El niño con patología oncológica en la etapa final de su vida

Las enfermedades oncológicas son una causa importante de muerte en los niños, y además representa el 2% de la mortalidad por cáncer de toda la población. Las manifestaciones de la enfermedad terminal pueden ser físicas, psicológicas o emocionales. Probablemente la muerte de un hijo sea el mayor duelo al que pueda enfrentarse un individuo. Sin embargo, se sabe poco sobre cuándo y cómo los padres adquieren la certeza emocional e intelectual sobre la muerte de sus hijos enfermos por cáncer, y cómo este onocimiento afecta la morbilidad de dichos padres a largo plazo durante el duelo. Diferentes estudios han mostrado que para los niños con patología oncológica es importante hablar sobre sus síntomas y de cómo se sienten, lo cual de alguna forma ayuda a aliviar su sufrimiento. Los niños son seres únicos y la forma que tienen de relacionarse con la familia y su entorno, su desarrollo conductual, psicológico y sus necesidades son factores que se deben tener en cuenta cuando se van a tomar decisiones al final de la vida. Los estudios continúan mostrando que entre el 50 y 60% de los niños diagnosticados con cáncer mueren en el hospital, la mitad de ellos en las unidades de cuidado intensivo

Thermal Sensation in Courtyards: Potentialities as a Passive Strategy in Tropical Climates

Climate change will bring changes to our living conditions, particularly in urban areas. Climate-responsive design strategies through courtyards can help to moderate temperatures and reduce the thermal stress of its occupants. Thermal response inside courtyard is affected not only by its morphological composition but also by subjective factors. Thus, standardized thermal scales may not reflect the stress of the occupants. This study investigated the impact on thermal attenuation provided by a courtyard located in a tropical climate under extreme cold and hot synoptic conditions by means of local thermal sensation scales. Microclimatic variables were monitored, simultaneously with the application of a thermal comfort questionnaire, by using weather stations installed outside and inside the courtyard. The Modified Physiological Equivalent Temperature Index (mPET) was utilized to predict the heat stress. Calibration was conducted using linear regression to attribute particular thermal sensation votes to correspondent mPET values. It was found that thermal sensation can be affected by factors such as psychological, behavioral, and physiological. The courtyard’s form provides a passive cooling effect, stabilizing interior thermal sensation, with attenuation peaks of 6.4 °C on a cold day and 5.0 °C on a hot day. Courtyards are an alternative passive strategy to improve thermal ambience in tropical climate, counterbalancing climate change

A twofold subjective measure of income inequality

Social scientists have been aiming to calculate a “subjective income Gini coefficient”of survey respondents that would describe their beliefs about income inequality in their country. Niehues (Subjective perceptions of inequality and redistributive preferences: an international comparison, Cologne Institute for Economic Research, IWTRENDS Discussion Paper, 2014) derives this estimate from respondents’ beliefs about the relative sizes of different social classes (answers to “shape of society” questions), while Kuhn (The individual perception of wage inequality: a measurement framework and some empirical evidence, Technical report, Institute of Labor Economics (IZA), 2015) estimates it using beliefs about the pay structure. We combine their efforts to calculate what we call a twofold subjective Gini coefficient, which incorporates both pieces of information independently from one another. We present the country-level distribution of perceived and desired twofold subjective Gini coefficients using the ISSP Social Inequality V survey (ISSP Research Group in International social survey programme: social inequalityv—issp 2019, 2019. https://doi.org/10.4225/13/511C71F8612C3 ). Accounting for both subjective class structure and pay structure yields much lower perceived and desired levels of inequality. At the country level the averages of the twofold subjective Gini coefficients are closer to actual income Gini coefficients than the previous measures. At the individual level the twofold subjective Gini coefficients are better predictors of the individual’s verbal assessment of inequality and their preferences towards redistribution

Technical Challenges for the Head-on Collisions and Extraction at the ILC

An interaction region with head-on collisions is considered as an alternative to the baseline ILC configuration. Progress in the final focus optics design includes engineered large bore superconducting final doublet magnets and their 3D magnetic integration in the detector solenoids. Progress on the beam separation optics is based on technical designs of electrostatic separator and special extraction quadrupoles. The spent beam extraction is realized by a staged collimation scheme relying on realistic collimators

