Estudi de l'especialitat farmacèutica ferroi-iodose-Ferrer en el context de la sanitat del segle XX

L'objectiu d'aquesta comunicació és donar a conèixer l'estudi de l'evolució de l'especialitat ferro-iodose-ferrer dins el context històric en el que va començar el seu desenvolupament. Destaca per ésser una especialitat premiada amb la medalla d'or de l'Exposició Internacional de Barcelona, l'any 1929

Multimorbidity as specific disease combinations, an important predictor factor for mortality in octogenarians: the Octabaix study

BACKGROUND: The population is aging and multimorbidity is becoming a common problem in the elderly. OBJECTIVE: To explore the effect of multimorbidity patterns on mortality for all causes at 3- and 5-year follow-up periods. MATERIALS AND METHODS: A prospective community-based cohort (2009-2014) embedded within a randomized clinical trial was conducted in seven primary health care centers, including 328 subjects aged 85 years at baseline. Sociodemographic variables, sensory status, cardiovascular risk factors, comorbidity, and geriatric tests were analyzed. Multimorbidity patterns were defined as combinations of two or three of 16 specific chronic conditions in the same individual. RESULTS: Of the total sample, the median and interquartile range value of conditions was 4 (3-5). The individual morbidities significantly associated with death were chronic obstructive pulmonary disease (COPD; hazard ratio [HR]: 2.47; 95% confidence interval [CI]: 1.3; 4.7), atrial fibrillation (AF; HR: 2.41; 95% CI: 1.3; 4.3), and malignancy (HR: 1.9; 95% CI: 1.0; 3.6) at 3-year follow-up; whereas dementia (HR: 2.04; 95% CI: 1.3; 3.2), malignancy (HR: 1.84; 95% CI: 1.2; 2.8), and COPD (HR: 1.77; 95% CI: 1.1; 2.8) were the most associated with mortality at 5-year follow-up, after adjusting using Barthel functional index (BI). The two multimorbidity patterns most associated with death were AF, chronic kidney disease (CKD), and visual impairment (HR: 4.19; 95% CI: 2.2; 8.2) at 3-year follow-up as well as hypertension, CKD, and malignancy (HR: 3.24; 95% CI: 1.8; 5.8) at 5 years, after adjusting using BI. CONCLUSION: Multimorbidity as specific combinations of chronic conditions showed an effect on mortality, which would be higher than the risk attributable to individual morbidities. The most important predicting pattern for mortality was the combination of AF, CKD, and visual impairment after 3 years. These findings suggest that a new approach is required to target multimorbidity in octogenarians

Evidence of functional declining and global comorbidity measured at baseline proved to be the strongest predictors for long-term death in elderly community residents aged 85 years: a 5-year follow-up evaluation, the OCTABAIX study

Objective: To investigate the predictive value of functional impairment, chronic conditions, and laboratory biomarkers of aging for predicting 5-year mortality in the elderly aged 85 years. Methods: Predictive value for mortality of different geriatric assessments carried out during the OCTABAIX study was evaluated after 5 years of follow-up in 328 subjects aged 85 years. Measurements included assessment of functional status comorbidity, along with laboratory tests on vitamin D, cholesterol, CD4/CD8 ratio, hemoglobin, and serum thyrotropin. Results: Overall, the mortality rate after 5 years of follow-up was 42.07%. Bivariate analysis showed that patients who survived were predominantly female (P=0.02), and they showed a significantly better baseline functional status for both basic (P<0.001) and instrumental (P<0.001) activities of daily living (Barthel and Lawton index), better cognitive performance (Spanish version of the Mini-Mental State Examination) (P<0.001), lower comorbidity conditions (Charlson) (P<0.001), lower nutritional risk (Mini Nutritional Assessment) (P<0.001), lower risk of falls (Tinetti gait scale) (P<0.001), less percentage of heart failure (P=0.03) and chronic obstructive pulmonary disease (P=0.03), and took less chronic prescription drugs (P=0.002) than nonsurvivors. Multivariate Cox regression analysis identified a decreased score in the Lawton index (hazard ratio 0.86, 95% confidence interval: 0.78-0.91) and higher comorbidity conditions (hazard ratio 1.20, 95% confidence interval: 1.08-1.33) as independent predictors of mortality at 5 years in the studied population. Conclusion: The ability to perform instrumental activities of daily living and the global comorbidity assessed at baseline were the predictors of death, identified in our 85-year-old community-dwelling subjects after 5 years of follow-up

