Social Determinants of Health: Underreported Heterogeneity in Systematic Reviews of Caregiver Interventions.

BACKGROUND AND OBJECTIVES:Although most people have some experience as caregivers, the nature and context of care are highly variable. Caregiving, socioeconomic factors, and health are all interrelated. For these reasons, caregiver interventions must consider these factors. This review examines the degree to which caregiver intervention research has reported and considered social determinants of health. RESEARCH DESIGN AND METHODS:We examined published systematic reviews and meta-analyses of interventions for older adults with age-related chronic conditions using the PRISMA and AMSTAR 2 checklists. From 2,707 papers meeting search criteria, we identified 197 potentially relevant systematic reviews, and selected 33 for the final analysis. RESULTS:We found scant information on the inclusion of social determinants; the papers lacked specificity regarding race/ethnicity, gender, sexual identity, socioeconomic status, and geographic location. The majority of studies focused on dementia, with other conditions common in later life vastly underrepresented. DISCUSSION AND IMPLICATIONS:Significant gaps in evidence persist, particularly for interventions targeting diverse conditions and populations. To advance health equity and improve the effectiveness of interventions, research should address caregiver heterogeneity and improve assessment, support, and instruction for diverse populations. Research must identify aspects of heterogeneity that matter in intervention design, while recognizing opportunities for common elements and strategies

Caregiving, Metabolic Syndrome Indicators, and 1-year Decline in Walking Speed: Results of Caregiver-SOF

BACKGROUND Chronic stress may lead to health decline through metabolic syndrome. Thus, persons in stressful caregiving situations who also have more indicators of metabolic syndrome may experience more decline than other caregivers or noncaregivers. METHODS The sample included 921 women (338 caregivers and 583 noncaregivers) from the Caregiver-Study of Osteoporotic Fractures study. Participants had home-based baseline and 1-year follow-up interviews between 1999 and 2003. At baseline, caregivers were categorized as long term (³4 years) versus short term (<4 years), and caring for someone with Alzheimer's disease/dementia or not. A metabolic risk composite score was the sum of four indicators: body mass index ³30, and diagnosis or using medications for hypertension, diabetes, or high cholesterol. Walking speed (m/second) was measured at both interviews. RESULTS Walking speed declined for the total sample (adjusted mean = −0.005 m/second, ±0.16) over an average of 1.04 years (±0.16). Overall, caregiving was not associated with decline. Increasing metabolic risk score was associated with greater decline for the total sample and long-term and dementia caregivers, but not other caregivers or noncaregivers. Metabolic risk score modified the adjusted associations between years of caregiving and dementia caregiving with walking speed decline (p values for interaction terms were 0.039 and 0.057, respectively). The biggest declines were in long-term caregivers and dementia caregivers who also had 3–4 metabolic indicators (−0.10 m/second and −0.155 m/second, respectively). CONCLUSIONS Walking speed declined the most among older women who had both stressful caregiving situations and more metabolic syndrome indicators, suggesting these caregiver subgroups may have increased risk of health decline.AG18037, AG05407, AR35582, AG05394, AR35584, and AR3558

Bioenergetic Measurements in Children with Bipolar Disorder: A Pilot 31^{31}P Magnetic Resonance Spectroscopy Study

Background: Research exploring Bipolar Disorder (BD) phenotypes and mitochondrial dysfunction, particularly in younger subjects, has been insufficient to date. Previous studies have found abnormal cerebral pH levels in adults with BD, which may be directly linked to abnormal mitochondrial activity. To date no such studies have been reported in children with BD. Methods: Phosphorus Magnetic Resonance Spectroscopy ($^{31}$P MRS) was used to determine pH, phopshocreatine (PCr) and inorganic phosphate (Pi) levels in 8 subjects with BD and 8 healthy comparison subjects (HCS) ages 11 to 20 years old. Results: There was no significant difference in pH between the patients and HCS. However, frontal pH values for patients with BD increased with age, contrary to studies of HCS and the pH values in the frontal lobe correlated negatively with the YMRS values. Global Pi was significantly lower in subjects with BD compared with HCS. There were no significant differences in PCr between the groups. Global PCr-to-Pi ratio (PCr/Pi) was significantly higher in subjects with BD compared with HCS. Conclusions: The change in Pi levels for the patients with BD coupled with the no difference in PCr levels, suggest an altered mitochondrial phosphorylation. However, our findings require further investigation of the underlying mechanisms with the notion that a mitochondrial dysfunction may manifest itself differently in children than that in adults. Limitations: Further investigations with larger patient populations are necessary to draw further conclusions

Social Determinants of Health: Underreported Heterogeneity in Systematic Reviews of Caregiver Interventions

