Development of burnout and moral distress in intensive care nurses: An integrative literature review.

AIMS: To describe, through an integrative literature review, the factors contributing to the development of burnout and moral distress in nursing professionals working in intensive care units and to identify the assessment tools used most frequently to assess burnout and moral distress. METHODS: An integrative literature review was carried out. PubMed, CINAHL, PsycINFO, SciELO, Dialnet, Web of Science, Scopus, and Cochrane databases were reviewed from January 2012 to February 2023. Additionally, snowball sampling was used. The results were analysed by using integrative synthesis, as proposed by Whittemore et al., the Critical Appraisal Skills Programme for literature reviews, the Strengthening the Reporting of Observational Studies in Epidemiology guidelines for quantitative observational studies, and the Joanna Briggs Institute checklist for qualitative research were used to evaluate evidence quality. RESULTS: Forty-one articles were selected for review: 36 were cross-sectional descriptive articles, and five were literature reviews. The articles were grouped into five-factor categories: 1) personal factors, 2) organisational factors, 3) labour relations factors, 4) end-of-life care factors, and 5) factors related to coronavirus disease 2019 (COVID-19). The Maslach Burnout Inventory-Human Services Survey and the Moral Distress Survey-Revised instruments were the most commonly used to measure burnout and moral distress. CONCLUSIONS: This review highlights the multiple personal, organisational, relational, situational, and end-of-life factors promoting burnout and moral distress among critical care nurses. Interventions in these areas are necessary to achieve nurses' job satisfaction and retention while improving nurses' quality of care.

[Dyadic self-care interventions in chronic heart failure in hospital settings: a systematic review].

Dyadic self-care in chronic heart failure (CHF) is key to ensure treatment continuity, reduce complications and readmissions, and minimise caregiver burden, but it requires specific strategies. The aim of the study was to identify dyadic self-management interventions in CHF in hospital settings by means of a systematic literature review conducted in the Pubmed, CINAHL and PsycInfo databases. Methodological quality was assessed according to CASPe and Joanna Briggs Institute tools. The main components of the interventions were identified: delivery format; dimensions and strategies used (cognitive-attitudinal, affective-emotional and behavioural); providers and recipients; measurement instruments used; and effectiveness. Most of the studies demonstrated improved outcomes, especially in depression and/or anxiety symptoms, adherence to treatment, diet and weight control. Innovative interventions that include components of the three dimensions identified and the use of valid, reliable and specific scales to measure outcomes are recommended.

Intervenciones de autocuidado diádico en la insuficiencia cardíacacrónica en el contexto hospitalario: una revisión sistemática / Dyadic self-care interventions in chronic heart failure in hospital settings: a systematic review

El autocuidado diádico en la insuficiencia cardiaca cró-nica (ICC) es clave para garantizar la continuidad del tra-tamiento, disminuir las complicaciones y los reingresos, yminimizar la sobrecarga del cuidador, pero demanda estra-tegias específicas. El objetivo fue identificar las intervencio-nes de autocuidado diádico en la ICC en el contexto hospi-talario mediante una revisión sistemática de la literatura enPubMed, CINAHL y PsycInfo; la calidad metodológica se valo-ró según las herramientas de CASPe y del Joanna Briggs Ins-titute. Se identificaron los principales componentes de lasintervenciones: formato de administración; dimensiones yestrategias utilizadas (cognitivo-actitudinal, afectiva-emo-cional y conductual); proveedores y receptores; instrumen-tos de medida utilizados; y efectividad. La mayoría de estu-dios mejoraron los resultados, especialmente síntomas dedepresión y/o ansiedad, adherencia al tratamiento, dieta ycontrol del peso. Se recomiendan intervenciones innova-doras que incluyan componentes de las tres dimensionesidentificadas y el uso de escalas válidas, fiables y específicaspara medir los resultados.(AU)

