Summary
The relation between age and mortality after hip fracture was analyzed in elderly patients. 5.5% of the 31,884 patients died. Compared to those 65–74 years old, the multivariate OR for ...mortality for those 75–84 and ≥85 were 2.11 (95% CI: 1.61–2.77) and 4.10 (95% CI: 3.14–5.35).
Purpose
To analyze the impact of Elixhauser comorbidities on the relation between age and mortality after hip fracture in elderly patients.
Methods
Cross-sectional study of the population ≥65 years old hospitalized in Spain in 2013 with a diagnosis of fall-related hip fracture in the Basic Minimum Set Data (BMSD). The impact of Elixhauser comorbidities on the association between mortality and age groups (65–74, 75–84, ≥85) was analyzed by logistic regression models with progressive adjustment for demographic variables and comorbidities introduced individually.
Results
We identified 31,884 patients, 5.5% of which died during hospitalization. Compared with those 65–74 years old, the multivariate OR of mortality for those 75–84 and ≥85 years old decreased from 2.23 (95% CI: 1.71–2.90) and 4.57 (95% CI: 3.54–5.90) to 2.11 (95% CI: 1.61–2.77) and 4.10 (95% CI: 3.14–5.35), respectively after adjustment for comorbidities. The OR of mortality for men was 1.77 (95% CI: 1.58–1.98) compared to women. The comorbidities with higher OR for mortality were congestive heart failure (OR: 3.88; 95% CI: 3.42–4.41), metastasis (OR: 3.44; 95% CI: 2.27–5.20), fluid and electrolyte disorders (OR: 2.95; 95% CI: 2.47–3.52), coagulation deficiencies (OR: 2.87; 95% CI: 2.08–3.96), and liver disease (OR: 2.40; 95% CI: 1.82–3.17).
Conclusions
The association between age and mortality after hip fracture remains after adjusting for numerous comorbidities. However, some potentially controllable disorders are associated with an increased risk for mortality, thus, improving their management could benefit survival.
The Global Activity Limitation Indicator (GALI) is an instrument that measures long-term overall disability. The objective of this study was to evaluate GALI's predictive value on mortality while ...examining variations according to sex, age, and educational level.
Longitudinal study.
This longitudinal study was based on 42,991 individuals aged ≥15 years who participated in the 2011–2012 National Health Survey and the 2014 European Health Survey in Spain. These records were linked to mortality data up to December 2021. GALI assessed self-reported functional limitation in the past 6 months and classified individuals into three categories: severely limited, limited but not severely, and not limited. Incidence rate ratios (IRR) were calculated using Poisson regression models, adjusting for sociodemographic, lifestyle, and health status variables.
Compared to individuals with no limitations, those with non-severe limitations had an IRR for mortality of 1.27 (95% CI: 1.16–1.38), and 2.04 (95% CI: 1.81–2.31) in those with severe limitations. Women with severe limitations exhibited a higher IRR (2.32; 95% CI: 1.98–2.71) compared to men (1.73; 95% CI: 1.45–2.08) (P for interaction = 0.005). Individuals <65 years with severe limitations showed a greater association (2.22; 95% CI: 1.58–3.10) than those ≥65 (1.49; 95% CI: 1.32–1.69) (P for interaction <0.001). Among individuals with lower educational attainment, the IRR was 2.08 (95% CI: 1.83–2.37), and 1.87 (95% CI: 1.37–2.56) for the higher education group (P for interaction = 0.017).
GALI is a robust predictor of all-cause mortality in the general population and subgroups. The association is stronger in women, individuals <65 years, and those with lower educational levels.
Despite the biological plausibility of the association between heavy metal exposure and mental health disorders, epidemiological evidence remains scarce. The objective was to estimate the association ...between heavy metals and metalloids in soil and the prevalence of mental disorders in the adult population of Spain.
