GDS) score of 5 to 7. The PAINAD scale was determined by a previously trained professional and the collection of salivary samples was performed using the passive secretion method. Human sTNF-RII and sIgA using ELISA kits. The results showed a correlation between the PAINAD scale (numeric, binary, and recoded) and sTNF-RII and sIgA (p < 0.001). No association between the sociodemographic and clinical variables and the PAINAD scale was found (p > 0.05). Between 97.3% and 96.2% of patients with pain on the PAINAD scale also showed pain based on the sTNF-RII levels; in all of them, sIgA levels did not fit the logistic models. Therefore, the correlation highlights the usefulness of this scale and confirms the usefulness of sTNF-RII and sIgA as biomarkers of pain.

Depression as a Risk Factor for Dementia and Alzheimer's Disease.

Preventing the onset of dementia and Alzheimer's disease (AD), improving the diagnosis, and slowing the progression of these diseases remain a challenge. The aim of this study was to elucidate the association between depression and dementia/AD and to identify possible relationships between these diseases and different sociodemographic and clinical features. In this regard, a case-control study was conducted in Spain in 2018-2019. The definition of a case was: A person ≥ 65 years old with dementia and/or AD and a score of 5-7 on the Global Deterioration Scale (GDS). The sample consisted of 125 controls; among the cases, 96 had dementia and 74 had AD. The predictor variables were depression, dyslipidemia, type 2 diabetes mellitus, and hypertension. The results showed that depression, diabetes mellitus, and older age were associated with an increased likelihood of developing AD, with an Odds Ratio (OR) of 12.9 (95% confidence interval (CI): 4.3-39.9), 2.8 (95% CI: 1.1-7.1) and 1.15 (95% CI: 1.1-1.2), respectively. Those subjects with treated dyslipidemia were less likely to develop AD (OR 0.47, 95% CI: 0.22-1.1). Therefore, depression and diabetes mellitus increase the risk of dementia, whereas treated dyslipidemia has been shown to reduce this risk.

Emotional universe of intensive care unit nurses from Spain and the United Kingdom: A hermeneutic approach.

AIM: To acquire an understanding of the emotional universe of intensive care unit nurses, working in Spain and the United Kingdom. METHODOLOGY: The study used a hermeneutic study design and was set in an academic environment. Participants included nurses with clinical experience in intensive care units. Data were collected from seven in-depth interviews, four in Spanish and three in English. The analysis followed Ricoeur's Theory of Interpretation. The affective taxonomy Universe of Emotions, served to establish starting categories in it. FINDINGS: Six themes were identified: 1) Critical patient care, critical context; 2) Intensive care… for whom?; 3) Nursing a dying patient; 4) In the company of others; 5) But… is it worth it? and 6) Emotional labour is crucial. These all describe different, multifaceted nurses' affective journeys, through categories such as: So little time-so much to do, Relatives, Young death vs. elderly death, Poorly-valued work and I'm in the profession I want to be. CONCLUSION: The sociocultural context shared by the Spanish and English nurses working in intensive care units generates a complex emotional universe, with opposing affective experiences, such as those related to fear, anxiety, sadness, anger, shame, love, surprise and happiness.

Correlation between biomarkers of pain in saliva and PAINAD scale in elderly people with cognitive impairment and inability to communicate: descriptive study protocol.

INTRODUCTION: Pain is an under-diagnosed problem in elderly people, especially in those with cognitive impairment who are unable to verbalise their pain. Although the Pain assessment in advanced dementia scale (PAINAD) scale is a tool recognised for its clinical interest in this type of patients, its correlation with the saliva biomarkers reinforced its utility. The aim of this research will be to correlate the scores of this scale with the levels of biomarkers of pain found in saliva samples of patients with cognitive impairment and inability to communicate. METHODS AND ANALYSIS: This is an observational study. The level of pain will be evaluated using the PAINAD scale. Moreover, pain biomarkers, in particular secretory IgA and soluble tumour necrosis factor receptor type II, will be determined in saliva. Both assessments will be conducted in 75 patients aged over 65 years with advanced cognitive impairment and inability to communicate. The PAINAD scores will be correlated with the levels of these biomarkers of pain. A control group consisting of 75 healthy subjects aged over 65 years will be included in the study. Moreover, sociodemographic variables and variables related to pain, dementia and other clinical conditions will be recorded. The analysis will be performed with the statistical package SPSS V.22 and the software R. ETHICS AND DISSEMINATION: The study has been reviewed and approved by the Andalusian Human Research Ethics Committee. In addition, this study has been financed by the Junta de Andalucía through a regional health research fund (Research code: PI-0357-2017). The results will be actively disseminated trough a high-impact journal in our study area, conference presentations and social media.

Undergraduate Nursing Students' Attitudes, Knowledge, and Skills Related to Children's Environmental Health.

BACKGROUND: Nurses are in a privileged position to detect environmental risks among children. The objective was to determine attitudes, knowledge, and skills related to children's environmental health in undergraduate nursing students. METHOD: A cross-sectional study was designed in eight universities (n = 2,462) from September 2017 to June 2018. Descriptive values and multivariate analysis of variance were calculated using three questionnaires. RESULTS: Of the total 2,462 students in the sample, 2,155 had a good attitude regarding addressing children's environmental health problems, 501 had good knowledge, and 1,162 had good skills. Students who had attended a session on sustainability more than 3 months prior had a better attitude (9.93%), knowledge (11.16%), and skills (3.82%). Second course students and men had better environmental competency (p < .001). CONCLUSION: Undergraduate nursing students have good attitudes; however, they lack knowledge and skills. There is a need to include children's environmental health in nursing curricula. [J Nurs Educ. 2019;58(7):401-408.].