Dyadic self-care in chronic heart failure (CHF) is key toensure treatment continuity, reduce complications and re-admissions, and minimise caregiver burden, but it requiresspecific strategies. The aim of the study was to identify dy-adic self-management interventions in CHF in hospital set-tings by means of a systematic literature review conductedin the Pubmed, CINAHL and PsycInfo databases. Methodo-logical quality was assessed according to CASPe and JoannaBriggs Institute tools. The main components of the inter-ventions were identified: delivery format; dimensions andstrategies used (cognitive-attitudinal, affective-emotionaland behavioural); providers and recipients; measurementinstruments used; and effectiveness. Most of the studiesdemonstrated improved outcomes, especially in depressionand/or anxiety symptoms, adherence to treatment, diet andweight control. Innovative interventions that include com-ponents of the three dimensions identified and the use ofvalid, reliable and specific scales to measure outcomes arerecommended(AU)

Nivel de empoderamiento de las personas con insuficiencia cardíaca crónica hospitalizadas / Level of empowerment of hospitalized chronic heart failure patient

Fundamento: Conocer el nivel de empoderamiento de laspersonas con insuficiencia cardiaca crónica hospitalizadas es crucial para identificar a las personas con un nivelde empoderamiento más bajo y fundamentar el diseño deestrategias efectivas para mejorar su control sobre lasdecisiones y acciones que afectan a su salud y bienestar.La falta de estudio de este fenómeno en esta poblacióny contexto, sugiere que estos pacientes no están siendoatendidos adecuadamente. Material y métodos: Estudio descriptivo, prospectivo. Seutilizó el Cuestionario de empoderamiento del pacientecon enfermedad crónica, traducido y validado al español,que consta de 47 ítems, agrupados en tres dimensiones:Actitud positiva y sentido del control, Toma de decisiones compartida e informada, y Búsqueda de informacióny compartir entre iguales. Fue distribuido para su cumplimentación en las 24 horas previas al alta hospitalaria.Resultados: Se recogieron 25 cuestionarios (81%). La puntuación global media de empoderamiento fue de 165,92 ±20,9. La dimensión Actitud positiva y sentido de controlfue la peor puntuada, con una media de 3,4 ± 0,5. Se encontró una relación inversa y débil entre el nivel de em-poderamiento y la edad (rho = -0,240; p = 0,000) y una relación débil y positiva con la supervivencia a los 10 años(rho = 0,316; p = 0,01).Conclusión: El nivel de empoderamiento de los pacientesde este estudio fue medio-alto. Las estrategias para abordar la atención de esta población deberían centrarse entrabajar su actitud respecto a la enfermedad y percepciónde control de la situación e individualizarse conforme ala edad.(AU)

Background: Establishing the level of chronic cardiac inpatient empowerment is essential. By doing so, it is possible to identify groups with a lower level. It also providesa basis for designing effective strategies to improve theircontrol over decision making and the actions that affecttheir health and wellness. The shortage of studies of thisphenomenon for this particular population and contextsuggests that such patients are not receiving proper care. Methods: A prospective and descriptive study was carried out. A validated Spanish version of the Patient empowerment in long-term conditions scale was used. Thesurvey has 47 items, grouped into three dimensions: Positive attitude and feeling of control, Knowledge in shareddecision making, and Seeking information and sharingwith other patients. It was distributed 24 hours beforehospital discharge. Results: Twenty five questionnaires were collected (81%).The mean global empowerment score of the patients was165.92 ± 20.9. The dimension Positive attitude and senseof control showed the lowest score, with a mean of 3.4± 0.5. An inverse weak relationship was found betweenthe level of empowerment and age (rho = -0.240; p = 0.000)while a positive one was found with 10-year survival(rho = 0,316; p = 0.01). Conclusion: The level of empowerment of the patients inthis study was medium-high. The strategies used to address the care of this population should focus on workingon their attitude towards the disease and perceived control of the situation, and should be individualized according to age.(AU)

[Level of empowerment of hospitalized chronic heart failure patient].