Prescription appropriateness of anti-diabetes drugs in elderly patients hospitalized in a clinical setting: evidence from the REPOSI Register

Diabetes is an increasing global health burden with the highest prevalence (24.0%) observed in elderly people. Older diabetic adults have a greater risk of hospitalization and several geriatric syndromes than older nondiabetic adults. For these conditions, special care is required in prescribing therapies including anti- diabetes drugs. Aim of this study was to evaluate the appropriateness and the adherence to safety recommendations in the prescriptions of glucose-lowering drugs in hospitalized elderly patients with diabetes. Data for this cross-sectional study were obtained from the REgistro POliterapie-Società Italiana Medicina Interna (REPOSI) that collected clinical information on patients aged ≥ 65 years acutely admitted to Italian internal medicine and geriatric non-intensive care units (ICU) from 2010 up to 2019. Prescription appropriateness was assessed according to the 2019 AGS Beers Criteria and anti-diabetes drug data sheets.Among 5349 patients, 1624 (30.3%) had diagnosis of type 2 diabetes. At admission, 37.7% of diabetic patients received treatment with metformin, 37.3% insulin therapy, 16.4% sulfonylureas, and 11.4% glinides. Surprisingly, only 3.1% of diabetic patients were treated with new classes of anti- diabetes drugs. According to prescription criteria, at admission 15.4% of patients treated with metformin and 2.6% with sulfonylureas received inappropriately these treatments. At discharge, the inappropriateness of metformin therapy decreased (10.2%, P < 0.0001). According to Beers criteria, the inappropriate prescriptions of sulfonylureas raised to 29% both at admission and at discharge. This study shows a poor adherence to current guidelines on diabetes management in hospitalized elderly people with a high prevalence of inappropriate use of sulfonylureas according to the Beers criteria

Clinical features and outcomes of elderly hospitalised patients with chronic obstructive pulmonary disease, heart failure or both

Background and objective: Chronic obstructive pulmonary disease (COPD) and heart failure (HF) mutually increase the risk of being present in the same patient, especially if older. Whether or not this coexistence may be associated with a worse prognosis is debated. Therefore, employing data derived from the REPOSI register, we evaluated the clinical features and outcomes in a population of elderly patients admitted to internal medicine wards and having COPD, HF or COPD + HF. Methods: We measured socio-demographic and anthropometric characteristics, severity and prevalence of comorbidities, clinical and laboratory features during hospitalization, mood disorders, functional independence, drug prescriptions and discharge destination. The primary study outcome was the risk of death. Results: We considered 2,343 elderly hospitalized patients (median age 81 years), of whom 1,154 (49%) had COPD, 813 (35%) HF, and 376 (16%) COPD + HF. Patients with COPD + HF had different characteristics than those with COPD or HF, such as a higher prevalence of previous hospitalizations, comorbidities (especially chronic kidney disease), higher respiratory rate at admission and number of prescribed drugs. Patients with COPD + HF (hazard ratio HR 1.74, 95% confidence intervals CI 1.16-2.61) and patients with dementia (HR 1.75, 95% CI 1.06-2.90) had a higher risk of death at one year. The Kaplan-Meier curves showed a higher mortality risk in the group of patients with COPD + HF for all causes (p = 0.010), respiratory causes (p = 0.006), cardiovascular causes (p = 0.046) and respiratory plus cardiovascular causes (p = 0.009). Conclusion: In this real-life cohort of hospitalized elderly patients, the coexistence of COPD and HF significantly worsened prognosis at one year. This finding may help to better define the care needs of this population

The “Diabetes Comorbidome”: A Different Way for Health Professionals to Approach the Comorbidity Burden of Diabetes

