Biopsychosocial factors related to the length of hospital stay in older people

This study aimed to know what variables influence increased length of hospital stay. A descriptive, cross-sectional study was conducted through an integrated geriatric assessment of 81 people over 65 years of age, admitted to a tertiary acute care hospital. Data were collected through the Pfeiffer Scale, Barthel Index, Goldberg Questionnaire, Family APGAR and Gijón Scale. The length of hospital stay increased in people over 80 years, people living alone or in a retirement home, patients with great physical dependence and those with a risk or problem of social exclusion. The most influential variable for longer hospitalization was cognitive impairment (pEste estudio tuvo como objetivo conocer qué variables influyen en el aumento de la duración de la estancia hospitalaria. Se trata de un estudio descriptivo transversal en el que se realizó una Valoración Geriátrica Integral a 81 personas mayores de 65 años de edad que ingresaron en un hospital de agudos de tercer nivel. Para ello, los datos fueron recogidos por medio de la Escala de Pfeiffer, el Índice de Barthel, el Cuestionario de Goldberg, el APGAR familiar y la Escala de Gijón. Se observó un aumento de la duración de la estancia hospitalaria entre los mayores de 80 años, las personas que vivían solas o en una residencia geriátrica, los pacientes que presentaban gran dependencia física y también, entre quienes tenían un riesgo o problema de exclusión social. La variable que más influyó en la mayor duración de la hospitalización fue el deterioro cognitivo (pEste estudo teve como objetivo conhecer quais as variáveis que influenciam o aumento do tempo de internação hospitalar. Trata-se de estudo descritivo e transversal, conduzido mediante ampla avaliação geriátrica de 81 pessoas com mais de 65 anos, internadas em hospital terciário de cuidados agudos. Os dados foram coletados através da Escala Pfeiffer, Índice de Barthel, Questionário de Goldberg, Apgar da Família e Escala de Gijón. Observou-se aumento no tempo de internação entre pessoas com mais de 80 anos, pessoas que vivem sozinhas ou em lar de idosos, pacientes que tinham grande dependência física, e entre aqueles com algum risco ou problema de exclusão social. A variável mais influente, para a maior duração da hospitalização, foi a deterioração cognitiva (p<0,05), em comparaç��o à maior colaboração do paciente sem essa condição ou ao seu desejo de superar a fase aguda da patologia que levou à internação hospitalar

Prolonged Sitting Time: Barriers, Facilitators and Views on Change among Primary Healthcare Patients Who Are Overweight or Moderately Obese

Background and Objectives Prolonged sitting time has negative consequences on health, although the population is not well aware of these harmful effects. We explored opinions expressed by primary care patients diagnosed as overweight or moderately obese concerning their time spent sitting, willingness to change, and barriers, facilitators, goals and expectations related to limiting this behaviour. Methods A descriptive-interpretive qualitative study was carried out at three healthcare centres in Barcelona, Spain, and included 23 patients with overweight or moderate obesity, aged 25 to 65 years, who reported sitting for at least 6 hours a day. Exclusion criteria were inability to sit down or stand up from a chair without help and language barriers that precluded interview participation. Ten in-depth, semi-structured interviews (5 group, 5 individual) were audio recorded from January to July 2012 and transcribed. The interview script included questions about time spent sitting, willingness to change, barriers and facilitators, and the prospect of assistance from primary healthcare professionals. An analysis of thematic content was made using ATLAS.Ti and triangulation of analysts. Results The most frequent sedentary activities were computer use, watching television, and motorized journeys. There was a lack of awareness of the amount of time spent sitting and its negative consequences on health. Barriers to reducing sedentary time included work and family routines, lack of time and willpower, age and sociocultural limitations. Facilitators identified were sociocultural change, free time and active work, and family surroundings. Participants recognized the abilities of health professionals to provide help and advice, and reported a preference for patient-centred or group interventions. Conclusions Findings from this study have implications for reducing sedentary behaviour. Patient insights were used to design an intervention to reduce sitting time within the frame of the SEDESTACTIV clinical trial

