Factors Related to Greater Functional Recovery after Suffering a Stroke

[Abstract] Background: In a stroke, the importance of initial functional status is fundamental for prognosis. The aim of the current study was to investigate functional status, assessed by the Functional Independence Measure (FIM) scale, and possible predictors of functional outcome at discharge from inpatient rehabilitation. Methods: This is a retrospective study that was carried out at the Physical Medicine and Rehabilitation Service in A Coruña (Spain). A total of 365 consecutive patients with primary diagnosis of stroke were enrolled. The functional assessments of all patients were performed through the FIM. A descriptive and a bivariate analysis of the variables included in the study was made and a succession of linear regression models was used to determine which variables were associated with the total FIM at discharge. Results: Prior to having the stroke, 76.7% were totally independent in activities of daily living. The FIM scale score was 52.5 ± 25.5 points at admission and 83.4 ± 26.3 at hospital discharge. The multivariate analysis showed that FIM scores on admission were the most important predictors of FIM outcomes. Conclusions: Our study indicates that the degree of independence prior to admission after suffering a stroke is the factor that will determine the functionality of patients at hospital discharge

Gender-based violence attitudes and dating violence experiences of students in nursing and other health sciences: a multicentre cross-sectional study

[Abstract] Background: Gender-based violence is a major public health problem. Healthcare providers' ability to identify this type of violence and support victims may be influenced by their knowledge, attitudes, and beliefs, which requires solid education. Objectives: To identify the gender-based violence attitudes and dating violence experiences of students in nursing and other health sciences. Design: A multicentre cross-sectional study was performed. Settings: This study was conducted in three faculties of the University of A Coruña, Spain. Participants: Participants were undergraduate students of nursing, podiatry, occupational therapy, and physiotherapy. Methods: The Attitudes towards Gender and Violence Questionnaire and the Dating Violence Questionnaire were used from October 2019 to March 2020. Descriptive and inferential statistics were calculated to determine associated factors and identify differences in gender-based violence attitudes and dating violence experiences between sexes and degrees. Results: Data from 459 students were analysed, of whom 180 (39.2 %) studied nursing. The mean age was 20.9 (SD = 3.6) and 76.0 % were women. Statistically significant differences were obtained in attitudes towards gender-based violence according to sex where men displayed more sexist attitudes and violence justification. Results showed a significant difference in attitudes regarding the biological usefulness of sexism and violence between students of nursing and other health sciences. 61.9 % of students had experienced one or more abusive behaviours in relationships; no significant differences were detected according to the degree. However, male students experienced dating violence more often than females. It was observed that students who had suffered dating violence showed greater agreement with sexist attitudes that justify violence. Conclusion: Students of health sciences, particularly males and nursing students, show sexist attitudes that justify gender-based violence. They also frequently experience dating violence, especially psychological violence. It is necessary to intensify or include education on these types of violence in the curricula of degrees in health sciences

Podiatric skin and nail involvement and biomechanical pathology in renal transplant recipients: assessment of the foot as a contributing factor to their health

[Abstract] Although several studies show the prevalence of podiatric conditions in people with end-stage renal disease or renal replacement therapy with hemodialysis, there is little scientific literature on this when subjects are undergoing kidney transplantation. The aim of this study is to determine the prevalence of podiatric skin and nail pathology in renal transplant recipients. A descriptive, observational, prevalence study was conducted at the Nephrology Department of the University Hospital of A Coruña. A total of 371 subjects were studied. The variables studied were sociodemographic (age, sex), anthropometric (Body Mass Index), comorbidity (Charlson Comorbidity Index), and podological (skin and nail alterations). A high presence of skin (83.1%) and nail pathology (85.4%) was observed, with hyperkeratosis (68.8%), onychogryphosis (39.4%), and onychocryptosis (36.9%) being the most predominant alterations. Although it was not significant, patients with a higher risk of presenting podiatric pathology were of female sex and had a high BMI, and both age and the Charlson comorbidity index were significantly associated with this risk. There was an increased risk of both skin and nail pathology at older age and in the presence of diabetes mellitus

