MALNUTRITION AND PHYSICAL PERFORMANCE IN NURSING HOME RESIDENTS: RESULTS FROM THE INCUR STUDY

Objectives: to investigate the association between malnutrition and physical performance in nursing home residents. Design: cross sectional study. Setting and Participants: a total of 499 older people (73.1% women) enrolled in the Incidence of pNeumonia and related ConseqUences in nursing home Residents (INCUR) cohort study. Methods: the nutritional status was defined using the Mini Nutritional Assessment\u2013Short Form (MNA-SF), whereas the physical performance was measured with the Short Physical Performance Battery (SPPB). Unadjusted and adjusted (for age, sex, education, Abbreviated Mental Test score and Charlson Comorbidy Index) linear regression analyses were used to assess the association between MNA-SF and SPPB (primary outcome). The MNA-SF items which seemed most strongly related to the SPPB (and its subtasks) were also explored. Finally, we explored the association of the MNA-SF with each subtest of the SPPB. Results: the mean age of the sample was 85.80 (standard deviation, SD 7.20). The mean SPPB score was 3.05 (SD 2.65) and the mean MNA-SF score 10.35 (SD 2.22). Higher scores of MNA-SF were associated with better physical performance. Food intake deficiency, mobility impairment, and recent psychological stress or acute disease were the items of the MNA-SF most strongly associated with the SPPB, even after adjustment for potential confounders. Among the three subtests of the SPPB, the MNA-SF showed the strongest and most consistent association with the gait speed. Conclusions and Implications: among nursing home residents, the MNA-SF and three of its sub-items (food intake deficiency, mobility impairment, and recent psychological stress) are significantly correlated with physical performance, independently of potential confounders. In particular, the association was evident for the gait speed subtask of the SPPB

Sarcopenia and swallowing disorders in older people.

Aging is accompanied by several changes which may affect swallowing function. The beginning of these changes, termed presbyphagia, still captures a preserved swallowing function, although burdened by the consequences of the physiological aging process. Several stressors (including diseases and medications) can easily trigger the disruption of this (increasingly weak) equilibrium and lead to overt dysphagia. It is noteworthy that the swallowing dysfunction may be aggravated by the sarcopenic process, characterizing the so-called "sarcopenic dysphagia", potentially responsible for several health-related negative outcomes. The assessment and management of sarcopenic dysphagia largely rely on the evaluation and integrated treatment of both constituting conditions (i.e., sarcopenia and dysphagia). The management of dysphagia requires a multidimensional approach and can be designed as either compensatory (aimed at producing immediate benefit for the patient through postural adjustments, swallowing maneuvers, and diet modifications) or rehabilitative. Interestingly, some evidence suggests that resistance training traditionally applied to tackle the lower extremity in sarcopenia may be simultaneously beneficial for sarcopenic dysphagia. If these preliminary results (discussed in the present review article) will be confirmed, the systemic beneficial effects of physical exercise will be indirectly demonstrated. This will also support the need of promoting healthy lifestyle in all sarcopenic individuals (thus potentially at risk of dysphagia)

Efficacy of Nutritional Interventions as Stand-Alone or Synergistic Treatments with Exercise for the Management of Sarcopenia

Sarcopenia is an age-related and accelerated process characterized by a progressive loss of muscle mass and strength/function. It is a multifactorial process associated with several adverse outcomes including falls, frailty, functional decline, hospitalization, and mortality. Hence, sarcopenia represents a major public health problem and has become the focus of intense research. Unfortunately, no pharmacological treatments are yet available to prevent or treat this age-related condition. At present, the only strategies for the management of sarcopenia are mainly based on nutritional and physical exercise interventions. The purpose of this review is, thus, to provide an overview on the role of proteins and other key nutrients, alone or in combination with physical exercise, on muscle parameters

UPAYA MENINGKATKAN PEMAHAMAN TERHADAP BENTUK GEOMETRI MELALUI MENGGAMBAR BENTUK BAGI ANAK KELOMPOK B TK PGRI PLUMBUNGAN TAHUN PELAJARAN 2014 / 2015

