Identifying the carers’ profiles of health literacy, eHealth literacy and caregiving concepts

Background

Carers of people with dementia (PwD) undertake the role of supporting their relatives in everyday life and caring tasks, sometimes without adequate knowledge of the progression of the disease, practical advice and support mechanisms or services. This study aims to describe the Health Literacy (HL) and eHealth Literacy (eHL) profiles of carers of PwD in Greece and Cyprus and to explore associations with dimensions influenced by the delivery of care.

Methods

This descriptive correlational design study measured HL (HLS-EU-Q16 tool), eHL (eHeals-Carer) and dimensions of care (Brief-COPE, caregiving self-efficacy, COPE index and Multidimensional Perceived Social Support). In total, 174 primary carers of PwD and 67 secondary carers participated in a face-to-face survey. Correlation and regression analysis were performed to explore associations between the concepts of interest and cluster analysis (N = 123) to identify profiles of carers.

Results

Carers, primary and secondary, reported high scores of eHL and HL. HL scores were associated with eHL and both variables with the two dimensions of caregiving self-efficacy: “obtain respite” and “behavior management”. Three carers' profiles were identified: 1) carers with high levels of HL, eHL, Self-Efficacy and low coping strategies, 2) carers with problematic coping, negative caregiving perceptions, and lower HL and eHL, and 3) carers with high HL and eHL, with strong Social Network, high emotional-focused coping strategies and low problematic coping.

Conclusions

Understanding the role of HL and eHL in the caregiving process and identifying carers' profiles could assist healthcare professionals in their educational role with families and planning of care. There is a need to develop more ways to assess these concepts for this population and to develop training courses focusing on enhancing the HL skills of carers and healthcare professionals.

The COST action NET4AGE-friendly supported the conference participation.

Key messages

HL and eHL are related to the caregiving role and may not only influence health-related decisions made by the carers on behalf of their relatives but also their own self-efficacy and coping. HL and eHL should be appropriately assessed and taken into consideration by healthcare professionals in management plans for PwD and their families.

Value of adding an IGRA to the TST to screen for latent tuberculous infection in Greek health care workers

SETTING

Ioannina University Hospital, Ioannina, Greece.

OBJECTIVE

To evaluate the value of adding an interferon-gamma release assay (IGRA) to the tuberculin skin test (TST) for detecting latent tuberculous infection (LTBI) in a Greek university hospital among health care workers (HCWs) predominantly vaccinated with bacille Calmette-Guérin (BCG).

DESIGN

Of 788 HCWs enrolled, 68.1% were BCG-vaccinated. A TST ⩾ 10 mm was considered positive and was followed by the QuantiFERON-TB(®) Gold In-Tube assay (QFT-GIT) in a two-step strategy.

RESULTS

Of the enrolled HCWs, 36.4% were TST-positive, of whom only 14.4% were IGRA-positive. Agreement between the tests was poor (κ = 0.019; 95%CI -0.014-0.05, P = 0.355). Both TST and IGRA positivity increased with TST diameter, from 5.7% in TST 10-14 mm to 48.8% in TST ⩾20 mm. TST-positive, IGRA-negative results were most likely in younger, recently BCG-vaccinated HCWs (84.6% in those aged 20-29 years) and less likely in older HCWs (45% in those aged 50-59 years). The two-step strategy would have been more cost saving compared to the TST-only approach if adherence to LTBI treatment in our cohort had been ⩾24%.

CONCLUSIONS

Poor overall agreement between TST and QFT-GIT was found. Use of IGRA as a second step in TST-positive cases offers an appropriate tool for LTBI detection among BCG-vaccinated HCWs in low-TB-incidence settings.

Spontaneous esophageal rupture as the underlying cause of pneumothorax: early recognition is crucial

Boerhaave's syndrome (BS), also known as "spontaneous rupture of the esophagus", constitutes an emergency that requires early diagnosis if death or serious morbidity are to be prevented. First described in 1724, BS is thought to be more common than once thought. Its true incidence remains unknown. Mortality ranges between 20-40% with timely treatment but this rises to virtually 100% if treatment is delayed by more than 48 hours. This is unfortunately a common occurrence due to delayed diagnosis. The commonest precipitating factor is vomiting but BS can be truly "spontaneous". The classical clinical presentation described consists of vomiting, chest pain, and subcutaneous emphysema. However, and contrary to popular belief, this triad is actually uncommon accounting for the frequently delayed diagnosis. A less recognised presenting feature of BS is with pneumothorax due to associated rupture of the parietal pleura. Pneumothorax has been shown to be present in more than 20% of cases of BS-sometimes with a coexistent pleural effusion (hydropneumothorax). This article aims to raise awareness about pneumothorax as the sole initial presenting feature of BS and alert clinicians to consider BS in the differential diagnosis of any patient with respiratory symptoms and a recent history of vomiting.

Endoscopic ultrasound in the diagnosis of pancreatic intraductal papillary mucinous neoplasms

Pancreatic cystic lesions are increasingly recognised due to the widespread use of different imaging modalities. Intraductal papillary mucinous neoplasms (IPMNs) of the pancreas represent a common, but also heterogeneous group of cystic tumors with a significant malignant potential. These neoplasms must be differentiated from other cystic tumors and properly classified into their different types, main-duct IPMNs vs branch-duct IPMNs. These types have a different malignant potential and therefore, different treatment strategies need to be implemented. Endoscopic ultrasound (EUS) offers the highest resolution of the pancreas and can aid in the differential diagnosis, classification and differentiation between benign and malignant tumors. The addition of EUS fine-needle aspiration can supply further information by obtaining fluid for cytology, measurement of tumor markers and perhaps DNA analysis. Novel techniques, such as the use of contrast and sophisticated equipment, like intraductal probes can provide information regarding malignant features and extent of these neoplasms. Thus, EUS is a valuable tool in the diagnosis and appropriate management of these tumors.

