Living with the chronic kidney disease patient: evaluation of the patients’ spouses’ psychological and physical health

Aim: To investigate the psychological and physical health of spouses’ caregivers of chronic kidney disease (CKD) patients, to define the factors which increase their caregiver burden and to compare this group with a group of spouses of people without CKD. Method: The present study was conducted at the Nephrology Department of the University Hospital of Ioannina, Greece and participants were 50 spouses - caregivers of patients with CKD who received medical care in the units of the Nephrology Department. The spouses - caregivers were divided in two groups, namely, spouses of dialysis dependent patients and spouses of not dialysis dependent patients. Also, a group of 50 spouses of healthy individuals without CKD form general population was included in the study. The inclusion criteria were the same for both groups and they only differed in the CKD factor. The caregiver burden, depression, anxiety, health related quality of life, shame and important demographic factors were evaluated in spouses with the following questionnaires: PHQ-9, GAD- 2, ZBI, EQ-5D- 3L, OAS, a list of common health problems and a questionnaire with important demographic factors. Statistical analysis was conducted using the Excel, SPSS and STATA programs.Results: In the group of patients’ spouses, the mean caregiver burden score was 27.26 (SD, 18.33), which constitutes mild to moderate burden. The mean depression score was 5.64 (SD, 4.80), which constitutes mild depression. Respectively, the mean score for anxiety was 1.90 (SD, 1.64). Finally, the mean score for external shame (10.98, SD 13.39) was within that of Greek population. The mean EQ5D index (0.747, SD 0.213) and the mean score for EQ5D VAS (70.86, SD 16.97) represent good quality of life. The subgroups differentiated (P=0.031) in the self evaluation of health which was higher in spouses of not dialysis dependent patients. Depression and income were found to effect the caregiver burden (B = 2.57, P ≤ .001 and B = 2.26, P ≤ 0.001 respectively). The majority of the parameters correlated strongly with each other (p≤0.001). In the group of spouses of healthy individuals, psychological and physical health was found to be equally good. While comparing the two groups, statistically important differences were found only in the evaluation of the factors affecting negatively the spousal relationship. Also, the patients’ spouses reported higher marital satisfaction (P=0.015). Conclusions: The psychological and physical health of spouses - caregivers of CKD patients was good and not different than in spouses of individuals without CKD. The strong relationship between caregiver burden and depression and its negative relationship with monthly income were confirmed in the present study. Designing programs of psychological and financial support for the family of patients constitutes a necessary preventive dimension and a part of Primary Health Care.