Engineered π⋯π interactions favour supramolecular dimers X@[FeL3]2 (X = Cl, Br, I): solid state and solution structure.

Ditopic bis-pyrazolylpyridine ligands usually react with divalent metal ions (M2+) to produce dinuclear triple-stranded helicates [M2L3]4+ or, via π⋯π interactions, dimers of monoatomic complexes ([ML3]2)4+. The introduction of an additional benzene ring at each end of ligand L increases the number of aromatic contacts within the supramolecular aggregate by 40%, driving the self-recognition process in an irreversible manner. Consequently, the mixing of new bis-pyrazolylquinoline L2 with FeX2 salts leads to crystallization of the tripartite high-spin assemblies (X@[Fe(L2)3]2)3+ (X = Cl, Br or I). The aggregates exhibit exceptional stability, as confirmed by a combination of paramagnetic 1H NMR techniques, demonstrating their persistence in solution. Our investigations further reveal that the guests Br- and I- are retained inside the associate in solution but Cl- is immediately released, resulting in the formation of the empty supramolecular dimer ([Fe(L2)3]2)4+.

Mobilidade como um Serviço: Indicações de Estratégias Interventivas no Hábito de Usar Automóvel Baseadas na Revisão da Literatura / Mobility as a Service: Indications for Intervention Strategies in Car Use Habits Based on Literature Review

A mobilidade integrada poderia ser prejudicada pelo hábito de usar o automóvel? Essa é uma questão central para a mobilidade que precisa ser discutida. Nessa perspectiva, objetivou-se, por meio da revisão da literatura, identificar as estratégias que favoreçam a implementação da mobilidade sustentável, a fim de apontar uma agenda de pesquisa baseada na literatura. Assim, iniciou-se com a conceituação acerca da Mobilidade como um Serviço (MaaS). Aborda-se a viabilidade da mobilidade alternativa, considerando-se o hábito de usar o automóvel, visto que a literatura aponta essa variável como uma barreira para a promoção da Mobilidade complementar. Segue-se com a discussão sobre os comportamentos habituais de se usar o automóvel e como eles podem ser modificados. Como um resultado, sugerem-se várias estratégias para a promoção da quebra do hábito de usar automóvel de modo que se favoreça a mobilidade complementar. Por último, a partir das diretrizes indicadas para promoção da Mobilidade como Serviço, sugere-se uma agenda de pesquisa futura para dar suporte à área de conhecimento.

Could integrated mobility be hindered by the habit of using the car? This is a central issue for mobility that needs to be discussed. In this perspective, it was aimed, through a literature review, to identify strategies that favor the implementation of sustainable mobility policies, in order to point out a research agenda. The literature review is started with the conceptualization of Mobility as a Service (MaaS). The viability of alternative mobility is addressed, considering the habit of using the car, since the literature points to this variable as a barrier to the promotion of complementary mobility. This is followed by a discussion of car-use behavior and how it can be modified. As a result, several strategies are suggested for the promotion of breaking the habit of car use and in order to favor complementary mobility. Finally, based on the guidelines indicated for the promotion of Mobility as a Service, a future research agenda is suggested to support the knowledge field.

A ferric guest inside a spin crossover ferrous helicate.

A designed dimetallic Fe(II) helicate made with biphenylene-bridged bispyrazolylpyridine ligands and exhibiting a process of spin crossover at temperatures above ambient is shown to encapsulate an S = 5/2 tris-oxalato Fe(III) ion. The spin relaxation dynamics of this guest are strongly reduced upon encapsulation.

Unravelling of a [High Spin-Low Spin] ↔ [Low Spin-High Spin] Equilibrium in Spin-Crossover Iron(II) Dinuclear Helicates Using Paramagnetic NMR Spectroscopy.

Spin-crossover between high-spin (HS) and low-spin (LS) states of selected transition metal ions in polynuclear and polymeric compounds is behind their use as multistep switchable materials in breakthrough electronic and spintronic devices. We report the first successful attempt to observe the dynamics of a rarely found broken-symmetry spin state in binuclear complexes, which mixes the states [HS-LS] and [LS-HS] on a millisecond timescale. The slow exchange between these two states, which was identified by paramagnetic NMR spectroscopy in solutions of two spin-crossover iron(II) binuclear helicates that are amenable to molecular design, opens a path to double quantum dot cellular automata for information storage and processing.

