Cuidados de enfermería desde la experiencia de personas que padecen trastornos alimentarios: un estudio cualitativo / Nursing care experiences of people with eating disordes: a qualitative study from patients' perspective

Resumen Los Trastornos de la Conducta Alimentaria suponen uno de los problemas más prevalentes en la sociedad, siendo los cuidados prestados por las enfermeras fundamentales para su recuperación. Es por ello necesario comprender la experiencia que tienen los pacientes de los cuidados que reciben, para poder adaptarse a sus necesidades. Este estudio cualitativo propone aproximarse a la vivencia de cuidados de pacientes que padecen trastornos alimentarios desde un enfoque fenomenológico hermenéutico. Diecinueve pacientes de Alcalá de Henares (Madrid) colaboraron en la investigación a través de entrevistas y relatos, que fueron grabados, transcritos y analizados temáticamente. Los resultados se agruparon en cuatro categorías: 1. Una ayuda inesperada, 2. Buscar raíces: encontrar el origen, 3. Derribar barreras y construir contrafuertes, 4. Entender el significado del Trastorno Conducta Alimentaria. Para los pacientes, las enfermeras son una figura tanto inesperada como relevante, mostrando la importancia de los aspectos psicológicos y emocionales, sociales y personales como reguladores de su relación con la comida, la imagen y la vivencia de la corporeidad. A través del estudio, se profundiza en la relación de cuidados entre enfermera y paciente, obteniendo una perspectiva de cuidados desconocida, que posibilita ampliar el conocimiento e individualizar los cuidados prestados.

Abstract Eating Disorders are one of the most prevalent problems in our society being nursing care essential for recovery. It is therefore necessary to understand patients' experience in order to adapt their actions to patients' needs. This qualitative study offers an approach to nursing care experience of people with eating disorders from an hermeneutical phenomenological approach. Nineteen patients from Alcalá de Henares (Madrid) collaborated in the research through in-depth interviews and stories, which were thematically recorded, transcribed and analyzed. The results were grouped in four categories: 1. Unexpected help, 2. In search for roots: discovering the origin, 3. To break down barriers and build buttresses, 4. To understand the meaning of the eating disorder. Patients emphasize that nurses are as unexpected as relevant in their lives, showing the importance of psychological, emotional, social and personal aspects, as regulators of their food relationship, their body image and their corporeality experience. This investigation allows getting a deeper view of care relationship between nurses and patients, previously unknown, which makes it possible to widen the knowledge and to individualize the care provided.

Holistic nursing care for people diagnosed with an eating disorder: A qualitative study based on patients and nursing professionals' experience.

PURPOSE: To analyze eating disorder patients and nursing professionals' views and experience of the relationship-based care established. DESIGN AND METHODS: A qualitative study that employs an interpretative phenomenological analysis. Nineteen patients and 19 nurses participated in the research through interviews and narrations. FINDINGS: Nurses' help is both unexpected and relevant during the patients' recovery process. They provide care not focusing just on nutritional aspects, other factors such as mutual help, the psychological, emotional, social, and personal aspects are highlighted. PRACTICE IMPLICATIONS: This study provides a deep understanding of the relationship-based care established that makes it possible to expand knowledge and to individualize the care provided.

Validación psicométrica del cuestionario COPE-Index (Carers of Older People in Europe) / Psychometric validation of the COPE-Index questionnaire (Carers of Older People in Europe)

OBJETIVO: describir el proceso de validación psicométrica del instrumento COPE-Index en población española. MÉTODO: estudio de validación del cuestionario COPE-Index, que cuenta con 15 ítems divididos en tres subescalas: valoración del impacto negativo, valoración del impacto positivo y calidad del apoyo. Los sujetos de estudio fueron 165 figuras cuidadoras de personas mayores, pertenecientes a la Asociación de Familiares de Alzheimer de la Comunidad de Madrid. Mediciones principales: factibilidad del instrumento COPE, consistencia interna, efecto techo y suelo, análisis factorial exploratorio, validez convergente y divergente (para ello se usaron los cuestionarios PACS, Duke-Unc y SF-12). RESULTADOS: la muestra de estudio estuvo formaba por 150 sujetos (tasa de respuesta del 90,9%). El 65,33% (n= 98) era mujer; la edad media (DE) fue de 64 (12,23). Los resultados se mostraron fiables en cuanto a su homogeneidad interna en relación con la subescala negativa y la subescala de calidad (alfas de Cronbach > 0,7) y menor en la subescala positiva (alfa de Cronbach: 0,61). No se apreció efecto techo ni suelo. La validez de constructo confirmó tres dimensiones del cuestionario COPE, que explicaban el 52% de la varianza total. En las pruebas de validez convergente/divergente se correlacionaron las puntuaciones de la subescala positiva del cuestionario COPE con los ítems del cuestionario PACS, la subescala negativa del cuestionario COPE se relacionó con las preguntas del cuestionario Duke-Unc y, finalmente, la subescala de calidad del cuestionario COPE se correlacionó con los ítems del instrumento SF-12 versión dos. CONCLUSIÓN: la versión española del cuestionario COPE-Index fue válida y confiable para identificar los aspectos positivos, negativos y de calidad del cuidado en cuidadoras de personas mayores

