Mortalidad a corto plazo en los pacientes con insuficiencia cardiaca en estadios finales

Objectives: This study is aimed at analyzing the impact of the main factors contributing to short and long-term mortality in patients at final stages of heart failure (HF). Setting: Patients attended at any of the 279 primary health care centers belonging to the Institut Català de la Salut, in Catalonia (Spain). Participants: Patients with Advanced HF. Design: Multicenter cohort study including 1148 HF patients followed for one-year after reaching New York Heart Association (NYHA) IV. Main measurements: The primary outcome was all-cause mortality. Multivariate logistic regression models were performed to assess the outcomes at 1, 3, 6, and 12 months. Results: Mean age of patients was 82 (SD 9) years and women represented 61.7%. A total of 135 (11.8%) and 397 (34.6%) patients died three months and one year after inclusion, respectively. Male gender, age, and decreased body mass index were associated with higher mortality at three, six and twelve months. In addition, low systolic blood pressure levels, severe reduction in glomerular filtration, malignancy, and higher doses of loop diuretics were related to higher mortality from 6 to 12 months. The most important risk factor over the whole period was presenting a body mass index lower than 20 kg/m2 (three months OR 3.06, 95% CI: 1.58–5.92; six months OR 4.42, 95% CI: 2.08–9.38; and 12 months OR 3.68, 95% CI: 1.76–7.69). Conclusions: We may conclude that male, age, and decreased body mass index determined higher short-term mortality in NYHA IV. In addition, low systolic blood pressure, reduced glomerular filtration, malignancy, and higher doses of loop diuretics contribute to increasing the risk of mortality at medium and long-term. Such variables are easily measurable and can help to decide the best way to face the most advances stages of the disease.Objetivos: Analizar los factores que contribuyen a la mortalidad de pacientes en las etapas finales de la insuficiencia cardiaca (IC). Ámbito: Centros de atención primaria del Institut Català de la Salut, Cataluña, España. Participantes: Pacientes con IC avanzada. Diseño: Estudio de cohortes multicéntrico. Incluyó 1.148 pacientes de IC seguidos durante un año tras el registro de estadio funcional NYHA IV. Mediciones principales: El resultado principal fue la mortalidad por todas las causas. Se realizaron modelos de regresión logística multivariada (1, 3, 6 y 12 meses). Resultados: Edad media 82 años (DE 9), las mujeres representaron el 61,7%. Un total de 135 (11,8%) y 397 (34,6%) pacientes murieron 3 meses y un año después de su inclusión. El sexo masculino, la edad y el índice de masa corporal (IMC) < 20 kg/m2 se asociaron con una mayor mortalidad a los 3, 6 y 12 meses. Bajos niveles de presión arterial sistólica, reducción severa en el filtrado glomerular, malignidad y dosis altas de diuréticos fueron relacionadas con una mortalidad más alta de 6 a 12 meses. El factor de riesgo más importante fue un IMC < 20 kg/m2 (3 meses OR: 3,06; IC 95%: 1,58-5,92; 6 meses OR: 4,42; IC 95%: 2,08-9,38 y 12 meses OR: 3,68; IC 95%: 1,76-7,69). Conclusiones: Los varones, la edad avanzada y un IMC disminuido determinaron una mortalidad a corto plazo más alta en pacientes NYHA IV. La baja presión arterial sistólica, la reducción del filtrado glomerular, la malignidad y las dosis altas de diuréticos aumentan el riesgo de mortalidad a medio y largo plazo. Estas variables son fáciles de obtener, y pueden ayudar a decidir las mejores estrategias para afrontar los estadios más avanzados de la enfermedad

Dressing-related pain in patients with chronic wounds: an international patient perspective

This cross-sectional international survey assessed patients’ perceptions of their wound pain. A total of 2018 patients (57% female) from 15 different countries with a mean age of 68.6 years (SD = 15.4) participated. The wounds were categorised into ten different types with a mean wound duration of 19.6 months (SD = 51.8). For 2018 patients, 3361 dressings/compression systems were being used, with antimicrobials being reported most frequently (n = 605). Frequency of wound-related pain was reported as 32.2%, ‘never’ or ‘rarely’, 31.1%, ‘quite often’ and 36.6%, ‘most’ or ‘all of the time’, with venous and arterial ulcers associated with more frequent pain (P = 0.002). All patients reported that ‘the wound itself’ was the most painful location (n = 1840). When asked if they experienced dressing-related pain, 286 (14.7%) replied ‘most of the time’ and 334 (17.2%) reported pain ‘all of the time’; venous, mixed and arterial ulcers were associated with more frequent pain at dressing change (P , 0<001). Eight hundred and twelve (40.2%) patients reported that it took ,1 hour for the pain to subside after a dressing change, for 449 (22.2%) it took 1–2 hours, for 192 (9.5%) it took 3–5 hours and for 154 (7.6%) patients it took more than 5 hours. Pain intensity was measured using a visual analogue scale (VAS) (0–100) giving a mean score of 44.5 (SD = 30.5, n = 1981). Of the 1141 who reported that they generally took pain relief,21% indicated that they did not feel it was effective. Patients were asked to rate six symptoms associated with living with a chronic wound; ‘pain’ was given the highest mean score of 3.1 (n = 1898). In terms of different types of daily activities, ‘overdoing things’ was associated with the highest mean score (mean = 2.6, n = 1916). During the stages of the dressing change procedure; ‘touching/handling the wound’ was given the highest mean score of 2.9, followed by cleansing and dressing removal (n = 1944). One thousand four hundred and eighty-five (80.15%) patients responded that they liked to be actively involved in their dressing changes, 1141 (58.15%) responded that they were concerned about the long-term side-effects of medication, 790 (40.3%) of patient indicated that the pain at dressing change was the worst part of living with a wound. This study adds substantially to our knowledge of how patients experience wound pain and gives us the opportunity to explore cultural differences in more detail