[Early discharge and postpartum home visit during the COVID-19 pandemic at the HULP (Madrid).] / Alta precoz y visita domiciliaria puerperal durante la pandemia por la COVID-19 en el Hospital Universitario La Paz (Madrid).

OBJECTIVE: The COVID-19 pandemic caused that the Health Department of the Autonomous Region of Madrid redirected the Obstetrics, Gynecology and Neonatology emergency care. On March 24th 2020, the HULP launched a program of postpartum early discharge and home visit. The objective of this work was to detect if the care strategy "Voluntary early discharge and home visit by the midwife (2nd year EIR)" applied by the HULP during the COVID-19 pandemic had any adverse effect on the woman and/or the newborn. METHODS: Cross-sectional observational descriptive study using convenience sampling among women included in the early discharge-home visit program from March 24th to May 5th 2020. 222 medical records and telephone surveys to postpartum women who complied with the inclusion criteria were analyzed. The statistical analysis was performed using SAS 9.4. RESULTS: The average of inpatient time was 25 hours and 15 minutes. 8.6% of newborns were sent back to the HULP, and 2.2% were readmitted for hyperbilirubinemia. 2.3% of parents took their infants to the Emergency Care Unit, but only 0.46% needed readmission. 0.4% of postpartum women were readmitted. At the discharge, 84.2% of newborns exclusively breastfed. After one week of the birth, 73.4% of infants were exclusively breastfeeding, 18% were mixed breastfeeding, and 8.6% were bottle feeding. 89.6% of women believed early discharge was appropriate. Home visit was described as "very satisfactory" in 83.3% of cases, and the care provided, in 88.7% of cases. CONCLUSIONS: With the early discharge-home visit program, continuity of care is provided, health problems were detected and resolved and high maternal satisfaction levels were obtained.

OBJETIVO: La pandemia por la COVID-19 motivó que la Consejería de Sanidad de la Comunidad de Madrid reorganizara la atención urgente de Obstetricia-Ginecología y Neonatología. El 24/03/2020 se inicia en el Hospital Universitario La Paz (HULP) un programa de alta precoz posparto y visita domiciliaria. El objetivo de este estudio fue detectar si la estrategia de "alta precoz voluntaria y visita domiciliaria por la residente de matrona" aplicada por el HULP durante la pandemia por la COVID-19 tuvo algún efecto adverso en puérpera y/o recién nacido (RN). METODOS: Estudio observacional descriptivo transversal, con muestreo de conveniencia en mujeres incluidas en el programa de alta precoz voluntaria-visita domiciliaria entre 24/03/2020 y 5/05/2020. Se analizaron 222 historias clínicas y cuestionarios telefónicos de puérperas que cumplieron los criterios de selección. El análisis estadístico se realizó con el programa SAS-9.4. RESULTADOS: La media de estancia hospitalaria fue de 25h 15min. Derivaron al HULP a 8,6% neonatos, ingresando un 2,2% por hiperbilirrubinemia. El 2,3% de padres con sus neonatos acudieron a urgencias, ingresando el 0,46%. El 0,4% de puérperas precisó reingreso. Al alta, el 84,2% de RN tomaban lactancia materna exclusiva (LME). A la semana, el 73,4% de RN estaban con LME, el 18% con lactancia mixta y el 8,6% con lactancia artificial. El 89,6% consideró adecuada el alta precoz. Percibieron como "muy satisfactoria" la visita domiciliaria un 83,3%, y la atención profesional recibida un 88,7%. CONCLUSIONES: Con el alta precoz-visita domiciliaria se ofrece continuidad de cuidados, detectando y resolviendo problemas, manteniendo un alto grado de satisfacción materna.

Designed asymmetric coordination helicates with bis-ß-diketonate ligands.

A new bis-(ß-diketone) ligand featuring built-up structural asymmetry yields non-symmetric Fe(iii) and Ga(iii) dinuclear, triple-stranded helicates by design. Their structural properties have been studied, both in solid state and in solution, and compared with their corresponding symmetric analogues. The robustness observed shows the potential of this synthetic strategy to develop non-symmetric helicoidal motifs with specific functional groups.

