Efectos de la complejización del proceso en pacientes con insuficiencia cardiaca y sus cuidadores. Estudio de cohortes

Introducción y objetivos: La progresión de la insuficiencia cardiaca (IC) implica una importante reducción de la calidad de vida con deterioro funcional progresivo y un elevado consumo de recursos sociosanitarios. El propósito de este estudio es describir el perfil de pacientes con IC y de sus cuidadores desde el punto de vista sociodemográfico, la sobrecarga, la depresión y la calidad de vida relacionada con la salud de ambos. Material y Método: Estudio observacional longitudinal analítico de cohortes retrospectivo en la Agencia Pública Costa del Sol. La población de estudio la constituían pacientes ingresados por IC con cuidador principal identificado. Los pacientes se seleccionaron a partir del ingreso en el hospital. Resultados: El perfil de cuidador en este medio es de mujer con unos 50 años que cuida de un paciente, que suele ser su padre o pareja con una edad media de 70 años. Las hijas o esposas de pacientes con niveles de dependencia elevados tienen mayor sobrecarga y reflejan una salud mental deteriorada (p=0,02). Conclusiones: Los cuidadores de pacientes con Insuficiencia Cardiaca responden al perfil habitual de cuidadores en nuestro medio, aunque con una media de edad menor. No cuentan con apoyo social, sino con la ayuda de otros familiares pero en el caso de recibir la ayuda social, la utilizan en un cuidador remunerado. Las hijas o esposas de pacientes con peores niveles funcionales que conviven con ellos e invierten un mayor número de horas en el cuidado, presentan mayor sobrecarga y mayores síntomas depresivos, factores que pueden minar la capacidad para el cuidado. La CVRS de los pacientes y cuidadores están relacionadas tanto transversal, como longitudinalmente. La CVRS de los cuidadores empeora con el paso del tiempo y el aumento de la complejidad del proceso. La CVRS de los pacientes está afectada por el aumento de la complejidad de su proceso, sobre todo por la utilización de servicios de Urgencias y de ingresos hospitalarios, que va minando a medio plazo su percepción de salud física y mental

Validation of living with chronic illness scale in a type 2 diabetes mellitus population

Background: Worldwide, type 2 diabetes mellitus (T2DM) is one of the most prevalent chronic diseases and one of those producing greatest impact on patients’ day-to-day quality of life. Our study aim is to validate the “Living with Chronic Illness Scale” for a Spanish-speaking T2DM population. Methods: In this observational, international, cross-sectional study, 582 persons with T2DM were recruited in primary care and outpatient hospital consultations, in Spain and Colombia, during the period from May 2018 to June 2019. The properties analysed were feasibility/acceptability, internal consistency, reliability, precision and (structural) content-construct validity including confrmatory factor analysis. The COSMIN checklist was used to assess the methodological/psychometric quality of the instrument. Results: The scale had an adequate internal consistency and test retest reliability (Cronbach’s alpha=0.90; intraclass correlation coefcient=0.96, respectively). In addition, the instrument is precise (standard error of measurement=3.34, with values<½SD=8.52) and correlates positively with social support (DUFSS) (rs=0.56), quality of life (WHOQOL-BREF) (rs=0.51–0.30) and ssatisfaction with life (SLS-6) (rs=0.50–0.38). The original 26-items version of the scale did not support totally the confrmatory factor analysis. The COSMIN checklist is favourable for all the properties analysed, although weaknesses are detected for structural validity. Conclusions: The LW-CI-T2DM is a valid, reliable and accurate instrument for use in clinical practice to determine how a person’s life is afected by the presence of diabetes. This instrument correlates well with the associated constructs of social support, quality of life and satisfaction. Additional research is needed to determine how well the questionnaire structure performs when robust factor analysis methods are applied.This study has been funded by the Ministry of Science, Innovation and University of the Spanish Government (FEDER/Ministerio de Ciencia, Innovación y Universidades-Agencia Estatal de Investigación/ Proyecto (CSO2017-82691-R)).S

International psychometric validation of the Living with Chronic Illness Scale in Spanish-speaking patients with chronic obstructive pulmonary disease

