Conocer las características y las diferencias clínicas entre pacientes institucionalizados y los de programas de atención domiciliaria.
Estudio observacional descriptivo transversal multicéntrico.
...Emplazamiento Sevilla, 2016.
Un total de 1.857 pacientes ancianos (1.441 institucionalizados y 416 en domicilio).
Las variables estudiadas fueron: sexo, edad, estado civil, apoyo familiar, patologías, criterios de pluripatología y fármacos. Se valoraron el estado funcional y el cognitivo mediante las escalas de Barthel, Lawton-Brody y Pfeiffer.
Un 71,40% fueron mujeres. Estadísticamente el hecho de estar institucionalizados o vivir en el domicilio se relaciona con las siguientes patologías y categorías: esquizofrenia (p<0,001), HTA (p=0,012), DM (p=0,001), FA (p<0,001) y neoplasias (p=0, 012), A1 (p=0,012), A2 (p<0,001), B1 (p<0,001), B2 (p=0,002), C (p<0,001), E1 (p<0,001), E3 (p=0,01), F2 (p<0,01), G2 (p=0,024) y H (p=0,005). El promedio del índice de Barthel de la muestra fue de 49,1±34,45 (IC95%: 47,49-50,7), el de Lawton-Brody en domicilio fue de 2,33±2,49 y en institucionalizados, de 1,59±2,12. La media de la escala de Pfeiffer fue de 4,93±3,53.
Se asocia con la institucionalización el deterioro cognitivo, consecuencia de posibles patologías neurológicas (categoría E3) y psiquiátricas. Por el contrario, no se asocia con la comorbilidad del paciente, puesto que es muy elevada en pacientes en situación de atención domiciliaria con mejores estados de independencia funcional y cognitivo.
To describe the characteristics and clinical differences between institutionalised patients and those included in a home care program.
A descriptive, observational, cross-sectional, and multicentre study.
Site Seville, 2016.
A total 1857 elderly patients of similar characteristics (1441 institutionalised and 416 at home) in Seville in 2016.
The variables studied included gender, age, civil status, family support, pathologies, multiple pathology criteria, and medication prescriptions. Functional and cognitive status was evaluated using the Barthel index, and the Lawton-Brody and Pfeiffer scales.
The majority of patients (71.40%) were women. The fact of being institutionalised or being included in a home care program were statistically related to the following pathologies and categories: schizophrenia (p<.001), arterial hypertension (p=.012), diabetes mellitus (p=.001), atrial fibrillation (p<.001), and neoplasia (p=.012), A1 (p=.012), A2 (p<.001), B1 (p<.001), B2 (p=.002), C (p<.001), E1 (p<.001), E3 (p=.01), F2 (p<.01), G2 (p=.024), and H (p=.005). The mean Barthel index of the sample was 49.1±34.45 (95% confidence interval: 47.49-50.7). The mean Lawton-Brody scale in the case of patients included the home care program was 2.33±2.49 and in those institutionalised 1.59±2.12. The mean Pfeiffer scale was 4.93±3.53.
Cognitive impairment was related to institutionalisation, being a result of possible neurological (E3 category) and psychiatric diseases. On the other hand, patient comorbidity was not related to it, because it is very high in patients included in a home care program, in whom functional and cognitive independency status is better.
The circular economy (CE) has been proposed as a potentially significant catalyst to enhance the current response to the global climate crisis. The objective of this study was to investigate the ...scientific literature of the research between climate change and CE adopting a knowledge mapping approach. Based on a total of 789 peer-reviewed publications extracted from Scopus, we found that research on climate change and CE is continually growing and interdisciplinary in nature. Europe notably leads scientific production. Keyword evolution shows that CE has been influenced by more lines of research than climate change. We also found that waste management is the CE approach most associated with climate change, mitigation is the climate action most impacted by CE, and food is the most reported greenhouse gas (GHG)-emitting material. However, there are knowledge gaps in the integration of the social dimension, the promotion of climate change adaptation, and the association of sustainable development goal (SDG) 13. Finally, we identified four potentially valuable directions for future studies: (i) CE practices, (ii) bioeconomy, (iii) climate and energy, and (iv) sustainability and natural resources, in which carbon recovery technologies, green materials, regional supply chains, circular agriculture models, and nature-based solutions are promising themes.
