Aspectos sociales y de salud como determinantes del estado nutricional y calidad de vida de las personas mayores

Programa Oficial de Doutoramento en Ciencias da Saúde. 5007V01[Resumen] La nutrición y la calidad de vida son aspectos que se han evaluado principalmente en personas mayores institucionalizadas. Son escasas las investigaciones realizadas en muestras grandes y representativas de personas mayores que residen en la comunidad. El objetivo del presente estudio ha sido determinar el efecto del estado de salud sobre el estado nutricional y la calidad de vida de las personas mayores, así como estimar la prevalencia del deterioro cognitivo en poblaciones urbanas y rurales. Se realizó un estudio transversal, enmarcado dentro del proyecto VERISAÚDE, sobre una muestra de 749 personas, representativa de la población mayor de Galicia. El área de residencia (urbano vs rural) no se relacionó de forma significativa con el deterioro cognitivo; sin embargo, haber tenido una profesión que implicase un nivel de habilidad mayor se asoció con un menor deterioro cognitivo. La presencia de sobrepeso u obesidad, los síntomas depresivos, la polifarmacia (uso de cinco o más medicamentos), la presencia de pre-fragilidad o fragilidad y una mala salud auto-percibida se asoció con malnutrición o riesgo de padecerla. Los mejores predictores de malnutrición/riesgo de malnutrición en mujeres han sido la polifarmacia y la mala salud auto-percibida, en cambio para los hombres lo fueron el sobrepeso u obesidad, la sintomatología depresiva y la polifarmacia. Por otra parte, en personas mayores que cumplían uno o dos criterios del estado de pre-fragilidad la sintomatología depresiva fue el principal determinante de la mala calidad de vida en todas las áreas del cuestionario abreviado de calidad de vida de la Organización Mundial de la Salud (WHOQOL-BREF). La edad solo se asoció con mala salud auto-percibida; el sexo femenino y el bajo nivel educativo se relacionaron con una baja calidad de vida física y una mala autoevaluación de la salud, respectivamente, pero solo en adultos mayores que cumplían con un criterio de fragilidad.[Resumo] A nutrición e a calidade de vida son aspectos que se avaliaron principalmente en persoas maiores institucionalizadas. Son escasas as investigacións realizadas en mostras grandes e representativas de persoas maiores que residen na comunidade. O obxectivo do presente estudo foi determinar o efecto do estado de saúde sobre o estado nutricional e a calidade de vida das persoas maiores, así coma estimar a prevalencia do deterioro cognitivo en poboacións urbanas e rurais. Realizouse un estudo transversal, enmarcado dentro do proxecto VERISAÚDE, sobre unha mostra de 749 persoas, representativa da poboación maior de Galicia. A área de residencia (urbano vs. rural) non se relacionou de forma significativa co deterioro cognitivo; sen embargo, ter unha profesión que necesitará un nivel de habilidade maior asociouse cun menor deterioro cognitivo. A presenza de sobrepeso ou obesidade, os síntomas depresivos, a polifarmacia (uso de cinco ou máis medicamentos), a presenza de pre-fraxilidade ou fraxilidade e unha mala saúde auto-percibida asociouse con malnutrición ou risco de padecela. Os mellores predictores de malnutrición/risco de malnutrición en mulleres foron a polifarmacia e a mala saúde auto-percibida, en cambio para os homes foron o sobrepeso ou obesidade, a sintomatoloxía depresiva e a polifarmacia. Por outra banda, en persoas maiores que cumprían un ou dous criterios de pre-fraxilidade a sintomatoloxía depresiva foi o principal determinante da mala calidade de vida en todas as áreas do cuestionario abreviado de calidade de vida da Organización Mundial da Saúde (WHOQOL-BREF). A idade só se asociou con mala saúde auto-percibida, o sexo feminino e o baixo nivel educativo relacionáronse cunha baixa calidade de vida física e unha mala autoavaliación da saúde, respectivamente, pero só en adultos maiores que cumprían cun criterio de fraxilidade.[Abstract] Nutrition and quality of life are aspects mainly assessed in institutionalized elderly people. Studies done in large and representative samples of community-dwelling older adults are scarce. The aim of the present study has been to determine the effect of health status on the nutritional status and quality of life of the elderly, as well as to estimate the prevalence of cognitive impairment in urban and rural populations. A cross-sectional study was carried out within the VERISAÚDE project, on a representative sample of 749 people, representative of the older population of Galicia. The place of residence (urban vs. rural) was not significantly related to cognitive impairment; however, having an occupation requiring higher skill level was associated with less cognitive impairment. The presence of overweight or obesity, depressive symptoms, polypharmacy (use of five or more drugs), pre-frailty or frailty and poor self-perceived health were associated with malnutrition/at risk of malnutrition. The best predictors of poorer nutritional status have been polypharmacy and poor self-perceived health in women and overweight or obesity, depressive symptomatology and polypharmacy in men. On the other hand, in older people fulfilling one or two prefrailty criteria depressive symptomatology was the main determinant of poor quality of life in all domains of the World Health Organization Quality of Life (WHOQOLBREF). Age was only associated with poor self-perceived health, female gender and low educational level were respectively associated with poor physical quality of life and poor health self-assessment, but only in older adults who met the criteria of frailty

