Medición de la fuerza de agarre de mano con dinamometría en población adulta de la Región Metropolitana

Magíster en ciencias médicas y biológicas mención nutrición.Introducción: La medición de la fuerza de agarre de mano (FAM) a través de la dinamometría presenta creciente y significativa evidencia como método de valoración nutricional. Su uso en la práctica clínica diaria aumenta la posibilidad de detección temprana de un deterioro funcional en individuos que presentan valores antropométricos normales. El objetivo principal de este estudio fue evaluar la fuerza de agarre de mano con dinamometría en población chilena sana de la Región Metropolitana, ajustado según edad y género. Además, se consideraron variables sociodemográficas, antropométricas y del estilo de vida. Métodos: Estudio analítico, observacional de corte transversal. Se midió la FAM con un dinamómetro hidráulico marca Jamar y se establecieron asociaciones con variables antropométricas, sociodemográficas y del estilo de vida mediante análisis de regresión lineal bivariado y multivariado. Resultados: Se incluyeron 535 voluntarios sanos. El 67,7% (n=362) fueron mujeres y el 32,3% (n=173) hombres. La mediana y rango intercuartílico (RIC) de edad fue 57 años (P25 43,0-P75 70,0). La mediana y RIC de FAM en mano dominante (MD) y mano no dominante (MND) fue 28,0 kg (P25 23,0-P75 32,0) y 25,5 kg (P25 21,0-P75 29,3) en mujeres y 45 kg (P25 38,0-P75 50,0) y 40 kg (P25 34,5-P75 45,5) en hombres, respectivamente. Los valores de FAM más altos se presentaron hasta los 39 años; a partir de los 40 años se observó un descenso sostenido en la FAM tanto en hombres como en mujeres. La FAM fue un 37% superior en hombres en comparación con mujeres para todos los rangos etarios (p<0,05). En el análisis bivariado todas las variables estudiadas estuvieron asociadas con FAM tanto para mano dominante como no dominante. En el modelo multivariado sólo se mantuvo asociación entre FAM y: Género (b= 11,66, 95% IC 10,14; 13,18, p<0,05), Edad (b= -0,21, 95%IC -0,24; - 0,18, p<0,05), Talla (b= 0,40, 95%IC 0,11; 0,69, p<0,05), Actividad física nivel bajo (b= - 1,37, 95% IC -2,34; -0,40, p<0,05), Actividad física nivel moderado (b= -1,07, 95% IC-1,70; -0,44, p<0,05). Conclusiones: La FAM fue un 37% superior en hombres en comparación con mujeres para todos los rangos etarios. Por cada año que envejece un individuo disminuye su FAM en 300 g en el caso de la mano dominante y en 290 g en el caso de la mano no dominante. Se encontró una asociación significativa con la estatura y el nivel de actividad física. No se encontró una relación significativa entre la FAM y el NSE. El tabaquismo y las variables antropométricas estudiadas no afectaron la FAM.Introduction: Handgrip strength (HGS) measured by dynamometry presents significant evidence as a nutritional assessment method. Its use in daily clinical practice increases the possibility of early detection of functional impairment in individuals with normal anthropometric values. The main objective of this study was to evaluate HGS in healthy chilean population of the Metropolitan Region, adjusted for age and gender. In addition, sociodemographic, anthropometric and lifestyle variables were considered. Methods: Analytical, observational cross-sectional study. The HGS was measured using the Jamar hydraulic dynamometer. Associations were established with anthropometric, sociodemographic and lifestyle variables through bivariate and multivariate linear regression analysis. Results: 535 healthy volunteers were included. 67.7% (n=362) were women and 32.3% (n=173) men. The median and interquartile range (IQR) of age was 57 years (P25 43.0-P75 70.0). The median and IQR of HGS in dominant hand (DH) and non-dominant hand (NH) was 28.0 kg (P25 23.0-P75 32.0) and 25.5 kg (P25 21.0-P75 29.3) in women and 45 kg (P25 38.0-P75 50.0) and 40 kg (P25 34.5-P75 45.5) in men, respectively. The highest grip strengths values were presented up to 39 years; after 40 years, there was a sustained decrease in HGS in both men and women. The HGS was 37% higher in men compared to women for all age range (p <0.05). In the bivariate analysis all the variables studied were associated with HGS for both dominant and non-dominant hand. In the multivariate model association was maintained between HGS and: Gender (b=11.66, 95% CI 10.14, 13.18, p <0.05), Age (b=- 0.21, 95% CI -0.24; -0.18, p <0.05), height (b = 0.40, 95% CI 0.11, 0.69, p <0.05), low level physical activity (b = -1.37, 95% CI -2.34, -0.40, p <0.05), moderate level physical activity (b = -1.07, 95% CI-1.70, -0.44, p <0.05). Conclusions: The HGS was 37% higher in men compared to women for all age range. For each year that age increases, HGS decreases by 300 g in the dominant hand and by 290 g in the case of the non-dominant hand. A significant association was found with height and low level physical activity. No significant relationship was found between HGS and the socioeconomic level. Smoking and the rest of the anthropometric variables studied did not affect HGS