To assess the comparative effects of glucagon-like peptide-1 receptor agonists (GLP-1RA), 4-dipeptidyl peptidase inhibitors (DPP-4I), and metformin treatment during one year on metabolic syndrome ...(MetS) components and severity in MetS patients.
Prospective study (n = 6165 adults) within the frame of PREDIMED-Plus trial. The major end-point was changes on MetS components and severity after one- year treatment of GLP-1RA, DPP-4I, and metformin. Anthropometric measurements (weight, height and waist circumference), body mass index (BM), and blood pressure were registered. Blood samples were collected after overnight fasting. Plasma glucose, glycosylated hemoglobin (HbA1c), plasma triglycerides and cholesterol were measured. Dietary intakes as well as physical activity were assessed through validated questionnaires.
MetS parameters improved through time. The treated groups improved glycaemia compared with untreated (glycaemia ∆ untreated: −1.7 mg/dL(± 13.5); ∆ metformin: − 2.5(± 23.9) mg/dL; ∆ DPP-4I: − 4.5(± 42.6); mg/dL ∆ GLP-1RA: − 4.3(± 50.9) mg/dL; and HbA1c: ∆ untreated: 0.0(± 0.3) %; ∆ metformin: − 0.1(± 0.7) %; ∆ DPP-4I: − 0.1(± 1.0) %; ∆ GLP-1RA: − 0.2(± 1.2) %. Participants decreased BMI and waist circumference. GLP-1RA and DPP-4I participants registered the lowest decrease in BMI (∆ untreated: −0.8(± 1.6) kg/m2; ∆ metformin: − 0.8(± 1.5) kg/m2; ∆ DPP-4I: − 0.6(± 1.3) kg/m2; ∆ GLP-1RA: − 0.5(± 1.2) kg/m2. and their waist circumference (∆ untreated: −2.8(± 5.2) cm; ∆ metformin: − 2.6(± 15.2) cm; ∆ DPP-4I: − 2.1(± 4.8) cm; ∆ GLP-1RA: − 2.4(± 4.1) cm.
In patients with MetS and healthy lifestyle intervention, those treated with GLP-1RA and DPP-4I obtained better glycemic profile. Anthropometric improvements were modest.
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•Patients treated with GLP-1RA and DPP-4I obtained a better glycemic profile, but anthropometric improvements were modest.•Patients who decreased their energy intake the least at one year of the intervention were those treated with DPP-4I.•The GLP-1RA participants had a higher systolic blood pressure reduction, compared to others.
Research related to sustainable diets is is highly relevant to provide better understanding of the impact of dietary intake on the health and the environment.
To assess the association between the ...adherence to an energy-restricted Mediterranean diet and the amount of CO
emitted in an older adult population.
Using a cross-sectional design, the association between the adherence to an energy-reduced Mediterranean Diet (erMedDiet) score and dietary CO
emissions in 6646 participants was assessed.
Food intake and adherence to the erMedDiet was assessed using validated food frequency questionnaire and 17-item Mediterranean questionnaire. Sociodemographic characteristics were documented. Environmental impact was calculated through greenhouse gas emissions estimations, specifically CO
emissions of each participant diet per day, using a European database. Participants were distributed in quartiles according to their estimated CO
emissions expressed in kg/day: Q1 (≤2.01 kg CO
), Q2 (2.02-2.34 kg CO
), Q3 (2.35-2.79 kg CO
) and Q4 (≥2.80 kg CO
).
More men than women induced higher dietary levels of CO
emissions. Participants reporting higher consumption of vegetables, fruits, legumes, nuts, whole cereals, preferring white meat, and having less consumption of red meat were mostly emitting less kg of CO
through diet. Participants with higher adherence to the Mediterranean Diet showed lower odds for dietary CO
emissions: Q2 (OR 0.87; 95%CI: 0.76-1.00), Q3 (OR 0.69; 95%CI: 0.69-0.79) and Q4 (OR 0.48; 95%CI: 0.42-0.55) vs Q1 (reference).