BACKGROUND: Establishing the level of chronic cardiac inpatient empowerment is essential. By doing so, it is possible to identify groups with a lower level. It also provides a basis for designing effective strategies to improve their control over decision making and the actions that affect their health and wellness. The shortage of studies of this phenomenon for this particular population and context suggests that such patients are not receiving proper care. METHODS: A prospective and descriptive study was carried out. A validated Spanish version of the Patient empowerment in long-term conditions scale was used. The survey has 47 items, grouped into three dimensions: Positive attitude and feeling of control, Knowledge in shared decision making, and Seeking information and sharing with other patients. It was distrib-uted 24 hours before hospital discharge. RESULTS: Twenty five questionnaires were collected (81%). The mean global empowerment score of the patients was 165.92 ± 20.9. The dimension Positive attitude and sense of control showed the lowest score, with a mean of 3.4 ± 0.5. An inverse weak relationship was found between the level of empowerment and age (rho = -0.240; p = 0.000) while a positive one was found with 10-year survival (rho = 0,316; p = 0.01). CONCLUSION: The level of empowerment of the patients in this study was medium-high. The strategies used to address the care of this population should focus on working on their attitude towards the disease and perceived control of the situation, and should be individualized according to age.

[Exploring the experience of living with a heart transplant: a systematic review of the literature]. / Explorando la experiencia de vivir con un trasplante cardíaco: una revisión sistemática de la literatura.

The focus of healthcare professionals is shifting from illness to health and the individual experience of each person. However, current health care continues to focus on the prevention and treatment of medical complications, leaving aside other important aspects of the experience of cardiac transplant patients. The aim of this systematic review of the literature was to explore how living with a transplanted heart affects their lives. We searched the databases Pubmed, Cinahl, Scielo, Scopus, Dialnet, Cuiden and PsyINFO, and specialized journals. Twenty-five articles were included for study. The analysis and interpretation of the results was based on the methodology by Dixon-Woods et al and by Evans. The results were grouped into seven categories: spiritual repercussions, psychological repercussions, social repercussions, relationship with the donor and the organ, repercussions in the physical environment and quality of life, coping strategies, and feelings towards the healthcare professionals. The results confirm the need for a change in the care given to cardiac transplant patients given that, although transplantation has been shown to improve the quality and quantity of life, it has multiple psychosocial implications that affect the well-being and day-to-day life of these patients.

Explorando la experiencia de vivir con un trasplante cardíaco: una revisión sistemática de la literatura / Exploring the experience of living with a heart transplant: a systematic review of the literature

El enfoque de los profesionales de la salud está cambiando, pasando de centrarse en la enfermedad a orientarse hacia la salud y la experiencia individual de cada persona. Sin embargo, aunque esta perspectiva se considera relevante para los pacientes trasplantados cardíacos, la atención sanitaria actual se sigue centrando en la prevención y el tratamiento de las complicaciones médicas, dejando de lado otros aspectos importantes de su vivencia. El objetivo de esta revisión sistemática de la literatura fue explorar la experiencia de vivir con un corazón trasplantado y las implicaciones vitales que esto supone. Se realizó una búsqueda en las bases de datos Pubmed, Cinahl, Scielo, Scopus, Dialnet, Cuiden y PsyINFO, y en revistas especializadas y se incluyeron 25 artículos cuyo análisis e interpretación se basó en la metodología propuesta por Dixon-Woods y col y por Evans. Los resultados se agruparon en siete categorías: repercusiones espirituales, repercusiones psicológicas, repercusiones sociales, relación con el donante y el órgano, repercusiones en el ámbito físico y calidad de vida, estrategias de afrontamiento, y sentimientos hacia los profesionales. Los resultados confirman la necesidad de que haya un cambio en la atención que se presta a las personas trasplantadas cardíacas. Se ha visto que aunque el trasplante mejora la calidad y la cantidad de vida, tiene múltiples repercusiones psicosociales que afectan al bienestar y al día a día de estos pacientes

The focus of healthcare professionals is shifting from illness to health and the individual experience of each person. However, current health care continues to focus on the prevention and treatment of medical complications, leaving aside other important aspects of the experience of cardiac transplant patiens. The aim of this systematic review of the literature was to explore how living with a transplanted heart affects their lives. We searched the databases Pubmed, Cinahl, Scielo, Scopus, Dialnet, Cuiden and PsyINFO, and specialized journals. Twenty-five articles were included for study. The analysis and interpretation of the results was based on the methodology by Dixon-Woods et al and by Evans. The results were grouped into seven categories: spiritual repercussions, psychological repercussions, social repercussions, relationship with the donor and the organ, repercussions in the physical environment and quality of life, coping strategies, and feelings towards the healthcare professionals. The results confirm the need for a change in the care given to cardiac transplant patients given that, although transplantation has been shown to improve the quality and quantity of life, it has multiple psychosocial implications that affect the well-being and day-to-day life of these patients

[The severity of rheumatoid arthritis as a timely predictor of instability in the asymptomatic cervical spine]. / La severidad de la artritis reumatoide como predictor oportuno de inestabilidad de la columna cervical asintomática.