Global variation in postoperative mortality and complications after cancer surgery: a multicentre, prospective cohort study in 82 countries

© 2021 The Author(s). Published by Elsevier Ltd. This is an Open Access article under the CC BY-NC-ND 4.0 licenseBackground: 80% of individuals with cancer will require a surgical procedure, yet little comparative data exist on early outcomes in low-income and middle-income countries (LMICs). We compared postoperative outcomes in breast, colorectal, and gastric cancer surgery in hospitals worldwide, focusing on the effect of disease stage and complications on postoperative mortality. Methods: This was a multicentre, international prospective cohort study of consecutive adult patients undergoing surgery for primary breast, colorectal, or gastric cancer requiring a skin incision done under general or neuraxial anaesthesia. The primary outcome was death or major complication within 30 days of surgery. Multilevel logistic regression determined relationships within three-level nested models of patients within hospitals and countries. Hospital-level infrastructure effects were explored with three-way mediation analyses. This study was registered with ClinicalTrials.gov, NCT03471494. Findings: Between April 1, 2018, and Jan 31, 2019, we enrolled 15 958 patients from 428 hospitals in 82 countries (high income 9106 patients, 31 countries; upper-middle income 2721 patients, 23 countries; or lower-middle income 4131 patients, 28 countries). Patients in LMICs presented with more advanced disease compared with patients in high-income countries. 30-day mortality was higher for gastric cancer in low-income or lower-middle-income countries (adjusted odds ratio 3·72, 95% CI 1·70–8·16) and for colorectal cancer in low-income or lower-middle-income countries (4·59, 2·39–8·80) and upper-middle-income countries (2·06, 1·11–3·83). No difference in 30-day mortality was seen in breast cancer. The proportion of patients who died after a major complication was greatest in low-income or lower-middle-income countries (6·15, 3·26–11·59) and upper-middle-income countries (3·89, 2·08–7·29). Postoperative death after complications was partly explained by patient factors (60%) and partly by hospital or country (40%). The absence of consistently available postoperative care facilities was associated with seven to 10 more deaths per 100 major complications in LMICs. Cancer stage alone explained little of the early variation in mortality or postoperative complications. Interpretation: Higher levels of mortality after cancer surgery in LMICs was not fully explained by later presentation of disease. The capacity to rescue patients from surgical complications is a tangible opportunity for meaningful intervention. Early death after cancer surgery might be reduced by policies focusing on strengthening perioperative care systems to detect and intervene in common complications. Funding: National Institute for Health Research Global Health Research Unit

Effects of hospital facilities on patient outcomes after cancer surgery: an international, prospective, observational study

© 2022 The Author(s). Published by Elsevier Ltd. This is an Open Access article under the CC BY 4.0 licenseBackground: Early death after cancer surgery is higher in low-income and middle-income countries (LMICs) compared with in high-income countries, yet the impact of facility characteristics on early postoperative outcomes is unknown. The aim of this study was to examine the association between hospital infrastructure, resource availability, and processes on early outcomes after cancer surgery worldwide. Methods: A multimethods analysis was performed as part of the GlobalSurg 3 study—a multicentre, international, prospective cohort study of patients who had surgery for breast, colorectal, or gastric cancer. The primary outcomes were 30-day mortality and 30-day major complication rates. Potentially beneficial hospital facilities were identified by variable selection to select those associated with 30-day mortality. Adjusted outcomes were determined using generalised estimating equations to account for patient characteristics and country-income group, with population stratification by hospital. Findings: Between April 1, 2018, and April 23, 2019, facility-level data were collected for 9685 patients across 238 hospitals in 66 countries (91 hospitals in 20 high-income countries; 57 hospitals in 19 upper-middle-income countries; and 90 hospitals in 27 low-income to lower-middle-income countries). The availability of five hospital facilities was inversely associated with mortality: ultrasound, CT scanner, critical care unit, opioid analgesia, and oncologist. After adjustment for case-mix and country income group, hospitals with three or fewer of these facilities (62 hospitals, 1294 patients) had higher mortality compared with those with four or five (adjusted odds ratio [OR] 3·85 [95% CI 2·58–5·75]; p<0·0001), with excess mortality predominantly explained by a limited capacity to rescue following the development of major complications (63·0% vs 82·7%; OR 0·35 [0·23–0·53]; p<0·0001). Across LMICs, improvements in hospital facilities would prevent one to three deaths for every 100 patients undergoing surgery for cancer. Interpretation: Hospitals with higher levels of infrastructure and resources have better outcomes after cancer surgery, independent of country income. Without urgent strengthening of hospital infrastructure and resources, the reductions in cancer-associated mortality associated with improved access will not be realised. Funding: National Institute for Health and Care Research