Predictores de mala salud autopercibida en una población de personas mayores

[Resumen] nIntroducción: La salud autopercibida forma parte del concepto global de «calidad de vida», además deser una medida válida para conocer el estado de salud. El objetivo principal de este trabajo es evaluarel efecto predictor de ciertas variables sobre la mala salud autopercibida en una población de personasmayores.Material y métodos: Se lleva a cabo un estudio transversal con una muestra de 140 personas mayores.Mediciones: edad, género, estudios, hábitat, estado cognitivo, discapacidad física, enfermedades, per-cepción de la salud y apoyo social. Para analizar el efecto de las diferentes variables sobre la mala saludautopercibida se aplicó un modelo de regresión logística y una curva ROC para establecer los valoresde corte de dichas variables, con la mejor sensibilidad y especificidad para la predicción de mala saludautopercibida.Resultados: Se observa una asociación significativa entre una mala salud autopercibida con la edad, lacomorbilidad, y con la percepción de apoyo social funcional débil, mientras que no existía asociación conel género, el hábitat o el nivel educativo.Conclusiones: La edad elevada, el número de enfermedades diagnosticadas, y el apoyo social funcionalson los factores de riesgo de la salud autopercibida, mientras que las características y repercusiones delas enfermedades no deben ser consideradas.[Abstract] Introduction: Self-Rated Health is part of the comprehensive concept of Quality of Life and is a validmeasurement of health status. The main objective of this study was to test the predictive value of somedifferent variables on the poor Self-Rated Health among elders.Material and methods: We performed a cross-sectional study on a sample consisting of 140 participants.Measurements: age, gender, level of education, environment, cognitive status, physical impairment,diseases, health perception and social support. The influence of the studied variables on the poor Self-Rated Health was performed with a logistic regression analysis and a ROC curve to establish the cut-offvalues for these variables with the best sensitivity and specificity to predict the poor Self-Rated Health.Results: A poor Self-Rated Health was significantly associated with age, comorbidity, and the percep-tion of poor functional social support, whereas no association was found with gender, environment andeducational level.Conclusions: Old age, the number of diagnosed diseases, and functional social support are Self-RatedHealth risk factors, while the characteristics and repercussions of the diseases should not be considered

Determinants of Quality of Life in Pre-Frail Older Adults According to Phenotypic Criteria: the VERISAUDE Study

[Abstract] Frailty is a dynamic clinical syndrome considered as part of an age-associated continuum of severity, including pre-frailty as an intermediate frailty status with potential reversibility to robustness. The main purpose of this study was to analyse the relationship between the different domains of quality of life, functional dependence and depressive symptomatology in older adults diagnosed as pre-frail, before progression to frailty occurs. Logistic regression analyses were conducted to examine whether sex, age, level of education and scores in the Geriatric Depression Scale 15-item Short Form (GDS-SF) and the Instrumental Activities of Daily Living Lawton scale determine the worst score in the WHOQOL-BREF (World Health Organization Quality of Life) in older adults meeting one or two frailty phenotypic criteria. Depressive symptomatology (GDS-SF score) was the main determinant of poor quality of life in both groups, and in all areas of WHOQOL-BREF. Age was only associated with poor satisfaction with own health. Female sex and low educational level were linked to low physical QOL and poor self-rated health, respectively, but only in older adults meeting one frailty criterion. Association between functional status and WHOQOL-BREF scores was only found in the univariate analysis. These results underline the importance of identifying multiple aspects, but mainly the presence of depressive symptomatology, as risk factors for all dimensions of quality of life in the pre-frailty process, where interventions might be targeted to reduce the progression of pre-frailty and frailty in older adults.Galicia. Consellería de Cultura, Educación e Ordenación Universitaria; EM 2012/100Xunta de Galicia; IN607C, 2016/0

Efectos del programa educativo GERO-HEALTH sobre el nivel de interiorización de conocimientos de prevención y promoción de la salud en personas mayores

