Chronic Obstructive Pulmonary Disease (COPD) may be associated with accelerated aging. Telomere shortening is a biomarker of aging. Cross-sectional studies describe shorter telomeres in COPD compared ...with matched controls. No studies have described telomere length trajectory and its relationship with COPD progression. We investigated telomere shortening over time and its relationship to clinical and lung function parameters in a COPD cohort and smoker controls without COPD.
At baseline leukocyte telomere length was measured by qPCR in 121 smokers with COPD and 121 without COPD matched by age (T/S
). The measurements were repeated in 70 of those patients with COPD and 73 non-COPD smokers after 3 years of follow up (T/S
).
At initial measurement, telomeres were shorter in COPD patients when compared to smoker controls (T/S = 0.68 ± 0.25 vs. 0.88 ± 0.52, p = 0.003) independent from age and sex. During the follow-up period, we observed an accelerated telomere shortening in individuals with COPD in contrast to smoker controls (T/S
= 0.66 ± 0.21 vs. T/S
= 0.46 ± 0.16, p < 0.001, for the patients with COPD and T/S
= 0.83 ± 0.56 vs. T/S
= 0.74 ± 0.52, p = 0.023 for controls; GLIM, p = 0.001). This shortening was inversely related to the baseline telomere length (r = -0.49, p < 0.001). No significant relationship was found between the rate of change in telomere length and change in lung function in the patients with COPD (p > 0.05).
Compared with smokers, patients with COPD have accelerated telomere shortening and this rate of attrition depends on baseline telomere length. Furthermore, the telomere length and its rate of shortening did not relate to clinical and lung function parameters changes over 3 years of follow-up.
Background Surgical site infection (SSI) after colorectal surgery is a frequent complication associated with substantial morbidity. Our objective was to identify surgical predictors of SSI in ...patients undergoing colorectal surgery using a retrospective case-control design. Material and Methods Randomly selected patients from all those undergoing colorectal surgery (2007-2013). Cases were patients who developed SSI within 30 days. Controls were patients who did not develop SSI within 30 days. Patients undergoing multiple procedures during a single surgical intervention were excluded. SSI was diagnosed according to Centers for Disease Control and Prevention definitions. The main outcome measures were SSI, surgical variables, and cumulative survival (Kaplan-Meier method). Variables considered predictors were compared using log-rank test. Results Of 911 patients undergoing colorectal surgery, 221 developed SSI (24.3%; 95% confidence interval, 24.0-24.6). On univariate analysis, significant risk factors for SSI were: female sex ( P = .02), >72 hours preoperative stay ( P = .04), open surgery ( P = .08), incision class: contaminated and dirty ( P = .001), and emergency procedures ( P = .006). On multivariate analysis, significant independent predictors of SSI and survival were dirty surgery (hazard ratio HR, 2.12; P = .015), contaminated surgery (HR, 1.74; P = .009), female sex (HR, 1.58; P = .003), open surgery, (HR, 1.51; P = .015) and >72 hours preoperative stay (HR, 1.48; P = .024). Conclusions Dirty or contaminated surgery, female sex, open surgery, and >72 hours preoperative stay were significant predictors of SSI.
It has been shown in a two-center study that high positive end-expiratory pressure (PEEP) and low tidal volume (LTV) improved outcome in ARDS. However, that study involved patients with underlying ...diseases unique to the study area, was conducted at only two centers, and enrolled a small number of patients. We similarly hypothesized that a ventilatory strategy based on PEEP above the lower inflection point of the pressure volume curve of the respiratory system (Pflex) set on day 1 with a low tidal volume would result in improved outcome in patients with severe and persistent acute respiratory distress syndrome (ARDS).
Randomized, controlled clinical trial.
Network of eight Spanish multidisciplinary intensive care units (ICUs) under the acronym of ARIES (Acute Respiratory Insufficiency: España Study).
All consecutive patients admitted into participating Spanish ICUs from March 1999 to March 2001 with a diagnosis of ARDS were considered for the study. If 24 hrs after meeting ARDS criteria, the Pao2/Fio2 remained < or =200 mm Hg on standard ventilator settings, patients were randomized into two groups: control and Pflex/LTV.
In the control group, tidal volume was 9-11 mL/kg of predicted body weight (PBW) and PEEP > or =5 cm H2O. In the Pflex/LTV group, tidal volume was 5-8 mL/kg PBW and PEEP was set on day 1 at Pflex + 2 cm H2O. In both groups, Fio2 was set to maintain arterial oxygen saturation >90% and Pao2 70-100 mm Hg, and respiratory rate was adjusted to maintain Paco2 between 35 and 50 mm Hg.
