Resiliencia en cuidadores de personas con demencia: estudio preliminar

Introduction

Caring for a relative with dementia often has negative effects on the caregive?s physical and psychological health. However, many caregivers successfully cope with the stress factors arising from care, and even have uplifts during their experience, showing high resilience levels. This study presents a preliminary analysis of resilience in caregivers of patients with dementia, exploring its relationship with different variables.

Material and methods

Resilience was assessed (by CD-RISC) in 53 family caregivers of patients with dementia. Resilience was correlated to the following variables: caregiving context, stressors (e.g., cognitive impairment), appraisals (e.g., burden), moderators (e.g., personality traits and resources), and caregiving consequences (physical and psychological health).

Results

The participants showed moderate scores on resilience. Resilience was associated with poor emotional and physical status (significant inverse correlations with anxiety, depression, psycho-active drug use, health habits…). High resilience scores were significantly correlated to burden, neuroticism and extraversion, self-efficacy, self-esteem and less use of emotion focused coping strategies.

Conclusions

Higher resilience relates to a good emotional and physical status in caregivers. Moreover, resilience is more associated with caregiver variables (e.g., appraisal and coping with care, personality features), than to situational variables. The data highlight the strengthening of these types of appraisal and coping as a way to improve caregivers’ resilience and, consequently, their health.     

From confounders to suspected risk factors: psychosocial factors and work-related upper extremity disorders.

Psychosocial variables have recently been more prominent among epidemiologic risk factors for work-related upper extremity disorders (WRUEDs), but bio-behavioral mechanisms underlying these associations have been elusive. One reason is that the psychosocial domain has included many broad and disparate variables (e.g. mood, coping skills, job control, job satisfaction, job stress, social support), and this lack of specificity in the conceptualization of psychosocial factors has produced limited hypothesis testing opportunities. Therefore, recent research efforts have focused on identifying and conceptualizing specific psychosocial factors that might more clearly delineate plausible bio-behavioral mechanisms linking psychosocial factors to WRUEDs. One such factor is workstyle, a strategy that workers may employ for completing, responding to, or coping with job demands that might affect musculoskeletal health. Preliminary studies have provided support for measurable differences in workstyle among individual workers and an association with upper extremity pain and discomfort. An initial self-report measure of workstyle has been pilot tested among office workers and shown acceptable reliability and validity. Future studies are needed to study this construct among other working populations and to determine its relationship with other clinical endpoints. Nevertheless, early findings suggest workstyle may be a potential focus of WRUED prevention efforts.     

Konsiliar-liaisonpsychiatrische Aspekte unfallbedingter körperlicher Verletzungen

Severity of the physical injury measured by the Injury Severity Score, Glasgow Coma Scale or Trauma Injury Severity Score is only modestly related to behavioral responses during a hospital stay, but may provide important information for psychological assessment and differential diagnosis. The personal meaning of the injury and pre-accident factors are the most important determinators for the acute behavioral responses in injured hospitalized patients. ICD-10 (acute stress reaction) or DSM-IV (acute stress disorder)-based diagnoses are insufficient for identifying behavioral responses during the hospital stay. However, injuries may be overlooked by surgeons which may lead to false assumptions about psychological etiology of complaints and behavior with subsequent referral to C-L psychiatry. Pathophysiological aspects of the injury may shape behavioral responses as well. Thus C-L psychiatrists must always make their own independent judgement of the etiology of complaints or deviant behavior and sometimes even recommend additional biological assessments. Routine psychological interventions (e.g., debriefing, crisis intervention) in subjects displaying normal behavioral responses do not benefit patients in the long-run and may sometimes actually increase the likelihood of long-term problems. Thus, psychiatric interventions should be based on indication only. Brief, but structured psychotherapies should be the first step in uncomplicated behavioral responses to trauma. Pharmacological treatment must consider its impact on the neurobiology of psychological trauma, but also the interaction with non-psychiatric drugs and the pathophysiology of the injury. Good knowledge of the pharmacodynamic profiles of different drugs and their pharmacokinetic interaction potential is a requirement for state-of-the-art psychopharmacological treatment in C-L psychiatry.     

