Normative Anthropometric and Physical-Function Scores for Costa Rican Older Adults

INTRODUCTION: The aging population is becoming significantly large in several countries due to improved health conditions and higher life expectancy. For instance, Costa Rican elderly have 17% less mortality at 90 yr. of age than elderly from high-income countries, and in Costa Rica life expectancy is higher for men than for women. In developed countries such as Spain, a large number of sedentary elderly have been found with elevated body fat percentage, which might impact their overall health and quality of life. Although the international scientific literature is extensive, the physical and functional status of Central American elderly is unknown. PURPOSE: The purpose of the study was to construct normative scores for anthropometric, adiposity and upper-arm strength variables in Costa Rican adults aged 60 to 110 yr. METHODS: Participants were 5494 Costa Rican elderly randomly selected from the Costa Rican National Population Census. These participants were assessed to determine their general health status and to obtain anthropometric, adiposity and hand grip strength measures. RESULTS: Nearly 50% of males and females showed an increased risk of metabolic complications (χ2 = 91.6; p ≤ 0.001). A higher percentage of females (64.5%) had abdominal obesity compared to males (18.6%). Males (39.8%) were more pre-obese than females (37.2%) and also type II obesity was more frequent in males (3.8%) than in females (3.5%). Males had higher body weight (4.4%) than females (3.9%), less type I obesity (13.4%) than women (17.5%) and less type III obesity (1.0%) than females (1.5%). Gender specific percentile-based norms (P10th, P25th, P50th, P75th, and P90th) were derived from data collected for each 10-year age groups (60-69, 70-79, 80-89, 90-99, and ≥100). CONCLUSION: This is the first population-based study in Central America reporting normative scores for anthropometric and physical-function variables in older adults

Global attitudes in the management of acute appendicitis during COVID-19 pandemic: ACIE Appy Study

Background: Surgical strategies are being adapted to face the COVID-19 pandemic. Recommendations on the management of acute appendicitis have been based on expert opinion, but very little evidence is available. This study addressed that dearth with a snapshot of worldwide approaches to appendicitis. Methods: The Association of Italian Surgeons in Europe designed an online survey to assess the current attitude of surgeons globally regarding the management of patients with acute appendicitis during the pandemic. Questions were divided into baseline information, hospital organization and screening, personal protective equipment, management and surgical approach, and patient presentation before versus during the pandemic. Results: Of 744 answers, 709 (from 66 countries) were complete and were included in the analysis. Most hospitals were treating both patients with and those without COVID. There was variation in screening indications and modality used, with chest X-ray plus molecular testing (PCR) being the commonest (19\ub78 per cent). Conservative management of complicated and uncomplicated appendicitis was used by 6\ub76 and 2\ub74 per cent respectively before, but 23\ub77 and 5\ub73 per cent, during the pandemic (both P < 0\ub7001). One-third changed their approach from laparoscopic to open surgery owing to the popular (but evidence-lacking) advice from expert groups during the initial phase of the pandemic. No agreement on how to filter surgical smoke plume during laparoscopy was identified. There was an overall reduction in the number of patients admitted with appendicitis and one-third felt that patients who did present had more severe appendicitis than they usually observe. Conclusion: Conservative management of mild appendicitis has been possible during the pandemic. The fact that some surgeons switched to open appendicectomy may reflect the poor guidelines that emanated in the early phase of SARS-CoV-2

Evaluation of a quality improvement intervention to reduce anastomotic leak following right colectomy (EAGLE): pragmatic, batched stepped-wedge, cluster-randomized trial in 64 countries

Background Anastomotic leak affects 8 per cent of patients after right colectomy with a 10-fold increased risk of postoperative death. The EAGLE study aimed to develop and test whether an international, standardized quality improvement intervention could reduce anastomotic leaks. Methods The internationally intended protocol, iteratively co-developed by a multistage Delphi process, comprised an online educational module introducing risk stratification, an intraoperative checklist, and harmonized surgical techniques. Clusters (hospital teams) were randomized to one of three arms with varied sequences of intervention/data collection by a derived stepped-wedge batch design (at least 18 hospital teams per batch). Patients were blinded to the study allocation. Low- and middle-income country enrolment was encouraged. The primary outcome (assessed by intention to treat) was anastomotic leak rate, and subgroup analyses by module completion (at least 80 per cent of surgeons, high engagement; less than 50 per cent, low engagement) were preplanned. Results A total 355 hospital teams registered, with 332 from 64 countries (39.2 per cent low and middle income) included in the final analysis. The online modules were completed by half of the surgeons (2143 of 4411). The primary analysis included 3039 of the 3268 patients recruited (206 patients had no anastomosis and 23 were lost to follow-up), with anastomotic leaks arising before and after the intervention in 10.1 and 9.6 per cent respectively (adjusted OR 0.87, 95 per cent c.i. 0.59 to 1.30; P = 0.498). The proportion of surgeons completing the educational modules was an influence: the leak rate decreased from 12.2 per cent (61 of 500) before intervention to 5.1 per cent (24 of 473) after intervention in high-engagement centres (adjusted OR 0.36, 0.20 to 0.64; P &lt; 0.001), but this was not observed in low-engagement hospitals (8.3 per cent (59 of 714) and 13.8 per cent (61 of 443) respectively; adjusted OR 2.09, 1.31 to 3.31). Conclusion Completion of globally available digital training by engaged teams can alter anastomotic leak rates. Registration number: NCT04270721 (http://www.clinicaltrials.gov)