Στόχος: Η διερεύνηση της ψυχικής και της σωματικής υγείας των συζύγων-φροντιστών ασθενών με χρόνια νεφρική νόσο (ΧΝΝ), ο προσδιορισμός των παραγόντων που αυξάνουν την αίσθηση της επιβάρυνσης τους και η σύγκριση τους με μια ομάδα συζύγων ατόμων χωρίς ΧΝΝ. Μέθοδος: Η παρούσα έρευνα πραγματοποιήθηκε στη Νεφρολογική Κλινική του Πανεπιστημιακού Νοσοκομείου Ιωαννίνων και συμμετείχαν 50 σύζυγοι - φροντιστές ασθενών με ΧΝΝ από όλα τα ειδικά ιατρεία της Νεφρολογικής Κλινικής. Οι σύζυγοι-φροντιστές χωρίστηκαν σε δύο υποομάδες, ανάλογα με το αν οι ασθενείς βρίσκονταν εντός νεφρικής κάθαρσης. Επίσης, συμπεριλήφθηκε μια ομάδα 50 συζύγων από το γενικό πληθυσμό ατόμων χωρίς ΧΝΝ. Τα κριτήρια ένταξης ήταν ίδια για τις δύο ομάδες και διέφεραν μόνο στην ύπαρξη ΧΝΝ. Οι παράγοντες που μελετήθηκαν ήταν η επιβάρυνση φροντιστή, η κατάθλιψη, το άγχος, η σχετιζόμενη με την υγεία ποιότητα ζωής, η ντροπή και σημαντικοί δημογραφικοί παράγοντες και χρησιμοποιήθηκαν τα εξής ερωτηματολόγια: PHQ-9, GAD-2, Zarit Burden Interview, EQ-5D- 3L, OAS, λίστα συμπτωμάτων υγείας και ερωτηματολόγιο δημογραφικών. Οι στατιστικές αναλύσεις έγιναν με τα προγράμματα Excel, SPSS και STATA.Αποτελέσματα: Η μέση επιβάρυνση στο σύνολο των συζύγων-φροντιστών ήταν 27.26 (SD, 18.33), δηλαδή ήπια - μέτρια επιβάρυνση. Η μέση τιμή κατάθλιψης ήταν 5.64 (SD, 4.80), δηλαδή ήπια κατάθλιψη. Αντίστοιχα, η μέση τιμή στο άγχος ήταν 1.90 (SD, 1.64). Τέλος, τα επίπεδα συνολικής εξωτερικής ντροπής (μ.ο. 10.98, SD 13.39) βρέθηκαν εντός των μέσων τιμών για τον ελληνικό πληθυσμό. Ο μέσος όρος του EQ5D index (0.747, SD 0.213) και η μέση τιμή του σκορ στην EQ5D VAS (70.86, SD 16.97) αναδεικνύουν καλή ποιότητα ζωής. Οι δυο υπο-ομάδες διέφεραν (P=0.031) στην αυτοαξιολόγηση του επιπέδου υγείας που ήταν υψηλότερη στους συζύγους των ασθενών εκτός νεφρικής κάθαρσης. Η κατάθλιψη και το μηνιαίο εισόδημα βρέθηκαν να επηρεάζουν στατιστικά πάρα πολύ σημαντικά την αίσθηση επιβάρυνσης (B = 2.57, P ≤ .001 και B = -5.95, P ≤ 0.050 αντίστοιχα). Βρέθηκαν ισχυρές συσχετίσεις μεταξύ της πλειοψηφίας των παραγόντων (p≤0.001). Στην ομάδα των συζύγων των υγιών τα επίπεδα ψυχικής και σωματικής υγείας ήταν παρόμοια καλά. Κατά τη σύγκριση των δύο ομάδων προέκυψαν στατιστικά σημαντικές διαφορές μόνο στην αξιολόγηση των παραγόντων που επιδρούν αρνητικά στη σχέση. Επίσης, οι σύζυγοι των ασθενών ανέφεραν υψηλότερη ικανοποίηση από το γάμο τους από ότι οι σύζυγοι των υγιών (P=0.015). Συμπεράσματα: Η ψυχική και σωματική υγεία των συζύγων – φροντιστών ασθενών με ΧΝΝ είναι σε καλά επίπεδα και δε διέφερε από τους συζύγους ατόμων χωρίς ΧΝΝ. Από την παρούσα έρευνα επιβεβαιώθηκε η ισχυρή επίδραση της κατάθλιψης στην αίσθηση επιβάρυνσης και η αρνητική σχέση της με το μηνιαίο εισόδημα, ανεξαρτήτως των υπολοίπων παραγόντων. Ο σχεδιασμός προγραμμάτων ψυχολογικής υποστήριξης και οικονομικής ενίσχυσης της οικογένειας των ασθενών αποτελεί μια απαραίτητη διάσταση της πρόληψης και της Πρωτοβάθμιας Φροντίδας Υγείας