The elixir of muscle activity and kinesiology in a health perspective: Evidence of worksite tailored exercise training alleviating muscle disorders

Physical activity is known to benefit health while muscle activation and movements performed during occupational work in contrast may result in work-related musculoskeletal disorders. Therefore, we posed the research question: which mode of muscle activation may result in a reversal of work-related disorders? To address this, we performed electromyographic (EMG) and kinematic assessments of workers with diverse exposure categories: sedentary monotonous work, prolonged walking/standing, and physically heavy work. The various job-specific exposure variables could be categorized in terms of duration, intensity, repetition, static component, peak force etc. that were subsequently identified as risk factors. Based on sports science principles we developed tailored exercise programs to counteract job exposure. EMG activity during exercise training was monitored to identify principal differences between exercise training and job patterns. Evidence from more than 20 RCT studies including >4000 workers showed positive effects such as decreased muscle pain and increased workability. Finally, we identified plausible underlying mechanisms in muscle tissue – human and animal - that confirmed metabolic, morphological, and hormonal changes with e.g. repetitive work that were reversal to adaptations reported with exercise training. Progress has been made in developing intelligent physical exercise training, IPET, as the best complementary activity to job exposure and includes muscle activations and movements that limit work-related inactivity atrophy as well as overload injury.     

Women's physical and psychological condition independently predict their preference for apparent health in faces

Physical condition (e.g., health, fertility) influences female mate preferences in many species, with females in good condition preferring "higher quality" (e.g., healthier) mates. In humans, condition may comprise both physical (e.g., health and fertility) and psychological factors (e.g., stress, anxiety, and depression). We found that women with low waist-to-hip ratios (indicating health and fertility) or who scored low on anxiety, depression, and stress measures expressed greater attraction to composite male (but not female) faces with color and texture cues associated with apparent health than did women with relatively high waist-to-hip ratios or who scored relatively high on the anxiety, depression, and stress measures. These effects of physical and psychological condition were independent and were not mediated by women's perceptions of their own attractiveness. Our findings indicate that women's physical and psychological conditions both contribute to individual differences in face preferences.     

Muscle pain, dyskinesia, and sleep

Muscle pain and poor sleep commonly occur together. Whether pain induces poor sleep or vice versa is difficult to know. Muscle pain is also observed in the presence of some types of dyskinesia or movement disorders. The interaction between sleep, movement disorders, and some musculoskeletal pain appears to be complex and may be influenced by various concomitant psychological and (or) biological factors.     

Beyond the “at risk mental state” concept: transitioning to transdiagnostic psychiatry

The “at risk mental state” for psychosis approach has been a catalytic, highly productive research paradigm over the last 25 years. In this paper we review that paradigm and summarize its key lessons, which include the valence of this phenotype for future psychosis outcomes, but also for comorbid, persistent or incident non‐psychotic disorders; and the evidence that onset of psychotic disorder can at least be delayed in ultra high risk (UHR) patients, and that some full‐threshold psychotic disorder may emerge from risk states not captured by UHR criteria. The paradigm has also illuminated risk factors and mechanisms involved in psychosis onset. However, findings from this and related paradigms indicate the need to develop new identification and diagnostic strategies. These findings include the high prevalence and impact of mental disorders in young people, the limitations of current diagnostic systems and risk identification approaches, the diffuse and unstable symptom patterns in early stages, and their pluripotent, transdiagnostic trajectories. The approach we have recently adopted has been guided by the clinical staging model and adapts the original “at risk mental state” approach to encompass a broader range of inputs and output target syndromes. This approach is supported by a number of novel modelling and prediction strategies that acknowledge and reflect the dynamic nature of psychopathology, such as dynamical systems theory, network theory, and joint modelling. Importantly, a broader transdiagnostic approach and enhancing specific prediction (profiling or increasing precision) can be achieved concurrently. A holistic strategy can be developed that applies these new prediction approaches, as well as machine learning and iterative probabilistic multimodal models, to a blend of subjective psychological data, physical disturbances (e.g., EEG measures) and biomarkers (e.g., neuroinflammation, neural network abnormalities) acquired through fine‐grained sequential or longitudinal assessments. This strategy could ultimately enhance our understanding and ability to predict the onset, early course and evolution of mental ill health, further opening pathways for preventive interventions.     