Penelitian ini bertujuan untuk meningkatkan pemahaman terhadap bentuk geometri melalui menggambar bentuk pada anak kelompok B TK PGRI Plumbungan tahun ajaran 2014/2015. Merupakan jenis penelitian tindakan kelas (PTK). Terdiri dari dua siklus. Setiap siklus dilaksanakan pada empat tahap, yaitu perencanaan, pelaksanaan, pengamatan (observasi), dan refleksi. Teknik pengumpulan data dilaksanakan melalui observasi, wawancara, dokumentasi, dan tes. Observasi digunakan untuk mengamati hasil kerja anak dan kinerja guru dalam menerapkan kegiatan menggambar bentuk. Wawancara untuk megetahui respon guru tentang kegiatan menggambar bentuk sebagai upaya meningkatkan pemahaman anak terhadap bentuk geometri. Tes dalam bentuk lembar kerja digunakan untuk mengetahui pemahaman anak terhadap bentuk geometri, sehingga akan diketahui perkembangan tersebut sudah sesuai dengan standar yang ditetapkan peneliti atau belum. Dokumentasi digunakan untuk menambah bukti-bukti yang valid guna mendukung jalannya penelitian.Validitas data menggunakan triangulasi sumber dan triangulasi metode. Analisis data yang digunakan dalam penelitian ini adalah reduksi data, penyajian data, dan penarikan kesimpulan. Hasil penelitian ini menunjukkan bahwa menggambar bentuk dapat meningkatkan pemahaman terhadap bentuk geometri

Facial Oedema Is Not Always Angioedema: A Case of Spontaneous Pneumomediastinum with Subcutaneous Emphysema during COPD Exacerbation

We report a case of acute facial oedema in an elderly hospitalized patient which was initially misdiagnosed as angioedema secondary to antibiotics in a patient with an allergic diathesis. We describe the differential aetiologies and then the true cause of the oedema, which was an uncommon complication of a very common condition in the elderly: a pneumomediastinum with subcutaneous emphysema probably due to rupture of an emphysematous lung bulla during chronic obstructive pulmonary disease (COPD) exacerbation. Lastly, we focus on the therapeutic procedures instituted for the treatment of the pneumomediastinum

Una proposta di formazione dagli specializzandi per gli specializzandi: i "gruppi incognitivi"

PREMESSA: Dalla curiosit\ue0 e dai dubbi per questioni che quotidianamente incontriamo nella pratica clinica \ue8 nata l'idea di costruire un gruppo che, attraverso il confronto tra noi Specializzandi e la condivisione di approfondimenti su temi specifici, potesse dare delle risposte e stimolare nuovi interrogativi. Si \ue8 dato cos\uec vita a questo gruppo, chiamato, un po' socraticamente, gruppo incognitivo. Questi gli obiettivi originari: 1. soddisfare, in aggiunta all'offerta del regolare piano accademico, il nostro bisogno di "formazione continua", 2. Confrontarsi tra Specializzandi su questioni pragmatiche, 3. "imparare ad insegnare", attraverso la preparazione di una lezione e quindi la sua esposizione, 4. realizzare un compendio che potesse essere utilizzato "al letto del malato" e quindi fruito anche da chi non avesse la possibilit\ue0 di partecipare agli incontri OBIETTIVO: Tutti gli specializzandi della scuola di Specialit\ue0 in Geriatria sono stati invitati, di volta in volta, a partecipare agli incontri e a preparare una lezione da presentare al gruppo su un argomento di loro scelta. La partecipazione agli incontri era su base volontaria. La possibilit\ue0 di partecipare agli incontri era stata estesa anche a strutturati e studenti di medicina. Per ogni incontro si chiedeva di presentare un file in formato Word, di poche pagine, che sintetizzasse in versione schematica quanto espresso nella lezione. Gli specializzandi hanno utilizzato libri di testo, articoli scientifici e contenuti di Uptodate. Il luogo degli incontri \ue8 stato la biblioteca della scuola di Specialit\ue0 di Geriatria ove avevamo a disposizione un supporto multimediale per la proiezione delle presentazioni. La durata degli incontri \ue8 stata variabile, a seconda della complessit\ue0 dell'argomento e della scelta di colui che esponeva, nella media circa 80 minuti. RISULTATI: Da Ottobre 2014 a Maggio 2015 abbiamo svolto 13 incontri con contenuti trasversali. Di seguito l'elenco degli argomenti: malnutrizione nell'anziano, i criteri di Beers e i farmaci inappropriati nell'anziano, gli inibitori dell'acetilcolinesterasi (nota AIFA e scheda tecnica dei farmaci), algoritmo Advance Life Support, infezioni delle vie urinarie, terapia farmacologica dei disturbi del comportamento e psicologici nella demenza, reverse therapy della emorragie maggiori correlate agli anticoagulanti diretti ed indiretti, tachicardie sopraventricolari e ventricolari, dispnea acuta, polmonite, endocarditi, reazioni cutanee da farmaco (quest'ultimo presentato da una specializzanda in Dermatologia). Ogni incontro era monotematico e veniva presentato da uno o due specializzandi. Di solito l'argomento veniva esposto dalla stessa persona che l'aveva proposto. Tra i limiti di questo progetto l'"autoreferenzialit\ue0" in quanto le informazioni veicolate non sono state passate al vaglio di un specialista in materia, pertanto non sempre siamo riusciti a dare una risposta soddisfacente a tutti gli interrogativi emersi. Questo \ue8 stato comunque di stimolo per ulteriori approfondimenti. CONCLUSIONI: Abbiamo realizzato una compendio che raccoglie i contenuti degli incontri esposti sopra. Come gi\ue0 accennato sopra, ci\uf2 che rende questi contenuti particolarmente fruibili \ue8 la loro pragmaticit\ue0 per la pratica clinica. Abbiamo in previsione di proseguire con un secondo ciclo di incontri da settembre 2015. Tra gli argomenti gi\ue0 in programma: iponatremia, questioni di bioetica, reazioni trasfusionali, principi base di neuroimaging. L'obiettivo con il prossimo anno \ue8 quello di coinvolgere specializzandi di altre Scuole. L'ultimo incontro tenuto da una Specializzanda di Dermatologia ha avuto un impatto molto positivo e desideriamo ripetere l'esperienza