Tasa de sudoración y factores ambientales en regatistas juveniles de clase Láser

Summary Introduction: Recent studies have reported differences in sweat rate (SR) in laser class (LC) sailors under extreme environ-mental conditions (EC). This study aimed to determine a ‘standard-like’ SR in junior Laser 4.7 sailors under ‘not-extreme’ weather conditions to achieve an adequate fluid replacement rate for training and racing sessions. Additionally, we analysed the hypothetical relationship between SR and certain environmental factors, not just considering them as independent variables, but also including them as a whole factor, usually known as ‘windchill’ (WCh).Material and method: Nine male elite junior Laser 4.7 class athletes were included in this descriptive study. They were mo-nitored during the entire year of training and racing sessions, including national and international championships. Body mass changes as well as their food and fluid intake were measured for each sailor before and after sailing to estimate SR, absolute body mass change, and percentage body mass variation for all the sessions. Athletes were asked to maintain “ab libitum” fluid and food intake during the study. Environmental temperature, wind speed, and relative humidity were measured.Results: Significant differences (p = 0.012) were observed between training and racing sessions with respect to SR, 0.18 (± 0.14) L.h−1vs. 0.23 (± 0.12 L.h−1). Environmental temperature and WCh during racing showed an inverse relationship with SR.Discussion: This result suggests that increased fluid and food intake are required under cold weather conditions to maintain the ‘target’ weight during the competitions and improve performance.Resumen Introducción: Recientemente, algunos estudios han reportado diferencias en la tasa de sudoración (SR) en regatistas de clase láser (LC) bajo condiciones ambientales (EC) extremas. Este estudio pretende determinar una especie de “SR standard” en regatistas juveniles de Láser 4.7 bajo condiciones “no extremas”, con el objetivo de alcanzar una adecuada reposición de líquidos tanto para entrenamientos como en competición. Adicionalmente, se ha analizado una hipotética relación entre SR y los factores ambientales, considerándolos no únicamente como variables independientes, sino también como una variable compleja, conocida habitualmente como “sensación térmica” (WCh).Material y método: Nueve regatistas juveniles de Láser 4.7 han participado en este estudio descriptivo y prospectivo. Todos ellos han sido monitorizados durante todo un año de sesiones de entrenamiento y competición, incluyendo regatas nacio-nales como internacionales. Los cambios en la masa corporal, así como la ingesta de líquidos y sólidos han sido registrados de forma individual para cada regatista, antes y después de cada sesión para estimar la SR, los cambios totales en la masa corporal, así como las variaciones en el porcentaje de masa corporal. Se instó a los regatistas a ingerir comida y bebida “ab libidtum” a lo largo del estudio. La temperatura ambiental, la intensidad de viento y la humedad relativa fueron registradas.Resultados: Se observaron diferencias significativas (p = 0,012) para la SR entre los entrenos y las competiciones 0,18 (± 0,14) L.h−1vs. 0,23 (± 0,12 L.h−1). La temperatura ambiental y la WCh durante las competiciones mostraron además una relacióninversa con la SR.Discusión: Estos resultados sugieren que una mayor ingesta de líquidos y sólidos bajo condiciones de “frío ambiental” es necesaria para mantener el peso ideal, mejorando así el rendimiento durante la competición

Description of multimorbidity clusters of admitted patients in medical departments of a general hospital

Review[Abstract] Objective: We aim to identify patterns of disease clusters among inpatients of a general hospital and to describe the characteristics and evolution of each group. Methods: We used two data sets from the CMBD (Conjunto mínimo básico de datos - Minimum Basic Hospital Data Set (MBDS)) of the Lucus Augusti Hospital (Spain), hospitalisations and patients, realising a retrospective cohort study among the 74 220 patients discharged from the Medic Area between 01 January 2000 and 31 December 2015. We created multimorbidity clusters using multiple correspondence analysis. Results: We identified five clusters for both gender and age. Cluster 1: alcoholic liver disease, alcoholic dependency syndrome, lung and digestive tract malignant neoplasms (age under 50 years). Cluster 2: large intestine, prostate, breast and other malignant neoplasms, lymphoma and myeloma (age over 70, mostly males). Cluster 3: malnutrition, Parkinson disease and other mobility disorders, dementia and other mental health conditions (age over 80 years and mostly women). Cluster 4: atrial fibrillation/flutter, cardiac failure, chronic kidney failure and heart valve disease (age between 70-80 and mostly women). Cluster 5: hypertension/hypertensive heart disease, type 2 diabetes mellitus, ischaemic cardiomyopathy, dyslipidaemia, obesity and sleep apnea, including mostly men (age range 60-80). We assessed significant differences among the clusters when gender, age, number of chronic pathologies, number of rehospitalisations and mortality during the hospitalisation were assessed (p<0001 in all cases). Conclusions: We identify for the first time in a hospital environment five clusters of disease combinations among the inpatients. These clusters contain several high-incidence diseases related to both age and gender that express their own evolution and clinical characteristics over time

