Rosario Ferrer-Cascales

Evaluación del bienestar espiritual en pacientes en hemodiálisis

INTRODUCTION Spirituality can be defined as a personal search for meaning and purpose in life that may or may not encompass religion. In this article we report on the development and testing of an instrument for measuring spiritual well-being within a sample of haemodialysis patients. MATERIAL AND METHOD The main instrument, a 21-item Meaning in Life Scale (MiLS), comprises four scales: Life Perspective, Purpose and Goals, Confusion and Lessened Meaning, Harmony and Peace, and Benefits of Spirituality. A total score for spiritual well-being is also produced. We also used the following variables: clinical (time on haemodialysis, modified Charlson comorbidity index), sociodemographic (age, gender), and self-assessments of health, quality of life (general and recent), personal happiness, religiosity, and belief in the afterlife. A cross-sectional study was carried out on 94 haemodialysis patients. RESULTS This study demonstrates that the MiLS-Sp is a psychometrically sound measure of spiritual well-being for dialysis patients (reliability, validity) as they manage the complex demands of a chronic illness. Spiritual well-being was significantly associated with various quality of life variables, health status, personal happiness, or religiosity in patients on dialysis. There was no relationship between spirituality scores and comorbidity, HD duration, gender, or age. Spiritual well-being is relatively low in dialysis patients. CONCLUSION Spirituality may play an important role on psychological well-being, quality of life, and self-rated health for patients on haemodialysis. Spiritual well-being in these patients is relatively low. Results suggest that assessing and addressing spiritual well-being in dialysis patients may be helpful in clinical practice.

Assessment of Health-Related Quality of Life in Chronic Dialysis Patients with the COOP/WONCA Charts

Background: The aim of the present work was to determine the health-related quality of life (HRQOL) of our patients on hemodialysis using the COOP/WONCA charts. A further aim was to explore its psychometric characteristics. Methods: The present study included all patients attending the hemodialysis unit of our hospital. The comparative study of the results was conducted with other population groups in which this questionnaire has been applied previously (primary-care patients, their accompanying persons, pregnant women, Alzheimer patient carers and drug addicts). The dimensional structure of the questionnaire was explored by factorial analysis of principal components, and internal consistency was evaluated with the Cronbach α factor. Concurrent validity was determined by comparative analysis of the results of the COOP/WONCA charts with those of another questionnaire, the 36-item short form of the Quality of Life Score (SF-36). To do so, 60 randomly chosen patients completed both questionnaires. Results: 98.9% of patients completed the COOP/WONCA charts in their entirety. The mean scores of all the charts, with the exception of overall health, are in the range of what could be called ‘favorable area of quality of life’ (below 3). With respect to the rest of the groups, the dialysis patients had the best scores on the ‘feelings’ and ‘social activities’ charts and none of the worst ones. The joint factorial analysis revealed that the questionnaire has a 3-factor structure: factor 1 or daily functioning, factor 2 or quality of life and health, factor 3 or the psychosocial factor. The Cronbach α value for the 9 charts was 0.766. All the correlations between equivalent dimensions of questionnaires COOP/WONCA and SF-36 were statistically significant (p < 0.01). The convergent validity mean was 0.57 and the discriminant validity mean was 0.22, appreciably lower than convergent validity. Conclusions: This study shows that the process of psychological adaptation to problems deriving from dialysis is satisfactory. Moreover, the COOP/WONCA charts are a useful instrument for the determination of the HRQOL in hemodialysis patients without losing psychometric quality.

Adolescent Alcohol Use in Spain: Connections with Friends, School, and Other Delinquent Behaviors.

This study examined the connections between adolescent alcohol use in Alicante, Spain and variables reflecting adolescents’ academic problems, potentially delinquent behaviors, friends’ alcohol consumption, and friendship quality. Information about alcohol use and a number of school and social variables was collected from adolescent students (N = 567) who completed the National Students School-Based Drug Survey in a classroom setting. Results suggested that gender was not significantly associated with alcohol use, although alcohol use increased with age and was more likely for adolescents enrolled in public schools compared to private. After controlling for age and type of school (public vs. private), academic problems explained 5.1% of the variance in adolescents’ alcohol use, potentially delinquent behaviors explained 29.0%, friends’ alcohol use 16.8%, and friendship quality 1.6%. When all unique predictors from these four models were included in a comprehensive model, they explained 32.3% of the variance in adolescents’ alcohol use. In this final model, getting expelled, participating in a fight, going out at night, the hour at which one returns, and the number of friends who have consumed alcohol were uniquely and positively associated with adolescents’ alcohol use. These results provide important information about multi-system influences on adolescent alcohol use in Alicante, Spain and suggest potential areas of focus for intervention research.

A relaxation technique enhances psychological well-being and immune parameters in elderly people from a nursing home: a randomized controlled study.