How psychological intervention may impact in dealing physical frailty? : a study protocol of an European Project (664367 — FOCUS — HP-PJ-2014)

OBJECTIVES: PoliFIT-INFOcus is a follow-on study , part of the FOCUS project in which we developed guidelines concerning interventions to prevent or treat frailty. The study is a psycho-physio-educational group-based intervention to promote physical activity in older people to test the impact of FOCUS guidelines in practice. METHODS: 3-arm randomized controlled trial involving participants of the PoliFIT study. RESUTS: Participants will be randomly assigned to: 1) Receiving a booklet including advice on physical activity, nutrition and health psychology topics (control group) 2) Booklet+Pedometer+Group-based sessions with a knowledge-based psychological intervention (intervention 1) 3) Booklet + Pedometer + Group-based training sessions with a motivation-based psychological intervention (intervention 2) Session will be performed by a physiotherapist, a nutritionist and a health psychologist. Outcomes will be changes at 5 months in: average daily step-count , PASE, SPPB and Fried\u2019s criteria score, quality of life/psychological wellbeing, cognitive and functional performance, nutritional status and the occurrence of clinical events (i.e. access to the Emergency Room, hospitalization, falls). CONCLUSIONthe absence of a health psychology component (e.g. behaviour change strategies) is a barrier to the success of some interventions on frailty, including those aimed to impact the physical dimension of frailty. Inclusion of social components (e.g. group-based and or fun-promoting activities) is also a key of success. It is important to promote educational and psychoeducational interventions because they might be low resource demanding and more sustainable program on the long-term

Plio-Quaternary sediment budget between thrust belt erosion and foreland deposition in the central Andes, southern Bolivia