Antimicrobial resistance among migrants in Europe: a systematic review and meta-analysis

BACKGROUND: Rates of antimicrobial resistance (AMR) are rising globally and there is concern that increased migration is contributing to the burden of antibiotic resistance in Europe. However, the effect of migration on the burden of AMR in Europe has not yet been comprehensively examined. Therefore, we did a systematic review and meta-analysis to identify and synthesise data for AMR carriage or infection in migrants to Europe to examine differences in patterns of AMR across migrant groups and in different settings. METHODS: For this systematic review and meta-analysis, we searched MEDLINE, Embase, PubMed, and Scopus with no language restrictions from Jan 1, 2000, to Jan 18, 2017, for primary data from observational studies reporting antibacterial resistance in common bacterial pathogens among migrants to 21 European Union-15 and European Economic Area countries. To be eligible for inclusion, studies had to report data on carriage or infection with laboratory-confirmed antibiotic-resistant organisms in migrant populations. We extracted data from eligible studies and assessed quality using piloted, standardised forms. We did not examine drug resistance in tuberculosis and excluded articles solely reporting on this parameter. We also excluded articles in which migrant status was determined by ethnicity, country of birth of participants' parents, or was not defined, and articles in which data were not disaggregated by migrant status. Outcomes were carriage of or infection with antibiotic-resistant organisms. We used random-effects models to calculate the pooled prevalence of each outcome. The study protocol is registered with PROSPERO, number CRD42016043681. FINDINGS: We identified 2274 articles, of which 23 observational studies reporting on antibiotic resistance in 2319 migrants were included. The pooled prevalence of any AMR carriage or AMR infection in migrants was 25·4% (95% CI 19·1-31·8; I2 =98%), including meticillin-resistant Staphylococcus aureus (7·8%, 4·8-10·7; I2 =92%) and antibiotic-resistant Gram-negative bacteria (27·2%, 17·6-36·8; I2 =94%). The pooled prevalence of any AMR carriage or infection was higher in refugees and asylum seekers (33·0%, 18·3-47·6; I2 =98%) than in other migrant groups (6·6%, 1·8-11·3; I2 =92%). The pooled prevalence of antibiotic-resistant organisms was slightly higher in high-migrant community settings (33·1%, 11·1-55·1; I2 =96%) than in migrants in hospitals (24·3%, 16·1-32·6; I2 =98%). We did not find evidence of high rates of transmission of AMR from migrant to host populations. INTERPRETATION: Migrants are exposed to conditions favouring the emergence of drug resistance during transit and in host countries in Europe. Increased antibiotic resistance among refugees and asylum seekers and in high-migrant community settings (such as refugee camps and detention facilities) highlights the need for improved living conditions, access to health care, and initiatives to facilitate detection of and appropriate high-quality treatment for antibiotic-resistant infections during transit and in host countries. Protocols for the prevention and control of infection and for antibiotic surveillance need to be integrated in all aspects of health care, which should be accessible for all migrant groups, and should target determinants of AMR before, during, and after migration. FUNDING: UK National Institute for Health Research Imperial Biomedical Research Centre, Imperial College Healthcare Charity, the Wellcome Trust, and UK National Institute for Health Research Health Protection Research Unit in Healthcare-associated Infections and Antimictobial Resistance at Imperial College London