BackgroundThe aging process involves a decline in immune functioning that renders elderly people more vulnerable to disease. In residential programs for the aged, it is vital to diminish their risk of disease, promote their independence, and augment their psychological well-being and quality of life.MethodsWe performed a randomized controlled study, evaluating the ability of a relaxation technique based on Benson’s relaxation response to enhance psychological well-being and modulate the immune parameters of elderly people living in a geriatric residence when compared to a waitlist control group. The study included a 2-week intervention period and a 3-month follow-up period. The main outcome variables were psychological well-being and quality of life, biomedical variables, immune changes from the pre-treatment to post-treatment and follow-up periods.ResultsOur findings reveal significant differences between the experimental and control groups in CD19, CD71, CD97, CD134, and CD137 lymphocyte subpopulations at the end of treatment. Furthermore, there was a decrease in negative affect, psychological discomfort, and symptom perception in the treatment group, which increased participants’ quality of life scores at the three-month follow-up.ConclusionsThis study represents a first approach to the application of a passive relaxation technique in residential programs for the elderly. The method appears to be effective in enhancing psychological well-being and modulating immune activity in a group of elderly people. This relaxation technique could be considered an option for achieving health benefits with a low cost for residential programs, but further studies using this technique in larger samples of older people are needed to confirm the trends observed in the present study.Trial registrationInternational Standard Randomised Controlled Trial Number Register ISRCTN85410212

Relationship between adherence to the Mediterranean diet and health-related quality of life and life satisfaction among older adults

ObjectivesEvaluate the relationship between adherence to the Mediterranean diet and health-related quality of life and degree of life satisfaction among older adults.Design and SettingCross-sectional descriptive study.ParticipantsA total of 351 people older than 60 years participated in the study.MeasurementsThe Mediterranean Diet Score (MDS) was calculated to assess the degree of adherence to the MD. MD adherence was related to health-related quality of life using the Short Form Healthy Survey (SF-12) questionnaire, to life satisfaction using the Satisfaction with Life Scale (SWLS), and to sociodemographic, clinical and lifestyle variables. Multiple logistic regression models were used to analyse this relationship.ResultsMediterranean diet adherence was related to health-related quality of life. Participants with better adherence to the MD were more physically active (p=0.01) and had better health-related quality of life (p<0.05) and lower consumption of alcoholic beverages (p=0.04). The age-adjusted model showed a significant association between the MD and mental function for both sexes and with physical function only for men. The fully adjusted model showed a direct relationship between the MD and life satisfaction of women (p>0.05) but not for that of men (p=0.31).ConclusionsThe adherence to the MD is directly associated with the self-perceived physical and mental function of both sexes and with the life satisfaction of women. Further studies in older adult populations should be performed to obtain conclusive results on the MD effect on health-related quality of life, including wellness indicators.

Subtypes of Severely Mentally Ill Violent Offenders in a Spanish Forensic Psychiatric Hospital

Conduct disorder (CD) prior to age 15 identifies a subgroup of men with severe mental illness (SMI) who present a high risk for violence that persists across the life span. The present study examined male violent offenders with SMI in a forensic hospital in Spain, comparing those with SMI+CD and those without SMI-CD on the HCR-20 and PCL:SV. Violent offenders with SMI+CD obtained higher HCR-20 and PCL: SV total scores, and much higher H and factor 2 scores as compared to those without prior CD. Men with SMI+CD present a challenge to forensic psychiatric services.

Evaluation of Mediterranean diet adherence scores: a systematic review

Objective The aim of this review was to evaluate the conceptual suitability, applicability and psychometric properties of scores used internationally to measure adherence to the Mediterranean diet (MD). Design This was a systematic review to identify original articles that examined some aspects of the conceptual suitability, applicability or psychometric properties of the MD adherence score. Electronic searches were carried out on the international databases MEDLINE, Scopus, Web of Science and EMBASE (from January 1980 to 31 December 2015). Eligibility criteria for selecting studies The study included original articles that examined some aspects of the conceptual suitability, applicability or psychometric properties of the MD adherence score. The studies where MD adherence scores were administered but did not bring forward any evidence about their performance related to conceptual suitability, applicability or psychometric properties were excluded. Data extraction Information relating to the scales was extracted in accordance with the quality criteria defined by the Scientific Advisory Committee of the Medical Outcomes Trust for measurement of health results and the quality criteria recommended by Terwee: (1) conceptual, (2) applicability and (3) psychometric properties. Three authors independently extracted information from eligible studies. Results Twenty-seven studies were identified as meeting the inclusion criteria, yielding 28 MD adherence scores. The results showed that evidence is scarce and that very few scores fulfilled the applicability parameters and psychometric quality. The scores developed by Panagiotakos et al, Buckland et al and Sotos-Prieto et al showed the highest levels of evidence. Conclusions Scores measuring adherence to MD are useful tools for identifying the dietary patterns of a given population. However, further information is required regarding existing scores. In addition, new instruments with greater conceptual and methodological rigour should be developed and evaluated for their psychometric properties.

