Bed occupancy in the ICU is a major constraint to in-patient care during COVID-19 pandemic. Diagnoses of acute respiratory infection (ARI) by general practitioners have not previously been ...investigated as an early warning indicator of ICU occupancy.
A population-based central health care system registry in the autonomous community of Catalonia, Spain, was used to analyze all diagnoses of ARI related to COVID-19 established by general practitioners and the number of occupied ICU beds in all hospitals from Catalonia between March 26, 2020 and January 20, 2021. The primary outcome was the cross-correlation between the series of COVID-19-related ARI cases and ICU bed occupancy taking into account the effect of bank holidays and weekends. Recalculations were later implemented until March 27, 2022.
Weekly average incidence of ARI diagnoses increased from 252.7 per 100,000 in August, 2020 to 496.5 in October, 2020 (294.2 in November, 2020), while the average number of ICU beds occupied by COVID-19-infected patients rose from 1.7 per 100,000 to 3.5 in the same period (6.9 in November, 2020). The incidence of ARI detected in the primary care setting anticipated hospital occupancy of ICUs, with a maximum correlation of 17.3 days in advance (95% confidence interval 15.9 to 18.9).
COVID-19-related ARI cases may be a novel warning sign of ICU occupancy with a delay of over two weeks, a latency window period for establishing restrictions on social contacts and mobility to mitigate the propagation of COVID-19. Monitoring ARI cases would enable immediate adoption of measures to prevent ICU saturation in future waves.
Due to the high prevalence of dementia, health care needs are increasing beyond existing formal resources. In Spain, it is the family that takes care of this disease.
To analyze the direct (health ...and non-health) and indirect economic costs related to care of people with dementia living with their informal caregiver in the home care/community environment, from the perspective of illness severity, associated comorbidity and social impact.
Multicentric, descriptive study.
Three primary care public health centers associated with Hospital Clínic, Barcelona (Spain).
Patients over 65 years old with a diagnosis of dementia, and included in a home care program.
People with a diagnosis of dementia made by a specialist neurologist; aged 65 years or older; a score ≤24 on the Mini-Mental State Examination, and identification of an informal caregiver.
Patients unable to identify an informal caregiver, and those with primary psychiatric pathology or Korsakoff's syndrome.
Use of Resources in Dementia to assess costs; Mini-Mental State Examination to evaluate cognitive capacity; Katz-Index to measure functional capacity; Neuropsychiatric Index for neuropsychiatric symptoms, and the Charlson-Index for comorbidity. Data collection took place between November, 2010 and April, 2012.
The average estimated monthly care costs for people with dementia in the home setting are 1956.2€ (SD 1463.9). Informal care was the major contributor to this with a mean estimated cost of 1214.86 (SD 902.68)€/month. Greater illness severity, dependency in activities of daily living, comorbidity and behavioral disturbance are associated with higher costs. Behavioral disturbance appeared as the only factor independently associated with cost in dementia care. The group of people with dementia with severe behavioral disturbance requires the most care resources with an average cost of 2545.2 (SD 1753.2)€/month.
There is a direct association between dementia severity and increased costs. In addition, informal caregivers looking after people with dementia in Spain represent an important social cost. The independent factor associated with an increase in the total costs of patient care was neuropsychiatric symptoms.
Knowledge concerning professionals involved in dementia care throughout its trajectory is sparse; the focus has mainly been on nursing-home care and less on home care, diagnosis and treatment of the ...disease and its complications despite the fact that home care is the most prominent type of care. The aim of this study was to explore and describe professional care providers involved in dementia care and their educational level applying the International Standard Classification of Education (ISCED) and further to investigate practice in the RightTimePlaceCare-countries with regard to screening, diagnostic procedures and treatment of dementia and home care. The findings demonstrate more similarities than differences in terms of type of professionals involved among the countries although untrained staff were more common in some countries. Findings also show that many types of professionals are involved, who to turn to may not be clear, for instance in terms of medical specialities and it may be unclear who bears the ultimate responsibility. The professionals involved in diagnosis, treatment and care are educated to bachelor’s level or above whilst everyday care is provided by people trained at a lower ISCED level or with no formal training. Registered nurses as well as occupational therapists have bachelor’s degrees in most countries, but not in Germany or Estonia. Professionals specifically trained in dementia care are not so common. Further research is needed to reveal not only who provides the diagnostics and treatment, but also how home care is organised and quality assured. Many different types of professionals serve as providers along the trajectory of the disease which may be difficult for the patient and the informal caregiver to cope with.
Autonomy has become an important focus within healthcare. Elderly patients, however, are often denied the right to independent decision making on grounds of incompetence and incapacity. In long-term ...institutions there are several ways in which the clinical nurse specialist can promote the autonomy of elderly patients. This article provides an overview of the concept of autonomy and discusses some of the problems in its realization in long-term nursing institutions. It also outlines strategies for supporting autonomy in elderly patients and concludes with a discussion of the implications of autonomy to nursing practice and research.
Respiratory chain complexes assemble into functional quaternary structures called supercomplexes (RCS) within the folds of the inner mitochondrial membrane, or cristae. Here, we investigate the ...relationship between respiratory function and mitochondrial ultrastructure and provide evidence that cristae shape determines the assembly and stability of RCS and hence mitochondrial respiratory efficiency. Genetic and apoptotic manipulations of cristae structure affect assembly and activity of RCS in vitro and in vivo, independently of changes to mitochondrial protein synthesis or apoptotic outer mitochondrial membrane permeabilization. We demonstrate that, accordingly, the efficiency of mitochondria-dependent cell growth depends on cristae shape. Thus, RCS assembly emerges as a link between membrane morphology and function.