The Mediterranean diet can be environmentally protective since the higher the adherence to the Mediterranean diet, the lower total dietary CO
emissions. Mediterranean Diet index may be used as a pollution level index.
Sedation is necessary in the management of critically ill patients, both to alleviate suffering and to cure patients with diseases that require admission to the intensive care unit. Such sedation ...should be appropriate to the patient needs at each timepoint during clinical evolution, and neither too low (undersedation) nor too high (oversedation). Adequate sedation influences patient comfort, safety, survival, subsequent quality of life, bed rotation of critical care units and costs. Undersedation is detected and quickly corrected. In contrast, oversedation is silent and difficult to prevent in the absence of management guidelines, collective awareness and teamwork. The Zero Oversedation Project of the Sedation, Analgesia and Delirium Working Group of the Spanish Society of Intensive and Critical Care Medicine and Coronary Units aims to offer a practical teaching and collective awareness tool for ensuring patient comfort, safety and management with a view to optimizing the clinical outcomes and minimizing the deleterious effects of excessive sedation. The tool is based on a package of measures that include monitoring pain, analgesia, agitation, sedation, delirium and neuromuscular block, keeping patients pain-free, performing dynamic sedation according to clinical objectives, agreeing upon the multidisciplinary protocol to be followed, and avoiding deep sedation where not clinically indicated.
La sedación es necesaria en el tratamiento de los pacientes críticos, tanto para aliviar el sufrimiento como para curar a los pacientes con enfermedades que precisan el ingreso en unidades de cuidados intensivos. Esta sedación debe ser la adecuada a las necesidades del paciente en cada momento de su evolución clínica, ni por debajo (infrasedación) ni por encima (sobresedación). Una sedación adecuada influye en la comodidad, la seguridad, la supervivencia, la calidad de vida posterior, la rotación de camas de las unidades de críticos y los costes. La infrasedación se detecta y corrige rápidamente. Sin embargo, la sobresedación es silente y difícil de prevenir sin unas pautas de actuación, una concienciación colectiva y un trabajo en equipo. El proyecto «Sobresedación Zero» del Grupo de Trabajo de Sedación, Analgesia y Delirium de la Sociedad Española de Medicina Intensiva, Crítica y Unidades Coronarias pretende ser una herramienta docente, práctica y de concienciación colectiva de comodidad, seguridad y gestión para maximizar el resultado clínico y minimizar los efectos perjudiciales de la sedación excesiva. Se basa en un paquete de medidas que se incluye monitorizar el dolor, la analgesia, la agitación, la sedación, el delirium y el bloqueo neuromuscular, mantener a los pacientes sin dolor, realizar una sedación dinámica según objetivos clínicos, consensuar el protocolo multidisciplinar a seguir y evitar la sedación profunda no indicada clínicamente.
To describe the characteristics and clinical differences between institutionalised patients and those included in a home care program.
A descriptive, observational, cross-sectional, and multicentre ...study. Site Seville, 2016.
A total 1857 elderly patients of similar characteristics (1441 institutionalised and 416 at home) in Seville in 2016.
The variables studied included gender, age, civil status, family support, pathologies, multiple pathology criteria, and medication prescriptions. Functional and cognitive status was evaluated using the Barthel index, and the Lawton-Brody and Pfeiffer scales.
The majority of patients (71.40%) were women. The fact of being institutionalised or being included in a home care program were statistically related to the following pathologies and categories: schizophrenia (p<.001), arterial hypertension (p=.012), diabetes mellitus (p=.001), atrial fibrillation (p<.001), and neoplasia (p=.012), A1 (p=.012), A2 (p<.001), B1 (p<.001), B2 (p=.002), C (p<.001), E1 (p<.001), E3 (p=.01), F2 (p<.01), G2 (p=.024), and H (p=.005). The mean Barthel index of the sample was 49.1±34.45 (95% confidence interval: 47.49-50.7). The mean Lawton-Brody scale in the case of patients included the home care program was 2.33±2.49 and in those institutionalised 1.59±2.12. The mean Pfeiffer scale was 4.93±3.53.
Cognitive impairment was related to institutionalisation, being a result of possible neurological (E3 category) and psychiatric diseases. On the other hand, patient comorbidity was not related to it, because it is very high in patients included in a home care program, in whom functional and cognitive independency status is better.