Objectives To validate the Living with Chronic Illness (LW-CI) Scale in patients with chronic obstructive pulmonary disease (COPD). Design Observational, cross-sectional validation study with retest. Acceptability, reliability, precision and construct validity were tested. Setting The study took place in primary and secondary specialised units of public and private hospitals of Spain and Colombia. Participants The study included 612 patients with COPD assessed from May 2018 to May 2019. A consecutive cases sampling was done. Inclusion criteria included: (A) patients with a diagnosis of COPD; (B) native Spanish speaking; (C) able to read and understand questionnaires; and (D) able to provide informed consent. Exclusion criteria included: (A) cognitive deterioration and (B) pharmacological effect or disorder that could disrupt the assessment. Results The LW-CI-COPD presented satisfactory data quality, with no missing data or floor/ceiling effects, showing high internal consistency for all the domains (Cronbach's alpha for the total score 0.92). Test-retest reliability was satisfactory (intraclass correlation coefficient=0.92). The LW-CI-COPD correlated 0.52-0.64 with quality of life and social support measures. The scale demonstrated satisfactory known-groups validity, yielding signifi cantly different scores in patients grouped according to COPD severity levels. Conclusions This has been the first validation study of the LW-CI-COPD. It is a feasible, reliable, valid and precise self-reported scale to measure living with COPD in the Spanish-speaking population. Therefore, it could be recommended for research and clinical practice to measure this concept and evaluate the impact of centred-care interdisciplinary interventions based on the patients' perspective, focused on providing holistic and comprehensive care to patients with COPDMinistry of Science, Innovation and University (FEDER/Ministerio de Ciencia, Innovacion y Universidades -Agencia Estatal de Investigacion)||Universidad de la Saban

A Generic Deep Learning Based Cough Analysis System from Clinically Validated Samples for Point-of-Need Covid-19 Test and Severity Levels

We seek to evaluate the detection performance of a rapid primary screening tool of Covid-19 solely based on the cough sound from 8,380 clinically validated samples with laboratory molecular-test (2,339 Covid-19 positive and 6,041 Covid-19 negative). Samples were clinically labelled according to the results and severity based on quantitative RT-PCR (qRT-PCR) analysis, cycle threshold and lymphocytes count from the patients. Our proposed generic method is a algorithm based on Empirical Mode Decomposition (EMD) with subsequent classification based on a tensor of audio features and deep artificial neural network classifier with convolutional layers called DeepCough'. Two different versions of DeepCough based on the number of tensor dimensions, i.e. DeepCough2D and DeepCough3D, have been investigated. These methods have been deployed in a multi-platform proof-of-concept Web App CoughDetect to administer this test anonymously. Covid-19 recognition results rates achieved a promising AUC (Area Under Curve) of 98.800.83%, sensitivity of 96.431.85%, and specificity of 96.201.74%, and 81.08%5.05% AUC for the recognition of three severity levels. Our proposed web tool and underpinning algorithm for the robust, fast, point-of-need identification of Covid-19 facilitates the rapid detection of the infection. We believe that it has the potential to significantly hamper the Covid-19 pandemic across the world

Calidad de vida y uso de servicios hospitalarios en la diada cuidador/paciente con insuficiencia cardiaca