The study was stopped early based on an efficacy stopping rule as described in the methods. Of 103 patients who were enrolled (50 control and 53 Pflex), eight patients (five in control, three in Pflex) were excluded from the final evaluation because the random group assignment was not performed in one center according to protocol. Main outcome measures were ICU and hospital mortality, ventilator-free days, and nonpulmonary organ dysfunction. ICU mortality (24 of 45 53.3% vs. 16 of 50 32%, p = .040), hospital mortality (25 of 45 55.5% vs. 17 of 50 34%, p = .041), and ventilator-free days at day 28 (6.02 +/- 7.95 in control and 10.90 +/- 9.45 in Pflex/LTV, p = .008) all favored Pflex/LTV. The mean difference in the number of additional organ failures postrandomization was higher in the control group (p < .001).
A mechanical ventilation strategy with a PEEP level set on day 1 above Pflex and a low tidal volume compared with a strategy with a higher tidal volume and relatively low PEEP has a beneficial impact on outcome in patients with severe and persistent ARDS.
ABSTRACT
Purpose
To assess the association between vulnerable populations and nursing care needs, using NANDA‐I diagnostics, in the population of the Canary Islands, Spain.
Methods
Nursing social ...epidemiology study. Cross Mapping of Medical Records to NANDA‐I to Identify Nursing Diagnoses in a Population usinga medical, epidemiological follow‐up study of a cohort of 7,190 people. The level of vulnerability of the participants was assigned, among those who were also assigned nursing diagnoses, using the “ICE index” to calculate the expected associations.
Findings
The most prevalent nursing diagnosis in our sample was Sedentary lifestyle (60.5%), followed by Ineffective health self‐management (33.8%) and Risk‐prone health behaviour (28.7%). Significant differences were found by sex, age group and social class, with the nursing diagnoses included in the study being more prevalent among the most socio‐economically disadvantaged social class.
Conclusions
: The cross‐mapping method is useful to generate diagnostic information in terms of care needs, using the NANDA‐I classification. The expected associations between high social vulnerability and care needs have been verified in a comprehensive and representative sample of the Canarian population (Spain).
Implications for nursing practice
From an epidemiological perspective, identifying nursing diagnoses at the population level allows us to find the most prevalent needs in the different community groups and to focus appropriate nursing interventions for their implementation and impact assessment.
Resumen
Objetivo
Evaluar la asociación entre las poblaciones vulnerables y las necesidades de cuidados de enfermería, utilizando la clasificación diagnóstica NANDA‐I, en la población de las Islas Canarias, España.
Métodos
Estudio de epidemiología social enfermera. Mapeo cruzado de registros médicos con la clasificación NANDA‐I para identificar los diagnósticos de enfermería en una población mediante un estudio de seguimiento médico y epidemiológico de una cohorte de 7.190 personas. Se asignó el nivel de vulnerabilidad de los participantes, entre los que también se asignaron diagnósticos de enfermería, utilizando el “índice REI” para calcular las asociaciones esperadas.
Resultados
El diagnóstico de enfermería más prevalente en nuestra muestra fue Estilo de vida sedentario (60,5%), seguido de Autogestión ineficaz de la salud (33,8%) y Tendencia a adoptar conductas de riesgo para la salud (28,7%). Se encontraron diferencias significativas por sexo, grupo de edad y clase social, siendo los diagnósticos de enfermería incluidos en el estudio más prevalentes entre la clase social más desfavorecida socioeconómicamente.
Conclusiones
El método de mapeo cruzado es útil para generar información diagnóstica en términos de necesidades de cuidados, utilizando la clasificación NANDA‐I. Se han verificado las asociaciones esperadas entre alta vulnerabilidad social y necesidades de cuidados en una muestra amplia y representativa de la población canaria (España).
Implicaciones para la práctica enfermera
Desde una perspectiva epidemiológica, la identificación de los diagnósticos de enfermería a nivel poblacional permite encontrar las necesidades más prevalentes en los diferentes grupos de la comunidad y focalizar las intervenciones enfermeras adecuadas para su implementación y evaluación de impacto.
The objective of this work was to develop a model to predict malaria incidence in an area of unstable transmission by studying the association between environmental variables and disease dynamics.
...The study was carried out in Karuzi, a province in the Burundi highlands, using time series of monthly notifications of malaria cases from local health facilities, data from rain and temperature records, and the normalized difference vegetation index (NDVI). Using autoregressive integrated moving average (ARIMA) methodology, a model showing the relation between monthly notifications of malaria cases and the environmental variables was developed.
The best forecasting model (R2adj = 82%, p < 0.0001 and 93% forecasting accuracy in the range +/- 4 cases per 100 inhabitants) included the NDVI, mean maximum temperature, rainfall and number of malaria cases in the preceding month.