Psychologische Aspekte des Diabetes in Kindheit und Adoleszenz

The intensified insulin therapy of type 1 diabetes imposes considerable demands in everyday life of children, adolescents and their families that often interfere with normal developmental tasks. Accordingly current guidelines on paediatric diabetes stated that psychosocial factors are the most important influences affecting the care and management of the chronic illness. This article reviews the main research findings from studies on psychological coping, family burden and dynamics, neurocognitive functioning, stress, psychosocial risk factors, psychological health and psychiatric disorders. In addition psychological support, age-appropriate educational and behavioural interventions as an integral part of every type 1 diabetes long-term therapy are described. Finally the vital role and the current situation of psychologists and social workers as members of the interdisciplinary paediatric diabetes teams especially in the context of the German Disease –Management Program for type 1 diabetes are discussed.     

Magnetic resonance imaging for chronic pain: diagnosis,manipulation, and biomarkers

Pain is a multidimensional subjective experience with biological, psychological, and social factors. Whereas acute pain can be a warning signal for the body to avoid excessive injury, long-term and ongoing pain may be developed as chronic pain. There are more than 100 million people in China living with chronic pain, which has raised a huge socioeconomic burden. Studying the mechanisms of pain and developing effective analgesia approaches are important for basic and clinical research. Recently, with the development of brain imaging and data analytical approaches, the neural mechanisms of chronic pain have been widely studied. In the first part of this review, we briefly introduced the magnetic resonance imaging and conventional analytical approaches for brain imaging data. Then, we reviewed brain alterations caused by several chronic pain disorders, including localized and widespread primary pain, primary headaches and orofacial pain, musculoskeletal pain, and neuropathic pain, and present meta-analytical results to show brain regions associated with the pathophysiology of chronic pain. Next, we reviewed brain changes induced by pain interventions, such as pharmacotherapy, neuromodulation, and acupuncture. Lastly, we reviewed emerging studies that combined advanced machine learning and neuroimaging techniques to identify diagnostic, prognostic, and predictive biomarkers in chronic pain patients.     

Preventive psychiatry: a blueprint for improving the mental health of young people

Preventive approaches have latterly gained traction for improving mental health in young people. In this paper, we first appraise the conceptual foundations of preventive psychiatry, encompassing the public health, Gordon''s, US Institute of Medicine, World Health Organization, and good mental health frameworks, and neurodevelopmentally‐sensitive clinical staging models. We then review the evidence supporting primary prevention of psychotic, bipolar and common mental disorders and promotion of good mental health as potential transformative strategies to reduce the incidence of these disorders in young people. Within indicated approaches, the clinical high‐risk for psychosis paradigm has received the most empirical validation, while clinical high‐risk states for bipolar and common mental disorders are increasingly becoming a focus of attention. Selective approaches have mostly targeted familial vulnerability and non‐genetic risk exposures. Selective screening and psychological/psychoeducational interventions in vulnerable subgroups may improve anxiety/depressive symptoms, but their efficacy in reducing the incidence of psychotic/bipolar/common mental disorders is unproven. Selective physical exercise may reduce the incidence of anxiety disorders. Universal psychological/psychoeducational interventions may improve anxiety symptoms but not prevent depressive/anxiety disorders, while universal physical exercise may reduce the incidence of anxiety disorders. Universal public health approaches targeting school climate or social determinants (demographic, economic, neighbourhood, environmental, social/cultural) of mental disorders hold the greatest potential for reducing the risk profile of the population as a whole. The approach to promotion of good mental health is currently fragmented. We leverage the knowledge gained from the review to develop a blueprint for future research and practice of preventive psychiatry in young people: integrating universal and targeted frameworks; advancing multivariable, transdiagnostic, multi‐endpoint epidemiological knowledge; synergically preventing common and infrequent mental disorders; preventing physical and mental health burden together; implementing stratified/personalized prognosis; establishing evidence‐based preventive interventions; developing an ethical framework, improving prevention through education/training; consolidating the cost‐effectiveness of preventive psychiatry; and decreasing inequalities. These goals can only be achieved through an urgent individual, societal, and global level response, which promotes a vigorous collaboration across scientific, health care, societal and governmental sectors for implementing preventive psychiatry, as much is at stake for young people with or at risk for emerging mental disorders.     

