Chronic-diabetes-related complications simultaneously compromise both the micro- and macrovascular trees, with target organs considered as the paradigm of large vessel injury also entailing ...microangiopathic changes. However, complications independent or partially independent from vascular damage are often overlooked. This includes neuronal dysfunction (e.g., retinal neurodegeneration), interstitial injury (e.g., tubulointerstitial disease), metabolic damage (e.g., in the heart and liver), and nonclassical conditions such as cognitive decline, impaired pulmonary function, or increased risk of cancer. In this scenario, researchers, endocrinologists and primary care physicians should have a holistic view of the disease and pay further attention to all organs and all potential clinical repercussions, which would certainly contribute to a more rational and integrated patient health care.
Diabetes complications include pathological changes beyond the vascular system and classical target organs.Microangiopathy may affect nonclassical target organs.Organs affected by microangiopathy may also show neuronal or structural deficits including: neurodegeneration and neurodysfunction of the retina; structural changes in the kidney tubular interstitium; and nerve fiber dysfunction.Organs affected by macroangiopathy also show microvascular and neuronal deficits including: microangiopathy of the arterial wall; microangiopathy and neuropathic changes adding to ischemic and nonischemic heart disease; metabolic peripheral nerve damage; cerebral small vessel disease; and structural changes leading to cognitive impairment.Nonclassical chronic complications include abnormal pulmonary function and microangiopathy, metabolic liver and myocardial damage, and increased risk of carcinogenesis.
In recent decades, there has been a massive incorporation of women into the labor market. However, the belief that certain jobs or business functions can be performed better by people of one gender ...than the other has not allowed for widespread changes in the business culture to achieve effective equality between women and men in companies. Examples of this are unequal access to employment, vertical and horizontal segregation in occupations, wage discrimination, problems in reconciling personal and professional life, or difficulties in accessing management positions in companies (glass ceiling). Other determinants of gender inequalities have been long working hours, as well as the presence of employees, characteristic of European business culture. The progress achieved to date began with the incorporation of women into the labor market under unequal conditions that soon called for the need to establish a regulatory framework to try to eradicate them. The legal status of women in Europe has undoubtedly improved as a result of the development of European regulations, which have been binding in the development of business policies in the Member States and have succeeded in modifying the organizational climate through proposals such as the development of Equality Plans or salary audits. Examples of the most recent legislative initiatives of the European Union on equality that affect business practices are Directive 2022/2041/EC on adequate minimum wages in the European Union or Directive 2022/2381/EC on a better gender balance among directors of listed companies. This study attempts to systematize the changes in the legislation on effective equality between men and women in business and to analyze its effect on organizational culture through the information available in the statistics on gender equality-mainly from the European Union-which gather quantitative and qualitative information on the adaptation of business culture to the new legal framework and the overcoming of gender stereotypes that have been guiding business management in the last decade.
To assess mortality trends at 1 and 3 years from 2001 to 2018 in a real-life cohort of HF outpatients from different etiologies with depressed and preserved LVEF. A total of 2368 consecutive patients ...with HF (mean age 66.4 ± 12.9 years, 71% men, 15.4% with preserved LVEF) admitted to a HF clinic from August 2001 to September 2018 were included in the study. Patients were divided into five quintiles (Q) according to the period of admission. Trends for all-cause and cardiovascular mortality from Q1 to Q5 were assessed by linear regression. Patients with LVEF < 50% had a progressive decrease in the rates of all-cause and cardiovascular death at 1 year (12.1% in Q1 to 6.5% in Q5, p = 0.003; and 8.4% in Q1 to 3.8% in Q5, p = 0.007, respectively) and 3 years (30.5% in Q1 to 17.0% in Q5, p = 0.003; and 23.9% in Q1 to 9.8% in Q5, p = 0.003, respectively). These trends remained significant after adjusting for clinical characteristics and risk. No significant trend in mortality was observed in patients with LVEF ≥ 50%. In a cohort of real-life ambulatory patients with HF, mortality progressively declined in patients with LVEF < 50%, but the same trend was not observed in patients with preserved LVEF.
The main objective of the study is to determine the efficiency in the execution of the START (Simple Triage and Rapid Treatment) triage, comparing Virtual Reality (VR) to Clinical Simulation (CS) in ...a Mass Casualty Incident (MCI). The secondary objective is to determine the stress produced in the health professionals in the two situations described.
