TRIBUNAL ARBITRAL DE ODICCO LTDA. VS. PATRIMONIO AUTÓNOMO FIDEICOMISO PROYECTO CONSTRUCCIÓN VIVIENDA NUEVA ADMINISTRADO POR FIDUBOGOTÁ S.A.

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Assessing the impact of physical exercise on cognitive function in older medical patients during acute hospitalization: secondary analysis of a randomized trial

Background: Acute illness requiring hospitalization frequently is a sentinel event leading to long-term disability in older people. Prolonged bed rest increases the risk of developing cognitive impairment and dementia in acutely hospitalized older adults. Exercise protocols applied during acute hospitalization can prevent functional decline in older patients, but exercise benefits on specific cognitive domains have not been previously investigated. We aimed to assess the effects of a multicomponent exercise intervention for cognitive function in older adults during acute hospitalization. Methods and findings: We performed a secondary analysis of a single-blind randomized clinical trial (RCT) conducted from February 1, 2015, to August 30, 2017 in an Acute Care of the Elderly (ACE) unit in a tertiary public hospital in Navarre (Spain). 370 hospitalized patients (aged ≥75 years) were randomly allocated to an exercise intervention (n = 185) or a control (n = 185) group (usual care). The intervention consisted of a multicomponent exercise training program performed during 5–7 consecutive days (2 sessions/day). The usual care group received habitual hospital care, which included physical rehabilitation when needed. The main outcomes were change in executive function from baseline to discharge, assessed with the dual-task (i.e., verbal and arithmetic) Gait Velocity Test (GVT) and the Trail Making Test Part A (TMT-A). Changes in the Mini Mental State Examination (MMSE) test and verbal fluency ability were also measured after the intervention period. The physical exercise program provided significant benefits over usual care. At discharge, the exercise group showed a mean increase of 0.1 m/s (95% confidence interval [CI], 0.07, 0.13; p < 0.001) in the verbal GVT and 0.1 m/s (95% CI, 0.08, 0.13; p < 0.001) in the arithmetic GVT over usual care group. There was an apparent improvement in the intervention group also in the TMT-A score (−31.1 seconds; 95% CI, −49.5, −12.7 versus −3.13 seconds; 95% CI, −16.3, 10.2 in the control group; p < 0.001) and the MMSE score (2.10 points; 95% CI, 1.75, 2.46 versus 0.27 points; 95% CI, −0.08, 0.63; p < 0.001). Significant benefits were also observed in the exercise group for the verbal fluency test (mean 2.16 words; 95% CI, 1.56, 2.74; p < 0.001) over the usual care group. The main limitations of the study were patients’ difficulty in completing all the tasks at both hospital admission and discharge (e.g., 25% of older patients were unable to complete the arithmetic GVT, and 47% could not complete the TMT-A), and only old patients with relatively good functional capacity at preadmission (i.e., Barthel Index score ≥60 points) were included in the study. Conclusions: An individualized, multicomponent exercise training program may be an effective therapy for improving cognitive function (i.e., executive function and verbal fluency domains) in very old patients during acute hospitalization. These findings support the need for a shift from the traditional (bedrest-based) hospitalization to one that recognizes the important role of maintaining functional capacity and cognitive function in older adults, key components of intrinsic capacity.This study was funded by a Gobierno de Navarra project Resolución grant 2186/2014 and acknowledged with the 'Beca Ortiz de Landazuri' as the best research clinical project in 2014, as well as by a research grant PI17/01814 of the Ministerio de Economía, Industria y Competitividad (ISCIII, FEDER)

Análisis de la amplitud acomodativa en sujetos miopes tras el implante de lente intraocular fáquica de cámara posterior

La cirugía refractiva con LIO fáquica es una alternativa eficaz para la corrección de defectos refractivos y conseguir independencia de las gafas y lentes de contacto, sobre todo en altas ametropías. Sin embargo, la escasez de evidencia científica que describa cómo responde el sistema acomodativo a la implantación de lentes ICL hace imprescindible seguir investigando. La Optometría juega un papel fundamental en este punto, ya que debe adaptarse a la aparición de nuevas técnicas de compensación visual y profundizar en su conocimiento. Sólo de esta forma se podrán mejorar los protocolos pre y postoperatorios, minimizar las complicaciones relacionadas con el sistema acomodativo y tratar las disfunciones visuales que puedan estar causadas por la cirugía