Background and Objectives: Although most people have some experience as caregivers, the nature and context of care are highly variable. Caregiving, socioeconomic factors, and health are all interrelated. For these reasons, caregiver interventions must consider these factors. This review examines the degree to which caregiver intervention research has reported and considered social determinants of health. Research Design and Methods: We examined published systematic reviews and meta-analyses of interventions for older adults with age-related chronic conditions using the PRISMA and AMSTAR 2 checklists. From 2,707 papers meeting search criteria, we identified 197 potentially relevant systematic reviews, and selected 33 for the final analysis. Results: We found scant information on the inclusion of social determinants; the papers lacked specificity regarding race/ethnicity, gender, sexual identity, socioeconomic status, and geographic location. The majority of studies focused on dementia, with other conditions common in later life vastly underrepresented. Discussion and Implications: Significant gaps in evidence persist, particularly for interventions targeting diverse conditions and populations. To advance health equity and improve the effectiveness of interventions, research should address caregiver heterogeneity and improve assessment, support, and instruction for diverse populations. Research must identify aspects of heterogeneity that matter in intervention design, while recognizing opportunities for common elements and strategies

Urografia-TC multidetettore: ruolo diagnostico nella valutazione del paziente con ematuria non traumatica

L’ematuria può originare da qualsiasi tratto dell’apparato urinario e può essere anche unico segno di patologia neoplastica (cancro del rene o della vescica). La letteratura raccomanda pertanto di sottoporre ad attenta valutazione clinico-strumentale tutti i casi di ematuria, macroscopica e microscopica. Lo scopo del presente contributo è quello di definire il ruolo diagnostico dell’urografia-TC multidetettore (uTC-MD) nella valutazione di questo sintomo e analizzarne l’impatto nel management del paziente attraverso lo studio di 181 pazienti consecutivi valutati per macro- e microematuria nel periodo compreso tra gennaio 2003 e marzo 2006

Life satisfaction and resilience in medical school – a six-year longitudinal, nationwide and comparative study

BACKGROUND: This study examined the relationship between life satisfaction among medical students and a basic model of personality, stress and coping. Previous studies have shown relatively high levels of distress, such as symptoms of depression and suicidal thoughts in medical undergraduates. However despite the increased focus on positive psychological health and well-being during the past decades, only a few studies have focused on life satisfaction and coping in medical students. This is the first longitudinal study which has identified predictors of sustained high levels of life satisfaction among medical students. METHODS: This longitudinal, nationwide questionnaire study examined the course of life satisfaction during medical school, compared the level of satisfaction of medical students with that of other university students, and identified resilience factors. T-tests were used to compare means of life satisfaction between and within the population groups. K-means cluster analyses were applied to identify subgroups among the medical students. Analysis of Variance (ANOVA) and logistic regression analyses were used to compare the subgroups. RESULTS: Life satisfaction decreased during medical school. Medical students were as satisfied as other students in the first year of study, but reported less satisfaction in their graduation year. Medical students who sustained high levels of life satisfaction perceived medical school as interfering less with their social and personal life, and were less likely to use emotion focused coping, such as wishful thinking, than their peers. CONCLUSION: Medical schools should encourage students to spend adequate time on their social and personal lives and emphasise the importance of health-promoting coping strategies

Alimentación de cerdos con plátano como fuente energética

En las explotaciones porcícolas, la alimentación representa entre un 65 a 75% de los costos totales de producción y para obtener óptimos rendimientos en la producción de carne, debe existir un buen balance en la dieta alimenticia suministrada a los cerdos en sus diferentes etapas de desarrollo. Debido a los altos costos de los concentrados comerciales, los porcicultores deben buscar alternativas de alimentación que les permita reducir dichos costos y de esta forma volverse mas eficientes y competitivos en este sistema de explotación. El plátano por ser un alimento energético que se encuentra disponible en el Piedemonte Llanero (50.000 has), sembradas actualmente, de las cuales en época de cosecha se pierde del 10 al 20% de la producción por problemas de comercialización y mercadeo, se convierte en una alternativa que puede ser aprovechada en la alimentación de cerdos como fuente energética, reduciendo sus costos y permitiendo obtener ganancias de peso promedias diarias entre 469 a 600 gramos, para sacar cerdos al mercado de 90 Kilos entre 4.3 y 5.5 meses de ceba

A comparison of course-related stressors in undergraduate problem-based learning (PBL) versus non-PBL medical programmes