The Relationship between Burden and Depression in Spouses of Chronic Kidney Disease Patients

The purpose of the present study was to investigate the burden and depression in spouses of patients with chronic kidney disease (CKD). The interrelation between burden and depression in family caregivers has been pointed out by previous researches in several chronic diseases and researchers agree that they clearly go together and one cannot talk about one without considering the other. More particularly, in the present study, the caregiver burden, the depression, anxiety, and also health-related quality of life and demographic factors of spouses of patients with CKD were examined, using self-report questionnaires. Participants were 50 spouses of patients with CKD, 29 of whom were dialysis dependent and 21 were not dialysis dependent. Group differences were examined for participants. Results confirm the interrelation between caregiver burden and depression in spouses. The increased perceived burden related to higher levels of depression. Low levels of caregiver burden, depression, anxiety, and satisfactory quality of life were found in spouses, with no differences between them relevant to whether the patients were dialysis dependent or not. All the above parameters interrelated. Implications for the findings and future research directions are discussed

Genetic variation in the visfatin (PBEF1/NAMPT) gene and type 2 diabetes in the Greek population

a b s t r a c t Visfatin (NAMPT formerly known as PBEF1) is an adipokine that is strongly expressed in visceral fat and has caused much debate among researchers, regarding its involvement in glucose homeostasis and insulin resistance. It was initially isolated from bone marrow cells, and its involvement in inflammatory procedures such as sepsis and acute lung inflammation is now evident. Several studies have also reported an association of plasma visfatin levels with obesity. We undertook an evaluation of the involvement of the NAMPT gene in the development of type 2 diabetes (T2DM) in the Greek population. We studied 178 patients with T2DM and 177 controls that were matched for sex, age and body mass index. We genotyped three tagging SNPs selected from the HapMap II CEPH European population as reference for the Greek population. These three SNPs tag another 12 SNPs over the entire NAMPT gene with a mean r 2 of 0.92. No indications of association with disease status were found with any of the tested variants or the inferred haplotypes. Results were also negative when the quantitative traits of weight and BMI were tested. Although our study covers common variants across the NAMPT gene, the possible involvement of rare variants in T2DM etiology cannot be ruled out and will require the investigation of very large numbers of cases and controls

Lipoprotein(a) in Atherosclerotic Diseases: From Pathophysiology to Diagnosis and Treatment

Lipoprotein(a) (Lp(a)) is a low-density lipoprotein (LDL) cholesterol-like particle bound to apolipoprotein(a). Increased Lp(a) levels are an independent, heritable causal risk factor for atherosclerotic cardiovascular disease (ASCVD) as they are largely determined by variations in the Lp(a) gene (LPA) locus encoding apo(a). Lp(a) is the preferential lipoprotein carrier for oxidized phospholipids (OxPL), and its role adversely affects vascular inflammation, atherosclerotic lesions, endothelial function and thrombogenicity, which pathophysiologically leads to cardiovascular (CV) events. Despite this crucial role of Lp(a), its measurement lacks a globally unified method, and, between different laboratories, results need standardization. Standard antilipidemic therapies, such as statins, fibrates and ezetimibe, have a mediocre effect on Lp(a) levels, although it is not yet clear whether such treatments can affect CV events and prognosis. This narrative review aims to summarize knowledge regarding the mechanisms mediating the effect of Lp(a) on inflammation, atherosclerosis and thrombosis and discuss current diagnostic and therapeutic potentials

An overview of the ASKOS campaign in Cabo Verde

In the framework of the ESA-NASA Joint Aeolus Tropical Atlantic Campaign (JATAC), the ASKOS experiment was implemented during the summer and autumn of 2021 and 2022. ASKOS comprised roughly 9 weeks of measurements in the Saharan dust outflow towards the North Atlantic, with operations conducted from the Cabo Verde Islands. Through its unprecedented dataset of synergistic measurements in the region, ASKOS will allow for the calibration and validation of the aerosol/cloud product from Aeolus and the preparation of the terrain for EarthCARE cal/val activities. Moreover, ASKOS marks a turning point in our ability to study Saharan dust properties and the processes affecting its atmospheric transport, as well as the link to other components of the Earth’s system, such as the effect of dust particles on cloud formation over the Eastern Atlantic and the effect of large and giant particles on radiation. This is possible through the synergy of diverse observations acquired during the experiment, which include intense 24/7 ground-based aerosol, cloud, wind, and radiation remote sensing measurements, and UAV-based aerosol in situ measurements within the Saharan air layer, up to 5.3 km altitude, offering particle size-distributions up to 40 μm as well as sample collection for mineralogical analysis. We provide an outline of the novel measurements along with the main scientific objectives of ASKOS. The campaign data will be publicly available by September of 2023 through the EVDC portal (ESA Validation Data Center)