A comparative study on the efficiency and the stress during triage in a MSI was conducted. The basal and post levels of salivary α-amylase (sAA) activity were measured in all the participants before and after the simulation.
The percentage of victims that were triaged correctly was 87.65% (SD = 8.3); 88.3% (SD = 9.65) for the Clinical Simulation with Actors (CSA) group and 87.2% (SD = 7.2) for the Virtual Reality Simulation (VRG) group, without any significant differences (p = 0.612) between both groups. The basal sAA was 103.26 (SD = 79.13) U/L with a significant increase (p < 0.001) with respect to the post-simulation levels (182.22, SD = 148.65 U/L). The increase of sAA was 80.70 (SD = 109.67) U/mL, being greater for the CSA group than the VRG group.
The results show that virtual reality method is as efficient as clinical simulation for training on the execution of basic triage (START model). Also, based on the sAA results, we can attest that clinical simulation creates a more stressful training experience for the student, so that is should not be substituted by the use of virtual reality, although the latter could be used as a complementary activity.
Evidence regarding any association of HDL-particle (HDL-P) derangements and HDL-cholesterol content with cardiovascular (CV) death in chronic heart failure (HF) is lacking. To investigate the ...prognostic value of HDL-P size (HDL-Sz) and the number of cholesterol molecules per HDL-P for CV death in HF patients. Outpatient chronic HF patients were enrolled. Baseline HDL-P number, subfractions and HDL-Sz were measured using 1H-NMR spectroscopy. The HDL-C/P ratio was calculated as HDL-cholesterol over HDL-P. Endpoint was CV death, with non-CV death as the competing event. 422 patients were included and followed-up during a median of 4.1 (0-8) years. CV death occurred in 120 (30.5%) patients. Mean HDL-Sz was higher in CV dead as compared with survivors (8.39 nm vs. 8.31 nm, p < 0.001). This change in size was due to a reduction in the percentage of small HDL-P (54.6% vs. 60% for CV-death vs. alive; p < 0.001). HDL-C/P ratio was higher in the CV-death group (51.0 vs. 48.3, p < 0.001). HDL-Sz and HDL-C/P ratio were significantly associated with CV death after multivariable regression analysis (HR 1.22 95% CI 1.01-1.47, p = 0.041 and HR 1.04 95% CI 1.01-1.07, p = 0.008 respectively). HDL-Sz and HDL-C/P ratio are independent predictors of CV death in chronic HF patients.
The impact of hypocapnia in the prognosis of cardiogenic acute pulmonary edema (CAPE) has not been sufficiently studied. The aim of this study was to analyse whether hypocapnia is a risk factor for ...non-invasive ventilation (NIV) failure and hospital mortality, in CAPE patients CAPE.
Retrospective observational study of all patients with CAPE treated with NIV. Patients were classified in three groups according to PaCO2 level (hypocapnic, eucapnic and hypercapnic). NIV failure was defined as the need for endotracheal intubation and/or death.
1138 patients were analysed, 390 (34.3%) of which had hypocapnia, 186 (16.3%) had normocapnia and 562 (49.4%) had hypercapnia. NIV failure was more frequent in hypocapnic (60 patients, 15.4%) than in eucapnic (16 pacientes, 8.6%) and hypercapnic group (562 pacientes, 10.7%), with statistical significance (p = 0.027), as well as hospital mortality, 73 (18.7%), 19(10.2%) and 83 (14.8%) respectively (p = 0.026). The predicted factors for NIV failure were the presence of do-not-intubate order, complications related to NIV, a lower left ventricular ejection fraction, higher SAPS II and SOFA score and a higher HACOR score at one hour of NIV initiation.
Hypocapnia in patients with CAPE is associated with NIV failure and a greater in-hospital mortality.
•Non-invasive ventilation is effective in cardiogenic pulmonary edema.•Patients with initial hypocapnia present worse prognosis.•Hypocapnia is associated with NIV failure and higher in-hospital mortality.•Predictors of NIV failure include higher SAPS II, SOFA and HACOR scores.•Lower left ventricular ejection fraction is also a predictor of NIV failure.
