Ansiedad entre cuidadores de pacientes con Enfermedad Pulmonar Obstructiva Crónica tras el alta hospitalaria

Objective: To identify the factors that influence changes in caregivers anxiety status three months after discharge for acute exacerbation of Chronic Obstructive Pulmonary Disease (COPD).Methodology: Longitudinal study. Participants included 87 caregivers of patients hospitalized for acute exacerbation of COPD. Anxiety was measured at the time of hospitalization and three months after discharge. We measured factors from four domains: context of care, caregiving demands, caregiver resources, and patient characteristics. We used multiple univariate and multivariate logistic regressions to determine changes in anxiety three months later. Univariate and multivariate multiple logistic regressions were used to determine changes in anxiety three months later.Results: A total of 57.5% of caregivers reported anxiety at the time of hospitalization. Of these, 44% had a remission of their anxiety three months after discharge. However, 22% of caregivers who had not experienced anxiety at the hospitalization became anxious at 3 months. The severity of COPD and not receiving help from another caregiver decreased the likelihood of remission of anxiety. Moderately high overload increases the likelihood of experiencing anxiety symptoms.Conclusions: The perception of anxious symptoms is dynamic. Caregivers are likely to recover from anxiety when they receive help from another caregiver and if the patient they are caring for does not have severe COPD.Objetivo: Identificar los factores que influyen en cambios en la ansiedad de los cuidadores tres meses después del alta hospitalaria por exacerbación aguda de la Enfermedad Pulmonar Obstructiva Crónica (EPOC).  Metodología: Estudio longitudinal. Participaron 87 cuidadores de pacientes hospitalizados por exacerbación aguda de EPOC. Se midió la ansiedad en el momento de la hospitalización y tres meses después del alta. Además, se midieron potenciales factores asociados a su cambio en cuatro dominios: Contexto del cuidado, demandas del cuidado, recursos y características del paciente. Utilizamos regresiones logísticas múltiples univariadas y multivariadas para determinar los cambios en la ansiedad tres meses después. Resultados: Presentaron ansiedad en el momento de la hospitalización el 57,5% de los cuidadores. De ellos, el 44% había remitido su ansiedad tres meses después del alta hospitalaria. Sin embargo, el 22% de los cuidadores quienes no habían presentado ansiedad en el momento de la hospitalización se mostraron ansiosos a los 3 meses. La gravedad de la EPOC y no recibir apoyo de otro cuidador disminuyó las probabilidades de remisión de la ansiedad. La sobrecarga moderadamente alta incrementa las probabilidades de presentar  nuevos síntomas de ansiedad. Conclusiones: La percepción de los síntomas de la ansiedad es dinámica. Los cuidadores pueden recuperarse si reciben ayuda de otro cuidador o si el paciente al que cuidan no está en un estado severo de EPOC

Organizations should know their people: a behavioral economics approach

Public and private organizations are increasingly applying behavioral economics methods to a variety of issues such as mechanism design and incentive architecture. However, there has been little focus on how experimental tools used in behavioral economics can help companies learn more about their (current or prospective) workforce and, more specifically, about their employees’ tastes and inclinations. This has important implications for broader organizational performance since some designs/incentives are likely to affect only individuals with a particular disposition (e.g. risk averse or fairness oriented) but not others, or can even have opposite effects on individuals with different sets of preferences. In this commentary, we point out a number of promising avenues for the application of a behavioral economics lens to understand and manage people within organizations. A comprehensive case study is also provided

Seguridad, declinación y recuperación funcional del paciente post-agudo hospitalizado en centros de readaptación funcional