This model is a simple and useful tool for producing reasonably reliable forecasts of the malaria incidence rate in the study area.
Aims: To explore the association between resistin expression and the incidence of ischemic heart disease in the general population. Methods: A follow-up study of 6636 adults recruited randomly from ...the general population. Results: The serum resistin concentration was higher in women (6.1 ng/mL; CI95%=6.0-6.2) than in men (5.6 ng/mL; CI95%=5.5-5.7). Individuals in the 5th quintile or higher of resistin (RQ5) were younger (P＜0.001) and had a lower prevalence of arterial hypertension (P＜0.001), abdominal obesity (P＜0.001), diabetes (P＜0.001) and dyslipidemia (P＜0.001). The cardiovascular risk estimated by the Framingham function was also lower in the RQ5 subgroup (P＜0.001); however, the prevalence of smoking was higher (P＜0.001), as was the prevalence of low HDL cholesterol (P＜0.001). After 3.5 years of follow-up, the RQ5 subgroup had a higher incidence of acute myocardial infarction (AMI, RR=1.9; CI95%=1.01-3.54). In the population without diabetes, the RQ5 subgroup had a higher risk of AMI (RR=2.4; CI95%=1.10-5.17), and the risk of AMI was highest in women in this group (4.97; CI95%=1.33-18.57). The risk levels were significant in the Cox models adjusted for age, sex and smoking; and the hazard ratio was 2.5 for AMI (CI95%=1.29-4.70) in the sample of patients matched by sex and smoking status. Conclusions: Resistin may be a risk marker for ischemic heart disease in the general population. The serum resistin concentration is higher in women, and the associated increase in the risk of AMI based on the resistin level is also higher in women than in men.
•The third-dose vaccination should be administered within three months in patients with kidney disease.•The level of immunoglobulin G receptor binding domain produced is less in patients with kidney ...disease than in the healthy population.•Highlights the booster effect after third-dose vaccination in patients with kidney disease.
The aim of this study was to determine and evaluate the postvaccination variation in immunoglobulin G (IgG) receptor-binding domain (RBD) produced in non-SARS-CoV-2–infected patients with nephropathy and renal replacement therapy.
This is a follow-up study of the humoral response to the BNT162b2 messenger ribonucleic acid COVID-19 vaccine in patients with nephropathy, comparing it with itself at different times and with the healthy population.
In patients with nephropathy, a very striking decrease in IgG RBD was observed compared with the healthy population (P<0.001) at three months after the second dose. In patients with nephropathy, the response rate ≥590 binding antibody units/ml (4154 AU/ml) was detected in 45% of patients, 15 days after the second dose, whereas at 3 months, this decreased to 9% (P<0.05) and then increased to 86% after the third dose (P<0.001).
In patients with nephropathy and renal replacement therapy, it is necessary to administer a third-dose vaccination within 3 months after the second dose. It is important to continue monitoring the humoral response to obtain a better SARS-CoV-2 vaccination schedule.
Determinar los cambios de frecuentación de consultas presenciales (CP) y telemáticas (CT) a su médico de familia en pacientes con diabetes tipo 2 (DM2) durante la pandemia de COVID-19 y su relación ...con el control de su enfermedad.
Estudio multicéntrico de seguimiento retrospectivo.
Siete centros de salud en Tenerife, España.
Un total de 3.543 pacientes con DM2.
Sexo, edad, CP, CT y control de DM2 mediante hemoglobina glicosilada (A1c) durante el periodo 2019-2021. Se ajustaron modelos de regresión logística con el control de DM2 como efecto, y con las demás mediciones como variables independientes.
El 50% eran mujeres. El 38% tenía 65 años o menos. Se midió la A1c al 84% de los pacientes en 2019, 68% en 2020, y 77% en 2021. Presentaron buen control el 58,4% en 2019, 46,1% en 2020 y 50,3% en 2021. Las CP fueron 7 en 2019, 4 en 2020 y 5 en 2021 (p<0,001). Las razones de ventaja (IC95%) de buen control en 2019 fueron 1,04 (1,04-1,05) por cada año más de edad y 1,03 (1,01-1,04) por cada CP más; en 2020 fueron 1,04 (1,03-1,05) por cada año más de edad, 1,05 (1,04-1,07) por cada CP más y 1,04 (1,02-1,07) por cada CT más; en 2021 fueron 1,04 (1,04-1,05) por cada año más de edad, 1,05 (1,03-1,06) por cada CP más y 1,02 (1,00-1,04) por cada CT más.