Multifactorial assessment and targeted intervention in nutritional status among the older adults: a randomized controlled trial: the Octabaix study

Background: Malnutrition is frequent among older people and is associated with morbi-mortality.he aim of the study is to assess the effectiveness of a multifactorial and multidisciplinary intervention in the nutritional status among the elderly. Methods: Randomized, single-blind, parallel-group, clinical trial conducted from January 2009 to December 2010 in seven primary health care centers in Baix Llobregat (Barcelona). Of 696 referred people, born in 1924, 328 subjects were randomized to an intervention group or a control group. The intervention model used an algorithm and was multifaceted for both the patients and their primary care providers. The main outcome was improvement in nutritional status assessed by Mini Nutritional Assessment (MNA). Data analyses were done by intention-to-treat. Results: Two-year assessment was completed for 127 patients (77.4%) in the intervention group and 98 patients (59.7%) in the control group. In the adjusted linear mixed models for MNA, intervention showed no significant effect during all follow-up period with −0.21 (CI: − 0.96; 0.26). In subjects with nutritional risk (MNA ≤ 23.5 / 30) existed a tendency towards improvement in MNA score 1.13 (95% CI −0.48; 2.74) after 2 years. Conclusion: A universal multifactorial assessment and target intervention over a two year period in subjects at nutritional risk showed a tendency to improve nutrition but not in the rest of community-dwelling studied subjects. Cognitive impairment was an independent factor strongly associated with a decline in nutritional status

Functional And Cognitive Decline Is Associated With Increased Endothelial Cell Inflammation And Platelet Activation. Liquid Biopsy Of Microvesicles In Community-Dwelling Octogenarians.

Increased life expectancy is usually associated with comorbidities, such as cardio andcerebrovascular disease causing impaired functionality. A common underlying cause ofthese comorbidities is vascular inflammation and injury. Elevated levels of circulatingmicrovesicles (cMV), as a product of a hemostatic and inflammatory cell activation,could be direct mapping of an imbalanced hemostasis. In this manuscript, we aimedto investigate by liquid biopsy whether successful aging can be discriminated bycMV levels and phenotype. To this purpose, we included 135 community-dwellingoctogenarians in a cross-sectional study. Successful aging was defined as goodfunctional (Barthel Index>90 points, and Lawton index score>7/4 points forwomen and men, respectively) and cognitive status (Spanish version of the Mini-Mental State Examination -MEC->24 points) and no need for institutionalization.Total, annexin V positive (AV+), and AV−cMV from different cell origins from thevascular compartment were phenotypically characterized and quantified from fastingplasma samples by flow cytometry. Successful aging was associated with lowerplasma concentrations of total and AV+CD141+/CD41+-CD61+, and PAC1+/AV+,CD141+/AV+, and CD36+/AV−cMV. From these phenotypes, ROC curve analysesrevealed that CD141+/AV+and CD141+/CD41+-CD61+/AV+endothelial- and platelet-derived cMV discriminate successful and non-successful aging with an AUC (95%CI) of0.655 (0.551, 0.758),P= 0.005, and 0.638 (0.535, 0.741),P= 0.013, respectively. In conclusion, successful aging is associated with low levels of cMV released by endothelialcells and platelets, indicating lower endothelial cell inflammation and platelet activation.Our results contribute to the understanding of the link between unsuccessful aging,cognitive decline and vascular cell inflammatory disturbances

Low co-morbidity, low levels of malnutrition, and low risk of falls in a community-dwelling sample of 85-year-old are associated with succesful aging: the Octabaix study