OBJECTIVE: to describe the psychometric validation process of the COPE-Index instrument for the Spanish population. METHOD: a validation study of the COPE-Index questionnaire, which consists of 15 items classified into three sub-scales: assessment of negative impact, assessment of positive impact, and quality of support. The study subjects were 165 carers for older people, from the Madrid Association of Relatives of Alzheimer's Patients. The main measurements were: the feasibility of the COPE instrument, internal consistency, ceiling and floor effect, exploratory factor analysis, convergent and divergent validity (the PACS, Duke-Unc and SF-12 questionnaires were used for this). RESULTS: the study sample was formed by 150 subjects (90.9% response rate). Of these, 65.33% (n= 98) were female, and their mean age (SD) was 64 (12.23). Results appeared reliable in terms of internal homogeneity regarding the negative sub-scale and the quality sub-scale (Cronbach's alphas > 0.7), and lower in the positive sub-scale (Cronbach's alpha: 0,61). Neither ceiling nor floor effect were observed. The construct validity confirmed three dimensions of the COPE questionnaire, which explained 52% of the total variance. In the convergent / divergent validity tests, the scores from the positive sub-scale of the COPE questionnaire were correlated with the PACS questionnaire items, the negative sub-scale of the COPE questionnaire was associated with the questions from the Duke-Unc questionnaire, and finally, the quality sub-scale of the COPE questionnaire was correlated with the items from the second version of the SF-12 instrument. CONCLUSION: the Spanish version of the COPE-Index questionnaire was valid and reliable to identify the positive, negative and quality aspects of care in caregivers for elderly persons

The promoter activity of human Mfn2 depends on Sp1 in vascular smooth muscle cells.

AIMS: Mitofusin-2 (Mfn2) expression is dysregulated in vascular proliferative disorders and its overexpression attenuates the proliferation of vascular smooth muscle cells (VSMCs) and neointimal lesion development after balloon angioplasty. We sought to gain insight into the mechanisms that control Mfn2 expression in VSMCs. METHODS AND RESULTS: We cloned and characterized 2 kb of the 5'-flanking region of the human Mfn2 gene. Its TATA-less promoter contains a CpG island. In keeping with this, 5'-rapid amplification of cDNA ends revealed six transcriptional start sites (TSSs), of which TSS2 and TSS5 were the most frequently used. The strong CpG island was found to be non-methylated under conditions characterized by large differences in Mfn2 gene expression. The proximal Mfn2 promoter contains six putative Sp1 motifs. Sp1 binds to the Mfn2 promoter and its overexpression activates the Mfn2 promoter in VSMCs. Chemical inhibition of Sp1 reduced Mfn2 expression, and Sp1 silencing reduced transcriptional activity of the Mfn2 promoter. In keeping with this view, Sp1 and Mfn2 mRNA levels were down-regulated in the aorta early after an atherogenic diet in apolipoprotein E-knockout mice or in VSMCs cultured in the presence of low serum. CONCLUSION: Sp1 is a key factor in maintaining basal Mfn2 transcription in VSMCs. Given the anti-proliferative actions of Mfn2, Sp1-induced Mfn2 transcription may represent a mechanism for prevention of VSMC proliferation and neointimal lesion and development.

Oxo-4-methylpentanoic acid directs the metabolism of GABA into the Krebs cycle in rat pancreatic islets.