Oral glucose-stimulated growth hormone (GH) test in adult GH deficiency patients and controls: potential utility of a novel test

[Abstract] Context. The diagnosis of adult GH deficiency requires confirmation with a GH stimulation test. Oral glucose (OG) administration affects GH secretion, initially decreasing and subsequently stimulating GH secretion. Objective. The aim of this study was to investigate the diagnostic efficacy and safety of a long OG test (LOGT) as a stimulus of GH secretion for the diagnosis of adult GH deficiency (AGHD). Design. Prospective experimental cross-sectional study. Settings. The study was conducted at the Endocrinology department of the University Hospital of a Coruña, Spain. Participants and methods. We included 60 (40 women) AGHD patients (15) and controls (45) paired 1:3, of similar age, sex and BMI. The area under the curve (AUC) and peak were calculated for GH. The Mann-Whitney test was used to compare the different groups. ROC curve analyses were used. p-Values < 0.05 were considered as statistically significant. Interventions. The intervention consisted of orally administering 75 g oral glucose administration; GH was obtained every 30 min for a total of 300 min. Main outcome measurement. Peak GH area under receiver operating characteristic curve (ROC-AUC) following LOGT. Results. Peak GH (μg/L) levels were lower in the AGHD patients (0.26 ± 0.09) than in the controls (4.00 ± 0.45), p < 0.001. After LOGT, with the ROC plot analysis the best peak GH cut-point was 1.0 μg/L, with 100% sensitivity, 78% specificity, ROC-AUC of 0.9089 and 81.82% accuracy. There were no relevant adverse events during any of the LOGT. Conclusions. The LOGT could be a cheap, safe, convenient and effective test for the diagnosis of AGHD.Instituto de Salud Carlos III; PI13/00322Instituto de Salud Carlos III; PI16/00884Xunta de Galicia; 10CSA916014P

Concordance among methods of nutritional assessment in patients included on the waiting list for liver transplantation

[Abstract] Background: The aim of the present study was to determine the extent of malnutrition in patients waiting for a liver transplant. The agreement among the methods of nutritional assessment and their diagnostic validity were evaluated. Methods: Patients on the waiting list for liver transplantation (n = 110) were studied. The variables were: body mass index, analytical parameters, liver disease etiology, and complications. Liver dysfunction was evaluated using the Child-Pugh Scale. Nutritional state was studied using the Controlling Nutritional Status (CONUT), the Spanish Society of Parenteral and Enteral Nutrition (SENPE) criteria, the Nutritional Risk Index (NRI), the Prognostic Nutritional Index (PNI-O), and the Subjective Global Assessment (SGA). Agreement was determined using the Kappa index. Area under receiver operator characteristic curves (AUCs), the Youden index (J), and likelihood ratios were computed. Results: Malnutrition varied depending on the method of evaluation. The highest value was detected using the CONUT (90.9%) and the lowest using the SGA (50.9%). The pairwise agreement among the methods ranged from K = 0.041 to K = 0.826, with an overall agreement of each criteria with the remaining methods between K = 0.093 and K = 0.364. PNI-O was the method with the highest overall agreement. Taking this level of agreement into account, we chose the PNI-O as a benchmark method of comparison. The highest positive likelihood ratio for the diagnosis of malnutrition was obtained from the Nutritional Risk Index (13.56). Conclusions: Malnutrition prevalence is high and prevalence estimates vary according the method used, with low concordance among methods. PNI-O and NRI are the most consistent methods to identify malnutrition in these patients.Instituto de Salud Carlos III; PI11/012