INTRODUCTION: Cervical spine involvement is common in patients with RA, risk factors such as disease activity may be related to asymptomatic cervical instability. OBJECTIVE: To determine the associated factors for asymptomatic cervical spine instability in patients with rheumatoid arthritis. MATERIAL AND METHODS: Case and control study from the external spine and rheumatology consultation of a level II trauma center to identify all patients diagnosed with rheumatoid arthritis (RA) and asymptomatic cervical instability. With simple X-rays of the cervical spine, carrying out radiographic measurements, the diagnosis of cervical instability was performed, risk factors such as the presence of rheumatoid factor (FR), previous articular surgeries, elevations of the C-reactive protein (PCR) values were evaluated. The severity and activity of the disease measured in the activity index of 28 articulations (DAS 28) in addition to the index of activity of the simplified disease (SDAI). RESULTS: We assessed 32 patients, nine patients (28.1%) met the criteria for instability of the anterior cervical spine atlantoaxial subluxation (SAAa) (100%), also one patient with SAAa presented vertical subluxation (SV), risk factors more relevant: DAS 28 with an OR = 3.54, SDA with an OR = 2.34 and finally the PCR 1.0 its OR = 2.88. CONCLUSION: The risk factors associated opportunely in our population are the severity of the activity of the disease that we can see in the DAS and SDAI when applied in patients and PCR 1.0.

INTRODUCCIÓN: La afectación de la columna cervical es común en pacientes con artritis reumatoide (AR), factores de riesgo como la actividad de la enfermedad puede estar relacionada con inestabilidad cervical asintomática. OBJETIVO: Determinar los factores asociados a la inestabilidad de la columna cervical asintomáticos en pacientes con artritis reumatoide. MATERIAL Y MÉTODOS: Estudio de casos y controles provenientes de la consulta externa de reumatología y columna de un centro de trauma de nivel II para identificar a todos los pacientes diagnosticados con AR e inestabilidad cervical asintomáticos. Con radiografías simples de la columna cervical que hacen mediciones radiográficas, se realizó el diagnóstico de inestabilidad cervical, se evaluaron los factores de riesgo como la presencia de factor reumatoide (FR), cirugías articulares previas, las elevaciones de los valores de proteína C reactiva (PCR), la severidad y actividad de la enfermedad medida en el índice de actividad de la enfermedad de 28 articulaciones (DAS 28), además del índice de actividad de la enfermedad simplificada (SDAI). RESULTADOS: Se evaluaron 32 pacientes, nueve (28.1%) cumplieron con los criterios para inestabilidad de la columna cervical con subluxación atlantoaxial anterior (SAAa) (100%), también un paciente con SAAa presentaba subluxación vertical (SV), los factores de riesgo más relevantes: el DAS 28 con un OR = 3.54, SDA con un OR = 2.34 y por último el PCR 1.0 su OR = 2.88. CONCLUSIÓN: Los factores de riesgo asociados oportunamente en nuestra población son la severidad de la actividad de la enfermedad que podemos observar en el DAS y SDAI al aplicarlos en los pacientes y PCR 1.0.