Differential effects of cognition-focused interventions for people with Alzheimer’s disease: A meta-analysis.

Objective: The efficacy of cognition-focused interventions (CFIs) for the treatment of Alzheimer’s disease (AD) has been questioned recently. To date, the specific effects of cognitive rehabilitation (CR), cognitive training (CT), and cognitive stimulation [CS] have not been analyzed due to inconsistencies in the use of the comparison groups. This work aims to analyze the differential effects of CFIs by removing the influence of the comparison group from the estimates of the effects. Method: a literature search performed in Pubmed, Proquest, and Embase databases yielded 65 potential studies, of which 33 studies with a sample size of 1,225 individuals were meta-analyzed. Each intervention group was treated as the unit of analysis to remove the confounding effects of the comparison condition. Measures of general cognitive functioning, memory and functional outcomes were compared using the hierarchical robust variance estimator metaregression. Age, education, sex, risk of bias, sample size, duration of intervention, the proportion of drop-outs, pharmacological treatment, and severity of disease were included as covariates. Results: Only CT differed from no cognition-focused interventions (NCFI) for memory outcomes in univariate analyses, but differences became nonsignificant when covariates were included in the model. CR showed a significantly higher effect in outcomes measuring functioning in targeted domains with no differences in standard cognitive tests relative to NCFI. Conclusions: This work supports previous findings questioning the efficacy of CT or CS for AD. Moving toward CFIs focused on relevant goals and including measures related to the skills, abilities or activities that are the focus of the intervention is encouraged.

Risk of progression to Alzheimer’s disease for different neuropsychological Mild Cognitive Impairment subtypes: A hierarchical meta-analysis of longitudinal studies.

Mild Cognitive Impairment (MCI) is a heterogeneous condition between normal aging and dementia. Upon neuropsychological testing, MCI can be divided into 4 groups: single-domain amnestic MCI (sd-aMCI), multiple-domain amnestic MCI (md-aMCI), single- and multiple-domain nonamnestic MCI (sd-naMCI, md-naMCI). Some controversy exists about whether the risk of progression to Alzheimer’s disease (risk-AD) is increased in all MCI subtypes. We meta-analyzed the risk-AD for 4 MCI groups using random-effects metaregression with the Hierarchical Robust Variance Estimator and sample size, criterion for objective cognitive impairment, length of follow-up and source of recruitment as covariates. From a pool of 134 available studies, 81 groups from 33 studies (N = 4,907) were meta-analyzed. All the studies were rated as having a high risk of bias. aMCI is overrepresented in studies from memory clinics. Multivariate analyses showed that md-aMCI had a similar risk-AD relative to sd-aMCI, whereas both sd-naMCI and md-naMCI showed a lower risk-AD compared with sd-aMCI. The risk-AD was significantly associated with differences in sample sizes across studies and between groups within studies. md-aMCI had a similar risk-AD relative to sd-aMCI in studies from memory clinics and in studies in the community. Several potential sources of bias such as blindness of AD diagnosis, the MCI diagnosis approach and the reporting of demographics were associated with the risk-AD. This work provides important data for use in both clinical and research scenarios.

Cross-Cultural Adaptation, Validity, and Reproducibility of the Mediterranean Islands Study Food Frequency Questionnaire in the Elderly Population Living in the Spanish Mediterranean

The objective of this study was to perform cross-cultural adaptation of the Mediterranean Islands Study Food Frequency Questionnaire (MEDIS-FFQ) and to evaluate its reproducibility and validity in a population over 60 years of age in the Spanish Mediterranean. Three hundred forty-one people completed the food frequency questionnaire (FFQ), which was administered twice (FFQ1 and FFQ2) with nine 24-h dietary recalls (24-HDRs) over a nine-month period to assess its reproducibility and validity. Cross-cultural translation and adaptation were performed according to the International Society for Pharmacoeconomics and Outcomes Research (ISPOR) guidelines and included direct translation, back-translation, and a pilot comprehension test. Reproducibility was evaluated with Pearson’s and interclass correlation coefficients. Validity was estimated using correlations between the FFQ food groups and the 24-HDR mean. The levels of agreement and misclassification were expressed as the proportions of individuals classified by comparing the estimated information from the FFQ2 and the 24-HDR. Reproducibility correlation coefficients ranged from r = 0.44 to r = 0.90. Validity indices ranged from 0.71 to 0.99. More than 80% of the subjects were classified in the same quartile on both instruments. The kappa statistic showed a moderate to high level of agreement (0.70–0.95) between the two instruments. In conclusion, the MEDIS-FFQ showed good reproducibility and validity in estimating the nutrient intake of the elderly population in the Spanish Mediterranean.