The aim of this paper was to assess the theoretical-practical dimension of the knowledge acquired by 65-year-olds and over according to sex and educational level during a health education program. A cross-sectional quasi-experimental design study was conducted with a sample of 73 senior citizens who completed a questionnaire at the beginning and at the end of the program. The questionnaire measured the level of assimilation of acquired knowledge. The results showed that participants´ knowledge of health issues significantly increased upon completion of the program, particularly in women and in participants with the lowest educational level. The program proved to be effective in promoting active aging, and combined relevant aging-related psychosocial issues such as intergenerational relationships and empowerment processes.El objetivo de este artículo fue evaluar la dimensión teórico-práctica de los conocimientos adquiridos por personas mayores de 65 años, en función del sexo y el nivel educativo, durante un programa de educación para la salud. Se realizó un estudio de tipo cuasi-experimental, transversal, sobre una muestra de 73 mayores, que fueron evaluados al comienzo y al final del programa mediante un cuestionario que determinaba el nivel de interiorización del conocimiento adquirido. Los resultados mostraron que, tras la realización del programa, los sujetos incrementaron significativamente sus conocimientos sobre salud, siendo este efecto mayor en las mujeres, y en los sujetos con menor nivel educativo. El programa se revela, por tanto, como eficaz en la promoción del envejecimiento activo, además de compaginar otros elementos psico-sociales relevantes en la vejez como las relaciones intergeneracionales y los procesos de empoderamiento

Effects of physical exercise interventions in frail older adults: a systematic review of randomized controlled trials

[Abstract] Background: Low physical activity has been shown to be one of the most common components of frailty, and interventions have been considered to prevent or reverse this syndrome. The purpose of this systematic review of randomized, controlled trials is to examine the exercise interventions to manage frailty in older people. Methods: The PubMed, Web of Science, and Cochrane Central Register of Controlled Trials databases were searched using specific keywords and Medical Subject Headings for randomized, controlled trials published during the period of 2003–2015, which enrolled frail older adults in an exercise intervention program. Studies where frailty had been defined were included in the review. A narrative synthesis approach was performed to examine the results. The Physiotherapy Evidence Database (PEDro scale) was used to assess the methodological quality of the selected studies. Results: Of 507 articles, nine papers met the inclusion criteria. Of these, six included multi-component exercise interventions (aerobic and resistance training not coexisting in the intervention), one included physical comprehensive training, and two included exercises based on strength training. All nine of these trials included a control group receiving no treatment, maintaining their habitual lifestyle or using a home-based low level exercise program. Five investigated the effects of exercise on falls, and among them, three found a positive impact of exercise interventions on this parameter. Six trials reported the effects of exercise training on several aspects of mobility, and among them, four showed enhancements in several measurements of this outcome. Three trials focused on the effects of exercise intervention on balance performance, and one demonstrated enhanced balance. Four trials investigated functional ability, and two showed positive results after the intervention. Seven trials investigated the effects of exercise intervention on muscle strength, and five of them reported increases; three trials investigated the effects of exercise training on body composition, finding improvements in this parameter in two of them; finally, one trial investigated the effects of exercise on frailty using Fried’s criteria and found an improvement in this measurement. Exercise interventions have demonstrated improvement in different outcome measurements in frail older adults, however, there were large differences between studies with regard to effect sizes. Conclusions: This systematic review suggested that frail older adults seemed to benefit from exercise interventions, although the optimal program remains unclear. More studies of this topic and with frail populations are needed to select the most favorable exercise program

Efficacy of a computerized cognitive training application on cognition and depressive symptomatology in a group of healthy older adults: a randomized controlled trial

[Abstract] Objective. The purpose of this study was to evaluate the efficacy of a multimedia and interactive cognitive program on cognition and depressive symptomatology in healthy older adults. Methods. Adults aged ≥65 years were randomly assigned to two groups: the experimental group in which the participants received a computerized cognitive training application; and the control group in which the participants received no intervention during the protocol. Performance on the mini-mental state examination (MMSE) and the short-form of the geriatric depression scale (GDS-SF) were analysed using a three-way repeated-measure analysis of variance. Results. To determine cognition after the training, the cognitive program was used and the results were assessed using the MMSE, indicating that the significant time effects within the groups reflected the score for cognitive assessment that was significantly better after the intervention in the experimental group. No significant differences were observed with regard to the depressive symptomatology or between the groups according to sex or educational level on the two dimensions previously established (cognition and depressive symptomatology). Conclusion. The development of technological applications for intervention in older adults is increasing. Based on the established objective, we can conclude that the computerized intervention may constitute a good alternative to enhance the cognitive status in older people