Introduction: The situation of heart failure in the current European context offers an epidemiological setting that involves a true challenge for health services. The aim of the study is to analyse the relationship between the use of hospital services by patients with heart failure and health-related quality of life of patients and family caregivers. Method: Ambispective analytical longitudinal observational cohort study. Perceived health (outcome) and the history of hospitalisations and emergency events in the previous years (presentation), as well as health-related quality of life of patients and caregivers, were retrospectively and prospectively analysed, respectively. Results: A risk of deterioration in patients’ quality of life was found, which was associated with previous emergency events (odds ratio [OR]: 2.82; 95% con€dence interval [95% CI]: 1.47-5.41) and with hospital admissions (OR: 4.66; 95% CI: 1.67-12.99). Among caregivers, the deterioration in their mental quality of life was associated with more hospital admissions (OR: 2.61; 95% CI: 1.06-6.45). Conclusions: There is a relationship between the use of hospital services and health-related quality of life of patients and their family caregivers. Patients with the worst physical health status made a greater use of hospital services. These €ndings seem to con€rm the need to measure patients’ state of health, as well as their family caregivers’, the latter becoming a group of risk because of deterioration in their own health.Introducción: La situación de la insu€ciencia cardiaca en el contexto europeo actual, ofrece un escenario epidemiológico que supone un verdadero desafío para los servicios de salud. El objetivo del estudio es analizar la relación entre el uso de los servicios hospitalarios en pacientes con insu€ciencia cardiaca y la calidad de vida relacionada con la salud de pacientes y sus cuidadores familiares. Método: Estudio observacional longitudinal analítico de cohortes ambispectivo. Se analizó retrospectivamente la salud percibida (desenlace) y los antecedentes de ingresos hospitalarios y episodios de urgencias en los años anteriores (exposición) y prospectivamente la calidad de vida relacionada con la salud de pacientes y cuidadores. Resultados: Se halló un riesgo de deterioro de calidad de vida de pacientes y se asoció al uso que episodios por urgencias previos (odds ratio [OR]: 2,82; intervalo de con€anza al 95% [IC95%]: 1,47-5,41) e ingresos hospitalarios (OR: 4,66; IC95%: 1,67-12,99). En los cuidadores se asoció el deterioro de su calidad de vida mental, a más ingresos hospitalarios (OR: 2,61; IC95%: 1,06-6,45). Conclusiones: Existe una relación entre el uso de los servicios hospitalarios y la calidad de vida relacionada con la salud de los pacientes y sus cuidadores familiares. Los pacientes con peor salud física presentaban un mayor uso de los servicios hospitalarios. Estos hallazgos parecen con€rmar la necesidad de medir el estado de salud de los pacientes y también el de los cuidadores familiares, cuyo propio deterioro de la salud los convierte en un grupo de riesgo

Calidad de vida relacionada con la salud y sobrecarga de cuidadores de pacientes ingresados con insuficiencia cardiaca

• Introduction: Heart failure (HF) progression involves an important reduction in the quality of life, with a progressive functional impairment and a high consumption of socio-sanitary resources. The aim of this study is to describe the profile of patients with HF and of their caregivers, the social demography, the overload, the depression and the healthrelated quality of life of both. • Methods: An analytical cross-sectional study was conducted at the public agency Costa del Sol. The study population was constituted by patients hospitalized for HF, with identified main caregiver. Patients were selected from their admission into the hospital. • Results: The caregiver’s profile in this setting corresponds to a woman about 50-years old who takes care of a patient averaged 70-years old and who is usually his daughter or partner. Women suffering from HF were more dependent than men, with a significant difference (p: 0.01) of 22.77 scores in the Barthel index. Daughters or wives of highly dependent patients suffer from a higher overload and display a deteriorated state of mental health (p: 0.02). A significant, moderate and inverse relationship was seen between the patient’s mental health-related quality of life (HRQL) and the caregiver’s effort level r: 0.453; p<0.0001. An inverse correlation was seen between the caregivers’ level of depression and the mental component of quality of life r: 0.362; p<0.0001. • Conclusions: Caregivers under this mental health condition, along with the overload, show symptoms of depression, which could adversely affect their endurance as caregivers.• Introducción y objetivos: La progresión de la insuficiencia cardiaca (IC) implica una importante reducción de la calidad de vida con deterioro funcional progresivo y un elevado consumo de recursos sociosanitarios. El propósito de este estudio es describir el perfil de pacientes con IC y de sus cuidadores desde el punto de vista sociodemográfico, la sobrecarga, la depresión y la calidad de vida relacionada con la salud de ambos. • Material y Método: Estudio transversal de corte analítico en la Agencia Pública Costa del Sol. La población de estudio la constituían pacientes ingresados por IC con cuidador principal identificado. Los pacientes se seleccionaron a partir del ingreso en el hospital. • Resultados: El perfil de cuidador en este medio es de mujer con unos 50 años que cuida de un paciente, que suele ser su padre o pareja con una edad media de 70 años. Las mujeres con IC presentaron más dependencia que los hombres con diferencia significativa en el índice de Barthel (p=0,01) de 22,77 puntos. Las hijas o esposas de pacientes con niveles de dependencia elevados tienen mayor sobrecarga y reflejan una salud mental deteriorada (p=0,02). Se observó una relación significativa moderada e inversa entre la calidad de vida relacionada con la salud (CVRS) mental del paciente y el índice de esfuerzo del cuidador: r=-0,453; p<0,0001. El nivel de depresión de los cuidadores mostró una correlación inversa con el componente mental de la calidad de vida r=0,362; p<0,0001. • Conclusiones: Las cuidadoras con esta salud mental, unida a la sobrecarga, presentan síntomas depresivos que pueden influir negativamente en su resistencia como cuidadora