El control de pacientes con DM2 durante 2019-2021 tuvo una relación directa con el cambio de frecuentación al centro de salud, con diferencias según el tipo de consulta y la edad.
To determine whether in patients with type 2 diabetes (DM2) the changes in their relationship with family doctors during the COVID-19 pandemic, in-person (iPC) and telematic (TC) consultations, were associated with control of their disease.
Multicentric study of retrospective follow-up.
Seven health centers in Tenerife, Spain.
3543 patients with DM2.
Sex, age, iPC, TC and DM2 control using glycosylated hemoglobin (A1c) during the period 2019-2021. Logistic regression models were fitted with DM2 control as an effect, and with the other measurements as independent variables.
50% were women. 38% were less than 65 years old. A1c was measured in 84% of patients in 2019, 68% in 2020, and 77% in 2021. 58.4% had good control in 2019, 46.1% in 2020, and 50.3% in 2021. Median iPC were 7 in 2019, 4 in 2020 and 5 in 2021 (p<0.001). The OR(95%CI) of good control in 2019 were 1.04(1.04-1.05) per year of age and 1.03(1.01-1.04) for each iPC; In 2020 they were 1.04 (1.03-1.05) per year of age, 1.05 (1.04-1.07) for each iPC and 1.04 (1.02-1.07) for each TC; in 2021 they were 1.04 (1.04-1.05) per year of age, 1.05 (1.03-1.06) for each iPC and 1.02 (1.00-1.04) for each TC.
The control of patients with DM2 during the period 2019-2021 had a direct relationship with the change in the frequency of consultations at the health center, with differences depending on the type of consultation and the age of the patient.
To compare gender differences in the clinical expression of COPD patients attending a pulmonary clinic.
We compared 53 FEV1-matched men and women with COPD attending a pulmonary clinic. We studied ...age, smoking pack-years history, Pao2, Paco2, functional residual capacity, body mass index (BMI), dyspnea, 6-min walk distance (6MWD), health-related quality of life, presence of comorbidities, and exacerbations in the previous year.
Women were younger (57 years vs 65 years, p < 0.05), smoked less (48 pack-years vs 69 pack-years, p < 0.05), had better Pao2 (74 mm Hg vs 67 mm Hg, p < 0.05), lower Paco2 (40 mm Hg vs 45 mm Hg, p < 0.05), lower BMI (25 vs 28, p < 0.05), more exacerbations in the last year (1 vs 0, p < 0.05), and fewer comorbidities (Charlson score 2 vs score 4, p < 0.05) than men. Even though women had the same FEV1, better oxygenation, better Paco2, and fewer comorbidities, they performed poorer in walking distance (6MWD percentage of predicted, 87% vs 105%; p = 0.05), had worse quality-of-life scores (Saint George's Respiratory Questionnaire SGRQ symptoms score, 51 vs 41, p < 0.05; SGRQ activity score, 58 vs 47, p < 0.05), and had a higher degree of dyspnea (Modified Medical Research Council scale > 2, 28% vs 6%, p = 0.05).
In a population of patients with COPD attending a pulmonary clinic, there are gender-related differences in the clinical expression of COPD that need further attention.
Chronic obstructive pulmonary disease (COPD) is thought to result in rapid and progressive loss of lung function usually expressed as mean values for whole cohorts.
Longitudinal studies evaluating ...individual lung function loss and other domains of COPD progression are needed.
We evaluated 1,198 stable, well-characterized patients with COPD (1,100 males) recruited in two centers (Florida and Tenerife, Spain) and annually monitored their multidomain progression from 1997 to 2009. Patients were followed for a median of 64 months and up to 10 years. Their individual FEV(1) (L) and BODE index slopes, expressed as annual change, were evaluated using regression models for repeated measures. A total of 751 patients with at least three measurements were used for the analyses.
Eighteen percent of patients had a statistically significant FEV(1) slope decline (-86 ml/yr; 95% confidence interval CI, -32 to -278 ml/yr). Higher baseline FEV(1) (relative risk, 1.857; 95% CI, 1.322-2.610; P < 0.001) and low body mass index (relative risk, 1.071; 95% CI, 1.035-1.106; P < 0.001) were independently associated with FEV(1) decline. The BODE index had a statistically significant increase (0.55, 0.20-1.37 point/yr) in only 14% of patients and these had more severe baseline obstruction. Concordance between FEV1 and BODE change was low (κ Cohen, 16%). Interestingly, 73% of patients had no significant slope change in FEV1 or BODE. Only the BODE change was associated with mortality in patients without FEV(1) progression.
The progression of COPD is very heterogeneous. Most patients show no statistically significant decline of FEV(1) or increase in BODE. The multidimensional evaluation of COPD should offer insight into response to COPD management.
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