Have We Taken Advantage of the Quarantine to Develop Healthy Habits? A Cross-Sectional Analysis of the Spanish COVID-19 Situation by Gender.

The confinement caused by the COVID-19 pandemic led to changes in people's lifestyles, which in part provided an opportunity to develop habits at home. The aims were: (1) to verify if the psychological well-being (PWB) of people related to healthy habits, and if physical activity (PA) and diet mediated this relationship; (2) to test if there were differences in this model of relationships between women and men; (3) to analyze if there were differences in healthy habits, PA, diet, and PWB depending on gender; (4) to test if there were differences in healthy habits, PA, diet, and PWB depending on living area; (5) and to assess if there were interaction effects of gender and living area in healthy habits, PA, diet, and PWB. Using a cross-sectional design, we obtained a sample of 1509 participants (18-78 years, 1020 women). Diet and PA fully mediated the relationship between PWB and healthy habits, and women developed more healthy habits than men, whereas men had higher levels of PA and PWB. We also found that people who lived in rural areas during confinement practiced more PA and had lower PWB levels than those who lived in urban areas. These results can help in the planning of strategies to promote healthy habits.

Psychological Well-Being and Home Conditions during COVID-19 Confinement. Internet Addiction and Nostalgia as Mediators.

The COVID-19 pandemic posed a challenge for all confined populations, dealing with their home resources and suffering changes in their psychological well-being. The aim of this paper is to analyze the relationship between home conditions (i.e., having children, square meters of the house and square meters of the terrace or similar) and psychological well-being, and to test whether this relationship is mediated by Internet addiction and nostalgia. The sample was composed of 1509 people, aged between 18 to 78 years (67.6% women). Structural Equations Models and 2 × 2 ANOVAs were analyzed. It was found that better home conditions mean greater psychological well-being, and that this relationship is partially mediated, in a negative sense, by Internet addiction and nostalgia, especially after day 45 of confinement and with greater intensity in women. These results provide evidence about how psychological well-being can be preserved during a confinement situation, which may be useful for planning healthy strategies in similar circumstances in the future.

Dexmedetomidine in medical cardiac intensive care units. Data from a multicenter prospective registry.

BACKGROUND: Dexmedetomidine induces cooperative and arousable sedation. Our aim was to analyze dexmedetomidine use in medical cardiac intensive care units (CICU). METHODS: Multicenter prospective registry of patients treated with dexmedetomidine in CICU. Consecutive inclusion during a 12-month period. RESULTS: A total of 410 patients were included, mean age was 67.4 ± 13.9 years, and 94 (22.9%) were women. Before using dexmedetomidine, 247 patients (60.2%) had delirium, 48 developed delirium after dexmedetomidine use. In 178 (43.4%) dexmedetomidine was used during weaning from mechanical ventilation, with a reintubation rate of 10.1%, early reintubation rate (<24 h) 1.7%. Seventy-seven patients (18.8%) died during admission. Dexmedetomidine mean dose infusion was 0.51 ± 0.25 µ/kg/h, during a median of 34 h (interquartile range 12-78 h). Three hundred forty-eight patients received adjuvant sedatives (84.9%). Sixty-eight patients (16.6%) had adverse effects. The most frequent adverse effects were hypotension with systolic blood pressure <80 mmHg (44 patients - 10.7%), bradycardia <40 beats per minute (15 patients - 3.7%), and both bradycardia and hypotension (4 patients - 1.0%). Patients with adverse effects received more frequently inotropes (53 [81.6%] vs. 212 [65.4%], p = 0.02) and fewer adjuvant sedatives (49 [75.4%] vs. 282 [87.0%], p = 0.01). The independent predictors of adverse effects were inotropes use (odds ratio [OR] 2.73, 95% confidence interval [CI] 1.30-5.74, p = 0.008) and lack of adjuvant sedatives (OR 3.03, 95% CI 1.49-6.26, p = 0.002). CONCLUSION: Dexmedetomidine safety for medical CICU patients seems to be similar to that for general intensive care unit patients. Inotropes and lack of adjuvant sedatives were associated with adverse effects.

FRAIL Scale also Predicts Long-Term Outcomes in Older Patients With Acute Coronary Syndromes.

OBJECTIVES: No previous studies have assessed the role of the FRAIL scale in predicting long-term outcomes in older patients with acute coronary syndromes (ACS). DESIGN, SETTING AND PARTICIPANTS: The multicenter observational LONGEVO-SCA registry included unselected patients ≥80 years of age with ACS from 44 centers. A comprehensive geriatric assessment was performed during hospitalization. MEASURES: Frailty was measured by the FRAIL scale. For the purpose of this study, main outcome measured was mortality or readmission at 24 months. RESULTS: A total of 498 patients were included. Mean age was 84.3 years. A total of 198 patients (33.1%) were prefrail and 135 (27.1%) frail. Patients who were prefrail and frail had a higher degree of comorbidities, and higher prevalence of disability, cognitive impairment, and nutritional risk. A total of 165 out of 498 patients (33.1%) died, and 331 patients (66.7%) died or were readmitted at 24 months. Both prefrailty and frailty were associated with a higher mortality compared with robust patients (P < .001). The incidence of mortality or readmission was also higher in patients who were prefrail or frail (P < .001). After adjusting for potential confounders, the association between frailty and mortality or readmission remained significant (hazard ratio 1.28 for prefrailty and hazard ratio 1.96 for frailty, P < .001). The FRAIL scale showed an optimal ability for predicting mortality or readmission (area under the receiver operating characteristics curve 0.86, 95% confidence interval 0.83‒0.89). The area under the receiver operating characteristics curve from the Global Registry of Acute Coronary Events risk score was 0.89. No significant differences were observed between both AUC values (P = .163). CONCLUSIONS AND IMPLICATIONS: The FRAIL scale independently predicted long-term outcomes in older patients with ACS. The predictive ability of this scale was comparable to the strongly recommended Global Registry of Acute Coronary Events risk score. Frailty assessment is mandatory for improving risk prediction in these complex patients.

An Easy Assessment of Frailty at Baseline Independently Predicts Prognosis in Very Elderly Patients With Acute Coronary Syndromes.

BACKGROUND: Information about the impact of frailty in patients with acute coronary syndromes (ACS) is scarce. No study has assessed the prognostic impact of frailty as measured by the FRAIL scale in very elderly patients with ACS. METHODS: The prospective multicenter LONGEVO-SCA registry included unselected patients with ACS aged 80 years or older. A comprehensive geriatric assessment was performed during hospitalization, including frailty assessment by the FRAIL scale. The primary endpoint was mortality at 6 months. RESULTS: A total of 532 patients were included. Mean age was 84.3 years, 61.7% male. Most patients had positive troponin levels (84%) and high GRACE risk score values (mean 165). A total of 205 patients were classified as prefrail (38.5%) and 145 as frail (27.3%). Frail and prefrail patients had a higher prevalence of comorbidities, lower left ventricle ejection fraction, and higher mean GRACE score value. A total of 63 patients (11.8%) were dead at 6 months. Both prefrailty and frailty were associated with higher 6-month mortality rates (P < .001). After adjusting for potential confounders, this association remained significant (hazard ratio [HR] 2.71; 95% confidence interval [CI] 1.09-6.73 for prefrailty and HR 2.99; 95% CI 1.20-7.44 for frailty, P = .024). The other independent predictors of mortality were age, Charlson Index, and GRACE risk score. CONCLUSIONS: The FRAIL scale is a simple tool that independently predicts mortality in unselected very elderly patients with ACS. The presence of prefrailty criteria also should be taken into account when performing risk stratification of these patients.