Individual data came from the Spanish National Health Survey 2011–2012, 18,073 individuals residing in 1772 census sections. Mental health was measured with the 12-item General Health Questionnaire. The concentration estimates of heavy metal and metalloid levels in topsoil (upper soil horizon) came from the Geochemical Atlas of Spain based on 13,317 soil samples. Levels of lead (Pb), arsenic (As), cadmium (Cd) and manganese (Mn) were estimated in each census section by “ordinary Kriging”. Odds ratios (OR) were calculated by multilevel logistic regression models.
Compared with the lowest Pb concentration levels quartile, the OR for the second quartile was 1.29 (95%CI: 1.11–1.50), increasing progressively to 1.37 (95%CI: 1.17–1.60) and 1.51 (95%CI: 1.27–1.79) in the third and fourth quartiles, respectively. For As, the association was observed in the third and fourth quartiles: 1.21 (95%CI: 1.04–1.41) and 1.42 (95% CI: 1.21–1.65), respectively. Cd was associated also following a gradient from the second quartile: 1.34 (95%CI: 1.15–1.57) through the fourth: 1.84 (95%CI: 1.56–2.15). In contrast, Mn only showed a positive association at the second quartile. Additionally, individuals consuming vegetables > once a day the OR for the fourth quartile of Pb concentration, vs. the first, increased to 2.93 (95%CI: 1.97–4.36); similarly for As: 3.00 (95%CI: 2.08–4.31), and for Cd: 3.49 (95%CI: 2.33–5.22).
Living in areas with a higher concentration of heavy metals and metalloids in soil was associated with an increased probability of having a mental disorder. These relationships were strengthened in individuals reporting consuming vegetables > once a day.
•Higher concentration of heavy metals in soil was associated with mental disorders.•We observed a gradient effect for Pb, As, and Cd.•Stronger association was found in people consuming >1 daily serving of vegetables.
Background: As a symptom of multiple sclerosis (MS), fatigue is difficult to manage because of its unknown etiology, the lack of efficacy of the drugs tested to date and the absence of consensus ...about which would be the ideal measure to assess fatigue. Objective: Our aim was to assess the frequency of fatigue in a sample of MS patients and healthy controls (HC) using two fatigue scales, the Fatigue Severity Scale (FSS) and the Modified Fatigue Impact Scale (MFIS) with physical, cognitive and psychosocial subscales. We also studied the relationship fatigue has with depression, disability and interferon beta. Methods: Three hundred and fifty-four individuals (231 MS patients and 123 HC) were included in this cross-sectional study. Fatigue was assessed using the FSS and MFIS. Depression was measured by the Beck Depression Inventory (BDI), and disability by the Expanded Disability Status Scale (EDSS). A status of fatigue was considered when the FSS≥ 5, of non-fatigue when the FSS≤4, and scores between 4.1 and 4.9 were considered doubtful fatigue cases. Results: Fifty-five percent of MS patients and 13% of HC were fatigued. The global MFIS score positively correlated with the FSS in MS and HC (r=0.68 for MS and r=0.59 for HC, p<0.0001). Nonetheless, the MFIS physical subscale showed the strongest correlation score with the FSS (r=0.75, p<0.0001). In addition, a prediction analysis showed the physical MFIS subscale to be the only independent predictor of FSS score (p<0.0001), suggesting other aspects of fatigue, as cognition and psychosocial functions, may be explored by the FSS to a lesser extent. Depression also correlated with fatigue (r=0.48 for the FSS and r=0.7 for the MFIS, p<0.0001) and, although EDSS correlated with fatigue as well, the scores decreased after correcting for depression. Interferon beta showed no relationship with fatigue. Conclusions: Fatigue is a frequent symptom found in MS patients and clearly related with depression. Each fatigue scale correlates with one another, indicating that they are measuring similar constructs. Nevertheless, spheres of fatigue as cognition and psychosocial functions are probably better measured by the MFIS, although this hypothesis will need to be confirmed with appropriate psychometrical testing.
