Knowledge and Practice of Health Professionals in the Management of Dysphagia

Background: Dysphagia is associated with poor outcome in stroke patients. Studies investigating the association of dysphagia and early dysphagia screening (EDS) with outcomes in patients with acute ischemic stroke (AIS) are rare. The aims of our study are to investigate the association of dysphagia and EDS within 24 h with stroke-related pneumonia and outcomes. Methods: Over a 4.5-year period (starting November 2007), all consecutive AIS patients from 15 hospitals in Schleswig-Holstein, Germany, were prospectively evaluated. The primary outcomes were stroke-related pneumonia during hospitalization, mortality, and disability measured on the modified Rankin Scale >= 2-5, in which 2 indicates an independence/slight disability to 5 severe disability. Results: Of 12,276 patients (mean age 73 +/- 13; 49% women), 9,164 patients (74%) underwent dysphagia screening; of these patients, 55, 39, 4.7, and 1.5% of patients had been screened for dysphagia within 3, 3 to 72 h following admission. Patients who underwent dysphagia screening were likely to be older, more affected on the National Institutes of Health Stroke Scale score, and to have higher rates of neurological symptoms and risk factors than patients who were not screened. A total of 3,083 patients (25.1%; 95% CI 24.4-25.8) had dysphagia. The frequency of dysphagia was higher in patients who had undergone dysphagia screening than in those who had not (30 vs. 11.1%; p < 0.001). During hospitalization (mean 9 days), 1,271 patients (10.2%; 95% CI 9.7-10.8) suffered from stroke-related pneumonia. Patients with dysphagia had a higher rate of pneumonia than those without dysphagia (29.7 vs. 3.7%; p < 0.001). Logistic regression revealed that dysphagia was associated with increased risk of stroke-related pneumonia (OR 3.4; 95% CI 2.8-4.2; p < 0.001), case fatality during hospitalization (OR 2.8; 95% CI 2.1-3.7; p < 0.001) and disability at discharge (OR 2.0; 95% CI 1.6-2.3; p < 0.001). EDS within 24 h of admission appeared to be associated with decreased risk of stroke-related pneumonia (OR 0.68; 95% CI 0.52-0.89; p = 0.006) and disability at discharge (OR 0.60; 95% CI 0.46-0.77; p < 0.001). Furthermore, dysphagia was independently correlated with an increase in mortality (OR 3.2; 95% CI 2.4-4.2; p < 0.001) and disability (OR 2.3; 95% CI 1.8-3.0; p < 0.001) at 3 months after stroke. The rate of 3-month disability was lower in patients who had received EDS (52 vs. 40.7%; p = 0.003), albeit an association in the logistic regression was not found (OR 0.78; 95% CI 0.51-1.2; p = 0.2). Conclusions: Dysphagia exposes stroke patients to a higher risk of pneumonia, disability, and death, whereas an EDS seems to be associated with reduced risk of stroke-related pneumonia and disability. (C) 2016 S. Karger AG, Base

Eating Habits and Physical Activity of the Spanish Population during the COVID-19 Pandemic Period

Due to the pandemic situation caused by the COVID-19 infection, some governments have implemented house confinement measures. The objective of our study is to learn the dietary patterns, consumption, and physical activity of the Spanish population before and during the period of confinement by COVID-19. A cross-sectional descriptive study based on a questionnaire during May 2020, coinciding with the period of confinement and the step forward into Phase 1, is carried out. During confinement, the adherence to the Mediterranean Diet increases (8.0% versus 4.7%; p < 0.001). No socio-demographic variables show statistical significance (p < 0.05) regarding good adherence to the Mediterranean Diet (MD) before and during confinement. During confinement, consumption of homemade baking shows a higher increase (0.28% versus 4.60%; p = 0.004). During confinement, the number of subjects that practice exercise decreases (29.4% versus 28.8%; p = 0.004), as well as the time spent exercising (more than an hour, 26.6% versus 14.7%, p = 0.001). Mediterranean Diet adherence slightly increases during confinement, although consumption of ‘unhealthy’ food also increases. Moreover, the number of subjects that practice physical activity, as well as the time spent on it weekly, decreases.The authors received funding from Danone Nutricia to cover the costs for the publication of the article.Ye