Coordination [CoII2] and [CoIIZnII] Helicates Showing Slow Magnetic Relaxation.

The slow magnetic relaxation of CoII ions in the elusive intermediate geometry between the trigonal prism and antiprism has been studied on the new [Co2L3]4+ and [CoZnL3]4+ coordination helicates [L is a bis(pyrazolylpyridine) ligand]. Solution paramagnetic 1H NMR and solid-state magnetization measurements unveil single-molecule-magnet behavior with small axial anisotropy, as predicted previously.

Síndrome Coronariana Aguda na Unidade de Terapia Intensiva Adulta / Coronary Syndromes in the Adult Intensive Therapy Unit

O estudo buscou avaliar a assistência intra-hospitalar aos pacientes admitidos com Síndrome Coronariana Aguda na Unidade de Terapia Intensiva Adulta para a criação de protocolos assistenciais de enfermagem. Trata-se de uma pesquisa do tipo documental, retrospectiva, de caráter exploratório, com abordagem quantitativa, referente ao mês de maio de 2017. Dos 26 pacientes admitidos, foi verificado que a maioria era do sexo masculino, sendo que a idade geral variou de 21 a 94 anos. A patologia mais frequente com 65,4% foi à hipertensão arterial sistêmica. Em relação aos exames, 69,2% realizaram cateterismo radial. Quanto aos procedimentos foi verificado que 23,1% dos pacientes realizaram angioplastia femoral e 15,4% angioplastia radial, e revascularização do miocárdio 23,6% dos pacientes, respectivamente. Os resultados encontrados fazem refletir sobre o perfil do paciente admitido na Unidade de Terapia Intensiva e a utilização de procedimentos invasivos para obter os diagnósticos e a assistência direcionada as SCA.(AU)

The study aimed to evaluate the in-hospital care of patients admitted with Acute Coronary Syndrome in the Adult Intensive Care Unit for the creation of nursing care protocols. This is a retrospective, documentary, exploratory, quantitative-based research project, for the month of May, 2017. Of the 26 admitted patients, it was verified that the majority were male, and the general age ranged from 21 to 94 years. The most frequent pathology with 65.4% was systemic arterial hypertension. Regarding the exams, 69.2% underwent radial catheterization. Regarding the procedures, 23.1% of the patients underwent femoral angioplasty and 15.4% of the radial angioplasty, and 23.6% of the patients, respectively, and myocardial revascularization. The results found reflect the profile of the patient admitted to the Intensive Care Unit and the use of invasive procedures to obtain the diagnosis and the targeted care of the SCA.(AU)

A Spin-Crossover Molecular Material Describing Four Distinct Thermal Pathways.

Spin-crossover (SCO) molecular solids are valued switchable materials for their common abrupt and reversible thermal transitions, large thermal hysteresis, or guest-dependent effects. These properties usually involve crystallographic transitions coupled to the SCO events. These phenomena are of great value for the understanding of solid-state transformations and also for exploiting them. We present here a lattice of the complex [FeL(bbp)](ClO4)2 (1; L and bbp are tris-imine ligands) featuring an unprecedented rich succession of SCO and crystallographic phase transformations. Magnetometry measurements unveil a thermally irreversible sequence of spin conversions that delineate four different thermal pathways. All of these are single-crystal-to-single-crystal processes and can thus be monitored by single crystal X-ray diffraction using one unique specimen. Fresh crystals of 1 contain one molecule of acetone per Fe center (1·ac) that abandons the lattice upon warming at the same time that a SCO from an ordered mixed spin state (1:1 high spin/low spin; HS/LS) to a fully HS state, 1α, occurs. This crystallographic phase, accessed through a template effect by the solvent, converts into another one, 1ß, upon cooling, as triggered by a HS to LS SCO. Warming of 1ß induces a new SCO (LS to ordered HS/LS) coupled to another crystallographic phase transition, 1ß â†’ 1γ. The fully HS state of 1γ can not be reached before decomposition of the compound. Instead, this phase cycles between the HS/LS and the LS states through superimposable pathways, different from that of the prerequired 1ß â†’ 1γ phase change. Analysis of the thermal variation of the free energy, G, through density functional theory methods provides trends in agreement with the observation of these transformations and clarifies the possible metastable nature of the various phases identified. This unique behavior allows the access to four different magnetic responses depending on the thermal history of the sample, within a given range of temperatures near the ambient conditions.

