Influence of the 60 Hz Magnetic Field on the Airborne Microbial Distribution of Indoor Environments

The aim of this work was to analyze the effect of the magnetic field generated by the household appliances on the airborne microbial surrounding these equipment located on indoor environments with particular interest in the environmental fungi. A simultaneous environmental study was carried out in locals of three different geographical places of Havana, Cuba, which have televisions, computers and an electric generator. The air samples were made by a sedimentation method using Malt Extract Agar. The concentration of total aerobic mesophilic as well as fungi and yeasts were determined in rainy and little rainy seasons by applying as factors: exposure time of dishes (5 to 60 min) and distance to the wall (0 and 1 m) at a height of 1 m above the floor. The predominant fungal genera were Cladosporium, Penicillium and Aspergillus. In the dishes that were placed at 0 and 0.5 m from the emitting sources were observed that some bacteria colonies formed inhibition halos, a great diversity of filamentous fungi and an increase in the mycelium pigmentation as well as the pigments excretion. In the rainy season, the highest amounts of fungi were obtained in all samples. In the little rain season the count of the Gram-negative bacilli increased three times the Gram-positive cocci

The IDENTIFY study: the investigation and detection of urological neoplasia in patients referred with suspected urinary tract cancer - a multicentre observational study

Objective To evaluate the contemporary prevalence of urinary tract cancer (bladder cancer, upper tract urothelial cancer [UTUC] and renal cancer) in patients referred to secondary care with haematuria, adjusted for established patient risk markers and geographical variation. Patients and Methods This was an international multicentre prospective observational study. We included patients aged ≥16 years, referred to secondary care with suspected urinary tract cancer. Patients with a known or previous urological malignancy were excluded. We estimated the prevalence of bladder cancer, UTUC, renal cancer and prostate cancer; stratified by age, type of haematuria, sex, and smoking. We used a multivariable mixed-effects logistic regression to adjust cancer prevalence for age, type of haematuria, sex, smoking, hospitals, and countries. Results Of the 11 059 patients assessed for eligibility, 10 896 were included from 110 hospitals across 26 countries. The overall adjusted cancer prevalence (n = 2257) was 28.2% (95% confidence interval [CI] 22.3–34.1), bladder cancer (n = 1951) 24.7% (95% CI 19.1–30.2), UTUC (n = 128) 1.14% (95% CI 0.77–1.52), renal cancer (n = 107) 1.05% (95% CI 0.80–1.29), and prostate cancer (n = 124) 1.75% (95% CI 1.32–2.18). The odds ratios for patient risk markers in the model for all cancers were: age 1.04 (95% CI 1.03–1.05; P < 0.001), visible haematuria 3.47 (95% CI 2.90–4.15; P < 0.001), male sex 1.30 (95% CI 1.14–1.50; P < 0.001), and smoking 2.70 (95% CI 2.30–3.18; P < 0.001). Conclusions A better understanding of cancer prevalence across an international population is required to inform clinical guidelines. We are the first to report urinary tract cancer prevalence across an international population in patients referred to secondary care, adjusted for patient risk markers and geographical variation. Bladder cancer was the most prevalent disease. Visible haematuria was the strongest predictor for urinary tract cancer

Gender Differences in Outcomes Following a Pain-Free, Home-Based Exercise Program for Claudication

Background: Peripheral artery disease (PAD) is a common cardiovascular pathology that affects mobility. In previous research, supervised exercise, a recommended treatment for claudication, was less effective in women. This study retrospectively investigated whether functional outcomes exhibit sex differences following a pain-free, home-based exercise program for PAD patients. Materials and Methods: Patients with PAD and claudication enrolled to a structured home-based program from 2003 to 2016 were studied. The program was prescribed at the hospital and based on two daily 10-minute pain-free walking sessions at progressively increasing speed. Outcome measures, which were assessed at baseline and discharge, were pain threshold speed (PTS) and maximal (Smax) during a treadmill test and pain-free walking distance (PFWD) and total distance walked in 6 minutes (6MWD). The ankle-brachial index (ABI), program duration, and patient adherence were determined. Results: A total of 1007 patients (women; n = 264; 26%) were enrolled. At baseline, compared to men, women exhibited similar ABI values but lower PTS and PFWD values (p &lt; 0.001). At discharge, with similar adherence (score 3/4 ± 1 each) in both groups, superimposable improvements were observed for PTS (0.8 ± 0.8 km/h each), Smax (0.4 ± 0.5 km/h each), PFWD (women 95 ± 100; men 86 ± 104), 6MWD (women 32 ± 65; men 35 ± 58), and ABI (women 0.07 ± 0.12; men 0.06 ± 0.11) without between-group differences (confirmed after propensity analysis). Conclusion: A personalized, structured pain-free exercise program for PAD patients performed inside the home for a few minutes a day was equally effective in both sexes. Programs favoring adherence and functional outcomes in women should be tested in prospective studies