Malnutrition in hospitalized patients: results from La Rioja / Desnutrición en pacientes hospitalizados: resultados en La Rioja

Background: There is a high malnutrition prevalence in hospitalized patients. Aim: To determine the malnutrition prevalence in hospitalized patients of La Rioja Community (Spain) when evaluated with different screening/ evaluation tools and its relationship with hospital stay and mortality. Methods: Cross sectional observational study of hospitalized adult patients (age > 18 years old) from medical and surgical departments that underwent within 72 h of their admission a nutritional screening with Malnutrition Universal Screening Tool (MUST), Nutritional Risk Screening (NRS) 2002, Controlling Nutritional Status (CONUT) y Subjective Global Assessment (SGA). Results: 384 patients (273 medical and 111 surgical) were evaluated. Almost fifty percent of them were considered malnourished independently of the screening/assessment tool used. High concordance was found between SGA and NRS-2002 (k = 0.758). Malnourished patients had a longer hospital stay than those well-nourished (9.29 vs. 7.10 days; p = 0.002), used a greater number of medicines (9.2 vs. 7.4; p = 0.001) and underwent a higher number of diagnostic tests (16.4 vs. 12.5; p = 0,002). Conclusions: Half of the hospitalized patients in the medical and surgical department of La Rioja are malnourished. This is associated with a longer hospital stay, higher use of medicines, diagnostics tests and greater mortality. Malnutrition could be detected with easy screening tools to treat it appropriately (AU)

Antecedentes: existe una alta prevalencia de malnutrición en los pacientes hospitalizados. Objetivo: conocer la prevalencia de la desnutrición en la comunidad de La Rioja con distintos métodos de cribado/valoración nutricional y su relación con la estancia media y mortalidad. Métodos: estudio transversal de 384 pacientes mayores de 18 años (273 pacientes en servicios médicos y 111 en servicios quirúrgicos), a los que se les realizó en las primeras 72 horas del ingreso un cribado/valoración nutricional con MUST (Malnutrition Universal Screening Tool), NRS-2002 (Nutritional Risk Screening), CONUT (Controlling Nutritional Status) y VGS (Subjective Global Assessment). Resultados: la desnutrición fue observada en más del 50% de los pacientes independientemente del método de cribado/valoración nutricional utilizado. Existe una fuerte concordancia entre la VGS y el NRS-2002. La desnutrición se relaciona con aumento de la estancia hospitalaria (9,29 vs. 7,10 días; p = 0,002), mayor consumo de fármacos (9,2 vs. 7,4; p = 0,001) y mayor consumo de pruebas diagnósticas durante la estancia hospitalaria (16,4 vs. 12,5; p = 0,002). Conclusiones: uno de cada dos pacientes hospitalizados en la comunidad de La Rioja está desnutrido. La desnutrición se relaciona con aumento de la estancia hospitalaria, aumento de la utilización de pruebas diagnósticas, mayor consumo de medicamentos y aumento de la mortalidad. La desnutrición puede ser detectada con medidas de cribado nutricional sencillas que permitirían tratarla adecuadamente (AU)

The experience of family caregivers caring for a terminal patient at home: A research review.

INTRODUCTION: One of the key aspects of the care of terminal patients is care delivered in their own home. Increasingly, the process of dying is moving from hospitals to homes. Although this process is directly related to the support of the social health environment, the involvement of family caregivers is essential. Given the impact that caring for a terminally ill family member has on people's lives, it is necessary to comprehend their personal experience in a holistic way. OBJECTIVE: To reveal the experience of family caregivers who are caring for a terminal patient in their home. DESIGN: A qualitative systematic review of articles published from 2000 to 2015 was conducted between March and September of 2015. The following databases were consulted: CINAHL, PubMed, PsycINFO, Cochrane Library, SciELO and Dialnet. After applying the selection criteria, 12 relevant studies were identified. Subsequently, two of the reviewers jointly performed a qualitative content analysis of them. RESULTS: The analysis permitted the caregivers' experiences to be grouped into five themes: 1) Learning the diagnosis: uncertainty about the future and the prospects of death; 2) Feeling the physical and emotional burden of care; 3) Experiencing a limited life; 4) Redefining the relationship with the person being cared for; and 5) Valuing the importance of the support of the environment. CONCLUSIONS: This review shows that caring for a family member with advanced illness in the home has a great impact on the personal realm of the caregiver and in the relationship he or she maintains with the ill family member. Being involved in the process of dying translates into a prodigious physical and psychological effort, together with a substantial limitation on the normal development of their own life. Additionally, the caregiver must face and establish a new relationship with the family member, in accordance with the new ethos, without the help of a formal structure providing the necessary support. These results may help to focus attention on family caregiver needs and to develop the knowledge necessary to meet the current demands of end-of-life health care in the home.

