Desnutrizioaren prebentzioa eta maneiua ospitaleratutako adinekoan

Sarrera: Osasunaren Munduko Erakundearen (OME) arabera adineko pertsonen desnutrizioa arazo garrantzitsua da. Ospitalean adineko pertsonek desnutrizio prebalentzia handiena dute, ospitaleko egonaldia luzatu eta konplikazioak areagotzen dituena. Nutrizio-egoeraren ebaluazio osoa egitea, arrisku-faktoreak identifikatzea eta nutrizio-behar indibidualak zehaztea da beharrezkoa. Nutrizio-baheketa goiztiarra eginez gero, zehaztasunez diagnostikatuz eta etengabeko esku-hartzearen bitartez desnutrizioa prebenitu eta tratatu daiteke. Prozesuan erizainak funtsezko papera du. Helburuak: ospitaleratutako adinekoaren desnutrizioa prebenitzeko eta horri aurre egiteko kontuan hartu beharreko erizaintza esku-hartze ezberdinak aztertzea. Metodologia: berrikuspen bibliografikoa egiteko Pubmed, Osasunaren Liburutegi Birtuala (BVS), Dialnet eta Cochrane bezalako datu-baseak erabili dira, baita web orriak, aldizkari elektronikoak eta liburu elektronikoak ere. 1024 artikuluz osatutako bilaketa egin ostean, iragazkiak eta barneratze- eta kanporatze-irizpideak erabili dira bilaketa gaiarekin lotutako artikuluetara mugatzeko, guztira 22 artikulu eskuratuz. Emaitzak: adineko pertsonek desnutrizioa izateko arrisku handiagoa izatea eragiten duten determinatzaile eta arrisku-faktoreak ezagutzen dira. Egoera prebenitzeko eta maneiatzeko, detekzio goiztiarreko eta ebaluazioko tresnak erabili behar dira, eta horretarako, gaur egun urriak diren ezagutzak eta prestakuntza behar da. Erizainak prozesu osoan laguntzen dio pazienteari, honen ardatz garrantzitsua bilakatuz. Azkenik, erizaintzako-zainketak pertsona bakoitzaren beharren arabera bermatzen dira. Eztabaida: autore batzuen ustez, adina, komorbilitatea eta polifarmazia dira desnutrizio-arrisku handiagoa izateko faktore garrantzitsuenak, baina beste ikertzaile batzuek faktore sozialen garrantzia nabarmentzen dute. Ez dago ebaluazio nutrizional estandarizaturik, eta ez da adostasunik lortu, lana oztopatuz. Oro har, uste da disziplina anitzeko lana funtsezkoa dela desnutrizioa prebenitzeko eta maneiatzeko, baina badira medikuen eskumeneko alderdia dela uste dutenak. Egin beharreko zainketak desberdinak dira pertsona bakoitzaren egoeraren arabera. Ondorioak: adineko pazienteen desnutrizio-arriskuak osasun-langileen identifikazioa eta zainketa holistikoak eskatzen ditu, arrisku-faktoreak eta desnutrizioaren prebentzioa kontuan hartuta. Desnutrizioaren detekzio goiztiarra funtsezkoa da emaitza klinikoetarako. Nutrizio-arreta hobetzeko, prestakuntza egokia eta etengabeko ikerketak behar dira eta gaur egun oraindik burutako ikerketak ez dira nahikoak

The impact of creativity on functional outcome in schizophrenia: a mediational model

Functional impairment remains one of the most challenging issues for treatment in schizophrenia. However, previous studies have mainly focused on the negative impact of symptoms excluding variables that could positively impact functional outcome, such as creativity, which is considered an adaptive capacity for real-life problem-solving. This study analyzed the predictive role of creativity on functional outcome in 96 patients with schizophrenia through a mediational model, including sociodemographic, clinical, neurocognitive, and social cognitive variables. Path analysis revealed that creativity significantly mediated the relationship between neurocognition and functional outcome, and that creativity mediated between negative symptoms and functional outcome. Additionally, neurocognition was directly associated with functional outcome and social functioning was associated with creativity. The involvement of creativity in functional outcome could have relevant implications for the development of new interventions. These findings open up a new field of research on additional personal resources as possible factors of functional outcome in schizophrenia and other diseases

Neurocognitive, social cognitive, and clinical predictors of creativity in schizophrenia