Estimates of the physical boundary conditions on sediment source and sink regions and the flux between them provide insights into the evolution of topography and associated sedimentary basins. We present a regional-scale, Plio-Quaternary to recent sediment budget analysis of the Grande, Parapeti and Pilcomayo drainages of the central Andean fold-thrust belt and related deposits in the Chaco foreland of southern Bolivia (18–23°S). We constrain source-sink dimensions, fluxes and their errors with topographic maps, satellite imagery, a hydrologically conditioned digital elevation model, reconstructions of the San Juan del Oro (SJDO) erosion surface, foreland sediment isopachs and estimated denudation rates. Modern drainages range from 7453 to 86 798 km 2 for a total source area of 153 632 km 2 . Palaeo-drainage areas range from 9336 to 52 620 km 2 and total 100 706 km 2 , suggesting basin source area growth of ∼50% since ∼10 Ma. About 2.4–3.1 × 10 4  km 3 were excavated from below the SJDO surface since ∼3 Ma. The modern foredeep is 132 080 km 2 with fluvial megafan areas and volumes ranging from 6142 to 22 511 km 2 and from 1511 to 3332 km 3 , respectively. Since EmborozÚ Formation deposition beginning 2.1 ± 0.2 Ma, the foreland has a fill of ∼6.4 × 10 4  km 3 . The volume and rate of deposition require that at least ∼40–60% of additional sediment be supplied beyond that incised from below the SJDO. The data also place a lower limit of ≥0.2 mm year −1 (perhaps ≥0.4 mm year −1 ) on the time- and space-averaged source area denudation rate since ∼2–3 Ma. These rates are within the median range measured for the Neogene, but are up to 2 orders of magnitude higher than some observations, as well as analytic solutions for basin topography and stratigraphy using a two-dimensional mathematical model of foreland basin evolution. Source-to-sink sediment budget analyses and associated interpretations must explicitly and quantitatively reconcile all available area, volume and rate observations because of their inherent imprecision and the potential for magnification when they are convolved.Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/73668/1/j.1365-2117.2008.00372.x.pd

Hyponatremia: how much attention do we pay to it?

The objective is to describe hyponatremia in patients hospitalized in geriatric (GU) and Internal medicine units (IM), its characteristics and diagnostic approach in order to improve its management and treatment. It is a retrospective study. We collected data through the informatic system of the hospital, performing statistical analysis with SmallStata14. We analyzed patients admitted during 2015 who showed hyponatremia at admission or developed it in any moment during hospitalization. On 824 patients admitted to the Geriatric (n=351) and Internal Medicine (n=473) wards during 2015 (mean age 77.5\ub114.6 yrs; 56% males), 140 patients (17%) had hyponatremia. Hyponatremia was already present at admission in the emergency unit in 49 patients (74% mild; 14% moderate and 12% severe); 10 patients had hypernatremia but developed hyponatremia thereafter. More than half of the patients was taking at least one drug or had a comorbidity possibly causing hyponatremia. 78 patients (56%) developed it during hospitalization (82% mild, 17% moderate and 1% severe). The mean sodium nadir during hospitalization was 131.8\ub12.4mEq/l. Further analyses to improve the diagnostic accuracy were performed in a minority of cases (plasmatic osmolarity has never been measured, urinary osmolarity and sodium in only 3 and 14 patients respectively). At hospital discharge 48 (34%) patients were still hyponatremic (in 79% mildly) and 71 patients were still assuming at least one drug possibly causing hyponatremia. The hyponatremia was often neglected in the letter of discharge. Hyponatremia is a common observation in GU and IM and it can be due to several causes thus guidelines for its treatment are often useless. The lack of appropriate investigations often lead to improper management. Since even mild hyponatremia has been associated with bad clinical outcomes, more attention should be given, in order to improve the management. Further studies are ongoing

A cascade of complications in a hospitalized frail older patient: is a better management possible?

Methods. Describing the complications that an older patient under- went during his hospital stay.Results. An 87-year-old man was admitted to the San Raffaele Hos- pital for a transient loss of consciousness (LOC). He was hospitalized for assessing the causes of the LOC. The LOC lasted 2 minutes, was associated with bilateral upper limb clonus and subsequent confu- sion. The patient was severely comorbid: he suffered from metabolic syndrome, chronic kidney failure, hemodynamically significant carotid atheromasia, anemia, and he had a dubious history of epilepsy. More- over, the patient was cognitively impaired and many episodes of LOC were reported in his medical history. During the hospital stay the patient developed many complications: a fall, nosocomial pneumonia, urinary retention and deconditioning.Conclusions. Global aging poses several challenges to society and public health systems. The traditional models of care are not suitable to face the complex needs of frail older people for whom standard deci- sional algorithms are seldom applicable. The context of hospitalization, though necessary, may be hazardous risky for the health of older peo- ple, especially the frailer ones