Adherence to antibiotic treatment guidelines and outcomes in the hospitalized elderly with different types of pneumonia

Background: Few studies evaluated the clinical outcomes of Community Acquired Pneumonia (CAP), Hospital-Acquired Pneumonia (HAP) and Health Care-Associated Pneumonia (HCAP) in relation to the adherence of antibiotic treatment to the guidelines of the Infectious Diseases Society of America (IDSA) and the American Thoracic Society (ATS) in hospitalized elderly people (65 years or older). Methods: Data were obtained from REPOSI, a prospective registry held in 87 Italian internal medicine and geriatric wards. Patients with a diagnosis of pneumonia (ICD-9 480-487) or prescribed with an antibiotic for pneumonia as indication were selected. The empirical antibiotic regimen was defined to be adherent to guidelines if concordant with the treatment regimens recommended by IDSA/ATS for CAP, HAP, and HCAP. Outcomes were assessed by logistic regression models. Results: A diagnosis of pneumonia was made in 317 patients. Only 38.8% of them received an empirical antibiotic regimen that was adherent to guidelines. However, no significant association was found between adherence to guidelines and outcomes. Having HAP, older age, and higher CIRS severity index were the main factors associated with in-hospital mortality. Conclusions: The adherence to antibiotic treatment guidelines was poor, particularly for HAP and HCAP, suggesting the need for more adherence to the optimal management of antibiotics in the elderly with pneumonia

Trends in Argentine consumption of local vegetables and fruits “Km 0”

La promoción de una alimentación adecuada que incluya una dieta rica en hortalizas y frutas (H y F), inocuas, de calidad y de origen conocido, es un aspecto fundamental para la salud de la población y representa un desafío para las instituciones. En tal sentido, y con el objetivo de estudiar el grado de conocimiento e importancia otorgada por los consumidores a las hortalizas y frutas locales y regionales (“Km 0”) y las Buenas Prácticas Agrícolas (BPA), se realizó la encuesta on line (formulario de Google) Realidad del consumo argentino de hortalizas “Km 0”, en el ámbito nacional argentino, en el marco de: proyecto interinstitucional “Producciones Vegetales Intensivas de Alimentos Saludables” (INTA-AUDEAS-CONADEV), como así también: programa de investigación y transferencia tecnológica “Cadena espárragos y otras hortalizas bajo un enfoque sistémico” FAA-UNCPBA, programa de Extensión “Hortalizas PRO Salud” (FAA y FCS-UNCPBA) y el Proyecto “Sistemas Agroalimentarios: Redes de valorización y diferenciación de alimentos en la construcción de territorios sustentables” (FCA-UNMdP). Los resultados evidencian, por un lado, el interés de la población argentina en conocer el origen de las H y F consumidas, y por otro, el desconocimiento en la categoría de productos actualmente denominados “Km 0”. En consecuencia, surge la necesidad de intensificar la difusión de BPA y de los beneficios del consumo de H y F.Fil: Castagnino, Ana Maria. Universidad Nacional del Centro de la Provincia de Buenos Aires. Facultad de Agronomía. Laboratorio de Biología Funcional y Biotecnología; ArgentinaFil: Díaz, K. E.. Universidad Nacional del Centro de la Provincia de Buenos Aires. Facultad de Agronomía. Laboratorio de Biología Funcional y Biotecnología; ArgentinaFil: Rogers, William John. Consejo Nacional de Investigaciones Científicas y Técnicas. Centro Cientifico Tecnolológico Mar del Plata. Instituto de Investigaciones en Biodiversidad y Biotecnología. Laboratorio de Biología Funcional y Biotecnología; ArgentinaFil: Rosini, María Belén. Universidad Nacional del Centro de la Provincia de Buenos Aires. Facultad de Agronomía. Laboratorio de Biología Funcional y Biotecnología; ArgentinaFil: González Ferrín, M. S.. Instituto Nacional de Tecnología Agropecuaria. Centro Regional Buenos Aires Sur. Estación Experimental Agropecuaria Barrow; ArgentinaFil: Berriolo, M. J.. Instituto Nacional de Tecnología Agropecuaria. Centro Regional Buenos Aires Sur. Estación Experimental Agropecuaria Barrow; ArgentinaFil: Zazzetta, Malvina Lis. Instituto Nacional de Tecnología Agropecuaria. Centro Regional Buenos Aires Sur. Estación Experimental Agropecuaria Hilario Ascasubi; ArgentinaFil: Cendón, María Laura. Instituto Nacional de Tecnología Agropecuaria. Centro Regional Buenos Aires Sur. Estación Experimental Agropecuaria Balcarce; ArgentinaFil: Fasciglione, Gabriela. Instituto Nacional de Tecnología Agropecuaria. Centro Regional Buenos Aires Sur. Estación Experimental Agropecuaria Balcarce; ArgentinaFil: Yommi, Alejandra Karina. Instituto Nacional de Tecnología Agropecuaria. Centro Regional Buenos Aires Sur. Estación Experimental Agropecuaria Balcarce; ArgentinaFil: Díaz, H.. Universidad Nacional del Centro de la Provincia de Buenos Aires. Facultad de Agronomía. Laboratorio de Biología Funcional y Biotecnología; ArgentinaFil: García Franco, A.. Universidad Nacional del Centro de la Provincia de Buenos Aires. Facultad de Agronomía. Laboratorio de Biología Funcional y Biotecnología; ArgentinaFil: Marina, J.. Universidad Nacional del Centro de la Provincia de Buenos Aires. Facultad de Agronomía. Laboratorio de Biología Funcional y Biotecnología; ArgentinaFil: Rubel, Irene Albertina. Universidad Nacional del Centro de la Provincia de Buenos Aires. Facultad de Agronomía. Laboratorio de Biología Funcional y Biotecnología; Argentin

