Nutritional screening is a fundamental aspect of the initial evaluation of the hospitalised patient. Body Mass Index (BMI) in association with other parameters is a good marker of malnutrition (<18.5 ...kg/m2), but it presents the handicap that the great majority of patients cannot be weighed and measured. For this reason it is necessary to find other indicators that can be measured in these patients.
1) Analyse the relationship between BMI and Mid-Upper Arm Circumference (MUAC); 2) establish a cut-off point of MUAC equivalent to BMI <18.5 kg/m2.
The anthropometric data of patients hospitalised over the period 2004-2013 were retrospectively revised. The following variables were collected: weight, height, BMI, MUAC, sex and age.
1373 patients were evaluated, who presented a mean weight of: 65.04±15.51 kg; height: 1.66±0.09 m; BMI: 23.48±5.03 kg/m2; MUAC: 26.95±4.50 cm; age: 56.24±16.77. MUAC correlates suitably to BMI by means of the following equation (simple linear regression): BMI = - 0.042 + 0.873 x MUAC (cm) (R2 = 0.609), with a Pearson r value of 0.78 (p<0.001). The area under the curve of MUAC for the diagnosis of malnutrition was 0.92 (95% CI: 0.90-0.94; p<0.001). The MUAC value ≤22.5 cm presented a sensitivity of 67.7%, specificity of 94.5%, and a correct classification of 90%. No significant statistical differences were found in the cut-off point of MUAC for the diagnosis of malnutrition based on sex (p = 0.115) and age (p = 0.694).
1) MUAC correlates positively and significantly with BMI. 2) MUAC ≤ 22.5 cm correlates properly with a BMI of <18.5 kg/m2, independent of the age or sex of the patient, although there are other alternatives. MUAC constitutes a useful tool as a marker of malnutrition, fundamentally in patients for whom weight and height cannot be determined.
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Dostopno za:
DOBA, IZUM, KILJ, NUK, PILJ, PNG, SAZU, SIK, UILJ, UKNU, UL, UM, UPUK
La literatura sobre plataformas digitales de trabajo ha subrayado la tendencia a la precarización de las relaciones laborales. En contraposición con esta hipótesis, a través del análisis del ...funcionamiento de la plataforma digital Zolvers, este artículo se propone comprender de qué manera las plataformas pueden también contribuir a la formalización de las relaciones laborales en el sector del trabajo doméstico remunerado, donde la mayoría de las trabajadoras se desempeña de manera informal. El artículo explora los efectos de esta intermediación respecto a la formalización de la relación laboral. Particularmente, se focaliza en el impacto durante el primer año de la pandemia del covid-19.
The article explores two key factors which contribute to shape the poor working conditions of nursing in Argentina. A first objective focuses on exploring the effect of the occupation's care ...component, closely associated with cultural images of "inherent" female qualities, on working conditions. A second objective aims to examine the way in which the organization of health services provision in Argentina intensifies the vulnerability of this occupation. Regarding the methodology, the fieldwork conducted in the Metropolitan Area of Buenos Aires included in-depth interviews with key informants and group interviews with nurses. Among the results, on the one hand it is shown how the social devaluation of care is reflected in the discourse of those who perform the occupation as well as in institutional practices and policies in the health sector. On the other hand, it is shown that the decentralization and fragmentation of the health system act as additional obstacles hampering the articulation of labor demands.
El análisis de las "ocupaciones del cuidado" ha cobrado creciente relevancia en la agenda feminista de los últimos años. Estas ocupaciones - mayormente concentradas en los sectores de la salud, la ...educación y el servicio doméstico - se encuentran altamente feminizadas y generan oportunidades de empleo para muchas mujeres. No obstante, las mismas presentan en general condiciones de trabajo relativamente pobres, dado que el cuidado suele asociarse a habilidades supuestamente femeninas, socialmente devaluadas en cuanto "auténtico trabajo". A su vez, las condiciones laborales deficientes, entre ellas los magros salarios, ponen en cuestión la calidad de los servicios de cuidado provistos. El presente artículo, en base al caso argentino, propone un análisis comparativo sobre un conjunto seleccionado de estas ocupaciones, entre las que se cuentan la enfermería, la docencia inicial y primaria y las trabajadoras domésticas. Si bien estas ocupaciones comparten ciertas vulnerabilidades asociadas a su contenido de cuidado, sus condiciones laborales presentan variaciones significativas. A partir de esta situación, el objetivo central que se plantea el trabajo es el de ahondar en el conocimiento de los factores que actúan atenuando o reforzando la desvalorización social y económica de este tipo de ocupaciones. El propósito último es el de generar reflexiones sobre los aspectos susceptibles de ser abordados por la política pública en pos de mejorar la situación laboral de las y los trabajadores involucrados y, por ende, de los servicios de cuidado provistos.