Background: Medical students report high levels of stress related to their medical training as well as to other personal and financial factors. The aim of this study is to investigate whether there are differences in course-related stressors reported by medical students on undergraduate problem-based learning (PBL) and non-PBL programmes in the UK. Method: A cross-sectional study of second-year medical students in two UK medical schools (one PBL and one non-PBL programme) was conducted. A 16-question self-report questionnaire, derived from the Perceived Medical Student Stress Scale and the Higher Education Stress Inventory, was used to measure course-related stressors. Following univariate analysis of each stressor between groups, multivariate logistic regression was used to determine which stressors were the best predictors of each course type, while controlling for socio-demographic differences between the groups. Results: A total of 280 students responded. Compared to the non-PBL students (N = 197), the PBL students (N = 83) were significantly more likely to agree that: they did not know what the faculty expected of them (Odds Ratio (OR) = 0.38, p = 0.03); there were too many small group sessions facilitated only by students resulting in an unclear curriculum (OR = 0.04, p < 0.0001); and that there was a lack of opportunity to explore academic subjects of interest (OR = 0.40, p = 0.02). They were significantly more likely to disagree that: there was a lack of encouragement from teachers (OR = 3.11, p = 0.02); and that the medical course fostered a sense of anonymity and feelings of isolation amongst students (OR = 3.42, p = 0.008). Conclusion: There are significant differences in the perceived course-related stressors affecting medical students on PBL and non-PBL programmes. Course designers and student support services should therefore tailor their work to minimise, or help students cope with, the specific stressors on each course type to ensure optimum learning and wellbeing among our future doctors

Parámetros hematológicos del suri (Rhea pennata) en condiciones de cautiverio en el altiplano peruano

The aim of this study was to evaluate the hematological constants of the red and white series in suri (Rhea pennata) in captivity in the Peruvian high plateau, considering, in addition, the sex and age variables. Sampling was done on 28 individuals from the Lupaca Rescue Center, El Collao province, Puno region, Peru, at 4530 m. The birds were 14 females and 14 males, corresponding to seven juveniles (12-23 months) and seven adults (more than 24 months) in each case. The animals were apparently healthy. The blood samples were obtained after fasting in the morning by puncture in the axillary vein. The count of erythrocytes and leukocytes was determined using the Neubauer hemocytometer, the Natt-Herrick solution and blood smear stained with the Wrigth stain, hematocrit by microhematocrit, and hemoglobin by spectrophotometry using the cyanometahemoglobin method. The hematological values between females and males were similar. The hematocrit found in juveniles was higher in 10%, the heterophiles in more than 5% and lymphocytes in 8% with respect to adults (p&lt;0.05), while monocytes and eosinophils were 5 and 9% higher, respectively, in adults as compared to juveniles (p&lt;0.05).El estudio tuvo como objetivo evaluar las constantes hematológicas de la serie roja y blanca del suri (Rhea pennata) en cautiverio en el altiplano peruano, considerando, además, las variables sexo y edad. La toma de muestras se hizo en 28 individuos del Centro de Rescate Lupaca, provincia El Collao, región Puno, Perú, a 4530 msnm. Las aves fueron 14 hembras y 14 machos, correspondiente a siete juveniles (12-23 meses) y siete adultos (más de 24 meses) en cada caso. Los animales estaban aparentemente sanos y las muestras de sangre se obtuvieron en ayunas en horas de la mañana por punción en la vena axilar. El conteo de eritrocitos y leucocitos se determinó utilizando el hemocitómetro de Neubauer, la solución de Natt-Herrick y frotis sanguíneo teñido con colorante Wrigth, el hematocrito mediante el microhematocrito, y la hemoglobina por espectrofotometría mediante el método de cianometahemoglobina. Los valores hematológicos entre hembras y machos fueron similares. El hematocrito hallado en juveniles fue mayor en 10%, los heterófilos en más de 5% y linfocitos en 8% con respecto a los adultos (p&lt;0.05), mientras que los monocitos y eosinófilos fueron 5 y 9% mayores, respectivamente, en adultos (p&lt;0.05)

Meditation-based interventions for family caregivers of people with dementia: a review of the empirical literature

Objectives: Providing care for a family member with dementia is associated with increased risk of adverse mental health sequelae. Recently, interventions utilising meditation-based techniques have been developed with the aim of reducing psychological distress among dementia caregivers. The present review aimed to critically evaluate the extant empirical literature in order to determine: (1) whether meditation-based interventions can reduce depression among dementia caregivers and (2) whether meditation-based interventions can reduce subjective burden among dementia caregivers. Method: After adhering to inclusion and exclusion criteria, a total of eight studies were included in the present review. Methodological quality was assessed using one of two scales dependent on study design. Results: The results provide tentative evidence that meditation-based interventions do indeed improve levels of depression and burden in family dementia caregivers. Conclusions: The review highlighted the strengths and weakness of the studies’ methodological designs. Whilst this novel review offers evidence in support of meditation-based interventions to improve the psychological distress of family dementia caregivers, future research should direct efforts to conduct larger scale, more rigorous studies. Clinical implications of the findings are also discussed