Efectividad de consejería de cesación tabáquica en dos tipos de intervenciones en centros de salud de APS en Chile / Effectiveness of two types of smoking cessation counseling

Este estudio explora la efectividad de dos tipos de consejería de cesación tabáquica, para ello se reclutaron 34 mujeres entre 18 y 48 años pertenecientes a dos CESFAM de la Región Metropolitana en Chile, de las cuales 30 cumplían con los criterios de inclusión. Fueron aleatorizadas en 2 grupos homogéneos de 15 personas cada uno y se sometieron a dos modalidades de consejería de cesación tabáquica según estrategia de las 5A.Posteriormente se realizó un seguimiento de 2 meses para observar el cambio de conducta. No hubo diferencias significativas en el porcentaje de cesación de ambos grupos: 23.08 por ciento de las mujeres dejó de fumar en el grupo 1 y 21,43 por ciento en el grupo 2. Se puede evidenciar que a pesar de realizar dos tipos diferentes de intervenciones, no se obtuvieron diferencias significativas en el porcentaje de cesación de ambos grupos.

This study explores the effectiveness of two types of smoking cessation counseling and for this we recruited 34women between 18 and 48 years from two CESFAM Metropolitan Region in Chile, of which 30 met the inclusion criteria. They were randomized into two homogeneous groups of 15 people each and were subjected to two forms of smoking cessation counseling by the 5A strategy. Subsequently followed up for two months to observe the change in behavior. No significant differences in the percentage of cessation of both groups: 23.08 percent of women quit smoking in group I and 21.43 percent in group II. It may show that despite making two different types of interventions, no significant differences in the percentage of cessation of both groups.

The cerebrospinal fluid lactate is decreased in early stages of multiple sclerosis

BACKGROUND: The purpose of this study was to investigate if the concentration of lactate can provide additional information for pathologies that need examination of the cerebrospinal fluid (CSF) in their diagnostic controls or protocols. METHODS: A prospective study carried out in the year 2001 at the University Hospital of Bellvitge (Barcelona), on 92 samples of CSF from patients who needed this examination. The concentration of lactate, glucose, and the cell count was determined. One year later, the diagnosis revealed from the previous analyzed samples were sorted into groups according to the diagnosis. RESULTS: In the group with multiple sclerosis (MS) (n = 30), there was a significant decrease in lactate concentration (1.52 +/- 0.19 mmol/L) compared to the control group (1.89 +/- 0.11 mmol/L) (p < 0.001). The glucose concentration remained within the normal range and the cell count was < 4 cell/microL even in the relapses. CONCLUSIONS: In the early stages of MS, the lactate concentration in CSF is decreased and this could be related to alterations in sensitivity observed in those patients. Further studies are needed to evaluate if this lactate concentration is a prognostic indicator of the disease.

La metacognición aplicada a la emoción / Metacognition and emotion

En este artículo se han expuesto algunas reflexiones sobre la importancia de incorporar el desarrollo de las habilidades metacognitivas al servicio del conocimiento, la regulación y la expresión emocional. La inteligencia emocional es una forma de interactuar con elmundo, tiene muy en cuenta los sentimientos y engloba numerosas habilidades, tales como el control de los impulsos, la autoconciencia, el entusiasmo y la empatía. Tanto la familia como el sistema educativo son los factores básicos que pueden contribuir a la estabilidademocional de la persona, al ajuste y equilibrio de sus emociones y sentimientos y a la mejora de su inteligencia emocional. La cuestión esencial es de qué manera podremos aportar más inteligencia a nuestras emociones y más afecto a nuestra vida social

This paper provides some reflections on the importance of incorporating the development of meta-cognitive abilities to improve emotional understanding, expressionand regulation. Emotional intelligence as a way of interacting with the world involves feelings along with a number of abilities such as drive control, self consciousness, enthusiasm, and empathy. Both the family and the educational system are key factors for the individual’s emotional stability, fitness and balance and for the improvement of his/her emotionalintelligence. The most important point is how we will be able to contribute more intelligence to our emotions and more affection to our social life

Other relevant components of nuts: phytosterols, folate and minerals.