The population is aging throughout the world. Preserving physical and cognitive functions is crucial to successful aging. The aim of this study was to determine the proportion of 85-year-old community-dwelling subjects aging successfully, applying a quantitative approach, and assessing the association of successful aging with sociodemographic data, global geriatric assessment, and co-morbidity. This was a community-based survey of inhabitants aged 85 years, with 328 out of 487 subjects born in 1924 assigned to seven primary health-care teams, representing a participation rate of 67.5%. Sociodemographic variables, Barthel index (BI), the Spanish version of the Mini-Mental State Examination (MEC), Mini Nutritional Assessment (MNA), Charlson Index, Gait Rating Scale, social risk, quality of life (QoL), and prevalent chronic diseases were assessed. Subjects scoring higher than 90 on the BI and higher than 24 on the MEC were compared with the rest. Multiple regression analysis was performed. Using these criteria, successful aging status was defined in 162 (49.3%) subjects. Using multiple logistic regression analysis, successful agers had significantly lower co-morbidity scores (p 0.0001). Almost half of the individuals presented successful aging. Successful agers had less co-morbidity and a lower risk of falls or malnutrition, and they had higher scores on the QoL scale

Evaluation of the effect of polymorphism on G-quadruplex-ligand interaction by means of spectroscopic and chromatographic techniques

Guanine-rich sequences may fold into highly ordered structures known as G-quadruplexes. Apart from the monomeric G-quadruplex, these sequences may form multimeric structures that are not usually considered when studying interaction with ligands. This work studies the interaction of a ligand, crystal violet, with three guanine-rich DNA sequences with the capacity to form multimeric structures. These sequences correspond to short stretches found near the promoter regions of c-kit and SMARCA4 genes. Instrumental techniques (circular dichroism, molecular fluorescence, size-exclusion chromatography and electrospray ionization mass spectrometry) and multivariate data analysis were used for this purpose. The polymorphism of G-quadruplexes was characterized prior to the interaction studies. The ligand was shown to interact preferentially with the monomeric G-quadruplex; the binding stoichiometry was 1:1 and the binding constant was in the order of 105 M-1 for all three sequences. The results highlight the importance of DNA treatment prior to interaction studie

El fracaso escolar y los supuestos esenciales de la reforma: la percepción del profesorado de la educación secundaria en Cataluña (España)

Nuestra intención y objetivo ha sido establecer un diálogo con profesores de la enseñanza secundaria Obligatoria (ESO) con la finalidad de comprender, analizar e interpretar sus pensamientos, ideas, acciones y opiniones en relación a los supuestos básicos de las reformas educativas y el fracaso escolar. Hemos realizado dicho diálogo desde una perspectiva tanto sincrónica como diacrónica y, a este efecto, el profesorado participante cumple el requisito de llevar más de 30 años en activo. Esta perspectiva sincrónica/diacrónica nos ha permitido rastrear el pensamiento y la experiencia vivida, de modo transversal, a través de las reformas educativas desde la postura profesional del “hoy”. En este contexto, hemos valorado el conocimiento y experiencia acumulada de aquellos profesionales que iniciaron sus carreras en plena etapa predemocrática y que han vivido todos los cambios como un valor añadido