Minimal Symptom Expression' in Patients With Acetylcholine Receptor Antibody-Positive Refractory Generalized Myasthenia Gravis Treated With Eculizumab

The efficacy and tolerability of eculizumab were assessed in REGAIN, a 26-week, phase 3, randomized, double-blind, placebo-controlled study in anti-acetylcholine receptor antibody-positive (AChR+) refractory generalized myasthenia gravis (gMG), and its open-label extension

Surgical site infection after gastrointestinal surgery in high-income, middle-income, and low-income countries: a prospective, international, multicentre cohort study

Background: Surgical site infection (SSI) is one of the most common infections associated with health care, but its importance as a global health priority is not fully understood. We quantified the burden of SSI after gastrointestinal surgery in countries in all parts of the world. Methods: This international, prospective, multicentre cohort study included consecutive patients undergoing elective or emergency gastrointestinal resection within 2-week time periods at any health-care facility in any country. Countries with participating centres were stratified into high-income, middle-income, and low-income groups according to the UN's Human Development Index (HDI). Data variables from the GlobalSurg 1 study and other studies that have been found to affect the likelihood of SSI were entered into risk adjustment models. The primary outcome measure was the 30-day SSI incidence (defined by US Centers for Disease Control and Prevention criteria for superficial and deep incisional SSI). Relationships with explanatory variables were examined using Bayesian multilevel logistic regression models. This trial is registered with ClinicalTrials.gov, number NCT02662231. Findings: Between Jan 4, 2016, and July 31, 2016, 13 265 records were submitted for analysis. 12 539 patients from 343 hospitals in 66 countries were included. 7339 (58·5%) patient were from high-HDI countries (193 hospitals in 30 countries), 3918 (31·2%) patients were from middle-HDI countries (82 hospitals in 18 countries), and 1282 (10·2%) patients were from low-HDI countries (68 hospitals in 18 countries). In total, 1538 (12·3%) patients had SSI within 30 days of surgery. The incidence of SSI varied between countries with high (691 [9·4%] of 7339 patients), middle (549 [14·0%] of 3918 patients), and low (298 [23·2%] of 1282) HDI (p < 0·001). The highest SSI incidence in each HDI group was after dirty surgery (102 [17·8%] of 574 patients in high-HDI countries; 74 [31·4%] of 236 patients in middle-HDI countries; 72 [39·8%] of 181 patients in low-HDI countries). Following risk factor adjustment, patients in low-HDI countries were at greatest risk of SSI (adjusted odds ratio 1·60, 95% credible interval 1·05–2·37; p=0·030). 132 (21·6%) of 610 patients with an SSI and a microbiology culture result had an infection that was resistant to the prophylactic antibiotic used. Resistant infections were detected in 49 (16·6%) of 295 patients in high-HDI countries, in 37 (19·8%) of 187 patients in middle-HDI countries, and in 46 (35·9%) of 128 patients in low-HDI countries (p < 0·001). Interpretation: Countries with a low HDI carry a disproportionately greater burden of SSI than countries with a middle or high HDI and might have higher rates of antibiotic resistance. In view of WHO recommendations on SSI prevention that highlight the absence of high-quality interventional research, urgent, pragmatic, randomised trials based in LMICs are needed to assess measures aiming to reduce this preventable complication

Differential cross section measurements for the production of a W boson in association with jets in proton–proton collisions at √s = 7 TeV