Caregiver's distress related to the patient's neuropsychiatric symptoms as a function of the care-setting

[Abstract] Prevalence of neuropsychiatric symptoms (NPS) and correlation between its intensity and caregiver distress were evaluated as a function of the care-setting in a cross-sectional study including 72 patient-caregiver dyads. The Neuropsychiatric Inventory and the Caregiver Distress Scale were administered. The most prevalent symptoms were: in the formal care-setting, agitation/aggression and depression/dysphoria (42.4%), and in the informal care-setting, aberrant motor behavior (59.0%). While changes in appetite and eating behaviors, depression/dysphoria and irritability/lability were more prevalent in the formal care-setting (p < .0001, p = .011, p = .021), aberrant motor behavior was more prevalent in the informal care-setting (p = .007). NPS were positively correlated with caregiver distress. High patients' scores in hallucinations, sleep and night-time disturbances, anxiety, and aberrant motor behavior were the best predictors of professional caregiver's distress. Agitation/aggression, delusions, disinhibition, apathy/indifference, depression/dysphoria, and elation/euphoria were the best predictors of informal caregiver's distress. Findings may have important clinical implications

Effectiveness of family metacognitive training in mothers with psychosis and their adolescent children: a multicenter study protocol

BackgroundMore than half of women with psychosis take care of their children despite the difficulties caused by the disease. Additionally, these kids have a higher risk of developing a mental health disorder. However, no interventions have been developed to meet these needs. Metacognitive Training (MCT) is a psychological intervention that has demonstrated its efficacy in improving cognitive insight, symptom management and social cognition in people with first-episode psychosis (FEP). Additionally, MCT has shown better results in women than men with FEP. This study aims to adapt and evaluate the efficacy of MCT-F in mothers and adolescent children in an online group context with the main purpose of improving family relationships, cognitive awareness and symptoms in women with psychosis and increase their children’s knowledge of the disease and their functioning. As secondary objectives, it also aims to evaluate improvements in metacognition, social cognition, symptoms, protective factors and self-perception of stigma.Materials and methodsA quasi-experimental design with participants acting as their own control will be carried out. Forty-eight mothers with psychosis and their adolescent children (between 12 and 20 years old) recruited from a total of 11 adult mental health care centers will receive MCT-F. Participants will be evaluated 11 weeks before the intervention (T1), at baseline (T2), and post-intervention (T3) with a cognitive insight scale, as a primary outcome. Measures of metacognitive and social cognition, symptoms, cognitive functioning, family and social functioning, protective factors (self-esteem, resilience, and coping strategies) and self-perceived stigma will be addressed as secondary outcomes. Assessment will also address trauma and attachment in mothers and, lastly, the feasibility and acceptability of MCT-F in both participant groups.DiscussionThis will be the first investigation of the efficacy, acceptability, and viability of the implementation of MCT-F. The results of this study may have clinical implications, contributing to improving mothers’ with psychosis and adolescents’ functioning and better understanding of the disease, in addition to the possible protective and preventive effect in adolescents, who are known to be at higher risk of developing severe mental disorders.Clinical trial registration:https://clinicaltrials.gov/, identifier [NCT05358457]

Impact of COVID-19 on cardiovascular testing in the United States versus the rest of the world