Predictive ability of the Mini Nutritional Assessment Short Form (MNA-SF) in a free-living elderly population: a cross-sectional study.

BACKGROUND: Various scales have been used to perform a quick and first level nutritional assessment, and the MNA is one of the most used and recommended by experts in the elderly in all areas. This scale has a short form, the MNA-SF, revised and validated in 2009, which has two versions: the BMI-MNA-SF contains the first six items of the full scale including Body Mass Index while the CC-MNA-SF includes Calf Circumference instead of BMI. OBJECTIVE: To evaluate the predictive ability for nutritional status of the two versions of the MNA-SF against the MNA in free-living elderly in the province of Valencia. METHODS: Cross-sectional study of 660 free-living elderly in the province of Valencia selected in 12 community centres using stratified sampling by blocks. Inclusion criteria: being aged 65 or over, living at home, having functional autonomy, residing in the province of study for more than one year, regularly attending community centres and voluntarily wanting to take part. RESULTS: Of the 660 subjects studied, 319 were men (48.3%) and 341 (51.7%) women with a mean age of 74.3 years (SD = 6.6). In terms of nutritional assessment, using the BMI-MNA-SF and the CC-MNA-SF we found that 26.5% and 26.2% were at risk of malnutrition and 0.9% and 1.5% were malnourished respectively. With the full MNA, 23.3% were at risk of malnutrition. Spearman's rank correlation coefficients indicate a high association between the full MNA score and the MNA-SFs scores (BMI-MNA-SF: ρ = 0.78p < 0.001; CC-MNA-SF: ρ = 0.78p < 0.001). In addition we obtained a very high correlation between the two MNA-SFs (ρ = 0.96p < 0.001). We evaluated the agreement between the full MNA and the MNA-SFs classification in three nutritional categories (normal nutritional status, risk of malnutrition, malnutrition) with Cohen's kappa coefficients (BMI-MNA-SF: κ = 0.54p < 0.001; CC-MNA-SF: κ = 0.52p < 0.001). These values indicate moderate agreement with the full MNA. There is very good agreement between the BMI-MNA-SF and CC-MNA-SF (κ = 0.88p < 0.001). In order to determine the ability of both MNA-SFs to identify subjects not requiring any nutritional intervention, we considered the dichotomised categorisation of the full MNA and the MNA-SFs as "normal nutritional status" vs. "malnutrition and risk of malnutrition" Areas under the ROC curves using MNA as the gold standard indicate moderately high prognostic accuracy (BMI-MNA-SF: AUC = 0.88p < 0.001; CC-MNA-SF: AUC = 0.87 p < 0.001). Both versions of the MNA-SF showed similar sensitivity, specificity and diagnostic effectiveness (BMI-MNA-SF: 73.4%, 86.6%, 83.5%; CC-MNA-SF 73.4%, 86.2%, 83.2%). CONCLUSIONS: In its two versions the MNA-SF presents useful predictive ability against the MNA. The advantage of the CC-MNA-SF is that using it requires fewer resources and less time in primary care, although always the characteristics of the population must take into account to make the right decision based on the MNA-SF scales.

Six simple questions to detect malnutrition or malnutrition risk in elderly women.

UNLABELLED: Of the numerous instruments available to detect nutritional risk, the most widely used is the Mini Nutritional Assessment (MNA), but it takes 15-20 min to complete and its systematic administration in primary care units is not feasible in practice. We developed a tool to evaluate malnutrition risk that can be completed more rapidly using just clinical variables. Between 2008 and 2013, we conducted a cross-sectional study of 418 women aged ≥60 years from Mexico. Our outcome was positive MNA and our secondary variables included were: physical activity, diabetes mellitus, hypertension, educational level, dentition, psychological problems, living arrangements, history of falls, age and the number of tablets taken daily. The sample was divided randomly into two groups: construction and validation. Construction: a risk table was constructed to estimate the likelihood of the outcome, and risk groups were formed. VALIDATION: the area under the ROC curve (AUC) was calculated and we compared the expected and the observed outcomes. The following risk factors were identified: physical activity, hypertension, diabetes, dentition, psychological problems and living with the family. The AUC was 0.77 (95% CI [0.68-0.86], p < 0.001). No differences were found between the expected and the observed outcomes (p = 0.902). This study presents a new malnutrition screening test for use in elderly women. The test is based on six very simple, quick and easy-to-evaluate questions, enabling the MNA to be reserved for confirmation. However, it should be used with caution until validation studies have been performed in other geographical areas.