Relationship of Body Mass Index and Footprint Morphology to the Actual Height of the Medial Longitudinal Arch of the Foot

[Abstract] The medial longitudinal arch height of the foot is linked to individual characteristics such as sex and body mass index, and these characteristics have been shown to be associated with conditions such as flat feet. In this cross-sectional descriptive study, we examined the medial longitudinal arch morphology in an adult population to determine if there are differences related to sex and body mass index, and values were obtained for the foot posture index. Normalized anthropometric measurements and arch indices were calculated from footprints. Groups, defined by sex and body mass index, were compared, and the correlations between body mass index and the variables were determined. In the population studied (266 women and 177 men), significant differences between men and women for the foot posture index and normalized arch measurements were found. Analysis of the variables related to body mass index indicated there were significant differences in arch indices. Significant differences and positive correlations were also found between the arch index and body mass index for the left and right feet among the men and women studied. The results obtained allow us to reflect on and analyze whether the medial longitudinal arch morphology classification methods used in the clinical and research setting are adequate or whether the influence of factors such as body mass index can generate confusion

Effectiveness of rotavirus vaccination in Spain

[Abstract] With the aim of determining rotavirus vaccine effectiveness (RVVE) in Spain, from Oct-2008/Jun-2009, 467 consecutive children below 2 years old with acute gastroenteritis (AGE) were recruited using a pediatric research network (ReGALIP-www.regalip.org) that includes primary, emergency and hospital care settings. Of 467 enrolled children, 32.3% were rotavirus positive and 35.0% had received at least one dose of any rotavirus vaccine. RRVE to prevent any episode of rotavirus AGE was 91.5% (95% CI: 83.7%-95.6%). RVVE to prevent hospitalization by rotavirus AGE was 95.6% (85.6-98.6%). No differences in RVVE were found regarding the vaccine used. Rotavirus vaccines have showed an outstanding effectiveness in Spain.Xunta de Galicia; 10PXIB918184PRInstituto de Salud Carlos III; RHI07/2Instituto de Salud Carlos III; PS0974

Effect of diagnostic delay on survival in patients with colorectal cancer: a retrospective cohort study

[Abstract] Background. Disparate and contradictory results make studies necessary to investigate in more depth the relationship between diagnostic delay and survival in colorectal cancer (CRC) patients. The aim of this study is to analyse the relationship between the interval from first symptom to diagnosis (SDI) and survival in CRC. Methods. Retrospective study of n = 942 CRC patients. SDI was calculated as the time from the diagnosis of cancer and the first symptoms of CRC. Cox regression was used to estimate five-year mortality hazard ratios as a function of SDI, adjusting for age and gender. SDI was modelled according to SDI quartiles and as a continuous variable using penalized splines. Results. Median SDI was 3.4 months. SDI was not associated with stage at diagnosis (Stage I = 3.6 months, Stage II-III = 3.4, Stage IV = 3.2; p = 0.728). Shorter SDIs corresponded to patients with abdominal pain (2.8 months), and longer SDIs to patients with muchorrhage (5.2 months) and rectal tenesmus (4.4 months). Adjusting for age and gender, in rectum cancers, patients within the first SDI quartile had lower survival (p = 0.003), while in colon cancer no significant differences were found (p = 0.282). These results do not change after adjusting for TNM stage. The splines regression analysis revealed that, for rectum cancer, 5-year mortality progressively increases for SDIs lower than the median (3.7 months) and decreases as the delay increases until approximately 8 months. In colon cancer, no significant relationship was found between SDI and survival. Conclusions. Short diagnostic intervals are significantly associated with higher mortality in rectal but not in colon cancers, even though a borderline significant effect is also observed in colon cancer. Longer diagnostic intervals seemed not to be associated with poorer survival. Other factors than diagnostic delay should be taken into account to explain this “waiting-time paradox”.Instituto de Salud Carlos III; PI14/ 00781Xunta de Galicia; PGIDIT06BTF91601P