Narratives Reflecting the Lived Experiences of People with Brain Disorders: Common Psychosocial Difficulties and Determinants

Background

People with brain disorders - defined as both, mental disorders and neurological disorders experience a wide range of psychosocial difficulties (PSDs) (e.g., concentrating, maintaining energy levels, and maintaining relationships). Research evidence is required to show that these PSDs are common across brain disorders.

Objectives

To explore and gain deeper understanding of the experiences of people with seven brain disorders (alcohol dependency, depression, epilepsy, multiple sclerosis, Parkinson’s disease, schizophrenia, stroke). It examines the common PSDs and their influencing factors.

Methods

Seventy seven qualitative studies identified in a systematic literature review and qualitative data derived from six focus groups are used to generate first-person narratives representing seven brain disorders. A theory-driven thematic analysis of these narratives identifies the PSDs and their influencing factors for comparison between the seven disorders.

Results

First-person narratives illustrate realities for people with brain disorders facilitating a deeper understanding of their every-day life experiences. Thematic analysis serves to highlight the commonalities, both of PSDs, such as loneliness, anger, uncertainty about the future and problems with work activities, and their determinants, such as work opportunities, trusting relationships and access to self-help groups.

Conclusions

The strength of the methodology and the narratives is that they provide the opportunity for the reader to empathise with people with brain disorders and facilitate deeper levels of understanding of the complexity of the relationship of PSDs, determinants and facilitators. The latter reflect positive aspects of the lives of people with brain disorders. The result that many PSDs and their influencing factors are common to people with different brain disorders opens up the door to the possibility of using cross-cutting interventions involving different sectors. This strengthens the message that ‘a great deal can be done’ to improve the lived experience of persons with brain disorders when medical interventions are exhausted.     

Fat chance! Obesity and the transition from unemployment to employment

This paper focuses on estimating the magnitude of any potential weight discrimination by examining whether obese job applicants in Germany get treated or behave differently from non-obese applicants. Based on two waves of rich survey data from the IZA Evaluation dataset, which includes measures that control for education, demographic characteristics, labor market history, psychological factors and health, we estimate differences in job search behavior and labor market outcomes between obese/overweight and normal weight individuals. Unlike other observational studies which are generally based on obese and non-obese individuals who might already be at different points in the job ladder (e.g., household surveys), in our data, individuals are newly unemployed and all start from the same point. The only subgroup we find in our data experiencing any possible form of negative labor market outcomes is obese women. Despite making more job applications and engaging more in job training programs, we find some indications that they experienced worse (or at best similar) employment outcomes than normal weight women. Obese women who found a job also had significantly lower wages than normal weight women.     

Pittsburgh Registry of Infant Multiplets (PRIM).

This paper describes the Pittsburgh Registry of Infant Multiplets (PRIM; Pittsburgh, Pennsylvania), the results of pilot research conducted in this registry, and the plans for future studies. The main focus of the registry is on psychological development and the risk for behavioral disorders. Particularly, characteristics associated with antisociality and the risk for substance use disorders (e.g., aggressivity, hyperactivity/impulsivity), as well as language development and other traits (e.g., dental health) are among the research targets.     