Background: Cognitive impairment is frequent in multiple sclerosis (MS) and lacks effective treatment. Cognitive rehabilitation is widely applied in neurorehabilitation settings. Functional magnetic ...resonance imaging (fMRI) may help in investigating changes in brain activity and provide a tool to assess the efficacy of rehabilitation.
Aim: To investigate the effect on brain activity as measured by fMRI of a cognitive rehabilitation programme in patients with MS and cognitive impairment.
Method: Fifteen patients with MS and cognitive impairment and five healthy subjects were recruited. Neuropsychological assessments were performed in patients with MS at study entry and after rehabilitation to assess cognitive changes. fMRI scans were performed at week −5 (baseline), week 0 (immediately before rehabilitation) and week 5 (immediately after rehabilitation). The fMRI paradigm was the Paced Auditory Serial Addition Test (PASAT). The cognitive rehabilitation programme was composed of 15 computer-aided drill and practice sessions and five non-computer-aided cognitive stimulation group sessions (over 5 weeks). Strict guidelines ensured comparability of all rehabilitation interventions.
Results: Patients had increased brain fMRI activity after rehabilitation in several cerebellar areas when compared with healthy subjects. After rehabilitation, patients had significantly improved their performance on the backward version of the Digit Span Test (p = 0.007) and on a composite score of neuropsychological outcomes (p = 0.009).
Conclusion: The results of the present study indicate that this cognitive rehabilitation programme increases brain activity in the cerebellum of cognitively impaired patients with MS. The role of fMRI in the assessment of neurorehabilitation schemes warrants further investigation.
Objectives Little is known about the dose–response relationship between physical activity and health benefits among young people. Our objective was to analyse the association between the frequency of ...undertaking moderate-to-vigorous physical activity (MVPA) and the self-reported health status of the adolescent population. Design Cross-sectional study. Setting All regions of Spain. Participants Students aged 11–18 years participating in the Spanish Health Behaviour in School-aged Children survey 2006. A total of 375 schools and 21 188 students were selected. Main outcomes The frequency of undertaking MVPA was measured by a questionnaire, with the following four health indicators: self-rated health, health complaints, satisfaction with life and health-related quality of life. Linear and logistic regression models were used to analyse the association, adjusting for potential confounding variables and the modelling of the dose–response relationship. Results As the frequency of MVPA increased, the association with health benefits was stronger. A linear trend (p<0.05) was found for self-rated health and health complaints in males and females and for satisfaction with life among females; for health-related quality of life this relationship was quadratic for both sexes (p<0.05). For self-reported health and health complaints, the effect was found to be of greater magnitude in males than in females and, in all scales, the benefits were observed from the lowest frequencies of MVPA, especially in males. Conclusions A protective effect of MVPA was found in both sexes for the four health indicators studied, and this activity had a gradient effect. Among males, health benefits were detected from very low levels of physical activity and the magnitude of the relationship was greater than that for females.
Summary
Falls are a major health problem in older adults, but their relationship with alcohol consumption in this population remains unclear. In a cohort with 2170 older adults followed up for ...3.3 years, both moderate drinking and the Mediterranean drinking pattern were associated with a lower risk of falls and injurious falls.
Introduction
This study aims to examine the association between certain patterns of alcohol consumption, including the Mediterranean drinking pattern (MDP), and the risk of falls in older adults.
Methods
A prospective cohort with 2170 community-dwelling individuals aged ≥60 years was recruited in Spain in 2008–2010 and followed up through 2012. At baseline, participants reported alcohol consumption and, at the end of follow-up, their falls during the previous year. The MDP was defined as moderate alcohol consumption (threshold between moderate and heavy intake was 40 g/day for men and 24 g/day for women) with preference for wine and drinking only with meals. Analyses were conducted with negative binomial or logistic regression, as appropriate, and adjusted for the main confounders.