Objectives: This study sought to quantify and compare the decline in volumes of cardiovascular procedures between the United States and non-US institutions during the early phase of the coronavirus disease-2019 (COVID-19) pandemic. Background: The COVID-19 pandemic has disrupted the care of many non-COVID-19 illnesses. Reductions in diagnostic cardiovascular testing around the world have led to concerns over the implications of reduced testing for cardiovascular disease (CVD) morbidity and mortality. Methods: Data were submitted to the INCAPS-COVID (International Atomic Energy Agency Non-Invasive Cardiology Protocols Study of COVID-19), a multinational registry comprising 909 institutions in 108 countries (including 155 facilities in 40 U.S. states), assessing the impact of the COVID-19 pandemic on volumes of diagnostic cardiovascular procedures. Data were obtained for April 2020 and compared with volumes of baseline procedures from March 2019. We compared laboratory characteristics, practices, and procedure volumes between U.S. and non-U.S. facilities and between U.S. geographic regions and identified factors associated with volume reduction in the United States. Results: Reductions in the volumes of procedures in the United States were similar to those in non-U.S. facilities (68% vs. 63%, respectively; p = 0.237), although U.S. facilities reported greater reductions in invasive coronary angiography (69% vs. 53%, respectively; p < 0.001). Significantly more U.S. facilities reported increased use of telehealth and patient screening measures than non-U.S. facilities, such as temperature checks, symptom screenings, and COVID-19 testing. Reductions in volumes of procedures differed between U.S. regions, with larger declines observed in the Northeast (76%) and Midwest (74%) than in the South (62%) and West (44%). Prevalence of COVID-19, staff redeployments, outpatient centers, and urban centers were associated with greater reductions in volume in U.S. facilities in a multivariable analysis. Conclusions: We observed marked reductions in U.S. cardiovascular testing in the early phase of the pandemic and significant variability between U.S. regions. The association between reductions of volumes and COVID-19 prevalence in the United States highlighted the need for proactive efforts to maintain access to cardiovascular testing in areas most affected by outbreaks of COVID-19 infection

Hyperoxemia and excess oxygen use in early acute respiratory distress syndrome : Insights from the LUNG SAFE study

Publisher Copyright: © 2020 The Author(s). Copyright: Copyright 2020 Elsevier B.V., All rights reserved.Background: Concerns exist regarding the prevalence and impact of unnecessary oxygen use in patients with acute respiratory distress syndrome (ARDS). We examined this issue in patients with ARDS enrolled in the Large observational study to UNderstand the Global impact of Severe Acute respiratory FailurE (LUNG SAFE) study. Methods: In this secondary analysis of the LUNG SAFE study, we wished to determine the prevalence and the outcomes associated with hyperoxemia on day 1, sustained hyperoxemia, and excessive oxygen use in patients with early ARDS. Patients who fulfilled criteria of ARDS on day 1 and day 2 of acute hypoxemic respiratory failure were categorized based on the presence of hyperoxemia (PaO2 > 100 mmHg) on day 1, sustained (i.e., present on day 1 and day 2) hyperoxemia, or excessive oxygen use (FIO2 ≥ 0.60 during hyperoxemia). Results: Of 2005 patients that met the inclusion criteria, 131 (6.5%) were hypoxemic (PaO2 < 55 mmHg), 607 (30%) had hyperoxemia on day 1, and 250 (12%) had sustained hyperoxemia. Excess FIO2 use occurred in 400 (66%) out of 607 patients with hyperoxemia. Excess FIO2 use decreased from day 1 to day 2 of ARDS, with most hyperoxemic patients on day 2 receiving relatively low FIO2. Multivariate analyses found no independent relationship between day 1 hyperoxemia, sustained hyperoxemia, or excess FIO2 use and adverse clinical outcomes. Mortality was 42% in patients with excess FIO2 use, compared to 39% in a propensity-matched sample of normoxemic (PaO2 55-100 mmHg) patients (P = 0.47). Conclusions: Hyperoxemia and excess oxygen use are both prevalent in early ARDS but are most often non-sustained. No relationship was found between hyperoxemia or excessive oxygen use and patient outcome in this cohort. Trial registration: LUNG-SAFE is registered with ClinicalTrials.gov, NCT02010073publishersversionPeer reviewe

Caracterización de un colectivo de cuidadores informales de acuerdo a su percepción de la salud

La salud autopercibida es un elemento clave a la hora de minimizar el impacto socioeconómico generado por el cuidado de personas mayores con dependencia. En este estudio, se pretende caracterizar a un colectivo de personas cuidadoras informales de acuerdo a dicha variable. Se realizó un estudio transversal con un grupo de cuidadores seleccionados por muestreo no probabilístico incidental, en el área urbana de A Coruña y área rural de Mondoñedo (Lugo). En nuestro estudio, el género y el hábitat se han mostrado como dos variables de gran relevancia a la hora de establecer las necesidades de apoyo de los cuidadores informales de acuerdo a su autopercepción de la salud