[Nutrition-related risk factors in autonomous non-institutionalized adult elderly people]. / Factores asociados al riesgo nutricional en adultos mayores autónomos no institucionalizados.

OBJECTIVES: To determine factors related to nutritional riskin autonomous non-institutionalized adult elder people. METHODS: Cross-sectional study including 660 autonomous non-institutionalized adult elder people. Participants were assessed in 12 social centres (province of Valencia) and selected using stratified sampling by blocks. INCLUSION CRITERIA: age 65 or over, living at home, functionally autonomous, having lived for more than 1 year in the province of Valencia, regularly visiting social centres and voluntary participation in the study. MNA is used for nutritional assessment and factors associated to nutritional status are collected by means of an ad-hoc survey. RESULTS: Out of the 660 study subjects, 48.33% are male and 51.67% are female, mean age is 74.3±6,57. 23.33% show malnutrition risk. Independent factors associated to malnutrition risk -with adjusted prevalence odds ratioare: absence of academic education (OR=2.29), feeling lonely (OR=2.34), following controlled diets (OR=0.55), reduced appetite (OR=2.56), number of fractions in daily intake (OR=0.66), suffering from xerostomia (OR=1.72), swallowing difficulties (OR=2.30), number of chronic diseases (OR=1.38) and having suffered from acute diseases during the last year (OR=2.03). An increase in BMI is associated with a good nutritional status (OR=0.85). These factors have allowed an accurate classification of 80% of the surveyed patients. CONCLUSIONS: Numerous chronic diseases, recent acute diseases, non-controlled diets, xerostomia and swallowing difficulties, eating few times a day and little appetite, feelling lonely and lacking from academic education are factors allowing the prediction of malnutrition risk in adult elder people.

Objetivos: Determinar factores asociados al riesgo nutricional en adultos mayores autónomos no institucionalizados. Métodos: Estudio transversal realizado en 660 adultos mayores autónomos, no institucionalizados. Los participantes fueron evaluados en 12 centros sociales (provincia de Valencia) seleccionados mediante un muestreo estratificado por bloques. Criterios de inclusión: tener 65 años o más, vivir en el domicilio, poseer autonomía funcional, residir más de un año en la provincia de Valencia, acudir periódicamente a los centros sociales y colaborar voluntariamente en el estudio. Se usa el MNA para la valoración nutricional y se recogen factores asociados al estado nutricional en una encuesta adhoc. Resultados: De los 660 sujetos estudiados, el 48,33% son hombres y el 51,67% mujeres, la edad media es de 74,3±6,57 años. El 23,33% presentan riesgo de malnutrición. Los factores independientes asociados al riesgo de malnutrición, con el odds de prevalencia ajustada, son: no poseer estudios (OR=2,29), sentir soledad (OR=2,34), mantener dietas controladas (OR=0,55), un apetito escaso (OR=2,56), número de fracciones en la ingesta diaria (OR=0,66), sufrir xerostomía (OR=1,72), tener dificultades para deglutir (OR=2,30), el número de enfermedades crónicas (OR=1,38) y haber sufrido enfermedades agudas en el último año (OR=2,03). Un incremento en el IMC se asocia a un buen estado nutricional (OR=0,85). Estos factores nos han permitido clasificar correctamente a un 80% de los pacientes encuestados. Conclusiones: Tener numerosas enfermedades crónicas, haber sufrido enfermedades agudas recientes, mantener dietas sin control, sufrir xerostomía y dificultad para deglutir, comer pocas veces al día y con escaso apetito, sentirse solo y no tener estudios son factores que, permiten predecir el riesgo de malnutrición en los adultos mayores.