USING INTERNATIONAL COLLABORATIONS TO SHAPE RESEARCH AND INNOVATION INTO CARE HOMES IN BRAZIL: A WHITE PAPER

© 2020 The Author(s).The Brazilian care home sector is underdeveloped, and the limited available evidence suggests that care quality falls below international standards. Development of the Brazilian care home sector could be associated with better outcomes for those receiving care, and more efficient use of resources across health and social care. Research has an important role to play. This article summarises research priorities for Brazilian long-term care homes developed as part of an international workshop held in Brazil and the UK, and attended by 71 clinicians and researchers from 6 Brazilian Universities, supported by an international faculty of 8 Brazilian, 8 British, 2 Dutch and 1 Austrian academics. The research priorities identified were: understanding and supporting multidisciplinary working in care homes, with emphasis on describing availability of multidisciplinary teams and how they operate; dignity and sensitivity to cultural needs, with emphasis on collating accounts from Brazilian stakeholders about dignity in care and how it can be delivered; enriching the care home environment with art, music and gardens, with a focus on developing arts in the care home space in a way that is sensitive to Brazilian cultural identity; and benchmarking quality of care, with emphasis on exploring how international quality benchmarking tools can be adapted for use in Brazilian care homes, taking account of new initiatives to include person-centred outcomes as part of benchmarking. Instrumental to research in these priority areas will be establishing care home research capacity in Brazil.Peer reviewe

Mortality rate and risk factors for gastrointestinal bleeding in elderly patients

Background: Gastrointestinal bleeding (GIB) is burdened by high mortality rate that increases with aging. Elderly patients may be exposed to multiple risk factors for GIB. We aimed at defining the impact of GIB in elderly patients. Methods: Since 2008, samples of elderly patients (age 65 65 years) with multimorbidity admitted to 101 internal medicine wards across Italy have been prospectively enrolled and followed-up (REPOSI registry). Diagnoses of GIB, length of stay (LOS), mortality rate, and possible risk factors, including drugs, index of comorbidity (Cumulative Illness Rating Scale [CIRS]), polypharmacy, and chronic diseases were assessed. Adjusted multivariate logistic regression models were computed. Results: 3872 patients were included (mean age 79 \ub1 7.5 years, F:M ratio 1.1:1). GIB was reported in 120 patients (mean age 79.6 \ub1 7.3 years, F:M 0.9:1), with a crude prevalence of 3.1%. Upper GIB occurred in 72 patients (mean age 79.3 \ub1 7.6 years, F:M 0.8:1), lower GIB in 51 patients (mean age 79.4 \ub1 7.1 years, F:M 0.9:1), and both upper/lower GIB in 3 patients. Hemorrhagic gastritis/duodenitis and colonic diverticular disease were the most common causes. The LOS of patients with GIB was 11.7 \ub1 8.1 days, with a 3.3% in-hospital and a 9.4% 3-month mortality rates. Liver cirrhosis (OR 5.64; CI 2.51\u201312.65), non-ASA antiplatelet agents (OR 2.70; CI 1.23\u20135.90), and CIRS index of comorbidity >3 (OR 2.41; CI 1.16\u20134.98) were associated with GIB (p < 0.05). Conclusions: A high index of comorbidity is associated with high odds of GIB in elderly patients. The use of non-ASA antiplatelet agents should be discussed in patients with multimorbidity