Is there a role for second-look capsule endoscopy in patients with obscure GI bleeding after a nondiagnostic first test?

BACKGROUND

Long-term follow-up data on patients with obscure GI bleeding subjected to capsule endoscopy (CE) are missing.

OBJECTIVE

Our purpose was to follow up patients with a nondiagnostic test and determine whether a second-look CE would be beneficial.

PATIENTS

We enrolled 293 subjects. CE studies were classified as diagnostic (positive findings) or nondiagnostic (findings of uncertain significance/no findings). Patients were followed up for a mean (SD) 24.8 (5.2) months. Outcome was defined as continued or complete resolution of bleeding.

INTERVENTIONS

Patients with a nondiagnostic test were subjected to a repeat CE if they manifested a new bleeding episode or a drop in hemoglobin >or=2 g/dL.

RESULTS

Positive findings, findings of uncertain significance, and no findings were identified in 41.6%, 16.0%, and 42.3% of our patients, respectively. Therapeutic intervention was possible in 72.1% of those with positive findings and in 30% of those with findings of uncertain significance. Complete resolution of bleeding occurred more often in patients with a diagnostic test (65.2%) compared with those with a nondiagnostic test (35.4%, P < .001). Second-look CE was performed in a subgroup of our patients (n = 76) and was diagnostic in those whose presentation changed from occult to overt or those whose hemoglobin dropped >or=4 g/dL.

CONCLUSIONS

In patients with obscure GI bleeding, a diagnostic CE leads to therapeutic interventions and a favorable outcome. Patients with a nondiagnostic test would definitely benefit from a second-look CE if the bleeding presentation changes from occult to overt or if the hemoglobin value drops >or=4 g/dL.

Does clinical response correlate with mucosal healing in patients with Crohn's disease of the small bowel? A prospective, case-series study using wireless capsule endoscopy

BACKGROUND

There are no studies assessing mucosal healing of the small bowel in patients with Crohn's disease (CD). Our aim was to assess the correlation between clinical response and mucosal healing of the small bowel using wireless capsule endoscopy (WCE).

METHODS

This was a prospective, multicenter, case-series study. Forty patients with known or suspected CD were included, recruited in 4 tertiary referral centers of Athens. They all had an acute flare-up of their disease (CD Activity Index [CDAI] >150), involvement of the small bowel, and the nonstricturing, nonpenetrating type of the disease. All patients underwent WCE prior to the initiation of any treatment. Treatment varied according to the treating physician. For the evaluation of mucosal healing, 3 endoscopic variables were collected: number of apthous ulcers, number of large ulcers, and period of time that any endoscopic lesion was visible (erythema, edema, ulcers). When patients achieved clinical response (after at least a month of treatment) they underwent a second WCE, with evaluation of the same parameters.

RESULTS

The number of large ulcers was the only endoscopic variable that showed a significant improvement. The numbers of large ulcers before and after treatment were 8.3 +/- 1.4 and 5 +/- 0.8, respectively (mean +/- SEM) (mean difference 3.3 +/- 1.2, 95% confidence interval [CI] 0.8-5.9, P = 0.01). The other 2 variables did not improve significantly.

CONCLUSIONS

Since only 1 out of 3 endoscopic variables improved significantly with treatment, we can conclude that clinical response does not seem to correlate with mucosal healing in patients with CD of the small bowel.

Bioglass-derived glass-ceramic scaffolds: study of cell proliferation and scaffold degradation in vitro

Cell support function as well as cell proliferation on highly porous Bioglass(R)-derived glass-ceramic scaffolds (designed for bone tissue engineering) have been assessed in vitro using osteoblast-like cells (MG 63) cultured for up to 6 days. The biodegradation and mechanical stability of the scaffolds in the cell-culture medium have also been investigated. It was found that the scaffolds had excellent cell supporting ability, with cells effectively infiltrating into and surviving at the center of the scaffolds. A quantitative study using the AlamarBlue assay revealed that the proliferation of cells on the glass-ceramic materials was comparable to that on the noncrystallized Bioglass. While the crystalline phase in the glass-ceramic scaffolds transformed into a biodegradable amorphous calcium phosphate phase during cell culture, the mechanical strength of the scaffolds was maintained when compared with that of scaffolds incubated in simulated body fluid or immersed in cell-free culture medium. It is believed that the attached cells and collagen secreted by cells could fill the micropores and microcracks on the surface of the foam struts, thus contributing to the mechanical stability of the degrading scaffolds. In summary, the developed glass-ceramic scaffolds possess the most essential features of a scaffold for bone tissue engineering: they are capable to support and foster relevant cells, able to provide temporary mechanical function, and biodegradable.

Candida colitis in a middle-aged male receiving permanent haemodialysis

Candida infections of the gastrointestinal tract are not rare, especially in immunocompromised patients. We present a case of candida colitis in a patient receiving permanent haemodialysis. Candida colitis can be a life-threatening condition and should be treated promptly, especially in immunocompromised patients.