OMP (oxo-4-methylpentanoic acid) stimulates by itself a biphasic secretion of insulin whereas L-leucine requires the presence of L-glutamine. L-Glutamine is predominantly converted into GABA (gamma-aminobutyric acid) in rat islets and L-leucine seems to promote its metabolism in the 'GABA shunt' [Fernández-Pascual, Mukala-Nsengu-Tshibangu, Martín del Río and Tamarit-Rodríguez (2004) Biochem. J. 379, 721-729]. In the present study, we have investigated how 10 mM OMP affects L-glutamine metabolism to uncover possible differences with L-leucine that might help to elucidate whether they share a common mechanism of stimulation of insulin secretion. In contrast with L-leucine, OMP alone stimulated a biphasic insulin secretion in rat perifused islets and decreased the islet content of GABA without modifying its extracellular release irrespective of the concentration of L-glutamine in the medium. GABA was transaminated to L-leucine whose intracellular concentration did not change because it was efficiently transported out of the islet cells. The L-[U-14C]-Glutamine (at 0.5 and 10.0 mM) conversion to 14CO2 was enhanced by 10 mM OMP within 30% and 70% respectively. Gabaculine (250 microM), a GABA transaminase inhibitor, suppressed OMP-induced oxygen consumption but not L-leucine- or glucose-stimulated respiration. It also suppressed the OMP-induced decrease in islet GABA content and the OMP-induced increase in insulin release. These results support the view that OMP promotes islet metabolism in the 'GABA shunt' generating 2-oxo-glutarate, in the branched-chain alpha-amino acid transaminase reaction, which would in turn trigger GABA deamination by GABA transaminase. OMP, but not L-leucine, suppressed islet semialdehyde succinic acid reductase activity and this might shift the metabolic flux of the 'GABA shunt' from gamma-hydroxybutyrate to succinic acid production.

Similar effects of succinic acid dimethyl ester and glucose on islet calcium oscillations and insulin release.

UNLABELLED: The relative contribution of glycolysis vs. oxidative metabolism to the stimulus secretion coupling mechanism of beta-cells was investigated in isolated islets. For that purpose, the secretory and intracellular calcium responses of islets to both glucose and succinic acid dimethyl ester (SAD) were compared. After 45 min of rat islet perifusion in the absence of substrates, the maximum secretory responses to glucose (20 mmol/L) and SAD (10 mmol/L) were qualitatively and quantitatively indistinguishable. Malonic acid dimethyl ester (a permeable citric acid cycle inhibitor) suppressed the insulin secretory response to both 20 mmol/L glucose and 10 mmol/L SAD (-70% on average). The inhibitor decreased within 70% the rate of 14CO2-production from 10 mmol/L [2-(14)C]pyruvate without affecting the rate of 20 mmol/L D-[5-(3)H]glucose utilization. Both, 11.1 mmol/L glucose and 10 mmol/L SAD, elevated the intracellular calcium concentration and induced a similar pattern of oscillations that were rapidly ablated by 20 mmol/L malonic acid dimethyl ester. However, the intracellular concentration of calcium declined to basal values several minutes after the introduction of the inhibitor in the presence of SAD whereas it remained elevated in the case of glucose. IN CONCLUSION: (1) An exclusive increase of mitochondrial metabolism in pancreatic islets was sufficient to mimic the effects of glucose on intracellular calcium and insulin secretion. (2) Islet glycolysis and/or the re-oxidation of cytoplasmic NADH allowed the maintenance of an elevated, though non-oscillating, intracellular calcium concentration, but a reduced response to glucose.

Conversion into GABA (gamma-aminobutyric acid) may reduce the capacity of L-glutamine as an insulin secretagogue.

We have carried out a detailed examination of L-glutamine metabolism in rat islets in order to elucidate the paradoxical failure of L-glutamine to stimulate insulin secretion. L-Glutamine was converted by isolated islets into GABA (gamma-aminobutyric acid), L-aspartate and L-glutamate. Saturation of the intracellular concentrations of all of these amino acids occurred at approx. 10 mmol/l L-glutamine, and their half-maximal values were attained at progressively increasing concentrations of L-glutamine (0.3 mmol/l for GABA; 0.5 and 1.0 mmol/l for Asp and Glu respectively). GABA accumulation accounted for most of the 14CO2 produced at various L-[U-14C]glutamine concentrations. Potentiation by L-glutamine of L-leucine-induced insulin secretion in perifused islets was suppressed by malonic acid dimethyl ester, was accompanied by a significant decrease in islet GABA accumulation, and was not modified in the presence of GABA receptor antagonists [50 micromol/l saclofen or 10 micromol/l (+)-bicuculline]. L-Leucine activated islet glutamate dehydrogenase activity, but had no effect on either glutamate decarboxylase or GABA transaminase activity, in islet homogenates. We conclude that (i) L-glutamine is metabolized preferentially to GABA and L-aspartate, which accumulate in islets, thus preventing its complete oxidation in the Krebs cycle, which accounts for its failure to stimulate insulin secretion; (ii) potentiation by L-glutamine of L-leucine-induced insulin secretion involves increased metabolism of L-glutamate and GABA via the Krebs cycle (glutamate dehydrogenase activation) and the GABA shunt (2-oxoglutarate availability for GABA transaminase) respectively, and (iii) islet release of GABA does not seem to play an important role in the modulation of the islet secretory response to the combination of L-leucine and L-glutamine.