Nuts contain significant amounts of essential micronutrients that are associated with an improved health status when consumed at doses beyond those necessary to prevent deficiency states. Nuts do not contain cholesterol, but they are rich in chemically related phytosterols, a class of compounds that interfere with intestinal cholesterol absorption and thus help lower blood cholesterol. Nuts also contain folate, a B-vitamin necessary for normal cellular function that plays an important role in detoxifying homocysteine, a sulphur-containing amino acid with atherothrombotic properties that accumulates in plasma when folate status is subnormal. Compared to other common foodstuffs, nuts have an optimal nutritional density with respect to healthy minerals, such as calcium, magnesium and potassium. Like that of most vegetables, the sodium content of nuts is very low. A high intake of calcium, magnesium and potassium, together with a low sodium intake, is associated with protection against bone demineralisation, arterial hypertension, insulin resistance, and overall cardiovascular risk. Phytosterols might justify part of the cholesterol-lowering effect of nut intake beyond that attributable to fatty acid exchange, while the mineral richness of nuts probably contributes to the prevention of diabetes and coronary heart disease observed in epidemiological studies in association with frequent nut consumption.

The effect of supplementation with n-3 fatty acids on the physical performance in subjects with spinal cord injury.

A global physical evaluation was performed in 21 males with spinal cord injury (SCI), at the beginning and at three and six months of omega-3 fatty acid (FA) supplementation. A significant increase in the proportion of eicosapentaenoic acid and docosahexanoic acid in plasma was observed in response to the supplementation (p<0.05). After six months of FA supplementation, strength endurance time increased from 127.7+/-19.0 s to 215.2+/-45.6 s in the right arm, and from 139+/-27.6 s to 237.7+/-48.7 s, in the left arm. The time to perform 20 repetitions of 70% maximum workload showed a reduction of 41% between the first and the third test. The time taken to cover a 90 meter long track, with a 6% slope, was reduced from 66.9+/-8.0 s to 59.3+/-6.7 s, at the end of the study (p<0.05). In conclusion, omega-3 FA supplementation could contribute to improve the functional capabilities in SCI subjects.

Creatine supplementation and performance in 6 consecutive 60 meter sprints.

Creatine is an ergogenic aid used in individual and team sports. The aim of this study is to analyze the effect of monohydrate creatine supplementation on physical performance during 6 consecutive maximal speed 60 meter races, and the changes induced in some characteristic biochemical and ventilatory parameters. The study was carried out on nineteen healthy and physically active male volunteers, and randomly distributed into two groups: Group C received a supplement of creatine monohydrate (20 g/day for 5 days) and group P received placebo. Tests were performed before and after supplementation. No significant changes were observed in weight or body water measured by bioimpedance or the sum of 7 skinfold or performance during the 60 meter races. Group C showed a statistically significant increase in plasma creatinine from 69.8 +/- 12.4 to 89.3 +/- 12.4 micromol x L(-1) (p<0.05). In group C in the second control day (after creatine supplementation), expiratory volume V(E), O2 uptake and CO2 production were lower after 2 minutes of active recovery period. These results indicate that creatine monohydrate supplementation does not appear to improve the performance in 6 consecutive 60 meter repeated races but may modify ventilatory dynamics during the recovery after maximal effort.

Long-term evolution of blood lipid profiles and glycemic levels in patients after spinal cord injury.

OBJECTIVE: To analyze the lipid and glycemic profiles in relation to age, time elapsed post injury and the level of injury in a group of patients with SCI. SUBJECTS: 2135 subjects with SCI were recruited during the annual routine health check-up carried out at the Institut Guttmann of Badalona, in Spain. The patients were classified according to the level of SCI and their age. METHODS: Serum lipid profiles and glycemic (glucose) levels were determined. Data was collected between 1996 and 2001, all biochemical analysis being performed by the same laboratory. RESULTS: Serum cholesterol levels show a statistically significant correlation with patient's age(P<0.001) and with time elapsed after injury (P<0.05). Differences can be observed between the values obtained from the different injury level groups (F=22.14; P<0.001). LDL-c shows a statistically significant difference between the four different age groups (F=3.51, P<0.05). There is an increase in plasma triglycerides related to the increase in age of the patients without observable differences between the injury level groups. The concentration of serum glucose increases with age (P<0.001) and also with the time elapsed after injury (P<0.05). CONCLUSION: There is a direct relationship between various biochemical parameters (total cholesterol, LDL-c and glucose) and the age of the patients, but not with the severity or time of evolution of the spinal cord injury.