Objetivos Describir el desarrollo y la evaluación psicométrica inicial de un instrumento de medida de movilidad para unidades postagudas de rehabilitación (Mobam-in). Evaluar la eficacia del marco contextual Mobam para la construcción de instrumentos basados en actividades de movilidad. Determinar la incidencia de efectos adversos y sus determinantes en ancianos hospitalizados en unidades de rehabilitación. Comparar la incidencia de efectos adversos entre ancianos a partir de 75 años, y menores de 75 años. Evaluar la relación entre la ocurrencia de efectos adversos y el cambio en el nivel de discapacidad entre la admisión y el alta en pacientes ancianos hospitalizados en unidades de rehabilitación. Método Estudio prospectivo de cohortes realizado en la unidad de rehabilitación de un hospital público. Se reclutó una muestra de 239 sujetos para el estudio dirigido al desarrollo del instrumento Mobam-in. Una submuestra de 216 sujetos fue seguida durante su estancia, para estudiar la incidencia de efectos adversos, sus determinantes y los cambios en niveles de discapacidad. El desarrollo inicial del instrumento Mobam-in se basó en la integración de ítems de instrumentos en categorías de actividades de movilidad de la Clasificación Internacional del Funcionamiento, de la Discapacidad y de la Salud (CIF). El instrumento Mobam-in fue usado para la evaluación de niveles de discapacidad y para la medición inicial de la discapacidad en las actividades de movilidad. La ocurrencia y tipo de efectos adversos fueron registrados. Se consideró tanto las variables asociadas a efectos adversos como las consecuencias de los mismos. Se usó registros y cuestionarios autoadministrados para la recogida de variables sociodemográficas, clínicas y funcionales. Resultados En la creación-desarrollo de Mobam-in, el escalaje multirasgo y los análisis factoriales confirmatorios confirmaron la asunción de unidimensionalidad de dominios. Las cinco dimensiones mostraron estabilidad a través de grupos diagnósticos. El modelo Rasch reveló que los ítems podían ser situados a lo largo de un continuo en cada dimensión, cumpliendo criterios de bondad de ajuste. La fiabilidad test-retest resultó excelente, y grupos con condiciones de mayor severidad y menor independencia puntuaron peor. Veintiséis pacientes (12%) sufrieron algún efecto adverso en el seguimiento de la cohorte, siendo las caídas el más frecuente (8.3%). El grupo de pacientes de edad igual o superior a 75 años experimentó mayor número de efectos adversos que los pacientes menores de 75 años (15.6% vs. 4.3%, P = 0.02). Los modelos de regresión logística multivariable mostraron una fuerte asociación entre la edad y cualquier efecto adverso (odds-ratio=1.06; 95%Cl=1.03-1.12), así como entre la edad y los efectos de caída (odds-ratio=1.1; 95%CI=1.02-1.17). Un total de 159 pacientes experimentaron mejora funcional entre admisión y alta, 56 permanecieron estacionarios, y nadie sufrió declinaciones. La experiencia de efectos adversos de caída (odds-ratio=0.32, 95%CI=0.11–0.97) y el grupo diagnóstico (odds-ratio=3.91, 95%CI=1.34–11.38) son factores predictores específicos de mejora en el nivel de discapacidad. Conclusiones El instrumento Mobam-in cubre cinco dimensiones, es fiable, válido y capaz de discriminar entre sujetos con diferentes niveles funcionales y de severidad. El marco contextual Mobam es eficaz para la construcción de instrumentos de medida de resultado basados en actividades de movilidad. El porcentaje de ancianos que experimentan efectos adversos en unidades postagudas de rehabilitación es similar al porcentaje hallado por otros autores en unidades no-quirúrgicas. La edad es un determinante fundamental en la ocurrencia de efectos adversos hospitalarios en unidades de rehabilitación. Pacientes ancianos con edades iguales o superiores a 75 años son más propensos a la experiencia de efectos adversos en unidades postagudas de rehabilitación. La ocurrencia de efectos adversos de caída y el grupo diagnóstico son factores predictores específicos de cambio en el nivel de discapacidad. ABSTRACT [English] Objectives To describe the development and initial psychometric evaluation of a mobility measure for inpatient postacute rehabilitation settings (Mobam-in). To evaluate the efficacy of the Mobam framework for building outcome instruments. To determine the incidence and determinants of adverse events between elderly patients aged 75 years and over, and patients under 75 years old. To assess the relationship between the occurrence of adverse events and the changes affecting the level of disability between admission and discharge during inpatient rehabilitation programs in a cohort of older adults admitted to a rehabilitation unit. Methods Prospective cohort study conducted in the rehabilitation unit of a public hospital. A sample of 239 subjects was recruited for the development of the Mobam-in instrument. A subsample of 216 participants was followed during their stay, to study the incidence and determinants of adverse events, as well as the changes in the levels of disability. The initial development of the Mobam-in instrument was guided by integrating items from a wide variety of patient-oriented instruments to categories of mobility activities from the International Classification of Functioning, Disability and Health (ICF). The Mobam-in instrument was subsequently used to evaluate the levels of disability, as well as for the initial assessment of disability in mobility activities. The occurrences and types of adverse events were reported. The variables associated either with the occurrence of adverse events or with the consequences of those events were considered. Records and auto-administrated questionnaires were used for collecting socio-demographic, clinical, and functional data. Results Concerning the development of the Mobam-in instrument, multitrait and confirmatory analyses supported the assumption of unidimensionality. The five dimensions appeared to be stable across diverse diagnostic groups. Rasch model (Masters’ partial credit) showed that all items could be located along a continuum in each dimension, with goodness-of-fit criteria of infit and outfit mean-square values between 0.6 and 1.4. Test-retest reliability was excellent (intraclass correlation coefficients median, .98). Groups with more severe conditions and lower functional independence scored lower on Mobam-in scales, as hypothesized. Twenty-six patients (12%) experienced at least an adverse event during the study. Fall-related events were the most frequent (8.3%). Patients aged 75 years old and above experienced higher number of adverse events than those aged under 75 years (15.6% vs. 4.3%, P=0.02). When performing multivariable logistic regression models, age showed strong association with fall-related events (odds-ratio=1.1; 95% confidence interval=1.02-1.17) and overall, when all types of events were combined (odds-ratio=1.06; 95% confidence interval =1.03-1.12). A total of 159 participants experienced an improvement at discharge, 56 made no change, and no participants experienced a decline. The occurrence of fall-related events (odds-ratio=0.32, 95%CI=0.11–0.97) and the diagnostic group (odds-ratio=3.91, 95%CI=1.34–11.38) are specific predictive factors of change in the level of disability. Conclusions Mobam-in covers 5 dimensions of mobility activities. It is a reliable and valid instrument, useful to discriminate on the basis of both a severity-based condition and functional independence. The Mobam framework is an effective reference for building outcome instruments. The incidence rates of older inpatients experiencing adverse events in postacute rehabilitation settings are consistent with other studies using elderly patients hospitalized in non-surgical departments. Age is a major determinant in the occurrence of adverse events during hospital stays in rehabilitation units. Some older patients are more likely to experience adverse events than others, in special those aged 75 years and older. The occurrence of fall-related events and the diagnostic group are specific predictive factors for changes in the levels of disability