Sister chromatid exchange, (SCE), High-Frequency Cells (HFCs) and SCE distribution patterns in peripheral blood lymphocytes of Spanish adult smokers compared to non-smokers

[EN] According to the International Agency for Research on Cancer, smoking tobacco is a major cause of cancer in humans. It causes about half of all male cancer deaths and an ever increasing number of cancer deaths in females. The aim of this study was to establish whether cigarette smoking increases sister chromatid exchanges (SCEs) in peripheral blood lymphocytes in two Spanish population groups; light and heavy smokers. The mean number of High-Frequency Cells (HFCs) was determined and, the SCE distribution pattern among the chromosomes was analysed represented by a ratio described below. A local sample of 101 adult smokers (n = 48) and non-smokers (n = 53), aged from 18 to 49 years, was studied using SCE levels in peripheral lymphocytes. Heavy smoking (>= 10 cigarettes per day) increased significantly the SCE frequency and the HFC parameters. Neither age nor sex significantly influenced the frequencies in the groups studied.Sebastia, N.; Hervas, D.; Almonacid, M.; Villaescusa, JI.; Soriano, JM.; Sahuquillo, V.; Esteban, V.... (2014). Sister chromatid exchange, (SCE), High-Frequency Cells (HFCs) and SCE distribution patterns in peripheral blood lymphocytes of Spanish adult smokers compared to non-smokers. Food and Chemical Toxicology. 66:107-112. doi:10.1016/j.fct.2014.01.011S1071126

Short-term mortality in end-stage heart failure patients

This study is aimed at analyzing the impact of the main factors contributing to short and long-term mortality in patients at final stages of heart failure (HF). Patients attended at any of the 279 primary health care centers belonging to the Institut Català de la Salut, in Catalonia (Spain). Patients with Advanced HF. Multicenter cohort study including 1148 HF patients followed for one-year after reaching New York Heart Association (NYHA) IV. The primary outcome was all-cause mortality. Multivariate logistic regression models were performed to assess the outcomes at 1, 3, 6, and 12 months. Mean age of patients was 82 (SD 9) years and women represented 61.7%. A total of 135 (11.8%) and 397 (34.6%) patients died three months and one year after inclusion, respectively. Male gender, age, and decreased body mass index were associated with higher mortality at three, six and twelve months. In addition, low systolic blood pressure levels, severe reduction in glomerular filtration, malignancy, and higher doses of loop diuretics were related to higher mortality from 6 to 12 months. The most important risk factor over the whole period was presenting a body mass index lower than 20 kg/m 2 (three months OR 3.06, 95% CI: 1.58-5.92; six months OR 4.42, 95% CI: 2.08-9.38; and 12 months OR 3.68, 95% CI: 1.76-7.69). We may conclude that male, age, and decreased body mass index determined higher short-term mortality in NYHA IV. In addition, low systolic blood pressure, reduced glomerular filtration, malignancy, and higher doses of loop diuretics contribute to increasing the risk of mortality at medium and long-term. Such variables are easily measurable and can help to decide the best way to face the most advances stages of the disease

Dressing-related pain in patients with chronic wounds: an international patient perspective

This cross-sectional international survey assessed patients’ perceptions of their wound pain. A total of 2018 patients (57% female) from 15 different countries with a mean age of 68.6 years (SD = 15.4) participated. The wounds were categorised into ten different types with a mean wound duration of 19.6 months (SD = 51.8). For 2018 patients, 3361 dressings/compression systems were being used, with antimicrobials being reported most frequently (n = 605). Frequency of wound-related pain was reported as 32.2%, ‘never’ or ‘rarely’, 31.1%, ‘quite often’ and 36.6%, ‘most’ or ‘all of the time’, with venous and arterial ulcers associated with more frequent pain (P = 0.002). All patients reported that ‘the wound itself’ was the most painful location (n = 1840). When asked if they experienced dressing-related pain, 286 (14.7%) replied ‘most of the time’ and 334 (17.2%) reported pain ‘all of the time’; venous, mixed and arterial ulcers were associated with more frequent pain at dressing change (P , 0<001). Eight hundred and twelve (40.2%) patients reported that it took ,1 hour for the pain to subside after a dressing change, for 449 (22.2%) it took 1–2 hours, for 192 (9.5%) it took 3–5 hours and for 154 (7.6%) patients it took more than 5 hours. Pain intensity was measured using a visual analogue scale (VAS) (0–100) giving a mean score of 44.5 (SD = 30.5, n = 1981). Of the 1141 who reported that they generally took pain relief,21% indicated that they did not feel it was effective. Patients were asked to rate six symptoms associated with living with a chronic wound; ‘pain’ was given the highest mean score of 3.1 (n = 1898). In terms of different types of daily activities, ‘overdoing things’ was associated with the highest mean score (mean = 2.6, n = 1916). During the stages of the dressing change procedure; ‘touching/handling the wound’ was given the highest mean score of 2.9, followed by cleansing and dressing removal (n = 1944). One thousand four hundred and eighty-five (80.15%) patients responded that they liked to be actively involved in their dressing changes, 1141 (58.15%) responded that they were concerned about the long-term side-effects of medication, 790 (40.3%) of patient indicated that the pain at dressing change was the worst part of living with a wound. This study adds substantially to our knowledge of how patients experience wound pain and gives us the opportunity to explore cultural differences in more detail