Results
Compared with never drinkers, the number of falls was lower in moderate drinkers (incidence rate ratio (95% confidence interval), 0.79 (0.63–0.99)) and drinkers with MDP (0.73 (0.56–0.96)). Also, moderate drinkers and those with MDP showed a lower risk of ≥2 falls (odds ratio (95% confidence interval), 0.58 (0.38–0.88) and 0.56 (0.34–0.93), respectively) and of falls requiring medical care (0.67 (0.46–0.96) and 0.61 (0.39–0.96), respectively).
Conclusion
Both moderate drinking and the MDP were associated with a lower risk of falls and injurious falls in older adults. However, sound advice on alcohol consumption should balance risks and benefits.
We aimed to single out multiple sclerosis (MS) cases with poor outcome after natalizumab withdrawal and to identify predictive variables. We ascertained 47 withdrawals, and compared their pre- and ...post-natalizumab periods. We objectively defined significant clinical worsening after natalizumab withdrawal as a 2-step increase in Expanded Disability Status Scale (EDSS). We performed regression models. As a group, post-natalizumab annualized relapse rate (ARR) was lower in the post-natalizumab period, and there were no differences in the mean number of gadolinium (Gd)-enhancing lesions between pre- and post-natalizumab magnetic resonance imaging (MRI). Corticosteroid treatment did not change the outcomes. Eight patients (19%) presented significant clinical worsening after natalizumab withdrawal, which was predicted by a higher baseline EDSS and a 1-step EDSS increase while on natalizumab.
Many time-series studies have shown positive associations between air pollutants and asthma morbidity. However, few studies have included pollen as a potential confounder when examining this ...relationship. This study analysed the short-term association between air pollutants (sulphur dioxide (SO2), particles measured with a median aerodynamic diameter of <10 microm (PM10), nitrogen dioxide (NO2) and ozone (O3)) and asthma emergency room admissions in Madrid, Spain, in 1995-1998, adjusting for four types of pollen with allergenic potential (Olea europaea, Plantago sp., Poaceae and Urticaceae). Data were analysed using autoregressive Poisson regression and generalised additive models (GAM). The strongest associations were observed at 1 day lag for O3, and 3 days lag for the remaining pollutants. Using Poisson regression, a single-pollutant model showed that a 10-microg x m(-3) rise in pollutant level led to relative risks of: 1.039 for PM10; 1.029 for SO2; 1.033 for NO2; and 1.045 for O3. Adjustment for the different types of pollen led to no substantial variation in these associations. In the multipollutant models for cold-season pollutants (including PM10, SO2 and the four types of pollen) and photochemical pollutants (including NO2, O3 and the four types of pollen) the associations for PM10, NO2 and O3 held, but no relationship with SO2 was evident. GAM analysis yielded the same results, both in terms of lags and of quantification of the effect for all pollutants. In conclusion, the usual air pollution levels in Madrid were associated with an increase in asthma emergency room admissions, and this association remained controlling for the presence of ambient pollen.
The clustering problem has been extensively studied over the last 50 years; however, it still has the attention of researchers. This paper presents a topological basis of a pseudometric-based ...clustering model which takes into account the local and global topological properties of the data to be clustered, as per the definition of homogeneity measurement. The proposed approach takes into account the homogeneity effect produced when a new particle is added to a group. The additional element can be accumulated in the group if its local homogeneity is not altered and, therefore, it is not necessary to carry out tests in another group. A new group needs to be generated if the threshold of the local homogeneity of the group exceeds. Theoretical results, their implementation, and their application to the problem of Content Based Image Retrieval (CBIR) are presented. The tests were performed using three image databases widely used in the literature, which are “Vogel and Shiele,” “Oliva and Torralba,” and “L. Fei- Fei, R. Fergus and P. Perona.” The results are presented and compared with the most competitive methods available in the literature.
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