Institucionalización: abandono o la mejor opción

Introduction: The predominance of the aging population and the social and economic changes of today make it necessary for institutionalization to be an increasingly common resource in our country. This is accompanied by both positive and negative feelings by the geriatric patient and his relatives. The main objective of this review is to analyze the process of adaptation to institutionalization with the emotional and psychosocial changes that concern both the elderly and their environment. Material and methods: A search of articles in both Spanish and English is carried out in different databases such as PubMed and CINHAL and metasearch engines. A total of 19 articles are selected using the PICO strategy, including thesis and final degree projects. Results: Depression and dependence are the main problems that appear upon admission to the residential center. To address these, an assessment is carried out using scales following the patient’s own needs, thus personalizing the institutionalization care. Family dependence complicates adaptation to change. Discussion: At first, the image of the residence is usually negative, which changes over time. Depression decreases to more time of hospitalization when adapting to the center. It is important that the family respect the rules and maintain contact with the patient, as well as the intervention of the multidisciplinary team. Conclusions: Institutionalization is a great change for the elderly and their family, which will be overcome until they consider it their new home.Introducción: El predominio de la población envejecida y los cambios sociales y económicos de la actualidad, hacen preciso que la institucionalización sea un recurso cada vez más común en nuestro país. Esto viene acompañado de sentimientos tanto positivos como negativos por parte del paciente geriátrico y sus familiares. El objetivo principal de esta revisión es analizar el proceso de adaptación a la institucionalización con los cambios emocionales y psicosociales que atañen tanto al anciano como a su entorno. Material y métodos: Se realiza una búsqueda de artículos tanto en castellano como en inglés en distintas bases de datos como PubMed y CINHAL y metabuscadores. Se seleccionan un total de 19 artículos usando la estrategia PICO, incluyendo tesis y trabajos fin de grado. Resultados: La depresión y la dependencia son los principales problemas que aparecen al ingreso en el centro residencial. Para el abordaje de estos, se realiza una valoración mediante escalas siguiendo las necesidades propias del paciente, personalizando así los cuidados en la institucionalización. La dependencia familiar complica la adaptación al cambio. Discusión: En un primer momento, la imagen de la residencia suele ser negativa, la cual va cambiando con el tiempo. La depresión disminuye a mayor tiempo de internamiento al irse adaptando al centro. Es importante que la familia respete las normas y mantenga el contacto con el paciente, así como la intervención del equipo multidisciplinar. Conclusiones: La institucionalización supone un gran cambio para el anciano y su familia, el cual se irá superando hasta considerarlo su nuevo hogar

Mortality and pulmonary complications in patients undergoing surgery with perioperative SARS-CoV-2 infection: an international cohort study

Background: The impact of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) on postoperative recovery needs to be understood to inform clinical decision making during and after the COVID-19 pandemic. This study reports 30-day mortality and pulmonary complication rates in patients with perioperative SARS-CoV-2 infection. Methods: This international, multicentre, cohort study at 235 hospitals in 24 countries included all patients undergoing surgery who had SARS-CoV-2 infection confirmed within 7 days before or 30 days after surgery. The primary outcome measure was 30-day postoperative mortality and was assessed in all enrolled patients. The main secondary outcome measure was pulmonary complications, defined as pneumonia, acute respiratory distress syndrome, or unexpected postoperative ventilation. Findings: This analysis includes 1128 patients who had surgery between Jan 1 and March 31, 2020, of whom 835 (74·0%) had emergency surgery and 280 (24·8%) had elective surgery. SARS-CoV-2 infection was confirmed preoperatively in 294 (26·1%) patients. 30-day mortality was 23·8% (268 of 1128). Pulmonary complications occurred in 577 (51·2%) of 1128 patients; 30-day mortality in these patients was 38·0% (219 of 577), accounting for 81·7% (219 of 268) of all deaths. In adjusted analyses, 30-day mortality was associated with male sex (odds ratio 1·75 [95% CI 1·28–2·40], p\textless0·0001), age 70 years or older versus younger than 70 years (2·30 [1·65–3·22], p\textless0·0001), American Society of Anesthesiologists grades 3–5 versus grades 1–2 (2·35 [1·57–3·53], p\textless0·0001), malignant versus benign or obstetric diagnosis (1·55 [1·01–2·39], p=0·046), emergency versus elective surgery (1·67 [1·06–2·63], p=0·026), and major versus minor surgery (1·52 [1·01–2·31], p=0·047). Interpretation: Postoperative pulmonary complications occur in half of patients with perioperative SARS-CoV-2 infection and are associated with high mortality. Thresholds for surgery during the COVID-19 pandemic should be higher than during normal practice, particularly in men aged 70 years and older. Consideration should be given for postponing non-urgent procedures and promoting non-operative treatment to delay or avoid the need for surgery. Funding: National Institute for Health Research (NIHR), Association of Coloproctology of Great Britain and Ireland, Bowel and Cancer Research, Bowel Disease Research Foundation, Association of Upper Gastrointestinal Surgeons, British Association of Surgical Oncology, British Gynaecological Cancer Society, European Society of Coloproctology, NIHR Academy, Sarcoma UK, Vascular Society for Great Britain and Ireland, and Yorkshire Cancer Research

