Health Related Quality of Life in Coronary Patients.

The increase observed in the survival of patients with ischemic cardiopathy, together with the effect of the disease on the social, professional, and family life of those suffering from it, have led researchers to consider that the traditional ways of measuring morbidity and mortality are not adequate for assessing the potential benefits of health care interventions. For this reason, there is common agreement on the need to use an indicator of subjective assessment of health, and of health related quality of life (HRQL), as a complementary criterion for monitoring the results of medical interventions in these patients. The term "quality of life" (QoL) or health related quality of life (HRQL) came into use during the 1970s as a multidimensional concept reflecting the overall subjective condition of the physical and mental welfare of the individual, which is a consequence not only of the disease but also of the family and social conditions forming the patient’s environment. The assessment of these patients’ HRQL has been tackled by several authors using both disease-specific and generic instruments such as the Nottingham Health Profile, the Sickness Impact Profile, the SF-36 or the SF-12 health questionnaire. Both types of instrument have advantages and disadvantages, and they may provide additional information since they quantify the patient’s overall health. Using different multidimensional measures, poorer HRQL has been observed in patients with Acute Myocardial Infarction (AMI) and angina pectoris than in other populations, and these differences have been related to low social class, female sex, the presence of mental disorders and the severity of the clinical condition. Measuring changes in the HRQL of coronary patients is also important as a way of assessing interventions and predicting needs for social care, because it has been shown that the focus of attention in the immediate period following a cardiac attack is generally the physical functioning, but following discharge from hospital and in the longer term, general health, vitality, social and emotional functions could be at least as important. In this chapter, we aim to provide an overview of the concept of HRQL and the usefulness of this measure from the perspective of a coronary patient. Likewise, we intend to review the main instruments used to assess HRQL and we analyse the factors that have been seen to affect the quality of life of these patients

El Deterioro Cognitivo: un Factor a Tener en Cuenta en la Evaluación e Intervención de Pacientes con Dolor Crónico.

El dolor crónico constituye un grave problema de salud pública, dada su elevada prevalencia y las consecuencias personales y sociales que produce. La presencia de dolor crónico se ha asociado con un deterioro cognitivo leve, sobre todo en los pacientes afectados por fibromialgia o dolor neuropático, habiéndose relacionado esto con la concurrencia en estos pacientes, de otros procesos, como la ansiedad, la depresión, los trastornos del sueño y el consumo de ciertos fármacos, todos ellos habituales en los pacientes con dolor crónico. En esta revisión, hacemos un repaso del complejo proceso de la cognición así como de los distintos elementos que lo integran. Asimismo, revisamos los mecanismos mediante los que el dolor crónico puede afectar el proceso de la cognición y el modo en el que este puede verse afectado por la concurrencia de otras patologías, o por los fármacos habitualmente utilizados para su tratamiento. Finalmente se plantea la necesidad de evaluar el deterioro cognitivo en los pacientes con dolor crónico, con el objetivo de evitar la progresión de la enfermedad cognitiva hacia un cuadro de deterioro más grave, así como de contribuir a mejorar la respuesta terapéutica al dolor y el aumento de la calidad de vida de los pacientes.Chronic pain constitutes a serious public health problem due to its high prevalence and the social and personal consequences. The presence of chronic pain has been associated with mild cognitive impairment, especially in patients with fibromyalgia and neuropathic pain, and it has been also related with other disease like anxiety, depression, sleep disorders and the use of certain drugs, usually taken on these patients. This document revises the complex issue of the cognitive process and the several elements that comprise it. Likewise, we review the different mechanisms by which pain affect cognitive process and the way it could be affected by other disease, or by drugs commonly used on treatment. It is necessary to assess mild cognitive impairment on chronic pain patients, in order to prevent the develop and the evolution of cognitive disease to a more severe impairment, as well as help to improve therapeutic response to pain and increase health related quality of life of patients

Sleep Characteristics in Diabetic Patients Depending on the Occurrence of Neuropathic Pain and Related Factors

This study aims to compare the sleep characteristics (structure and quality) in patients with type-2 diabetes mellitus with and without diabetic neuropathic pain (DNP), and to investigate the relationship of sensory phenotypes, anxiety, and depression with sleep quality in DNP patients. A cross-sectional study was performed in patients with type-2 diabetes mellitus and neuropathy. Patients were classified into two groups-with or without neuropathic pain-according to the "Douleur Neuropathique-4 (DN4)" scale. Sleep characteristics and quality (Medical Outcomes Study-MOS-sleep), pain phenotype (Neuropathic Pain Symptom Inventory-NPSI), mood status (Hospital Anxiety and Depression scale-HADS), pain intensity (Visual Analogue Scale-VAS), and quality of life (SF-12v2) were measured. The sample included 130 patients (65 with DNP). The mean scores in all the dimensions of the MOS-sleep scale were higher (more disturbances) in the DNP patients. Higher scores in anxiety or depression, greater intensity of pain or a higher score in the paroxysmal pain phenotype were associated with lower sleep quality in DNP patients. A shorter duration of the diabetes and lower levels of glycated hemoglobin were also associated with lower sleep quality. The results show the relationship between DNP and sleep quality, and the importance of assessing sensory phenotypes and mental comorbidities in these patients. Taking these factors into consideration, to adopt a multimodal approach is necessary to achieve better clinical results

A nationwide study of chronic pain prevalence in the general Spanish population, identifying clinical subgroups through cluster analysis.