Factores asociados al riesgo nutricional en adultos mayores autónomos no institucionalizados / Nutrition-related risk factors in autonomous non-institutionalized adult elderly people

Objetivos: Determinar factores asociados al riesgo nutricional en adultos mayores autónomos no institucionalizados. Métodos: Estudio transversal realizado en 660 adultos mayores autónomos, no institucionalizados. Los participantes fueron evaluados en 12 centros sociales (provincia de Valencia) seleccionados mediante un muestreo estratificado por bloques. Criterios de inclusión: tener 65 años o más, vivir en el domicilio, poseer autonomía funcional, residir más de un año en la provincia de Valencia, acudir periódicamente a los centros sociales y colaborar voluntariamente en el estudio. Se usa el MNA para la valoración nutricional y se recogen factores asociados al estado nutricional en una encuesta ad hoc. Resultados: De los 660 sujetos estudiados, el 48,33% son hombres y el 51,67% mujeres, la edad media es de 74,3±6,57 años. El 23,33% presentan riesgo de malnutrición. Los factores independientes asociados al riesgo de malnutrición, con el odds de prevalencia ajustada, son: no poseer estudios (OR=2,29), sentir soledad (OR=2,34), mantener dietas controladas (OR=0,55), un apetito escaso (OR=2,56), número de fracciones en la ingesta diaria (OR=0,66), sufrir xerostomía (OR=1,72), tener dificultades para deglutir (OR=2,30),el número de enfermedades crónicas (OR=1,38) y haber sufrido enfermedades agudas en el último año (OR=2,03). Un incremento en el IMC se asocia a un buen estado nutricional (OR=0,85). Estos factores nos han permitido clasificar correctamente a un 80% de los pacientes encuestados. Conclusiones: Tener numerosas enfermedades crónicas, haber sufrido enfermedades agudas recientes, mantener dietas sin control, sufrir xerostomía y dificultad para deglutir, comer pocas veces al día y con escaso apetito, sentirse solo y no tener estudios son factores que, permiten predecir el riesgo de malnutrición en los adultos mayores (AU)

Objectives: To determine factors related to nutritional risk in autonomous non-institutionalized adult elder people. Methods: Cross-sectional study including 660 autonomous non-institutionalized adult elder people. Participants were assessed in 12 social centres (province of Valencia) and selected using stratified sampling by blocks. Inclusion criteria: age 65 or over, living at home, functionally autonomous, having lived for more than 1 year in the province of Valencia, regularly visiting social centres and voluntary participation in the study. MNA is used for nutritional assessment and factors associated to nutritional status are collected by means of an ad-hoc survey. Results: Out of the 660 study subjects, 48.33% are male and 51.67% are female, mean age is 74.3±6,57. 23.33% show malnutrition risk. Independent factors associated to malnutrition risk -with adjusted prevalence odds ratio are: absence of academic education (OR=2.29), feeling lonely (OR=2.34), following controlled diets (OR=0.55), reduced appetite (OR=2.56), number of fractions in daily intake (OR=0.66), suffering from xerostomia (OR=1.72), swallowing difficulties (OR=2.30), number of chronic diseases (OR=1.38) and having suffered from acute diseases during the last year (OR=2.03). An increase in BMI is associated with a good nutritional status (OR=0.85). These factors have allowed an accurate classification of 80% of the surveyed patients. Conclusions: Numerous chronic diseases, recent acute diseases, non-controlled diets, xerostomia and swallowing difficulties, eating few times a day and little appetite, feelling lonely and lacking from academic education are factors allowing the prediction of malnutrition risk in adult elder people (AU)

[Study on the nutritional risk of autonomous non-institutionalized adult elder people]. / Estudio del riesgo nutricional en adultos mayores autónomos no institucionalizados.

OBJECTIVES: To assess the nutritional status of autonomous, non-institutionalized, elder adults in social centers by means of the MNA scale and to analyze their distribution according to socio-demographical variables: gender, age, civil status, living with other people, educational level, and rural/urban setting. METHODS: Cross-sectional study performed in 660 autonomous, non-institutionalized elder adults in social center of the province of Valencia. The subjects were assessed at 12 social centers selected though stratified sample sets. The inclusion criteria were: being 65 years of older, living at home, having functional autonomy, residing for more than one year in the province of Valencia, attending periodically the social center, and willing to participate. The MNA scale was used for nutritional assessment. RESULTS: Of the 660 included subjects, 48.33% were males and 51.6% females; the mean age was 74.3 ± 6.57 years. 23.3% of the participants were at risk for malnutrition. The prevalence of malnutrition odds ratio was higher in: females as compared to men (OR = 1.43), subjects ≥ 85 years as compared to the 65-69 years group (OR = 2.27), widowed subjects as compared to those with a stable companion (OR = 1.82) and people with the lowest educational level as compared to those with some educational level (OR = 1.73). CONCLUSIONS: The prevalence of malnutrition risk in autonomous, non-institutionalized elder adults at social centers of the province of Valencia reaches one out of four people, being higher in widowed subjects (mostly elder women living alone) and in uneducated people.