Antibiotic use and associated factors in a large sample of hospitalised older people

Objectives: The aims of this study were to assess (i) the prevalence of antibiotic use, (ii) factors associated with their use and (iii) the association with in-hospital mortality in a large sample of hospitalised older people in Italy. Methods: Data were obtained from the 2010\u20132017 REPOSI register held in more than 100 internal medicine and geriatric wards in Italy. Patients aged 6565 years with at least one antibiotic prescription during their hospitalisation were selected. Multivariable logistic regression models were used to determine factors associated with antibiotic use. Results: A total of 5442 older patients were included in the analysis, of whom 2786 (51.2%) were prescribed antibiotics during their hospitalisation. The most frequently prescribed antibiotic class was \u3b2- lactams, accounting for 50% of the total prescriptions. Poor physical independence, corticosteroid use and being hospitalised in Northern Italy were factors associated with a higher likelihood of being prescribed antibiotics. Antibiotic use was associated with an increased risk of in-hospital mortality (odds ratio = 2.52, 95% confidence interval 1.82\u20133.48) also when accounting for factors associated with their use. Conclusion: Hospitalised older people are often prescribed antibiotics. Factors related to poor physical independence and corticosteroid use are associated with increased antibiotic use. Being prescribed antibiotics is also associated with an increased risk of in-hospital death. These results demand the implementation of specific stewardship programmes to improve the correct use of antibiotics in hospital settings and to reduce the risk of antimicrobial resistance

Use of non-steroidal anti-inflammatory drugs and analgesics in a cohort of hospitalized elderly patients: Results from the REPOSI study.

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Disability, and not diabetes, is a strong predictor of mortality in oldest old patients hospitalized with pneumonia

Background: Pneumonia causes more deaths than any other infectious disease, especially in older patients with multiple chronic diseases. Recent studies identified a low functional status as prognostic factor for mortality in elderly patients with pneumonia while contrasting data are available about the role of diabetes. The aim of this study was to evaluate the in-hospital, 3-month and 1-year mortality in elderly subjects affected by pneumonia enrolled in the RePoSi register.Methods: We retrospectively analyzed the data collected on hospitalized elderly patients in the frame of the REPOSI project. We analyzed the socio-demographic, laboratory and clinical characteristics of subjects with pneumonia. Multivariate logistic analysis was used to explore the relationship between variables and mortality.Results: Among 4714 patients 284 had pneumonia. 52.8% were males and the mean age was 80 years old. 19.8% of these patients had a Barthel Index &lt;= 40 (p &lt; 0.0001), as well as 43.2% had a short blessed test &gt;= 10 (p &lt; 0.0117). In these subjects a significant CIRS for the evaluation of severity and comorbidity indexes (p &lt; 0.0001) were present. Although a higher fasting glucose level was identified in people with pneumonia, in the multivariate logistic analysis diabetes was not independently associated with in-hospital, 3-month and 1-year mortality, whereas patients with lower Barthel Index had a higher mortality risk (odds ratio being 9.45, 6.84, 19.55 in hospital, at 3 and 12 months).Conclusion: Elderly hospitalized patients affected by pneumonia with a clinically significant disability had a higher mortality risk while diabetes does not represent an important determinant of short and long-term outcome

Therapeutic Duplicates in a Cohort of Hospitalized Elderly Patients: Results from the REPOSI Study

Background: Explicit criteria for potentially inappropriate prescriptions in the elderly are recommended to avoid prescriptions of duplicate drug classes and to optimize monotherapy within a single drug class before a new agent is considered. Duplicate drug class prescription (or therapeutic duplicates) puts the patient at increased risk of adverse drug reactions with no additional therapeutic benefits. To our knowledge, the prevalence of elderly inpatients receiving therapeutic duplicates has never been studied. Objectives: Our objective was to assess the prevalence of therapeutic duplicates at admission, discharge, and 3-month follow-up of hospitalized elderly patients. Methods: This cross-sectional prospective study was conducted in 97 Italian internal medicine and geriatric wards. Therapeutic duplicates were defined as at least two drugs of the same therapeutic class prescribed simultaneously to a patient. A patient\u2019s drug therapy at admission relates to prescriptions from general practitioners, whereas prescriptions at discharge are those from hospital internists or geriatricians. Results: The study sample comprised 5821 admitted and 4983 discharged patients. In all, 143 therapeutic duplicates were found at admission and 170 at discharge. The prevalence of patients exposed to at least one therapeutic duplicate rose significantly from hospital admission (2.5 %) to discharge (3.4 %; p = 0.0032). Psychotropic drugs and drugs for peptic ulcer or gastroesophageal reflux disease were the most frequently involved. A total of 86.8 % of patients discharged with at least one therapeutic duplicate were still receiving them at 3-month follow-up. Conclusions: Hospitalization and drugs prescribed by internists and geriatricians are both factors associated with a small but definite increase in overall therapeutic duplicates in elderly patients admitted to internal medicine and geriatric wards. More attention should be paid to the indications for each drug prescribed, because therapeutic duplicates are not supported by evidence and increase both the risk of adverse drug reactions and costs. Identification of unnecessary therapeutic duplicates is essential for the optimization of polypharmacy