Inhibition of Gastric Lipase as a Mechanism for Body Weight and Plasma Lipids Reduction in Zucker Rats Fed a Rosemary Extract Rich in Carnosic Acid

BACKGROUND: Rosemary (Rosmarinus officinalis L.) extracts (REs) exhibit hepatoprotective, anti-obesity and anti-inflammatory properties and are widely used in the food industry. REs are rich in carnosic acid (CA) and carnosol which may be responsible for some of the biological activities of REs. The aim of this study was to investigate whether inhibition of lipase activity in the gut may be a mechanism by which a RE enriched in CA (40%) modulates body weight and lipids levels in a rat model of metabolic disorders and obesity. METHODS AND PRINCIPAL FINDINGS: RE was administered for 64 days to lean (fa/+) and obese (fa/fa) female Zucker rats and body weight, food intake, feces weight and blood biochemical parameters were monitored throughout the study. Lipase activity (hydrolysis of p-nitrophenylbutyrate) was measured in the gastrointestinal tract at the end of the study and the contents of CA, carnosol and methyl carnosate were also determined. Sub-chronic administration of RE moderately reduced body weight gain in both lean and obese animals but did not affect food intake. Serum triglycerides, cholesterol and insulin levels were also markedly decreased in the lean animals supplemented with RE. Importantly, lipase activity was significantly inhibited in the stomach of the RE-supplemented animals where the highest content of intact CA and carnosol was detected. CONCLUSIONS: Our results confirm that long-term administration of RE enriched in CA moderates weight gain and improves the plasma lipids profile, primarily in the lean animals. Our data also suggest that these effects may be caused, at least in part, by a significant inhibition of gastric lipase and subsequent reduction in fat absorption

Two-photon neuronal and astrocytic stimulation with azobenzene-based photoswitches

Synthetic photochromic compounds can be designed to control a variety of proteins and their biochemical functions in living cells, but the high spatiotemporal precision and tissue penetration of two-photon stimulation have never been investigated in thes

613 cases of splenic rupture without risk factors or previously diagnosed disease: a systematic review

Background Rupture of the spleen in the absence of trauma or previously diagnosed disease is largely ignored in the emergency literature and is often not documented as such in journals from other fields. We have conducted a systematic review of the literature to highlight the surprisingly frequent occurrence of this phenomenon and to document the diversity of diseases that can present in this fashion. Methods Systematic review of English and French language publications catalogued in Pubmed, Embase and CINAHL between 1950 and 2011. Results We found 613 cases of splenic rupture meeting the criteria above, 327 of which occurred as the presenting complaint of an underlying disease and 112 of which occurred following a medical procedure. Rupture appeared to occur spontaneously in histologically normal (but not necessarily normal size) spleens in 35 cases and after minor trauma in 23 cases. Medications were implicated in 47 cases, a splenic or adjacent anatomical abnormality in 31 cases and pregnancy or its complications in 38 cases. The most common associated diseases were infectious (n = 143), haematologic (n = 84) and non-haematologic neoplasms (n = 48). Amyloidosis (n = 24), internal trauma such as cough or vomiting (n = 17) and rheumatologic diseases (n = 10) are less frequently reported. Colonoscopy (n = 87) was the procedure reported most frequently as a cause of rupture. The anatomic abnormalities associated with rupture include splenic cysts (n = 6), infarction (n = 6) and hamartomata (n = 5). Medications associated with rupture include anticoagulants (n = 21), thrombolytics (n = 13) and recombinant G-CSF (n = 10). Other causes or associations reported very infrequently include other endoscopy, pulmonary, cardiac or abdominal surgery, hysterectomy, peliosis, empyema, remote pancreato-renal transplant, thrombosed splenic vein, hemangiomata, pancreatic pseudocysts, splenic artery aneurysm, cholesterol embolism, splenic granuloma, congenital diaphragmatic hernia, rib exostosis, pancreatitis, Gaucher's disease, Wilson's disease, pheochromocytoma, afibrinogenemia and ruptured ectopic pregnancy. Conclusions Emergency physicians should be attuned to the fact that rupture of the spleen can occur in the absence of major trauma or previously diagnosed splenic disease. The occurrence of such a rupture is likely to be the manifesting complaint of an underlying disease. Furthermore, colonoscopy should be more widely documented as a cause of splenic rupture