(1) Background: Pakistani women are among one of Catalonia's most affected groups by obesity and cardiovascular disease. The design of health education strategies for them has become a compelling ...need. This paper aims to enlighten the elaboration and evaluation procedure of culturally and linguistically tailored nutrition education materials for Pakistani women participating in the PakCat Program, which aims to evaluate the efficacy of a nutrition education strategy allowing the participants to become ambassadors of healthy eating habits for their community. (2) Methods: In this Randomised Control Trial (RCT), 137 Pakistani women (70 from the intervention and 67 from the control group) took part. We conducted 10 sessions for the intervention group and 3 sessions for the control group in the form of small groups. The sessions were conducted in Urdu and Punjabi, and the material was translated into Urdu, Catalan, Spanish and English. For some sessions, we elaborated on new materials and for others, we adapted them from the existing nutrition material in aspects of language and culture. We evaluated the nutritional material from the observation carried out by the dietician who developed the sessions, participants' feedback at the end of the sessions and a satisfaction questionnaire. (3) Results: We summarised the elaborated material in form of two multilingual nutritional guidelines about portion size and heart-healthy foods. We also registered several materials generated for the PakCat program such as an infographic about myths and beliefs related to food, a booklet to read and interpret the food labels, a recipe book for healthy snacks, and an infographic of 10 tips for healthy eating. We also organised a PhotoVoice exhibition of 70 healthy plates elaborated by the intervention group participants. The participants highly appreciated the material in terms of visualization, cultural and linguistic adequacy, and level of comprehension through all three evaluation methods. (4) Conclusions: The design of culturally and linguistically tailored nutrition education material for Pakistani women living in Catalonia is attainable and effective to meet their specific needs. The healthy dietary recommendation can be adapted to them preserving their traditional dietary pattern, and they acquire the confidence to start following a healthy diet.
Mixed-methods study.
Evaluate the knowledge that family caregivers of individuals with spinal cord injuries acquired through the use of a high-fidelity simulation-based learning (SBL) program.
The ...study was comprised of three phases: a previous qualitative research study detecting training needs, one in which clinical simulation scenarios were designed, and a final quasi-experimental phase in which ten caregivers of individuals with spinal cord injuries were trained in their care using simulations at the Toledo National Hospital for Paraplegics (Spain).
The competences acquired by the family were evaluated before and after the simulation training. A researcher-validated tool for each scenario was utilized for this evaluation.
Four learning scenarios were designed based on the needs identified through the caregiver interviews. Following the training of the caregivers with SBL, an increase in their knowledge and skills was identified. For all the scenarios, the caregivers obtained a higher average score on the post test than on the pre test, and these differences were significant (p < 0.001).
Simulation training is a useful and efficient learning tool for caregivers of individuals with a spinal cord injury.
The impact of glycemic optimization on lipoprotein subfraction parameters in apparently normolipidemic subjects with new-onset type 1 diabetes mellitus (T1D) was examined.
We evaluated the serum ...lipid and advanced lipoprotein profiles in twenty subjects at onset of T1D and twenty non-diabetic controls by laboratory methods and 1H NMR spectroscopy shortly after diabetes diagnosis (baseline), and after achieving optimal glycemic control (HbA1c ≤ 7.0%).
Advanced lipoprotein analysis revealed a significant reduction from baseline in serum concentrations of triglycerides (TG), cholesterol (C), and apolipoprotein (Apo)B-containing lipoproteins of treated subjects (VLDL-TG: −21%, IDL-TG: −30%, LDL-TG: −34%, LDL-TG: −36%, P < 0.05; VLDL-C: –23%, IDL-C: −44%, LDL-C: −16%; p < 0.05). Decreased VLDL and LDL lipids were mainly attributed to concomitant reductions in the concentration of medium-sized VLDL (–36%) and medium-sized LDL (–31%) and, to a lesser extent, to large-sized LDL (–14%). Notably, proatherogenic IDL characteristics and related surrogates of atherogenicity were resolved upon achievement of optimal glycemic status. Moreover, the concentration of HDL-TG was also reduced (−18%) at follow-up.
Our data showed that the achievement of optimal glycemic control after T1D onset corrected hidden derangements in ApoB-containing lipoproteins (particularly IDL) and HDL-TG that are related to higher cardiovascular risk in poorly controlled T1D.
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