(1) Background: The disease burden related to diabetes is increasing greatly, particularly in older subjects. A more comprehensive approach towards the assessment and management of diabetes’ comorbidities is necessary. The aim of this study was to implement our previous data identifying and representing the prevalence of the comorbidities, their association with mortality, and the strength of their relationship in hospitalized elderly patients with diabetes, developing, at the same time, a new graphic representation model of the comorbidome called “Diabetes Comorbidome”. (2) Methods: Data were collected from the RePoSi register. Comorbidities, socio-demographic data, severity and comorbidity indexes (Cumulative Illness rating Scale CIRS-SI and CIRS-CI), and functional status (Barthel Index), were recorded. Mortality rates were assessed in hospital and 3 and 12 months after discharge. (3) Results: Of the 4714 hospitalized elderly patients, 1378 had diabetes. The comorbidities distribution showed that arterial hypertension (57.1%), ischemic heart disease (31.4%), chronic renal failure (28.8%), atrial fibrillation (25.6%), and COPD (22.7%), were the more frequent in subjects with diabetes. The graphic comorbidome showed that the strongest predictors of death at in hospital and at the 3-month follow-up were dementia and cancer. At the 1-year follow-up, cancer was the first comorbidity independently associated with mortality. (4) Conclusions: The “Diabetes Comorbidome” represents the perfect instrument for determining the prevalence of comorbidities and the strength of their relationship with risk of death, as well as the need for an effective treatment for improving clinical outcomes

Antidiabetic Drug Prescription Pattern in Hospitalized Older Patients with Diabetes

Objective: To describe the prescription pattern of antidiabetic and cardiovascular drugs in a cohort of hospitalized older patients with diabetes. Methods: Patients with diabetes aged 65 years or older hospitalized in internal medicine and/or geriatric wards throughout Italy and enrolled in the REPOSI (REgistro POliterapuie SIMI—Società Italiana di Medicina Interna) registry from 2010 to 2019 and discharged alive were included. Results: Among 1703 patients with diabetes, 1433 (84.2%) were on treatment with at least one antidiabetic drug at hospital admission, mainly prescribed as monotherapy with insulin (28.3%) or metformin (19.2%). The proportion of treated patients decreased at discharge (N = 1309, 76.9%), with a significant reduction over time. Among those prescribed, the proportion of those with insulin alone increased over time (p = 0.0066), while the proportion of those prescribed sulfonylureas decreased (p < 0.0001). Among patients receiving antidiabetic therapy at discharge, 1063 (81.2%) were also prescribed cardiovascular drugs, mainly with an antihypertensive drug alone or in combination (N = 777, 73.1%). Conclusion: The management of older patients with diabetes in a hospital setting is often sub-optimal, as shown by the increasing trend in insulin at discharge, even if an overall improvement has been highlighted by the prevalent decrease in sulfonylureas prescription

Clinical features and outcomes of elderly hospitalised patients with chronic obstructive pulmonary disease, heart failure or both

Background and objective: Chronic obstructive pulmonary disease (COPD) and heart failure (HF) mutually increase the risk of being present in the same patient, especially if older. Whether or not this coexistence may be associated with a worse prognosis is debated. Therefore, employing data derived from the REPOSI register, we evaluated the clinical features and outcomes in a population of elderly patients admitted to internal medicine wards and having COPD, HF or COPD + HF. Methods: We measured socio-demographic and anthropometric characteristics, severity and prevalence of comorbidities, clinical and laboratory features during hospitalization, mood disorders, functional independence, drug prescriptions and discharge destination. The primary study outcome was the risk of death. Results: We considered 2,343 elderly hospitalized patients (median age 81 years), of whom 1,154 (49%) had COPD, 813 (35%) HF, and 376 (16%) COPD + HF. Patients with COPD + HF had different characteristics than those with COPD or HF, such as a higher prevalence of previous hospitalizations, comorbidities (especially chronic kidney disease), higher respiratory rate at admission and number of prescribed drugs. Patients with COPD + HF (hazard ratio HR 1.74, 95% confidence intervals CI 1.16-2.61) and patients with dementia (HR 1.75, 95% CI 1.06-2.90) had a higher risk of death at one year. The Kaplan-Meier curves showed a higher mortality risk in the group of patients with COPD + HF for all causes (p = 0.010), respiratory causes (p = 0.006), cardiovascular causes (p = 0.046) and respiratory plus cardiovascular causes (p = 0.009). Conclusion: In this real-life cohort of hospitalized elderly patients, the coexistence of COPD and HF significantly worsened prognosis at one year. This finding may help to better define the care needs of this population