Vell Frágil / Identificar factores de riesgo

Objective. To describe whether older people diagnosed with frailty have undergone  preventive interventions for the factors identified in the nursing consultation of the Primary Care Center of Raval Nord.   Matter and method. A simple random sample of all older people with record of frailty diagnosis that attended nursing visits during the period February 2008 to February 2009 was made. A data base of the different analyzed variables was created and the data was run through the computer program Statistical Package for the Social Sciences, (SPSS).   Results. The total number of persons with frailty diagnosis was 469. It was noted that 15.7% of the mentioned population had begun to participate in the Home Care Program (ATDOM, initials in Spanish), and the other 395 persons continued going to nursing visits independently. 79 cases,20% of the total, were analyzed.  It was observed that the average age was 82.52 years; that the deviation was 5.7 years; that the age range was between 63 and 94; that 67.1% were female; and that 29.6% lived alone. In analyzing the population an assessment test was carried out. It was noted that only 25.3% carried out the Barthel test and 19% the Pfeiffer test, and that the Nursing Cure Plan had been made to 43% of the population. In analyzing whether a carer or a person of reference was registered in the record, it was found that in 29.1% of the cases one of these people were on the register. In relation to social assistance, it was noted that 7.6% had at home tele-alarm, and that only 6.3% had gone to social services. In analyzing the frequency with which the population went to the health center or the reference hospital,  a high frequent use was detected. In the Center AP, 54.5% made over 12 visits in the consultation, and 37.7% had gone to the emergency services. In relation to the hospital emergency department, it was observed that 39.2% had been treated, and 22.8% admitted to hospital. It was also noted that computerized history through the Ecap system is not sensitive to qualitative variables, noting that can cause loss of information from the nursing activity Conclusions. It is possible to note that there is a good grasp of the frailty of the people attended to but it should be more focused on capturing the causes of frailty for interventions aimed at health promotion and prevention so that the frailty is not reconverted into avoidable disabilities.Objetivo. Describir si a las personas mayores con diagnóstico de fragilidad se les han realizado las  intervenciones preventivas de los factores de riesgo en las consultas de enfermería del Centro de Atención Primaría de Raval Nord.   Material y Método. Se realizó una muestra aleatoria simple del total de personas mayores que acudían a las consultas de enfermería durante el periodo de febrero de 2008 a febrero de 2009 y constaba el diagnostico de fragilidad. Se elaboró una base de datos de las diferentes variables analizadas y se realizó la explotación de los datos a través del programa informático Statistical Package for the Social Sciencies (SPSS).   Resultados. De un total de 469 personas en las que constaba el diagnóstico de personas frágiles se observó que el 15,7% de dicha población había pasado al programa de Atención domiciliaria (ATDOM) y el resto, un total de 395, seguían acudiendo de forma autónoma a las consultas.  Del total se analizó el 20% (representó 79 casos). Observándose que la media de edad fue de 82,52 años con una desv.tip de 5,7 años y la franja de edades comprendida entre  63 y 94 años. Que el 67,1% pertenecía al sexo femenino y que 29,6% vivía sola/o. Al analizar si a dicha población se le  había realizado tests de valoración, se observó que solo a un 25,3% se había realizado el test de Barthel, a un 19% el test de Pfeiffer y que el Plan de Cura de Enfermería se había aplicado al 43% de la población. Al analizar si constaba el cuidador o persona referente se observó que solo constaba en un 29,1%, En relación a ayudas sociales, se observó que el 7,6% constaba que tenía en su domicilio tele-alarma y que solo un 6,3% había acudido a solicitar ayudas o valoración en  servicios sociales. Al analizar la frecuentación al centro de salud (AP)  o al hospital de referencia, se observó una elevada hiperfrecuentacion. En el centro de AP un 54,5% había realizado más de 12 visitas a  las consultas y un 37,7% había acudido al servicio de urgencias. Y en relación al servicio de urgencias hospitalarias  se observó que el 39,2% había sido atendido, y un 22,8% ingresado. También se destacó que la historia informatizada a través del sistema Ecap no es sensible a las variables cualitativas, observándose que puede ser causa de pérdida de información de la actividad de enfermería.   Conclusiones. Se puede observar que existe una buena captación de la fragilidad de las personas atendidas, pero por otra parte se debe incidir más en la captación de las causas de la fragilidad para realizar  intervenciones dirigidas a la promoción y prevención de salud, para que la fragilidad no se reconvierta en incapacidades evitables.

Utility of geriatric assessment to predict mortality in the oldest old: the Octabaix Study 3-year follow-up

Objective: Few studies have prospectively evaluated the utility of geriatric assessment tools as predictors of mortality in the oldest population. We investigated predictors of death in an oldest-old cohort after 3 years of follow-up. Methods: The Octabaix study is a prospective, community-based study with a follow-up period of 3 years involving 328 subjects aged 85 at baseline. Data were collected on functional and cognitive status, co-morbidity, nutritional and falls risk, quality of life, social risk, and long-term drug prescription. Vital status for the total cohort was evaluated after 3 years of follow-up. Results: Mortality after 3 years was 17.3%. Patients who did not survive had significantly poorer baseline functional status for basic and instrumental activities of daily living (Barthel and Lawton Index), higher co-morbidity (Charlson), higher nutritional risk (Mini Nutritional Assessment), higher risk of falls (Tinetti Gait Scale), poor quality of life (visual analog scale of the Quality of Life Test), and higher number of chronic drugs prescribed. Cox regression analysis identified the Lawton Index (hazard ratio [HR] 0.82, 95% confidence interval [CI] 0.73-0.89) and the number of chronic drugs prescribed (HR 1.09, 95% CI 1.01-1.18) as independent predictors of mortality at 3 years. Conclusions: Among the variables studied, the ability to perform instrumental activities of daily living and using few drugs on a chronic basis at baseline are the best predictors of which oldest-old community-dwelling subjects survive after a 3-year follow-up period