Age–sex differences in the global burden of lower respiratory infections and risk factors, 1990–2019: results from the Global Burden of Disease Study 2019

Summary Background The global burden of lower respiratory infections (LRIs) and corresponding risk factors in children older than 5 years and adults has not been studied as comprehensively as it has been in children younger than 5 years. We assessed the burden and trends of LRIs and risk factors across all age groups by sex, for 204 countries and territories. Methods In this analysis of data for the Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) 2019, we used clinician-diagnosed pneumonia or bronchiolitis as our case definition for LRIs. We included International Classification of Diseases 9th edition codes 079.6, 466–469, 470.0, 480–482.8, 483.0–483.9, 484.1–484.2, 484.6–484.7, and 487–489 and International Classification of Diseases 10th edition codes A48.1, A70, B97.4–B97.6, J09–J15.8, J16–J16.9, J20–J21.9, J91.0, P23.0–P23.4, and U04–U04.9. We used the Cause of Death Ensemble modelling strategy to analyse 23 109 site-years of vital registration data, 825 site-years of sample vital registration data, 1766 site-years of verbal autopsy data, and 681 site-years of mortality surveillance data. We used DisMod-MR 2.1, a Bayesian meta-regression tool, to analyse age–sex-specific incidence and prevalence data identified via systematic reviews of the literature, population-based survey data, and claims and inpatient data. Additionally, we estimated age–sex-specific LRI mortality that is attributable to the independent effects of 14 risk factors. Findings Globally, in 2019, we estimated that there were 257 million (95% uncertainty interval [UI] 240–275) LRI incident episodes in males and 232 million (217–248) in females. In the same year, LRIs accounted for 1·30 million (95% UI 1·18–1·42) male deaths and 1·20 million (1·07–1·33) female deaths. Age-standardised incidence and mortality rates were 1·17 times (95% UI 1·16–1·18) and 1·31 times (95% UI 1·23–1·41) greater in males than in females in 2019. Between 1990 and 2019, LRI incidence and mortality rates declined at different rates across age groups and an increase in LRI episodes and deaths was estimated among all adult age groups, with males aged 70 years and older having the highest increase in LRI episodes (126·0% [95% UI 121·4–131·1]) and deaths (100·0% [83·4–115·9]). During the same period, LRI episodes and deaths in children younger than 15 years were estimated to have decreased, and the greatest decline was observed for LRI deaths in males younger than 5 years (–70·7% [–77·2 to –61·8]). The leading risk factors for LRI mortality varied across age groups and sex. More than half of global LRI deaths in children younger than 5 years were attributable to child wasting (population attributable fraction [PAF] 53·0% [95% UI 37·7–61·8] in males and 56·4% [40·7–65·1] in females), and more than a quarter of LRI deaths among those aged 5–14 years were attributable to household air pollution (PAF 26·0% [95% UI 16·6–35·5] for males and PAF 25·8% [16·3–35·4] for females). PAFs of male LRI deaths attributed to smoking were 20·4% (95% UI 15·4–25·2) in those aged 15–49 years, 30·5% (24·1–36·9) in those aged 50–69 years, and 21·9% (16·8–27·3) in those aged 70 years and older. PAFs of female LRI deaths attributed to household air pollution were 21·1% (95% UI 14·5–27·9) in those aged 15–49 years and 18·2% (12·5–24·5) in those aged 50–69 years. For females aged 70 years and older, the leading risk factor, ambient particulate matter, was responsible for 11·7% (95% UI 8·2–15·8) of LRI deaths. Interpretation The patterns and progress in reducing the burden of LRIs and key risk factors for mortality varied across age groups and sexes. The progress seen in children younger than 5 years was clearly a result of targeted interventions, such as vaccination and reduction of exposure to risk factors. Similar interventions for other age groups could contribute to the achievement of multiple Sustainable Development Goals targets, including promoting wellbeing at all ages and reducing health inequalities. Interventions, including addressing risk factors such as child wasting, smoking, ambient particulate matter pollution, and household air pollution, would prevent deaths and reduce health disparities

