Nutritional status in chronically-ill elderly patients. Is it related to quality of life?

OBJECTIVE: The aim of this study is to assess the quality of life in chronically-ill elderly patients and its relationship with parameters concerning the patients' nutritional status. DESIGN: A cross-sectional study. SETTING: Primary health-care centres in Jaen, Spain. PARTICIPANTS: A total of 168 chronically-ill elderly outpatients aged from 65 to 89 years. MEASUREMENTS: Quality of life was measured using the World Health Organization Quality of Life (WHOQOL-BREF) questionnaire. A nutritional assessment was undertaken including socio-demographic variables, anthropometric measurements (body-mass index and calf circumference), functional evaluation (Barthel index and Folstein mini-mental status test) and a dietetic questionnaire. The mini-nutritional assessment test was used as an assessment tool to detect nutritional risk. RESULTS: Quality of life in chronically-ill elderly subjects, as determined by the WHOQOL-BREF questionnaire, which diminishes with age, is independent of anthropometric parameters and a statistically significant difference was found between gender, socio-demographic characteristics, functional capacity, nutritional status and the kind of chronic disease (p<0.05). CONCLUSION: The relationship between the quality of life with the patients' socio-demographic characteristics, functional capacity and nutritional status underlines the importance of taking these factors into account in the management of chronically ill patients, especially women.

[Estrangement in psychopathology: depersonalization, derealization, disorders of the self?]. / El extrañamiento en la Psicopatología: despesonalización, desrealización, transtornos del yo?

The history of estrangement as a clinical object is very recent and concrete. It is negatively defined through the following syndromes: depersonalization, derealization and disturbances of the self. The limits that are established for its definition are very lax and unsuitable. The models that have been applied to these phenomena are explained in this paper: the model of the psychology of faculties, the model of the self-awareness as a reflective structure and the model of the consciousness as a passive synthesis. The authors propose to recover estrangement as a primary experience and to concentrate on the concepts of subject and person's re-examination.

El extrañamiento en la Psicopatología: ¿despersonalización, desrealización, trastornos del yo? / Estrangement in Psychopathology: depersonalization, derealization, disorders of the self?

La historia del extrañamiento como objeto clínico es reciente y concreta. Su definición negativa se descubre en tres síndromes: despersonalización, desrealización y trastornos del yo. Los límites establecidos para su definición son laxos e insuficientes. Los autores exponen los modelos de yo, sujeto y autoconciencia que se han aplicado a estos fenómenos: el modelo de la psicología de facultades, el modelo de la autoconciencia como estructura reflexiva y el modelo de la conciencia como síntesis pasiva. Los objetivos del trabajo han sido mostrar las aporías que encierran dichos modelos y el desacuerdo resultante en su conceptualización clínica. Como conclusión se propone regresar al extrañamiento como experiencia primaria y atender a una reelaboración de los conceptos de sujeto y persona (AU)

La esquizofrenia simple: ¿desarrollo de la personalidad o proceso? / Simple schizophrenia: Personality development or a condition?

El término 'esquizofrenia simple' nace a principios del siglo XX para designar una va riedad formal de la esquizofrenia. Sin una definición precisa pierde progresivamente su significación clínica como subtipo de esquizofrenia y se convierte paradójicamente en el representante puro del modelo de trastorno fundamental esquizofrénico. Su significado viene determinado históricamente por su origen en la intersección de tres categorías principales de la psicopatología clínica: psicosis, endogeneidad y proceso. La reciente exclusión del término esquizofrenia simple de los manuales diagnósticos y su reubicación taxonómica en los trastornos de personalidad será la consecuencia final del balance nosológico. El itinera rio del concepto 'esquizofrenia simple' nos sirve para cuestionar la viabilidad de una definición única del objeto clínico y para destacar el efecto configurador que los modelos teóricos ejercen sobre la taxonomía psiquiátrica (AU)

[Simple schizophrenia: personality development or a condition?]. / La esquizofrenia simple: desarrollo de la personalidad o proceso?

The term simple schizophrenia was firstly used in the early twentieth century to designate a formal variety of schizophrenia. Without a precise definition the concept progressively looses its clinical significance as a subtype of schizophrenia and becomes paradoxically the representation of the pure fundamental disorder. The intersection of three clinical psychopathology categories psychoses, endogenity and process has historically determined the meaning of simple schizophrenia. The recent exclusion of the term simple schizophrenia from the diagnostic manuals and its taxonomical realignment as a personality disorder are the result of the nosological approach. The review of the concept of simple schizophrenia allow us to question the viability of a unique definition of clinical objects and to point out the configurating effect of theory on psychiatric taxonomy.

Psychosocial factors and birth outcome: African American women in case management.

The relationship between psychosocial risk factors and birth outcomes among African American pregnant women is explored. The study focuses on social/environmental stressors and proposes a workable model for delivery of services based on case management principles. Unstable income, perinatal medical problems, alcohol use, smoking, access to prenatal care, internal barriers to care, compliance problems, negative experiences with providers, depression, unresolved grief, and fetal substance exposure were significantly associated with low birthweight. Unstable income, compliance problems, internal barriers to care, and poor access to care were significantly associated with preterm delivery. Specific interventions aimed at providing social support, facilitating access to care, health education, and encouragement to verbalize feelings about problems were significantly associated with the number of problems that the client was able to solve. The data indicated the importance of psychosocial, environmental and medical risk factors in the prediction of low birthweight and preterm delivery in a high-risk population.

Nursing case management and its role in perinatal risk reduction: development, implementation, and evaluation of a culturally competent model for African American women.

The authors outline the need for comprehensive perinatal services management for African American pregnant women, based on social/environmental stressors, and propose a workable model for delivery of services based on case management principles. The implications of case management as an intervention to ameliorate these stressors are discussed. Data from 5 years of comprehensive case management are included to support the effectiveness of case management as an intervention among high-risk women. Steps utilized to develop, implement, and evaluate case management are also discussed.

Cultural diversity issues in the development of valid and reliable measures of health status.

The development of instruments for use in culturally diverse settings and populations really involves much more than mere translation. Measurements must be tested for content validity and appropriate meaning among members of the group to be studied. Attention to issues of validity, reliability, and cross-cultural differences will lead to effective assessment, culturally competent health care, and the enhancement of the client/provider relationship. The concerns surrounding the use of quantitative measurement in diverse cultural groups are substantial. While the refinement of scales to meet the needs of various groups is a challenging task, such effort is essential to the diagnosis of disease, determination of health status, and the measurement of health outcomes in the diverse subgroups of this country's population.

[The understanding of psychopathology and the role of phenomenology. Contribution to a controversy]. / El sentido de la psicopatología y el papel de la fenomenología. Contribución a una controversia.

The sense of psychopathology is interpreted as the development of a descriptive language, that allowed the approach to the psychiatric disease in the context of natural sciences. The phenomenology was introduced as a methodological tool for the improvement of this language. Since then this topic has been present in the foundations problems of psychiatry. In this paper the discussion is set towards the influence of phenomenology in psychopathology, as a controversy between two opposite points of view. The authors establish their own arguments about the limits of psychopathological knowledge and psychiatric experience.