Measurements are reported of differential cross sections for the production of a W boson, which decays into a muon and a neutrino, in association with jets, as a function of several variables, including the transverse momenta (pT) and pseudorapidities of the four leading jets, the scalar sum of jet transverse momenta (HT), and the difference in azimuthal angle between the directions of each jet and the muon. The data sample of pp collisions at a centre-of-mass energy of 7 TeV was collected with the CMS detector at the LHC and corresponds to an integrated luminosity of 5.0 fb[superscript −1]. The measured cross sections are compared to predictions from Monte Carlo generators, MadGraph + pythia and sherpa, and to next-to-leading-order calculations from BlackHat + sherpa. The differential cross sections are found to be in agreement with the predictions, apart from the pT distributions of the leading jets at high pT values, the distributions of the HT at high-HT and low jet multiplicity, and the distribution of the difference in azimuthal angle between the leading jet and the muon at low values.United States. Dept. of EnergyNational Science Foundation (U.S.)Alfred P. Sloan Foundatio

Impacts of the Tropical Pacific/Indian Oceans on the Seasonal Cycle of the West African Monsoon

The current consensus is that drought has developed in the Sahel during the second half of the twentieth century as a result of remote effects of oceanic anomalies amplified by local land–atmosphere interactions. This paper focuses on the impacts of oceanic anomalies upon West African climate and specifically aims to identify those from SST anomalies in the Pacific/Indian Oceans during spring and summer seasons, when they were significant. Idealized sensitivity experiments are performed with four atmospheric general circulation models (AGCMs). The prescribed SST patterns used in the AGCMs are based on the leading mode of covariability between SST anomalies over the Pacific/Indian Oceans and summer rainfall over West Africa. The results show that such oceanic anomalies in the Pacific/Indian Ocean lead to a northward shift of an anomalous dry belt from the Gulf of Guinea to the Sahel as the season advances. In the Sahel, the magnitude of rainfall anomalies is comparable to that obtained by other authors using SST anomalies confined to the proximity of the Atlantic Ocean. The mechanism connecting the Pacific/Indian SST anomalies with West African rainfall has a strong seasonal cycle. In spring (May and June), anomalous subsidence develops over both the Maritime Continent and the equatorial Atlantic in response to the enhanced equatorial heating. Precipitation increases over continental West Africa in association with stronger zonal convergence of moisture. In addition, precipitation decreases over the Gulf of Guinea. During the monsoon peak (July and August), the SST anomalies move westward over the equatorial Pacific and the two regions where subsidence occurred earlier in the seasons merge over West Africa. The monsoon weakens and rainfall decreases over the Sahel, especially in August.Peer reviewe

Penilaian Kinerja Keuangan Koperasi di Kabupaten Pelalawan

This paper describe development and financial performance of cooperative in District Pelalawan among 2007 - 2008. Studies on primary and secondary cooperative in 12 sub-districts. Method in this stady use performance measuring of productivity, efficiency, growth, liquidity, and solvability of cooperative. Productivity of cooperative in Pelalawan was highly but efficiency still low. Profit and income were highly, even liquidity of cooperative very high, and solvability was good

Juxtaposing BTE and ATE – on the role of the European insurance industry in funding civil litigation

One of the ways in which legal services are financed, and indeed shaped, is through private insurance arrangement. Two contrasting types of legal expenses insurance contracts (LEI) seem to dominate in Europe: before the event (BTE) and after the event (ATE) legal expenses insurance. Notwithstanding institutional differences between different legal systems, BTE and ATE insurance arrangements may be instrumental if government policy is geared towards strengthening a market-oriented system of financing access to justice for individuals and business. At the same time, emphasizing the role of a private industry as a keeper of the gates to justice raises issues of accountability and transparency, not readily reconcilable with demands of competition. Moreover, multiple actors (clients, lawyers, courts, insurers) are involved, causing behavioural dynamics which are not easily predicted or influenced. Against this background, this paper looks into BTE and ATE arrangements by analysing the particularities of BTE and ATE arrangements currently available in some European jurisdictions and by painting a picture of their respective markets and legal contexts. This allows for some reflection on the performance of BTE and ATE providers as both financiers and keepers. Two issues emerge from the analysis that are worthy of some further reflection. Firstly, there is the problematic long-term sustainability of some ATE products. Secondly, the challenges faced by policymakers that would like to nudge consumers into voluntarily taking out BTE LEI