A major barrier to a healthy diet may be the higher price of healthy foods compared to low-quality foods.
This study aimed to assess the association between the monetary cost of food and diet quality ...in Spanish older adults at high risk of cardiovascular disease.
Cross-sectional analysis was carried out in Spanish older adults (
= 6,838; 48.6% female). A validated food frequency questionnaire was used to assess dietary intake. Metabolic syndrome severity, adherence to the Mediterranean diet (MedDiet), adherence to a provegetarian dietary pattern, and dietary inflammatory index were assessed. The economic cost of the foods was obtained from the Spanish Ministry of Agriculture Fisheries and Food database (2015-2017, the period of time when the participants were recruited). The total cost of diet adjusted per 1,000 kcal was computed.
The healthier dietary pattern was associated with a higher cost of the diet. Higher adherence to the MedDiet, anti-inflammatory diet, and the healthy version of the provegetarian dietary pattern were related to higher costs of the diet.
Higher diet quality was associated with a higher dietary cost of the diet per 1,000 kcal/day. Food prices can be an important component of interventions and policies aimed at improving people's diets and preventing diet-related chronic diseases.
The trial was registered in 2014 at the International Standard Randomized Controlled Trial (ISRCT; http://www.isrctn.com/ISRCTN89898870) with the number 89898870.
Metabolic syndrome (MetS) has become a growing risk factor of some non-communicable diseases. Increase of greenhouse gas emissions affects the planet.
To assess the association between MetS severity ...and amount of carbon dioxide (CO
) emitted in an adult population.
Cross-sectional study (n = 6646; 55-76-year-old-men; 60-75-year-old-women with MetS).
Dietary habits were assessed using a pre-validated semi quantitative 143-item food frequency questionnaire. The amount of CO
emitted due to the production of food consumed by person and day was calculated using a European database, and the severity of the MetS was calculated with the MetS Severity Score.
Higher glycaemia levels were found in people with higher CO
emissions. The risk of having high severe MetS was related to high CO
emissions.
Low CO
emissions diet would help to reduce MetS severity. Advantages for both health and the environment were found following a more sustainable diet.
ISRCTN, ISRCTN89898870 . Registered 05 September 2013.
Background
Metabolic syndrome (MetS) worsens quality of life and increases mortality. Dissatisfaction with weight in patients with MetS may modify the effect of lifestyle interventions to achieve ...changes in health-related behaviors.
Objective
To assess 1-year changes in cardiovascular risk scores, self-perceived general health and health-related behaviors according to observed changes in desired weight loss during the first year of intervention in a large cardiovascular prevention trial.
Design
Prospective analysis of the PREDIMED-PLUS trial, including 5,499 adults (55–75 years old) with overweight or obesity at baseline.
Methods
The desired weight loss was the difference between ideal and measured weight. Tertiles of change in desired weight loss (1 year vs. baseline) were defined by the following cut-off points: ≥0.0 kg (T1,
n
= 1,638); 0.0 to −4.0 kg (T2, n = 1,903); ≤−4.0 kg (T3,
n
= 1,958). A food frequency questionnaire assessed diet and the Minnesota-REGICOR questionnaire assessed physical activity. The Framingham equation assessed cardiovascular risks. The changes in the severity of MetS were also assessed. The Beck Depression Inventory assessed depressive symptoms and the SF-36 assessed health-related quality of life. Data were analyzed using general linear models.
Results
BMI decreased at T2 and T3 (T1: 0.3, T2: −0.7, T3: −1.9). The most significant improvement in diet quality was observed at T3. Cardiovascular risk decreased at T2 and T3. Mean reductions in MetS severity score were: −0.02 at T1, −0.39 at T2 and −0.78 at T3. The perception of physical health increases in successive tertiles.
Conclusions
In older adults with MetS, more ambitious desired weight loss goals were associated with improvements in diet, cardiovascular health and perceived physical health during the first year of a healthy lifestyle intervention programme. Weight dissatisfaction needs to be considered by health professionals.
Clinical trial registration
http://www.isrctn.com/ISRCTN89898870
, identifier 89898870.
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