Los microorganismos y el arte

El presente trabajo muestra algunos datos sobre la acción silenciosa de los microorganismos en las obras de arte para resaltar la existencia de efectos a menudo ignorados y para introducir el desarrollo de algunas técnicas innovadoras en el área de la conservación y la restauración. Se espera que las obras de arte duren siglos o milenios, pero la protección frente al ataque microbiano puede no ser tan duradera a menos que se conozcan los principios que permiten establecer resistencias a la colonización microbiana. A la vez que los microorganismos pueden contribuir al deterioro de las obras de arte, el mundo microbiano también ofrece recursos para su conservación

Stability and Predictors of Poor 6-min Walking Test Performance over 2 Years in Patients with COPD

Poor performance in the 6-min walk test (6MWT < 350 m) is an important prognostic indicator of mortality and risk of exacerbations in patients with chronic obstructive pulmonary disease (COPD). Little is known about the stability of this state over time and what factors might predict a poor 6MWT performance. To determine the stability of 6MWT performance over a 2-year period in COPD patients participating in annual medical follow-up visits, and to assess the ability of several clinical, pulmonary, and non-pulmonary factors to predict poor 6MWT performance, we prospectively included 137 patients with stable COPD (mean age, 66.9 ± 8.3 years). The 6MWT was scored at baseline and 2-year follow-up. To evaluate clinical, pulmonary, and non-pulmonary variables as potential predictors of poor 6MWT performance, we used multiple logistic regression models adjusted for age, sex, weight, height, and 6MWT performance at baseline. Poor 6MWT performance was stable over 2 years for 67.4% of patients. Predictors of poor 6MWT performance included a five-repetition sit-to-stand test score ≤2 (OR, 3.01; 95% CI, 1.22–7.42), the percentage of mobility activities with limitations (OR, 1.03; 95% CI, 1.00–1.07), and poor 6MWT performance at baseline (OR, 4.64; 95% CI, 1.88–11.43). Poor 6MWT performance status was stable for the majority of COPD patients. Lower scores on the five-repetition sit-to-stand test and a higher number of mobility activities with limitations were relevant predictors of poor 6MWT performance over 2 years. Prognostic models based on these non-pulmonary factors can provide non-inferior discriminative ability in comparison with prognostic models based on only pulmonary factors

Rho1 GTPase and PKC ortholog Pck1 are upstream activators of the cell integrity MAPK pathway in fission yeast

This is an open-access article distributed under the terms of the Creative Commons Attribution License.In the fission yeast Schizosaccharomyces pombe the cell integrity pathway (CIP) orchestrates multiple biological processes like cell wall maintenance and ionic homeostasis by fine tuning activation of MAPK Pmk1 in response to various environmental conditions. The small GTPase Rho2 positively regulates the CIP through protein kinase C ortholog Pck2. However, Pmk1 retains some function in mutants lacking either Rho2 or Pck2, suggesting the existence of additional upstream regulatory elements to modulate its activity depending on the nature of the environmental stimulus. The essential GTPase Rho1 is a candidate to control the activity of the CIP by acting upstream of Pck2, whereas Pck1, a second PKC ortholog, appears to negatively regulate Pmk1 activity. However, the exact regulatory nature of these two proteins within the CIP has remained elusive. By exhaustive characterization of strains expressing a hypomorphic Rho1 allele (rho1-596) in different genetic backgrounds we show that both Rho1 and Pck1 are positive upstream regulatory members of the CIP in addition to Rho2 and Pck2. In this new model Rho1 and Rho2 control Pmk1 basal activity during vegetative growth mainly through Pck2. Notably, whereas Rho2-Pck2 elicit Pmk1 activation in response to most environmental stimuli, Rho1 drives Pmk1 activation through either Pck2 or Pck1 exclusively in response to cell wall damage. Our study reveals the intricate and complex functional architecture of the upstream elements participating in this signaling pathway as compared to similar routes from other simple eukaryotic organisms. © 2014 Sánchez-Mir et al.This work was supported by grants BFU2011-22517 (Ministerio de Economía y Competitividad) and 15280/PI/10 (Fundación Séneca, Región de Murcia), Spain to J.C., and BFU2010-15641 (Ministerio de Economía y Competitividad) to P.P. ERDF (European Regional Development Fund) co-funding was received from the EU.Peer Reviewe

Wishes and perceptions about exercise programs in exercising institutionalized older adults living in long-term care institutions: A qualitative study.

The level of exercise among older adults is low, particularly among those living in health-care institutions. To gain insight into the perceptions of institutionalized older adults towards the exercise programs developed in long-term care institutions and to identify their wishes and needs regarding these programs, we conducted a qualitative study using focus group discussions. Thirty-six institutionalized participants (≥ 65 years) were recruited. Six common themes emerged: participants' attitudes and motivations towards the exercise programs, self-perceived health, knowledge of the concept of physical exercise, perceived effects of the exercise programs, and wishes or expectations for the exercise programs. The main wishes were to increase frequency of exercise sessions, to exercise outdoor and to increase walking times. The results suggest the need for changes in the development of exercise programs, including changes in the frequency, performance environment and types of exercises performed

Frailty transitions and associated clinical outcomes in patients with stable COPD: A longitudinal study.