Effects of a 12-week Vivifrail exercise program on intrinsic capacity among frail cognitively impaired community-dwelling older adults: secondary analysis of a multicentre randomised clinical trial

Introduction: The World Health Organisation recently defined the construct of intrinsic capacity (IC), a function-based marker of older adult’s health encompassing all mental and physical capacities of the individual. Multicomponent physical exercise (MCE) is a potential intervention capable to maintain/increase IC at older age; however, evidence is scarce on the effects of MCE on IC in cognitively impaired pre-frail/frail older adults. Methods: Secondary analyses of a randomised clinical trial. One hundred and eighty-eight older outpatients (age = 84.06 ± 4.77, 70.2% women) presenting with pre-frailty/frailty (according to Fried Criteria) and mild cognitive impairment (MCI)/mild dementia were recruited in the Geriatric clinics of three tertiary hospitals in Spain. Subjects were randomised to participate in the 12-week home-based individualised Vivifrail MCE or usual care. An IC index was created based on the z-score of the locomotion (Short Physical Performance Battery), cognitive (Montreal Cognitive Assessment), psychology (15-item Geriatric Depression Scale Yesavage) and vitality (handgrip strength) domains. Results: After the 3-month intervention, linear mixed models showed significant between-group differences in the evolution of the IC composite score (β=0.48; 95% confidence interval [CI] = 0.24, 0.74; P < 0.001), IC Locomotion (β = 0.42; 95% CI = 0.10, 0.74; P < 0.001), IC Cognition (β = 0.45; 95% CI = 0.03, 0.87; P < 0.05) and IC Vitality domains (β = 0.50; 95% CI = 0.25, 0.74 at 3-month) favouring the MCE group. Conclusions: The 12-week Vivifrail multicomponent exercise program is an effective strategy to enhance IC, especially in terms of locomotion, cognition and vitality IC domains in community-dwelling older adults with pre-frailty/frailty and MCI/mild dementia, compared to usual care.This study has been funded by a Gobierno de Navarra project grant and FEDER Funds (426/2016,del 30 September28/16)

Enfermedad celíaca: experiencia en un hospital de tercer nivel (2003-2005)

Los autores de este artículo pretenden analizar las características clínicas y analíticas de presentación en los pacientes pediátricos diagnosticados de enfermedad celíaca en la provincia de Salamanca, así como la evolución de estos parámetros seis meses y un año tras el diagnóstico

Flood Consequences of Land‐Use Changes at a Ski Resort: Overcoming a Geomorphological Threshold (Portainé, Eastern Pyrenees, Iberian Peninsula)

The sensitive mountain catchment of Portainé (Eastern Pyrenees, Iberian Peninsula) has recently experienced a significant change in its torrential dynamics due to human disturbances. The emplacement of a ski resort at the headwaters led to the surpassing of a geomorphological threshold, with important consequences during flood events. Consequently, since 2008, channel dynamics have turned into sediment‐laden, highly destructive torrential flows. In order to assess this phenomenon and to acquire a holistic understanding of the catchment's behaviour, we carried out a field work‐based multidisciplinary study. We considered the interaction of the various controlling factors, including bedrock geology, geomorphological evolution, derived soils and coluvial deposits, rainfall patterns, and the hydrological response of the catchment to flood events. Moreover, anthropogenic land‐use changes, its consequential hydrogeomorphic effects and the role of vegetation were also taken into account. Robust sedimentological and geomorphological evidence of ancient dense debris flows show that the basin has shifted around this threshold, giving rise to two different behaviours or equilibrium conditions throughout its history: alternating periods of moderate, bedload‐laden flows and periods of high sediment‐laden debris flow dynamics. This shifting could have extended through the Holocene. Finally, we discuss the possible impact of climate and global change, as the projected effects suggest future soil and forest degradation; this, jointly with more intense rainfalls in these mountain environments, would exacerbate the future occurrence of dense sediment‐laden flows at Portainé, but also in other nearby, similar basins