Malnutrition is prevalent in surgical patients and leads to comorbidities and a poorer postoperative course. There are no studies that compare the clinical outcomes of implementing a nutrition ...screening tool in surgical patients with standard clinical practice. An open, non-randomized, controlled study was conducted in general and digestive surgical hospitalized patients, who were either assigned to standard clinical care or to nutrition screening using the Control of Food Intake, Protein, and Anthropometry (CIPA) tool and an associated treatment protocol (
= 210 and 202, respectively). Length of stay, mortality, readmissions, in-hospital complications, transfers to critical care units, and reinterventions were evaluated. Patients in the CIPA group had a higher Charlson index on admission and underwent more oncological and hepatobiliary-pancreatic surgeries. Although not significant, a shorter mean length of stay was observed in the CIPA group (-1.48 days;
< 0.246). There were also fewer cases of exitus (seven vs. one) and fewer transfers to critical care units in this group (
= 0.068 for both). No differences were detected in other clinical variables. In conclusion, patients subjected to CIPA nutrition screening and treatment showed better clinical outcomes than those receiving usual clinical care. The results were not statistically significant, possibly due to the heterogeneity across patient groups.
Hospital malnutrition is very common and worsens the clinical course of patients while increasing costs. Lacking clinical-economic studies on the implementation of nutrition screening encouraged the ...evaluation of the CIPA (Control of Food Intake, Protein, Anthropometry) tool.
An open, non-randomized, controlled clinical trial was conducted on patients admitted to internal medicine and general and digestive surgery wards, who were either assigned to a control (standard hospital clinical care) or to an intervention, CIPA-performing ward (412 and 411, respectively;
= 823). Length of stay, mortality, readmission, in-hospital complications, and quality of life were evaluated. Cost-effectiveness was analysed in terms of cost per quality-adjusted life years (QALYs).
The mean length of stay was higher in the CIPA group, though not significantly (+ 0.95 days;
= 0.230). On the surgical ward, more patients from the control group moved to critical care units (
= 0.014); the other clinical variables did not vary. Quality of life at discharge was similar (
= 0.53), although slightly higher in the CIPA group at 3 months (
= 0.089). Patients under CIPA screening had a higher mean cost of € 691.6 and a mean QALY gain over a 3-month period of 0.0042. While the cost per QALY for the internal medicine patients was € 642 282, the results for surgical patients suggest that the screening tool is both less costly and more effective.
The CIPA nutrition screening tool is likely to be cost-effective in surgical but not in internal medicine patients.
There is no gold-standard method for hospital nutrition screening. The new screening tool termed Control of Food Intake, Protein, and Anthropometry (CIPA) gives positive results when at least one of ...the following parameters is met: control of food intake for 72 h < 50%, serum albumin < 3 g/dl, body mass index < 18.5 kg/m
or mid-upper arm circumference ≤ 22.5 cm. This method was validated in comparison with Subjective Global Assessment (SGA) in hospitalized patients with non-surgical pathologies.
A prospective, longitudinal study was performed on 221 consecutively enrolled patients. Prevalence or risk of malnutrition was estimated with CIPA vs. SGA screening at hospital admission and the concordance (k index -
) between the two methods and their sensitivity (S) and specificity (SP) were studied. Mean length of stay (LOS), mortality, and rate of early readmission were analyzed.