Objective. This study aims to assess the prevalence of chronic pain, its characteristics, and its impact on the general Spanish population. Also, to establish chronic pain patient subgroups according to the characteristics of pain and to identify variables specifically associated with each subgroup. Design. Telephone-based, cross-sectional nationwide study. Subjects. A sample of 1,957 individuals representative of the Spanish population. Methods. Data were collected through telephone interviews. A subject was considered to have chronic pain if they had suffered pain (at least 4 days a week) during the last 3 months. The subjects were divided into two subgroups through a cluster analysis, and a regression model was established to determine the variables most specifically associated with these subgroups. Results. The prevalence of chronic pain was 16.6% (95% confidence interval: 14.9–18.3) and among these subjects, more than 50% referred to limitations in their daily activities, 30% felt sad and/or anxious, and 47.2% indicated that their pain was affecting their family life. Two subgroups of subjects with pain were identified: 1) characterized by generalized pain in more than one location and of a long evolution (150 months); and 2) characterized by pain localized to only one site with a shorter duration (100 months). Individuals who felt anxious because of their pain and those who considered that their pain was affecting their family were more likely to belong to group 1. Conclusions. Pain affects an important proportion of the Spanish adult population and that it has a strong personal impact. Two pain groups were clearly distinguished by their clinical characteristics

Aplicación de método de enseñanza basada en el problema (EBP) en el aprendizaje de la asignatura Salud Pública en Fisioterapia.

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Challenges and strategies in developing research in nursing

Introducción: Como resultado del perfeccionamiento continuo del Sistema Nacional de Educación, se ha producido en nuestro país una profunda re-conceptualización de los procesos de enseñanza-aprendizaje, teniendo un particular impacto el ámbito investigativo. En este contexto, el presente estudio, persigue evaluar y analizar tanto los conocimientos básicos investigativos por parte de los estudiantes de enfermería, como las destrezas y capacidades de análisis, solución de problemas, argumentación y comparación de experiencias que adquieren los estudiantes al finalizar el estudio. Metodología: El estudio adoptó una metodología de investigación de carácter exploratorio y descriptivo seguido por una estrategia de campo, dirigida a la recolección de información primaria. Las técnicas e instrumentos aplicados fueron de orden cuantitativo (cuestionario pre-test y post-test entre otros) y cualitativo (grupos de discusiones y audio-video grabaciones). Resultados: El procesamiento, y posterior análisis de los resultados obtenidos, permitió identificar los conocimientos previos y posteriores, la satisfacción y la motivación por parte del alumnado, así como un conjunto de factores que inciden, afectan, limitan e influyen en la práctica del proceso evaluativo de los aprendizajes. Conclusiones: los estudiantes valoran el conocimiento de una metodología de investigación y son conscientes de su importancia tanto en la elaboración de un proyecto fin de grado como para su futuro laboral. Sin embargo, no se involucran, en el tema propuesto y si lo hacen, mayoritariamente es por necesidad. Por ello, a pesar de los programas de formación en investigación, los estudiantes se muestran poco dinámicos e incluso reacios a desarrollar cualquier tipo de proyecto investigativo que no esté relacionado con el proyecto fin de grado, materia obligatoria dentro del nuevo plan de estudio

Darunavir/cobicistat maintains the effectiveness of darunavir/ritonavir in HIV-infected patients under mono or dual therapy

[Abstract] OBJECTIVES: Darunavir/ritonavir (DRV/r) in mono or dual therapy has proven efficacy in selected patients. The aim of this study was to evaluate the efficacy of switching from DRV/r to DRV/cobicistat (DRV/c) in patients under mono or dual therapy. METHODS: This was a prospective multicenter cohort study of patients using DRV/r under mono or dual therapy plus lamivudine who changed to DRV/c maintaining the previous regimen. All patients had a controlled HIV viral load (<50 copies/ml) when switched and were examined every 12 weeks. The primary end-point was the percentage of participants without virological failure (VF) at week 48 in the intent-to-treat analysis. The CD4 cell count and concentrations of cholesterol, triglyceride, and creatinine were measured from baseline to week 48. RESULTS: A total of 162 patients were included: 68.5% were men, and their mean age was 46 ± 12 years. Seventy (43.2%) patients were treated with DRV/r monotherapy, and 92 (56.8%) were treated with DRV/r plus lamivudine. The efficacy at week 48 was 95.1% (95% CI: 90.6%-97.5%) in the intent-to-treat analysis and 98.7% (95.5-99.6%) in the on-treatment analysis. Two VFs were documented but without development of resistance mutations. No significant changes were found in the lipid profile. Creatinine concentration increased significantly by 0.07 mg/dl (0.04-0.10, P < 0.001). CONCLUSIONS: Switching from DRV/r to DRV/c in patients under mono or dual therapy is safe and effective.Instituto de Salud Carlos III; JR17/0002