Choice and Outcomes of Rate Control versus Rhythm Control in Elderly Patients with Atrial Fibrillation: A Report from the REPOSI Study

Background: Among rate-control or rhythm-control strategies, there is conflicting evidence as to which is the best management approach for non-valvular atrial fibrillation (AF) in elderly patients. Design: We performed an ancillary analysis from the \u2018Registro Politerapie SIMI\u2019 study, enrolling elderly inpatients from internal medicine and geriatric wards. Methods: We considered patients enrolled from 2008 to 2014 with an AF diagnosis at admission, treated with a rate-control-only or rhythm-control-only strategy. Results: Among 1114 patients, 241 (21.6%) were managed with observation only and 122 (11%) were managed with both the rate- and rhythm-control approaches. Of the remaining 751 patients, 626 (83.4%) were managed with a rate-control-only strategy and 125 (16.6%) were managed with a rhythm-control-only strategy. Rate-control-managed patients were older (p&nbsp;=&nbsp;0.002), had a higher Short Blessed Test (SBT; p&nbsp;=&nbsp;0.022) and a lower Barthel Index (p&nbsp;=&nbsp;0.047). Polypharmacy (p&nbsp;=&nbsp;0.001), heart failure (p&nbsp;=&nbsp;0.005) and diabetes (p&nbsp;=&nbsp;0.016) were more prevalent among these patients. Median CHA2DS2-VASc score was higher among rate-control-managed patients (p&nbsp;=&nbsp;0.001). SBT [odds ratio (OR) 0.97, 95% confidence interval (CI) 0.94\u20131.00, p&nbsp;=&nbsp;0.037], diabetes (OR 0.48, 95% CI 0.26\u20130.87, p&nbsp;=&nbsp;0.016) and polypharmacy (OR 0.58, 95% CI 0.34\u20130.99, p&nbsp;=&nbsp;0.045) were negatively associated with a rhythm-control strategy. At follow-up, no difference was found between rate- and rhythm-control strategies for cardiovascular (CV) and all-cause deaths (6.1 vs. 5.6%, p&nbsp;=&nbsp;0.89; and 15.9 vs. 14.1%, p&nbsp;=&nbsp;0.70, respectively). Conclusion: A rate-control strategy is the most widely used among elderly AF patients with multiple comorbidities and polypharmacy. No differences were evident in CV death and all-cause death at follow-up

Prevalence, characteristics and treatment of chronic pain in elderly patients hospitalized in internal medicine wards.

BACKGROUND: Chronic pain is a frequent characteristic of elderly people and represents an actual and still poorly debated topic. OBJECTIVE: We investigated pain prevalence and intensity, and its pharmacological therapy in elderly patients hospitalized in 101 internal medicine wards. METHODS: Taking advantage of the "REgistro POliterapie Società Italiana Medicina Interna" (REPOSI), we collected 2535 patients of whom almost a quarter was older than 85 years old. Among them, 582 patients were affected by pain (either chronic or acute) and 296 were diagnosed with chronic pain. RESULTS: Patients with pain showed worse cognitive status, higher depression and comorbidities, and a longer duration of hospital stay compared to those without pain (all p < .0366). Patients with chronic pain revealed lower level of independency in their daily life, worse cognitive status and higher level of depression compared to acute pain patients (all p < .0156). Moreover, most of them were not treated for pain at admission (73.4%) and half of them was not treated with any analgesic drug at discharge (50.5%). This difference affected also the reported levels of pain intensity. Patients who received analgesics at both admission and discharge remained stable (p = .172). Conversely, those not treated at admission who received an analgesic treatment during the hospital stay decreased their perceived pain (p < .0001). CONCLUSIONS: Our results show the need to focus more attention on the pharmacological treatment of chronic pain, especially in hospitalized elderly patients, in order to support them and facilitate their daily life after hospital discharge