[Alzheimer's caregiver burden and psychological distress. A neglected association in the assessment of dementias]. / Sobrecarga del cuidador de pacientes con enfermedad de Alzheimer y distrés psíquico. Una asociación relegada en la valoración de las demencias.

INTRODUCTION: Caregivers of dementia patients have a high risk of developing mental disorders. Nevertheless, their burden is not routinely assessed during the clinical assessment of the Alzheimer's type dementia patients. This study was designed to evaluate the association between caregiver's burden and psychological distress and to estimate the prevalence of mental disorders among the caregivers. METHODS: Cross-sectional study of Alzheimer patients' caregivers (n = 40). The caregiver burden was assessed by the Zarit scale whereas the GHQ-28 was used to evaluate psychological distress. RESULTS: The Zarit caregiver burden scale was able to discriminate the psychic distress levels (area under the curve: 0.87; 95% CI: 0.77 0.98). Its sensitivity (93%; 95% CI: 68.0 99.8) and specificity (80%; 95% CI: 59.3 93.2) were good for a cut-off point of 62/63. The estimated prevalence of psychiatric disorders in the caregivers was 20.7% (95% CI: 0.0 60.0%). CONCLUSION: The Zarit caregiver burden scale is useful for assessing psychological distress and should be included in any clinical protocol devised to evaluate the needs of patients with dementia.

Ginecomastia como primera manifestación de un hipertiroidismo / Gynecomastia as the first manifestation of hyperthyroidism

En el varón el hipertiroidismo puede producir alteraciones del metabolismo de las hormonas sexuales, debido fundamentalmente a un aumento en la conversión periférica de testosterona en estradiol, que puede dar lugar a disminución de la libido y ginecomastia. Sin embargo, lo habitual es que estas alteraciones sean leves y pasen inadvertidas en el contexto de un cuadro de tirotoxicosis y, de hecho, es muy infrecuente que estos síntomas sean la forma de presentación, por lo que hasta la fecha hay muy pocos casos descritos en la bibliografía. Presentamos el caso de un varón de mediana edad que fue remitido al servicio de endocrinología debido a la presencia de ginecomastia bilateral, y en el estudio se detectó un hipertiroidismo debido a enfermedad de Graves-Basedow. Después de ser descartadas otras causas de ginecomastia, se instauró tratamiento antitiroideo con metimazol y se observó una regresión de la ginecomastia de forma paralela a la normalización de las hormonas tiroideas (AU)

Hipogonadismo hipogonadotropo secundario a un traumatismo craneoencefálico / Hypogonadotropic hypogonadism after head injury

El traumatismo craneoencefálico es una causa poco frecuente de hipogonadismo hipogonadotropo adquirido. Aunque en la mayoría de los casos se trata de traumatismos craneoencefálicos graves, que ocasionan hipopituitarismos completos de instauración brusca, también pueden ser debidos a leves, sin otra afección adenohipofisaria, de instauración más lenta y sin evidencia de lesión en los estudios de imagen. Presentamos el caso de un varón de 29 años con hipogonadismo hipogonadotropo adquirido y aislado subsiguiente a un traumatismo craneoencefálico leve por accidente de tráfico, en el que se demostró integridad del resto de los ejes hipotálamo-hipofisarios y sin evidenciarse lesiones en la resonancia magnética. Concluimos que ante un hipogonadismo hipogonadotropo en el que se hayan descartado las causas más comunes (prolactinomas, tumores, fármacos o trastornos alimentarios), debe considerarse e incluirse en la anamnesis dirigida el traumatismo craneoencefálico como posible causa de la deficiencia hormonal (AU)