Validation of living with chronic illness scale in a type 2 diabetes mellitus population

Background Worldwide, type 2 diabetes mellitus (T2DM) is one of the most prevalent chronic diseases and one of those producing greatest impact on patients’ day-to-day quality of life. Our study aim is to validate the “Living with Chronic Illness Scale” for a Spanish-speaking T2DM population. Methods In this observational, international, cross-sectional study, 582 persons with T2DM were recruited in primary care and outpatient hospital consultations, in Spain and Colombia, during the period from May 2018 to June 2019. The properties analysed were feasibility/acceptability, internal consistency, reliability, precision and (structural) content-construct validity including confirmatory factor analysis. The COSMIN checklist was used to assess the methodological/psychometric quality of the instrument. Results The scale had an adequate internal consistency and test retest reliability (Cronbach’s alpha = 0.90; intraclass correlation coefficient = 0.96, respectively). In addition, the instrument is precise (standard error of measurement = 3.34, with values < ½SD = 8.52) and correlates positively with social support (DUFSS) (rs = 0.56), quality of life (WHOQOL-BREF) (rs = 0.51–0.30) and ssatisfaction with life (SLS-6) (rs = 0.50–0.38). The original 26-items version of the scale did not support totally the confirmatory factor analysis. The COSMIN checklist is favourable for all the properties analysed, although weaknesses are detected for structural validity. Conclusions The LW-CI-T2DM is a valid, reliable and accurate instrument for use in clinical practice to determine how a person’s life is affected by the presence of diabetes. This instrument correlates well with the associated constructs of social support, quality of life and satisfaction. Additional research is needed to determine how well the questionnaire structure performs when robust factor analysis methods are applied.This study has been funded by the Ministry of Science, Innovation and University of the Spanish Government (FEDER/Ministerio de Ciencia, Innovación y Universidades—Agencia Estatal de Investigación/ Proyecto (CSO2017-82691-R)).Ye

Validation of living with chronic illness scale in a type 2 diabetes mellitus population

Background: Worldwide, type 2 diabetes mellitus (T2DM) is one of the most prevalent chronic diseases and one of those producing greatest impact on patients’ day-to-day quality of life. Our study aim is to validate the “Living with Chronic Illness Scale” for a Spanish-speaking T2DM population. Methods: In this observational, international, cross-sectional study, 582 persons with T2DM were recruited in primary care and outpatient hospital consultations, in Spain and Colombia, during the period from May 2018 to June 2019. The properties analysed were feasibility/acceptability, internal consistency, reliability, precision and (structural) content-construct validity including confirmatory factor analysis. The COSMIN checklist was used to assess the methodological/psychometric quality of the instrument. Results: The scale had an adequate internal consistency and test retest reliability (Cronbach’s alpha = 0.90; intraclass correlation coefficient = 0.96, respectively). In addition, the instrument is precise (standard error of measurement = 3.34, with values &lt; ½SD = 8.52) and correlates positively with social support (DUFSS) (r s = 0.56), quality of life (WHOQOL-BREF) (r s = 0.51–0.30) and ssatisfaction with life (SLS-6) (r s = 0.50–0.38). The original 26-items version of the scale did not support totally the confirmatory factor analysis. The COSMIN checklist is favourable for all the properties analysed, although weaknesses are detected for structural validity. Conclusions: The LW-CI-T2DM is a valid, reliable and accurate instrument for use in clinical practice to determine how a person’s life is affected by the presence of diabetes. This instrument correlates well with the associated constructs of social support, quality of life and satisfaction. Additional research is needed to determine how well the questionnaire structure performs when robust factor analysis methods are applied. </p