Background: Creativity is considered an essential human accomplishment and a key component for daily life problem solving. It has been suggested that impairment in working memory, cognitive flexibility, and theory of mind could lead to lower creativity in schizophrenia. Additionally, other neurocognitive and social cognitive domains, as well as clinical symptoms could play a role in this relationship. However, the extent to which each of these domains influences creativity in schizophrenia remains unknown. Therefore, the aim of this study was to simultaneously investigate the specific contribution of neurocognitive, social cognitive, and clinical variables to creativity in schizophrenia. Methods: One hundred and one patients with schizophrenia were assessed in terms of sociodemographic, clinical, neurocognitive, social cognitive, and creativity variables. Results: After controlling for sociodemographic variables, regression analyses showed that higher social perception (beta = 0.286, p = .004) and processing speed (beta = 0.219, p = .023) predicted creativity total score. Higher social perception (beta = 0.298, p = .002) and processing speed (beta = 0.277, p = .004) explained figural creativity. Finally, lower negative symptoms (beta =-0.302, p = .002) and higher social perception (beta = 0.210, p = .029) predicted verbal creativity. Conclusions: Results suggest that neurocognitive, social cognitive, as well as clinical symptoms influence creativity of patients with schizophrenia. Moreover, these findings point out the prominent role of social cognition in creativity in schizophrenia.This study has been supported by the Spanish Ministry of Economy and Competitiveness (PI16/01022) and the Department of Education and Science of the Basque Government (Team A) (IT946-16). AS was supported by a Fellowship from the Fundacion Tatiana Perez de Guzman el Bueno. The funding agencies had no role in the study design, data collection and analysis, decision to publish, or preparation of the manuscript

Brain White Matter Correlates of Creativity in Schizophrenia: A Diffusion Tensor Imaging Study

The relationship between creativity and psychopathology has been a controversial research topic for decades. Specifically, it has been shown that people with schizophrenia have an impairment in creative performance. However, little is known about the brain correlates underlying this impairment. Therefore, the aim of this study was to analyze whole brain white matter (WM) correlates of several creativity dimensions in people with schizophrenia. Fifty-five patients with schizophrenia underwent diffusion-weighted imaging on a 3T magnetic resonance imaging machine as well as a clinical and a creativity assessment, including verbal and figural creativity measures. Tract-based spatial statistic, implemented in FMRIB Software Library (FSL), was used to assess whole brain WM correlates with different creativity dimensions, controlling for sex, age, premorbid IQ, and medication. Mean fractional anisotropy (FA) in frontal, temporal, subcortical, brain stem, and interhemispheric regions correlated positively with figural originality. The most significant clusters included the right corticospinal tract (cerebral peduncle part) and the right body of the corpus callosum. Verbal creativity did not show any significant correlation. As a whole, these findings suggest that widespread WM integrity is involved in creative performance of patients with schizophrenia. Many of these areas have also been related to creativity in healthy people. In addition, some of these regions have shown to be particularly impaired in schizophrenia, suggesting that these WM alterations could be underlying the worse creative performance found in this pathology.This study has been supported by the Spanish Ministry of Economy and Competitiveness (PI16/01022) and the Department of Education and Science of the Basque Government (Team A) (IT946-16). AS was supported by a fellowship from the Fundacion Tatiana Perez de Guzman el Bueno. AG-G was supported by a fellowship from the Education, Language, Politics and Culture Department of the Basque Government (PRE_2015_1_0444). The funding agencies had no role in the study design, data collection and analysis, decision to publish, or preparation of the manuscript

Cognitive, creative, functional, and clinical symptom improvements in schizophrenia after an integrative cognitive remediation program: a randomized controlled trial

[EN] This study analyzed the effectiveness of an integrative cognitive remediation program (REHACOP) in improving neurocognition, social cognition, creativity, functional outcome, and clinical symptoms in patients with schizophrenia. In addition, possible mediators predicting improvement in functional outcomes were explored. The program combined cognitive remediation with social cognitive training and social and functional skill training over 20 weeks. The sample included 94 patients, 47 in the REHACOP group and 47 in the active control group (occupational activities). Significant differences were found between the two groups in change scores of processing speed, working memory, verbal memory (VM), inhibition, theory of mind, emotion processing (EP), figural creative strengths, functional competence, disorganization, excitement, and primary negative symptoms. A mediational analysis revealed that changes in VM, inhibition, and EP partially explained the effect of cognitive remediation on functional competence improvement. This study provides initial evidence of the effect of integrative cognitive remediation on primary negative symptoms and creativity.This work was supported by the Carlos III Health Institute of the Spanish Ministry of Economy and Competitiveness (PI16/01022); the Department of Education and Science of the Basque Government (Team A) (IT946-16); the Fundacion Tatiana Perez de Guzman el Bueno (to AS); and the University of the Basque Country (UPV/EHU) (PIF 19/40 to MTE). The funding agencies had no role in the design, data collection, and analysis, decision to publish, or preparation of the study. The authors thank all the participants and clinical teams who were involved in this study as well as the English language editing service. Our special thanks to Amaia Ortiz de Zarate, Edorta Elizagarate, and Isabel Hervella for all the support in the recruitment and management of patients