BACKGROUND:Although frailty is a frequent occurrence in chronic obstructive pulmonary disease (COPD) patients, evidence on the frequency of frailty transition is scarce. AIMS:The present study aimed to describe the frailty status transition rates over a 2-year period and their associated clinical outcomes in stable COPD patients, and to determine predictors of improvement in frailty status. METHODS:We prospectively included 119 patients with stable COPD (mean age ± SD, 66.9 ± 7.9 years) over a follow-up period of 2 years. Frailty was assessed using the Fried criteria (unintentional weight loss, weakness, exhaustion, low activity level, and slow walking speed). Several demographic, clinical, and health-related variables were measured. We calculated the rates for each of the frailty transitions (no change, improvement, or worsening) between baseline and 2 years. Outcomes were compared using one-way analysis of variance and predictors of improvement were identified in multivariate logistic regression. RESULTS:After 2 years of follow-up, 21 (17.6%) patients had an improved frailty status, 14 (11.7%) had worsened, and 84 (70.5%) had maintained the same frailty status. The worsening group (vs no change group) had greater dyspnea (p = 0.013) and disability (p = 0.036) and lower handgrip strength (p = 0.001). In contrast, the improved group (vs no change group) had greater handgrip (p<0.001) and quadriceps strength (p = 0.032). Furthermore, the improved group had greater handgrip strength (p<0.001), quadriceps strength (p = 0.003), physical activity (p = 0.008), and lower disability (p = 0.019) than the worsening group. Additionally, we determined that the 5STS test (≤ 13.6s) and exacerbations (≥ 2) were independent predictors for improvement in frailty status [adjusted OR 9.46, p = 0.058 and adjusted OR 0.12, p = 0.026, respectively]. CONCLUSIONS:Frailty is a dynamic process for approximately one-third of patients with stable COPD and transitions in frailty status are associated with significant changes in clinical outcomes. The 5STS and exacerbations were independent predictors of improvement in frailty status

Role of the fission yeast cell integrity MAPK pathway in response to glucose limitation

<p>Abstract</p> <p>Background</p> <p>Glucose is a signaling molecule which regulates multiple events in eukaryotic organisms and the most preferred carbon source in the fission yeast <it>Schizosaccharomyces pombe</it>. The ability of this yeast to grow in the absence of glucose becomes strongly limited due to lack of enzymes of the glyoxylate cycle that support diauxic growth. The stress-activated protein kinase (SAPK) pathway and its effectors, Sty1 MAPK and transcription factor Atf1, play a critical role in the adaptation of fission yeast to grow on alternative non-fermentable carbon sources by inducing the expression of <it>fbp1</it>^<it>+</it> gene, coding for the gluconeogenic enzyme fructose-1,6-bisphosphatase. The cell integrity Pmk1 pathway is another MAPK cascade that regulates various processes in fission yeast, including cell wall construction, cytokinesis, and ionic homeostasis. Pmk1 pathway also becomes strongly activated in response to glucose deprivation but its role during glucose exhaustion and ensuing adaptation to respiratory metabolism is currently unknown.</p> <p>Results</p> <p>We found that Pmk1 activation in the absence of glucose takes place only after complete depletion of this carbon source and that such activation is not related to an endogenous oxidative stress. Notably, Pmk1 MAPK activation relies on <it>de novo</it> protein synthesis, is independent on known upstream activators of the pathway like Rho2 GTPase, and involves PKC ortholog Pck2. Also, the Glucose/cAMP pathway is required operative for full activation of the Pmk1 signaling cascade. Mutants lacking Pmk1 displayed a partial growth defect in respiratory media which was not observed in the presence of glucose. This phenotype was accompanied by a decreased and delayed expression of transcription factor Atf1 and target genes <it>fbp1</it>⁺ and <it>pyp2</it>⁺. Intriguingly, the kinetics of Sty1 activation in Pmk1-less cells was clearly altered during growth adaptation to non-fermentable carbon sources.</p> <p>Conclusions</p> <p>Unknown upstream elements mediate Pck2-dependent signal transduction of glucose withdrawal to the cell integrity MAPK pathway. This signaling cascade reinforces the adaptive response of fission yeast to such nutritional stress by enhancing the activity of the SAPK pathway.</p