'Gut health': a new objective in medicine?

'Gut health' is a term increasingly used in the medical literature and by the food industry. It covers multiple positive aspects of the gastrointestinal (GI) tract, such as the effective digestion and absorption of food, the absence of GI illness, normal and stable intestinal microbiota, effective immune status and a state of well-being. From a scientific point of view, however, it is still extremely unclear exactly what gut health is, how it can be defined and how it can be measured. The GI barrier adjacent to the GI microbiota appears to be the key to understanding the complex mechanisms that maintain gut health. Any impairment of the GI barrier can increase the risk of developing infectious, inflammatory and functional GI diseases, as well as extraintestinal diseases such as immune-mediated and metabolic disorders. Less clear, however, is whether GI discomfort in general can also be related to GI barrier functions. In any case, methods of assessing, improving and maintaining gut health-related GI functions are of major interest in preventive medicine

Prevalence, associated factors and outcomes of pressure injuries in adult intensive care unit patients: the DecubICUs study

Abstract: Purpose: Intensive care unit (ICU) patients are particularly susceptible to developing pressure injuries. Epidemiologic data is however unavailable. We aimed to provide an international picture of the extent of pressure injuries and factors associated with ICU-acquired pressure injuries in adult ICU patients. Methods: International 1-day point-prevalence study; follow-up for outcome assessment until hospital discharge (maximum 12 weeks). Factors associated with ICU-acquired pressure injury and hospital mortality were assessed by generalised linear mixed-effects regression analysis. Results: Data from 13,254 patients in 1117 ICUs (90 countries) revealed 6747 pressure injuries; 3997 (59.2%) were ICU-acquired. Overall prevalence was 26.6% (95% confidence interval [CI] 25.9–27.3). ICU-acquired prevalence was 16.2% (95% CI 15.6–16.8). Sacrum (37%) and heels (19.5%) were most affected. Factors independently associated with ICU-acquired pressure injuries were older age, male sex, being underweight, emergency surgery, higher Simplified Acute Physiology Score II, Braden score 3 days, comorbidities (chronic obstructive pulmonary disease, immunodeficiency), organ support (renal replacement, mechanical ventilation on ICU admission), and being in a low or lower-middle income-economy. Gradually increasing associations with mortality were identified for increasing severity of pressure injury: stage I (odds ratio [OR] 1.5; 95% CI 1.2–1.8), stage II (OR 1.6; 95% CI 1.4–1.9), and stage III or worse (OR 2.8; 95% CI 2.3–3.3). Conclusion: Pressure injuries are common in adult ICU patients. ICU-acquired pressure injuries are associated with mainly intrinsic factors and mortality. Optimal care standards, increased awareness, appropriate resource allocation, and further research into optimal prevention are pivotal to tackle this important patient safety threat

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Immediate affective responses of gait training in neurological rehabilitation: a randomized crossover trial

Objective: To examine the immediate effects of physical therapy and robotic-assisted gait training on affective responses of gait training in neurological rehabilitation. Design: Randomized crossover trial with blinded observers. Patients: Sixteen patients with neurological disorders (stroke, traumatic brain injury, spinal cord injury, multiple sclerosis). Methods: All patients underwent 2 single treatment sessions: physical therapy and robotic-assisted gait training. Both before and after the treatment sessions, the self-report Mood Survey Scale was used to assess the effects of the treatment on distinct affective states. The subscales of the Mood Survey Scale were tested for pre-post changes and differences in effects between treatments, using non-parametric tests. Results: Fourteen participants completed the study. Patients showed a significant increase in activation (r=0.55), elation (r=0.79), and calmness (r=0.72), and a significant decrease in anger (r=0.64) after robotic-assisted gait training compared with physical therapy. Conclusion: Affective responses might be positively influenced by robotic-assisted gait training, which may help to overcome motivational problems during the rehabilitation process in neurological patients.(VLID)3080985Version of recor

To What Extent Do Attitudes Regarding Ski Helmets Change After a Period of Utilization?

Background: Common reasons reported for helmet non-use are impaired hearing and impaired vision and an increasing level of risk taking. Therefore, health communication programmes should be instituted to get non-helmeted skiers and snowboarders to try out helmets to eliminate their potential prejudices. Aim: to evaluate whether and to what extent attitudes regarding ski helmets change after a period of utilization. Methods: Subjects who wanted to borrow a ski helmet in a ski rental shop had to rate 14 attitudes about ski helmets using a 5-point Likert scale two times (1) before they borrow a helmet and (2) after the return of the helmet. Results: A total of 231 (43.7% females) subjects with a mean age of 35.2 +/- 14.3 years participated. A ski helmet was used never before, one time, and more times by 21.2, 16.7, and 62.1%, respectively. There was a significant increase after borrowing in the agreement that all winter sport participants should wear a ski helmet (p = .003), and that a ski helmet damages the hairstyle (p = .021) while there was a decreasing agreement that a ski helmet looks good/is stylish (p = .030). According to a factor analysis, attitudes about ski helmets clustered around two major dimensions - “safety awareness/comfort” and “subjective disadvantages” explaining 42-43% of the overall variance. A significant increase in the dimension “safety awareness/comfort” from pre- 31.8 5.9 to post-borrowing 32.6 5.9 (p < .001) was found while the dimension “subjective disadvantages” did not significantly change (pre: 18.6 4.3 vs. post: 19.1 4.3, p = .091). Regarding subgroup analysis with these two dimensions, previous helmet use (never before vs. one time vs. more times) did not show significant differences in the change in attitudes. Conclusion: The ski helmet-related dimension “safety awareness/comfort” significantly increased after a period of utilization, irrespective of previous helmet use.(VLID)3080979Version of recor