Analyzing structural and functional brain changes related to an integrative cognitive remediation program for schizophrenia: A randomized controlled trial

Cognitive remediation has been shown to improve cognition in schizophrenia, but little is known about the specific functional and structural brain changes related to the implementation of an integrative cognitive remediation program. This study analyzed the functional and structural brain changes identified after implementing an integrative cognitive remediation program, REHACOP, in schizophrenia. The program combined cognitive remediation, social cognitive training, and functional and social skills training. The sample included 59 patients that were assigned to either the REHACOP group or an active control group for 20 weeks. In addition to a clinical and neuropsychological assessment, T1-weighted, diffusion-weighted and functional magnetic resonance images were acquired during a resting-state and during a memory paradigm, both at baseline and follow-up. Voxel-based morphometry, tract-based spatial statistics, resting-state functional connectivity, and brain activation analyses during the memory paradigm were performed. Brain changes were assessed with a 2 × 2 repeated-measure analysis of covariance for group x time interaction. Intragroup paired t-tests were also carried out. Repeated-measure analyses revealed improvements in cognition and functional outcome, but no significant brain changes associated with the integrative cognitive remediation program. Intragroup analyses showed greater gray matter volume and cortical thickness in right temporal regions at post-treatment in the REHACOP group. The absence of significant brain-level results associated with cognitive remediation may be partly due to the small sample size, which limited the statistical power of the study. Therefore, further research is needed to clarify whether the temporal lobe may be a key area involved in cognitive improvements following cognitive remediation.This study has been supported by the Carlos III Health Institute of the Spanish Ministry of Economy and Competitiveness (PI16/01022) and the Department of Education and Science of the Basque Government (Team A; IT946-16). AS was supported by a Fellowship from the Fundación Tatiana Pérez de Guzmán el Bueno. MTE was supported by a Fellowship from University of the Basque Country (UPV/EHU; PIF 19/40). The funding agencies had no role in the study design, data collection and analysis, decision to publish, or preparation of the manuscript

A new Late Pleistocene non-anthropogenic vertebrate assemblage from the northern Iberian Peninsula: Artazu VII (Arrasate, Basque Country)

Late Pleistocene palaeontological sites without human intervention are limited in the Cantabrian region, and even more so those with a good state of preservation and rich biodiversity. A new vertebrate fossiliferous locality discovered at Kobate Quarry (Arrasate, northern Iberian Peninsula) is presented in this article. This site, in which remains of 40 different vertebrate taxa were accumulated, acted as a natural trap. The preliminary vertebrate faunal list includes five amphibian taxa, four reptiles, seven species of birds and 24 mammalian taxa. While small mammals are represented by 13 small mammal taxa (seven in the Order Rodentia, five in the Order Eulipotyphla, and one in the Order Chiroptera), the large mammal fauna comprises eleven species, including ungulates and carnivores. The palaeoecology inferred from this faunal assemblage suggests the existence of large forested areas with some grassland and a watercourse nearby, within a notably warm and humid climate. These palaeoenvironmental conditions, combined with AMS and AAR results carried out in macrofaunal bone samples, suggest that the deposit from Artazu VII would be located in the first half of the Late Pleistocene, in the Marine Isotope Stage (MIS) 5c. Résumé Les gisements paléontologiques de la fin du Pléistocène sont limités dans la région Cantabrique, et encore plus limités sont les sites ayant fourni des restes osseux en bon état de conservation et montrant une grande biodiversité. Nous présentons ici un nouveau site trouvé dans la carrière de Kobate (Arrasate, Nord de la péninsule Ibérique). Ce site a certainement agi comme un piège naturel et contient une accumulation de restes appartenant à 40 espèces différentes de vertébrés. La liste préliminaire de la faune de vertébrés comprend cinq taxons d’amphibiens, quatre de reptiles, sept espèces d’oiseaux et 24 taxons de mammifères. Alors que les mammifères sont représentés par 13 taxons de micromammifères (sept appartiennent à l’ordre Rodentia, cinq à l’ordre Eulipothypla, et un à l’ordre Chiroptera), les grands mammifères sont représentés par onze espèces, y compris des ongulés et des carnivores. Cette association faunique suggère un paléoenvironnement caractérisé par de vastes étendues boisées avec quelques prairies et un cours d’eau à proximité, dans un climat particulièrement chaud et humide. Ces conditions paléoenvironnementales, combinées à des datations AMS et AAR à partir d’échantillons d’os de la macrofaune, permettent de localiser le gisement d’Artazu VII dans la première moitié du Pléistocène supérieur, et plus précisement dans le stade isotopique marin (MEI) 5c