Ion channels-related diseases

There are many diseases related to ion channels. Mutations in muscle voltage-gated sodium, potassium, calcium and chloride channels, and acetylcholine-gated channel may lead to such physiological disorders as hyper- and hypokalemic periodic paralysis, myotonias, long QT syndrome, Brugada syndrome, malignant hyperthermia and myasthenia. Neuronal disorders, e.g., epilepsy, episodic ataxia, familial hemiplegic migraine, Lambert-Eaton myasthenic syndrome, Alzheimer's disease, Parkinson's disease, schizophrenia, hyperekplexia may result from dysfunction of voltage-gated sodium, potassium and calcium channels, or acetylcholine- and glycine-gated channels. Some kidney disorders, e.g., Bartter's syndrome, policystic kidney disease and Dent's disease, secretion disorders, e.g., hyperinsulinemic hypoglycemia of infancy and cystic fibrosis, vision disorders, e.g., congenital stationary night blindness and total colour-blindness may also be linked to mutations in ion channels.     

Sickness absence among municipal workers in a Brazilian municipality: a secondary data analysis

Background

Sickness absence, work disability associated with illness or injury, is a major public health problem worldwide. Some studies have investigated determinants of sickness absence among workers with shorter job tenure, but have only focused on certain diagnostic groups. Although it is well established that job tenure has an inverse relationship with work injury rate, less is known about its association with sickness absence for other disorders. Therefore, this study aimed to investigate the risk factors for incidence and duration of sickness absence according to diagnosis over a 7-year period. A dynamic cohort consisting of all permanent civil servants hired from 2005 to 2011 by the Goiania municipality-Brazil. Data of certified sickness absences longer than 3 days were analyzed. The incidence density was calculated per 1000 person-years in each ICD-10 category. The association between sickness absence and socio-demographic and occupational characteristics was examined using negative binomial regression models.

Results

18,450 workers, mean age of 32 years, accumulated 14,909 episodes of sickness absence. Overall, the incidence density was 234.6 episodes per 1000 person years. Diagnostic groups with the highest incidence density of sickness absences were injuries (49.1), musculoskeletal disorders (31.3) and mental disorders (29.2). Factors predicting any sickness absence were female gender, older age, low education, being a health professional, multiple jobs and full-time employment. Mental health disorders were more common among education professionals, musculoskeletal disorders among blue collar workers and injuries among inspection workers. Prolonged time on sick leave was associated with male gender, older age groups, low education and income, blue-collar workers, more than one job contract and full time employment.

Conclusions

These findings demonstrate a substantial sickness absentee burden and they provide relevant information for targeting prevention and health promotion policies to the most vulnerable occupational groups.

     

Attitudes toward Animals among Kindergarten Children: Species Preferences

ABSTRACT

Attitudes toward animals are influenced by both animal traits (e.g., similarity to humans, aesthetic quality, size) and individual human attributes (e.g., gender, age, educational level, cultural factors). Although the examination of children's interest in animals, and their preference for different species, may evidence specific trends and help explain the development of attitudes, the vast majority of research has not considered children younger than 6 years. The present study was aimed at assessing preferences for a variety of animal species in a sample of 3–6 year-old Italian children, using a forced-choice task and visual aids (images of the animals). Pictures of 48 animal species, ranging from mammals to invertebrates, were presented to the children. Two photographic stimuli were simultaneously displayed and participants were asked to indicate their preference. Results show that the children preferred higher-order species, and domestic over wild animals. Apart from a few exceptions, invertebrates were the most disliked group of species among the children. Girls showed more negative and fear-related attitudes than the boys. Results are discussed taking into account different factors that may affect children's preferences for various animal species, that is, similarity to humans and aesthetical appeal. Greater knowledge on early attitudes toward animals has implications for promoting interest in animals and for building educational interventions for kindergarten children. This is particularly important in light of the growing use of different animals in educational and therapeutic contexts, as well as from an animal welfare perspective.     

Intelligence and Disability Pension in Swedish Men and Women Followed from Childhood to Late Middle Age

Objective

To investigate the association between intelligence and disability pension due to mental, musculoskeletal, cardiovascular, and substance-use disorders among men and women, and to assess the role of childhood social factors and adulthood work characteristics.

Methods

Two random samples of men and women born 1948 and 1953 (n = 10 563 and 9 434), and tested for general intelligence at age 13, were followed in registers for disability pension until 2009. Physical and psychological strains in adulthood were assessed using job exposure matrices. Associations were examined using Cox proportional hazard regression models, with increases in rates reported as hazard ratios (HRs) with 95% confidence intervals (95%CI) per decrease in stanine intelligence.