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•Dissociation of cristae remodeling from OMM permeabilization•Cristae shape determines assembly of respiratory chain supercomplexes•Efficiency of mitochondrial respiration and cellular growth depends on cristae shape
The ability to perturb cristae shape without affecting other key aspects of mitochondrial physiology reveals that membrane shape influences supercomplex assembly and stability to regulate mitochondrial respiration and cellular respiratory growth. Quaternary structures such as supercomplexes therefore emerge as a link between membrane morphology and function.
Bladder Cancer (BC) represents a clinical and social challenge due to its high incidence and recurrence rates, as well as the limited advances in effective disease management. Currently, a ...combination of cytology and cystoscopy is the routinely used methodology for diagnosis, prognosis and disease surveillance. However, both the poor sensitivity of cytology tests as well as the high invasiveness and big variation in tumour stage and grade interpretation using cystoscopy, emphasizes the urgent need for improvements in BC clinical guidance. Liquid biopsy represents a new non-invasive approach that has been extensively studied over the last decade and holds great promise. Even though its clinical use is still compromised, multiple studies have recently focused on the potential application of biomarkers in liquid biopsies for BC, including circulating tumour cells and DNA, RNAs, proteins and peptides, metabolites and extracellular vesicles. In this review, we summarize the present knowledge on the different types of biomarkers, their potential use in liquid biopsy and clinical applications in BC.
Introduction: Of the serious problems that characterise the current crisis in Spain, the most alarming and revealing is unemployment, which, despite being so common, continues to be quite a negative ...experience for most people, often with serious negative effects on their biopsychosocial health. The perpetuation of this situation has given rise to a new syndrome of the unemployed. If these effects of economic downsizing are accompanied by the magnitude of the current situation brought about by COVID-19, the results can be devastating for the individuals and families experiencing it. Objective: To compare the symptoms of the unemployed syndrome in three population groups. Method: Three groups were studied: short-term unemployed (n = 91), long-term unemployed (n = 150), and those unemployed during the COVID-19 pandemic (n = 94). Unemployment syndrome was assessed with the Unemployment Syndrome Scale (USS). The three population groups were contacted through web pages, social networks, etc. and answered the instruments online in a single session. Once the responses were obtained, their information was encoded in a database and analysed through the SPSS v. 21 program. Population groups were compared using the ANOVA analysis and the Bonferroni post hoc test. Results: The unemployed individuals who lost their job during the pandemic reported higher scores in the symptoms of the Unemployed Syndrome Scale compared to the long- and short-term unemployed individuals. ANOVA analyses for symptoms of USS were all significant in the different groups considering a significance level of <0.005. Participants who were unemployed for less than one year had lower scores in the USS than the long-term unemployed participants and those unemployed during the COVID-19 pandemic that reported a significantly higher number of symptoms in the USS.
Aim
Febrile urinary tract infection is a common bacterial infection in childhood. The kidney damage after acute pyelonephritis (APN) could be related to the stimulation of the proinflammatory ...response. We aimed to investigate the role of inflammatory cytokines and the effect of dexamethasone after a first episode of APN.
Methods
Subanalysis of the DEXCAR RCT in which children with confirmed APN (1 month–14 years) were randomly assigned to receive a 3 days course of either intravenous dexamethasone or placebo. Urinary cytokine levels at diagnosis and after 72 h of treatment were measured.
Results
Ninety‐two patients were recruited. Younger patients, males and those with abnormalities in the ultrasound study or vesicoureteral reflux showed higher values of urinary cytokines. Patients with severe APN had higher Tumour Necrosis Factor (TNF)α levels (81.0 ± 75.8 vs. 33.6 ± 48.5 pg/mg creatinine, p = 0.015). Both intervention groups showed similar basal clinical characteristics, including urinary cytokine levels. Treatment reduced urinary cytokine levels irrespective of dexamethasone administration. Neither the intervention group nor the urinary cytokine levels modulated the development of kidney scars.
Conclusion
Basal urinary cytokines were associated with age, abnormal ultrasound and vesicoureteral reflux. Patients with severe APN had higher TNFa urinary levels. Administration of dexamethasone in children with APN does not improve the control of the proinflammatory cytokine cascade.
The available E. coli vaccines involve two main types (inactivated and live non-pathogenic) and two routes of administration (oral and parenteral) but the mechanism by which both vaccines and routes ...of administration work is not yet fully elucidated. The influence of a parenteral vaccine (PV) and an oral one (OV) was studied by analyzing the gene expression of biomarkers indicating cellular infiltration (calprotectin, CAL), tight junction proteins (occludin OCL, and zonulin ZON) that maintain intestinal paracellular integration and two proinflammatory (IFN-γ) and anti-inflammatory (TGF-β) mediator cytokines, as well as histomorphology and IgA production cell density. Differences were observed in CAL, more infiltrated in orally vaccinated animals; OCL also increased in orally vaccinated animals, and higher density of IgA-producing cells in ileum for orally vaccinated groups. Cytokine expression is also different; and there is a lower mRNA for IFN-γ in the parenteral than in the oral vaccinated animals. Finally, the villus height-to-crypt depth ratio was higher in the orally vaccinated groups. The data collectively show clear and different effects derived from the use of each type of vaccine, route of administration and regimen. The results suggest a more rapid and direct effect of oral vaccination and a state of suppression in the absence of a second oral stimulus by the pathogen.
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