A Nationwide Cross-Sectional Study of Self-Reported Adherence and Factors Associated with Analgesic Treatment in People with Chronic Pain

This study aims to shed light on the frequency and associated factors of self-reported adherence to analgesic treatment among chronic pain (CP) patients in the Spanish population. A nationwide cross-sectional study was performed of 1066 Spanish adults, of whom 251 suffered from CP and 168 had been prescribed analgesic treatment. Adherence was assessed using a self-reported direct questionnaire and related factors were collected. Descriptive and bivariate analyses were conducted. Among the 23.5% (95% CI: 21.0-26.2%) of the sample with CP, 66.9% (95% CI: 60.7-72.7%) were taking analgesic treatment prescribed by a doctor, and 81.0% (95% CI: 74.2-86.6%) said they took the treatment as the doctor indicated. However, 17.6% forgot to take the medication, 11% overused them when in great pain, 46.3% stopped the treatment when feeling better and 33.3% when feeling worse, and 7.3% stopped taking them for financial reasons. Higher intensity of pain, polymedication, administration route (injection/patches) and some patient-related factors were associated with self-perceived adherence to treatment. Most Spanish people with CP consider that they are adherent to their analgesic treatment. However, their behavior presents contradictions. It would be advisable for professionals to inform patients about appropriate behavior regarding their therapy recommendations, and to explore potential factors related to non-adherence. This could contribute to improving pain control

Knowledge of COVID-19 and prevention measures among university workers. Identification of subgroups through cluster analysis

Introduction: The knowledge of COVID-19 and the recommended preventive measures for controlling the disease have been widely studied in the general population, but little is known about whether the University workers as educators and transmitters of knowledge have appropriate knowledge and take preventive measures for COVID-19. This study aims to analyze the knowledge of COVID-19 and the recommended preventive measures in university workers, to identify groups according to the preventive practices they adopt, and to analyze the factors associated with these practices. Material and methods: A cross-sectional study was conducted on 677 university workers in the University of Cádiz, Spain. A questionnaire with sociodemographic variables, housing, health conditions, knowledge of COVID-19 and preventive measures were administered. The information was collected between 8th and 22nd April, 2020. A cluster analysis was performed to identify subgroups depending on the preventive measures. Associated factors were tested with binary logistic regression. Results: Two groups were identified. Group 1 included 513 subjects who took preventive measures most frequently (means 2.59-4.83). Group 2 included 164 subjects who took preventive measures less frequently (means 1.59-4.22). Men (OR = 1.39), the Teaching and research personnel (OR = 1.49) and individuals with a chronic illness (OR = 1.60) were more likely to belong to the group 2. Those with more knowledge about isolation prevention (OR = 0.167) and early treatment (OR = 0.665) were more likely to belong to group 1. Conclusion: In order to reduce the transmission of the disease, it is necessary to promote the knowledge and use of preventive measures among the group of individuals identified as less engaged in preventive measures. © 2022 The Author

Psychological Impact of the Lockdown Due to the COVID-19 Pandemic in University Workers: Factors Related to Stress, Anxiety, and Depression

This study aims to explore the psychological impact of the coronavirus disease (COVID-19)-related lockdown in university workers, and to analyse the factors related to their levels of stress, anxiety, and depression. A cross-sectional study was conducted between 8-22 April 2020, 3.5 weeks after the COVID-19-related lockdown in Spain. We collected sociodemographic and occupational data, in addition to housing, work and health conditions. Coping strategies (Brief COPE-28); level of anxiety, stress, and depression (Depression Anxiety Stress Scales DASS-21); perception of the disease (COVID-19) (Brief Illness Perception Questionnaire BIPQ); and perceived level of social support (Escala Multidimensional de Apoyo Social EMAS) were measured. Multiple linear regression models were fitted to explore the factors related to the level of anxiety, depression, and stress. The sample included 677 subjects. Higher scores in depression, anxiety, and stress occurred among females, younger subjects, administration and service workers; and subjects with a smaller home, as well as those with worse health status, worse quality of sleep, and dysfunctional coping strategies. The COVID-19-related lockdown had a great impact on the mental health of university workers. The participants with specific sociodemographic and occupational characteristics, clinical disorders, and dysfunctional coping strategies were more at risk