Search for CPCP violation in D0^0→\to KS0^0_\mathrm{S}KS0^0_\mathrm{S} decays in proton-proton collisions at s\sqrt{s} = 13 TeV

International audienceA search is reported for charge-parity D$^0$$\to$ K$^0_\mathrm{S}$K$^0_\mathrm{S}$$CP$ violation in D$^0$$\to$ K$^0_\mathrm{S}$K$^0_\mathrm{S}$ decays, using data collected in proton-proton collisions at $\sqrt{s}$ = 13 TeV recorded by the CMS experiment in 2018. The analysis uses a dedicated data set that corresponds to an integrated luminosity of 41.6 fb$^{-1}$, which consists of about 10 billion events containing a pair of ẖadrons, nearly all of which decay to charm hadrons. The flavor of the neutral D meson is determined by the pion charge in the reconstructed decays D$^{*+}$$\to$ D$^0\pi^+$ and D$^{*-}$$\to$ D$^0\pi^-$. The D$^0$$\to$ K$^0_\mathrm{S}$K$^0_\mathrm{S}$$CP$ asymmetry in D$^0$$\to$ K$^0_\mathrm{S}$K$^0_\mathrm{S}$ is measured to be $A_{CP}$( K$^0_\mathrm{S}$K$^0_\mathrm{S}$) = (6.2 $\pm$ 3.0 $\pm$ 0.2 $\pm$ 0.8)%, where the three uncertainties represent the statistical uncertainty, the systematic uncertainty, and the uncertainty in the measurement of the D$^0$ $\to$ K$^0_\mathrm{S}$K$^0_\mathrm{S}$ $CP$ asymmetry in the D$^0$ $\to$ K$^0_\mathrm{S}\pi^+\pi^-$ decay. This is the first D$^0$ $\to$ K$^0_\mathrm{S}$K$^0_\mathrm{S}$ $CP$ asymmetry measurement by CMS in the charm sector as well as the first to utilize a fully hadronic final state

Observation of the Ξb−\Xi^-_\mathrm{b}→\toψ\psi(2S)Ξ−\Xi^- decay and studies of the Ξb∗0\Xi_\mathrm{b}^{\ast{}0} baryon in proton-proton collisions at s\sqrt{s} = 13 TeV

International audienceThe first observation of the decay $\Xi^-_\mathrm{b}$$\to$$\psi$(2S)$\Xi^-$ and measurement of the branching ratio of $\Xi^-_\mathrm{b}$$\to$$\psi$(2S)$\Xi^-$ to $\Xi^-_\mathrm{b}$$\to$ J/$\psi$$\Xi^-$ are presented. The J/$\psi$ and $\psi$(2S) mesons are reconstructed using their dimuon decay modes. The results are based on proton-proton colliding beam data from the LHC collected by the CMS experiment at $\sqrt{s}$ = 13 TeV in 2016-2018, corresponding to an integrated luminosity of 140 fb$^{-1}$. The branching fraction ratio is measured to be $\mathcal{B}$($\Xi^-_\mathrm{b}$$\to$$\psi$(2S)$\Xi^-$)/$\mathcal{B}$($\Xi^-_\mathrm{b}$$\to$ J/$\psi$$\Xi^-$) = 0.84$^{+0.21}_{-0.19}$ (stat) $\pm$ 0.10 (syst) $\pm$ 0.02 ($\mathcal{B}$), where the last uncertainty comes from the uncertainties in the branching fractions of the charmonium states. New measurements of the $\Xi_\mathrm{b}^{\ast{}0}$ baryon mass and natural width are also presented, using the $\Xi_\mathrm{b}^-\pi^+$ final state, where the $\Xi^-_\mathrm{b}$ baryon is reconstructed through the decays J/$\psi \Xi^-$, $\psi$(2S)$\Xi^-$, J/$\psi \Lambda$K$^-$, and J/$\psi \Sigma^0$K$^-$. Finally, the fraction of the $\Xi^-_\mathrm{b}$ baryons produced from $\Xi_\mathrm{b}^{\ast{}0}$ decays is determined

Search for the decay of the Higgs boson to a pair of light pseudoscalar bosons in the final state with four bottom quarks in proton-proton collisions at s\sqrt{s} = 13 TeV