Pentadactyl ankylosaurian manus tracks from the Lower Cretaceous of Galve (Teruel, Spain): first occurrence of Tetrapodosaurus in the Iberian Peninsula

Introduction This work is a detailed description of ankylosaurian natural casts found in Galve (Teruel, Spain), with the identification and classification of the major dynamic and static structures that depend on the phase of autopodial (hand) movement. Geological setting Specimens come from the Lower Cretaceous (Barremian) of the eastern sector of the Iberian Range. The depositional environment is of continental coastal influence with both fluvial and tidal current structures. Material and methods We studied the morphology and main features of approximately 50 manus casts of Tetrapodosaurus. The structures were correlated with the different stages of the movement during the formation of the print (footprint formation phases of Thulborn and Wade 1989). Description We describe the prints, lithological composition and the features observed at the top, the base and the walls of the casts (striae, lineations, grooves and polygonal scales) for understand the autopodial shape, the response of the pads and the hand movement. Comparative palaeoichnology Manus prints of sauropods, stegosaurs and ankylosaurs may show a similar morphology. However, the presence of five perfectly-distinct, protruding and separate digits in the Galve specimens make these ichnites incompatible with those of stegosaurs or with those of sauropods. Discussion We examine the original definition and the diagnosis of Tetrapodosaurus, including other similar pentadactyl tracks; also the global distribution and palaeoenvironments of these ankylosaurian ichnites, and the possible affinities of the trackmaker. Conclusions The first citation of Tetrapodosaurus in Galve (Spain) confirms the palaeontological importance of this area, due to the variety of sites and dinosaur fossil types found. Careful examination of the casts has allowed reconstruction of the kinds of joint and forelimb movements that are independent of, but consistent with, interpretations based on functional aspects of the forelimb skeleton. The structures observed in the walls and in the base of the casts indicate that the digital pads of the ankylosaur hands were flexible calluses.Introducción En este trabajo se describen los contramoldes encontrados en Galve (Teruel, España), con la identificación y clasificación de las estructuras dinámicas y estáticas que dependen de la fase del movimiento del autopodio (mano). Geología Los contramoldes son del Cretácico Inferior (Barremiense) del sector Este de la Cordillera Ibérica. El ambiente sedimentario es continental costero con influencia tanto de corrientes fluviales como de marea. Material y me´todos Estudiamos la forma y estructuras principales de unos 50 contramoldes de mano de Tetrapodosaurus. Las estructuras se ha correlacionado con los estados de movimiento durante la formación de la huella (fases de formación de la huella de Tulborn y Wade, 1989). Descripción Describimos las huellas, la composición litológica del relleno y las estructuras observadas en el techo, base y paredes de los contramoldes (estrias, lineaciones, acanaladuras y escamas poligonales) para investigar la forma del autopodio, la respuesta de las almohadillas y el movimiento de la mano. Paleoicnología comparada Las huellas de mano de saurópodos, estegosaurios y anquilosaurios pueden tener forma similar. No obstante las huellas de Galve tienen cinco dedos identificables que sobresalen y están perfectamente aislados y separados., lo que hace que estas icnitas sean incompatibles con las de estegosaurios o con las de saurópodos. Discusión Examinamos la definición original y la diagnosis de Tetrapodosaurus junto con la de otras huellas pentadáctilas similares; también la distribución mundial y paleoambientes en las que están las huellas de anquilosaurios así como susafinidades posibles de los autores. Conclusiones Esta primera cita de Tetrapodosaurus en Galve (España) confirma la importancia paleontológica de la zona, debido a la variedad de yacimientos y tipos de dinosaurio encontrados allí. El exámen cuidadoso de los contramoldes permite la reconstrucción del tipo de articulacionees y del movimiento de las extremidades delanterar, independientemente aunque coincidentes con las interpretaciones basadas en los aspectos funcionales del esqueleto. Las estructuras observadas en las paredes y en la base de los contramoldes indican que las almohadillas dactilares de las manos de los anquilosaurios con callosidades flexibles