Results

In both men and women increased risks were found for disability pension due to all causes, musculoskeletal disorder, mental disorder other than substance use, and cardiovascular disease as intelligence decreased. Increased risk was also found for substance use disorder in men. In multivariate models, HRs were attenuated after controlling for pre-school plans in adolescence, and low job control and high physical strain in adulthood. In the fully adjusted model, increased HRs remained for all causes (male HR 1.11, 95%CI 1.07–1.15, female HR 1.06, 95%CI 1.02–1.09) and musculoskeletal disorder (male HR 1.16, 95%CI 1.09–1.24, female HR 1.08, 95%CI 1.03–1.14) during 1986 to 2009.

Conclusion

Relatively low childhood intelligence is associated with increased risk of disability pension due to musculoskeletal disorder in both men and women, even after adjustment for risk factors for disability pension measured over the life course.     

A New Method for Detecting Associations with Rare Copy-Number Variants

Copy number variants (CNVs) play an important role in the etiology of many diseases such as cancers and psychiatric disorders. Due to a modest marginal effect size or the rarity of the CNVs, collapsing rare CNVs together and collectively evaluating their effect serves as a key approach to evaluating the collective effect of rare CNVs on disease risk. While a plethora of powerful collapsing methods are available for sequence variants (e.g., SNPs) in association analysis, these methods cannot be directly applied to rare CNVs due to the CNV-specific challenges, i.e., the multi-faceted nature of CNV polymorphisms (e.g., CNVs vary in size, type, dosage, and details of gene disruption), and etiological heterogeneity (e.g., heterogeneous effects of duplications and deletions that occur within a locus or in different loci). Existing CNV collapsing analysis methods (a.k.a. the burden test) tend to have suboptimal performance due to the fact that these methods often ignore heterogeneity and evaluate only the marginal effects of a CNV feature. We introduce CCRET, a random effects test for collapsing rare CNVs when searching for disease associations. CCRET is applicable to variants measured on a multi-categorical scale, collectively modeling the effects of multiple CNV features, and is robust to etiological heterogeneity. Multiple confounders can be simultaneously corrected. To evaluate the performance of CCRET, we conducted extensive simulations and analyzed large-scale schizophrenia datasets. We show that CCRET has powerful and robust performance under multiple types of etiological heterogeneity, and has performance comparable to or better than existing methods when there is no heterogeneity.     

Biodiversity change under adaptive community dynamics

Compositional change is a ubiquitous response of ecological communities to environmental drivers of global change, but is often regarded as evidence of declining “biotic integrity” relative to historical baselines. Adaptive compositional change, however, is a foundational idea in evolutionary biology, whereby changes in gene frequencies within species boost population-level fitness, allowing populations to persist as the environment changes. Here, we present an analogous idea for ecological communities based on core concepts of fitness and selection. Changes in community composition (i.e., frequencies of genetic differences among species) in response to environmental change should normally increase the average fitnessof community members. We refer to compositional changes that improve the functional match, or “fit,” between organisms' traits and their environment as adaptive community dynamics. Environmental change (e.g., land-use change) commonly reduces the fit between antecedent communities and new environments. Subsequent change in community composition in response to environmental changes, however, should normally increase community-level fit, as the success of at least some constituent species increases. We argue that adaptive community dynamics are likely to improve or maintain ecosystem function (e.g., by maintaining productivity). Adaptive community responses may simultaneously produce some changes that are considered societally desirable (e.g., increased carbon storage) and others that are undesirable (e.g., declines of certain species), just as evolutionary responses within species may be deemed desirable (e.g., evolutionary rescue of an endangered species) or undesirable (e.g., enhanced virulence of an agricultural pest). When assessing possible management interventions, it is important to distinguish between drivers of environmental change (e.g., undesired climate warming) and adaptive community responses, which may generate some desirable outcomes. Efforts to facilitate, accept, or resist ecological change require separate consideration of drivers and responses, and may highlight the need to reconsider preferences for historical baseline communities over communities that are better adapted to the new conditions.