The prevalence or risk of malnutrition identified by CIPA and SGA was 35.7% and 23.1%, respectively.
was 0.401 (
< 0.001); S and SP of CIPA vs. SGA were 72.5% and 75.3%, respectively. In contrast to SGA, CIPA-positive patients had an increased mean LOS compared to the negative ones (19.53 vs. 12.63 days,
< 0.001). Both methods detected a major risk of mortality in positive patients, but no difference in early readmission.
The CIPA and the SGA screening tools detect patients with a higher risk of mortality, but only CIPA identifies patients with an increased mean LOS. CIPA screening proved valid for use in non-surgical inpatients.
This article examines the social organization of care for children and dependent older adults in Argentina, based on data from the National Survey on Social Structure. It analyzes perceptions and ...practices around care in public and private institutions, home-based care services, and care provided by families, with a particular focus on gender implications. Due to a shortage of public services, care is highly feminized, largely performed by families, and subject to class inequalities. Although family care tends to be preferred for early childhood, among mothers with better labor opportunities there is a growing (and often unmet) demand for public care services. The outsourcing of care is more widely accepted for the elderly, for whom there is an acute lack of public services, but only better-off families can afford these privatized solutions. In both cases, the organization of care reflects shortfalls in care policies and deep-rooted cultural patterns.
•High levels of feminization and provision of care within the family in Argentina•Commodification of care services for young children and the elderly•Households from higher socioeconomic strata are more likely to outsource care.•Private care services are more common for the elderly than for children.•Higher demand for childcare services among better-educated women
Introducción: La desnutrición en el paciente hospitalizado es muy prevalente, por lo que es importante incorporar métodos de depistaje. Se ha desarrollado en nuestro centro un método mixto de cribado ...nutricional (CIPA), que incluye cuatro parámetros: a) control de ingestas 72 h; b) IMC; c) proteínas; y d) albúmina. Objetivos: 1) conocer la prevalencia de desnutrición en pacientes hospitalizados en el servicio de Medicina Interna de nuestro centro; 2) analizar variables asociadas a mayor prevalencia de desnutrición; 3) evaluar su efecto pronóstico clínico. Material y métodos: Se revisaron retrospectivamente los resultados de los test de cribado nutricional efectuados a 305 pacientes ingresados en el servicio de Medicina Interna en el periodo noviembre/2012-octubre/2013. Se analizó la prevalencia de desnutrición hospitalaria y la asociación del resultado positivo en el cribado (al menos un ítem positivo) con las siguientes variables: IMC, edad, sexo, patología subyacente, estancia, reingreso precoz (< de 1 mes) y mortalidad. Resultados: El test fue positivo en un 23% de los pacientes. Los pacientes con cribado positivo presentaban un IMC inferior (24,9 ± 7,2 vs 27,8 ± 6,4 kg/m; p = 0,002). La patología neoplásica e infecciosa se asociaron a mayor positividad (35,3 y 28,9%, respectivamente; p=0,006). El sexo y la edad no se asociaron con el resultado del test de cribado. Los pacientes con cribado positivo presentaban mayor estancia media (26,7 ± 25 vs 6,8%; p = 0,003) y mortalidad (30 vs 10,3%; p < 0,001). Conclusiones: El test de cribado CIPA es capaz de detectar al paciente malnutrido y predecirle un peor pronóstico clínico (mortalidad, estancia media y reingreso precoz).
La introducción del dosier incluye, por un lado, un esquema analítico para abordar el estudio de las plataformas digitales de trabajo doméstico remunerado en América Latina y, por otro, en el marco ...de dicho esquema, presenta los aportes de los distintos artículos que lo integran. La propuesta analítica distingue tres grandes dimensiones. En primer lugar, discutir los desafíos metodológicos que supone la aproximación a las plataformas digitales de trabajo del sector, así como las distintas estrategias comúnmente utilizadas para sortear los obstáculos más frecuentes. En segundo lugar, plantea una serie de criterios posibles para clasificar las diferencias que existen entre las plataformas de trabajo, frente a la heterogeneidad que las caracteriza. Por último, cuestionar el impacto de estas plataformas en las condiciones laborales de las trabajadoras domésticas y las desigualdades que experimentan. Para ello, se sugiere una serie de aspectos a estudiar que permiten delimitar líneas de investigación sobre los efectos de la intermediación digital en un sector históricamente marcado por la precariedad.
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