International audienceA search is presented for the decay of the 125 GeV Higgs boson (H) to a pair of new light pseudoscalar bosons (a), followed by the prompt decay of each a boson to a bottom quark-antiquark pair, H $\to$ aa $\to$$\mathrm{b\bar{b}b\bar{b}}$. The analysis is performed using a data sample of proton-proton collisions collected with the CMS detector at a center-of-mass energy of 13 TeV, corresponding to an integrated luminosity of 138 fb$^{-1}$. To reduce the background from standard model processes, the search requires the Higgs boson to be produced in association with a leptonically decaying W or Z boson. The analysis probes the production of new light bosons in a 15 $\lt$$m_\mathrm{a}$$\lt$ 60 GeV mass range. Assuming the standard model predictions for the Higgs boson production cross sections for pp $\to$ WH and ZH, model independent upper limits at 95% confidence level are derived for the branching fraction $\mathcal{B}$(H $\to$ aa $\to$ $\mathrm{b\bar{b}b\bar{b}}$). The combined WH and ZH observed upper limit on the branching fraction ranges from 1.10 for $m_\mathrm{a} =$ 20 GeV to 0.36 for $m_\mathrm{a} =$ 60 GeV, complementing other measurements in the $\mu\mu\tau\tau$, $\tau\tau\tau\tau$ and bb$\ell\ell$ ($\ell=$ $\mu$,$\tau$) channels

Observation of the J/ψ\psi →\to μ+μ−μ+μ−\mu^+\mu^-\mu^+\mu^- decay in proton-proton collisions at s\sqrt{s} = 13 TeV

International audienceThe J/$\psi$$\to$$\mu^+\mu^-\mu^+\mu^-$ decay has been observed with a statistical significance in excess of five standard deviations. The analysis is based on an event sample of proton-proton collisions at a center-of-mass energy of 13 TeV, collected by the CMS experiment in 2018 and corresponding to an integrated luminosity of 33.6 fb${-1}$. Normalizing to the J/$\psi$$\to$$\mu^+\mu^-$ decay mode leads to a branching fraction [10.1$^{+3.3}_{-2.7}$ (stat) $\pm$ 0.4 (syst) ]$\times$ 10$^{-7}$, a value that is consistent with the standard model prediction

Search for new resonances decaying to pairs of merged diphotons in proton-proton collisions at s\sqrt{s} = 13 TeV

International audienceA search is presented for an extended Higgs sector with two new particles, X and $\phi$, in the process X $\to$$\phi\phi$$\to$$(\gamma\gamma)(\gamma\gamma)$. Novel neural networks classify events with diphotons that are merged and determine the diphoton masses. The search uses LHC proton-proton collision data at $\sqrt{s}$ = 13 TeV collected with the CMS detector, corresponding to an integrated luminosity of 138 fb$^{-1}$. No evidence of such resonances is seen. Upper limits are set on the production cross section versus the resonance masses, representing the most sensitive search in this channel

Enriching the physics program of the CMS experiment via data scouting and data parking

International audienceSpecialized data-taking and data-processing techniques were introduced by the CMS experiment in Run 1 of the CERN LHC to enhance the sensitivity of searches for new physics and the precision of standard model measurements. These techniques, termed data scouting and data parking, extend the data-taking capabilities of CMS beyond the original design specifications. The novel data-scouting strategy trades complete event information for higher event rates, while keeping the data bandwidth within limits. Data parking involves storing a large amount of raw detector data collected by algorithms with low trigger thresholds to be processed when sufficient computational power is available to handle such data. The research program of the CMS Collaboration is greatly expanded with these techniques. The implementation, performance, and physics results obtained with data scouting and data parking in CMS over the last decade are discussed in this Report, along with new developments aimed at further improving low-mass physics sensitivity over the next years of data taking

Observation of the J/ψ\psi→\toμ+μ−μ+μ−\mu^+\mu^-\mu^+\mu^- decay in proton-proton collisions at s\sqrt{s} = 13 TeV

International audienceThe J/$\psi$$\to$$\mu^+\mu^-\mu^+\mu^-$ decay has been observed with a statistical significance in excess of five standard deviations. The analysis is based on an event sample of proton-proton collisions at a center-of-mass energy of 13 TeV, collected by the CMS experiment in 2018 and corresponding to an integrated luminosity of 33.6 fb${-1}$. Normalizing to the J/$\psi$$\to$$\mu^+\mu^-$ decay mode leads to a branching fraction [10.1$^{+3.3}_{-2.7}$ (stat) $\pm$ 0.4 (syst) ]$\times$ 10$^{-7}$, a value that is consistent with the standard model prediction