Objetivos: Valorar el estado nutricional en adultos mayores autónomos, no institucionalizados, en centros sociales, mediante la escala MNA y analizar su distribución según las variables sociodemográficas: sexo, edad, estado civil, convivencia, estudios y ámbito rural o urbano. Métodos: Estudio transversal realizado en 660 adultos mayores autónomos, no institucionalizados en centros sociales de la provincia de Valencia. Los sujetos fueron evaluados en 12 centros sociales seleccionados mediante un muestreo estratificado por bloques. Los criterios de inclusión en el estudio fueron: tener 65 años o más, vivir en el domicilio, tener autonomía funcional, residir más de un año en la provincia de Valencia, acudir periódicamente a centros sociales y querer colaborar. Se usó el MNA para la valoración nutricional. Resultados: De los 660 sujetos incluidos en el estudio, el 48,33% son hombres y el 51,6% mujeres, la edad media es de 74,3 ± 6,57 años. El 23,3% de los encuestados presenta riesgo de malnutrición. El odds de prevalencia del riesgo de malnutrición es mayor en: mujeres respecto a hombres (OR = 1,43), personas ≥?85 años respecto al grupo de 65-69 años (OR = 2,27), personas viudas respecto a casadas o con pareja estable (OR = 1,82) y en personas sin estudios respecto a las que disponen de algún nivel de estudios (OR = 1,73). Conclusiones: La prevalencia de riesgo nutricional en adultos mayores autónomos, no institucionalizados en centros sociales de la provincia de Valencia alcanza a una de cada cuatro personas, siendo más elevada en personas viudas (en su mayor parte mujeres mayores, que viven solas) y en personas sin estudios.

Estudio del riesgo nutricional en adultos mayores autónomos no institucionalizados / Study on the nutritional risk of autonomous non-institutionalized adult elder people

Objetivos: Valorar el estado nutricional en adultos mayores autónomos, no institucionalizados, en centros sociales, mediante la escala MNA y analizar su distribución según las variables sociodemográficas: sexo, edad, estado civil, convivencia, estudios y ámbito rural o urbano. Métodos: Estudio transversal realizado en 660 adultos mayores autónomos, no institucionalizados en centros sociales de la provincia de Valencia. Los sujetos fueron evaluados en 12 centros sociales seleccionados mediante un muestreo estratificado por bloques. Los criterios de inclusión en el estudio fueron: tener 65 años o más, vivir en el domicilio, tener autonomía funcional, residir más de un año en la provincia de Valencia, acudir periódicamente a centros sociales y querer colaborar. Se usó el MNA para la valoración nutricional. Resultados: De los 660 sujetos incluidos en el estudio, el 48,33% son hombres y el 51,6% mujeres, la edad media es de 74,3 ± 6,57 años. El 23,3% de los encuestados presenta riesgo de malnutrición. El odds de prevalencia del riesgo de malnutrición es mayor en: mujeres respecto a hombres (OR = 1,43), personas ≥?85 años respecto al grupo de 65-69 años (OR = 2,27), personas viudas respecto a casadas o con pareja estable (OR = 1,82) y en personas sin estudios respecto a las que disponen de algún nivel de estudios (OR = 1,73). Conclusiones: La prevalencia de riesgo nutricional en adultos mayores autónomos, no institucionalizados en centros sociales de la provincia de Valencia alcanza a una de cada cuatro personas, siendo más elevada en personas viudas (en su mayor parte mujeres mayores, que viven solas) y en personas sin estudios (AU)

OBJECTIVES: To assess the nutritional status of autonomous, non-institutionalized, elder adults in social centers by means of the MNA scale and to analyze their distribution according to socio-demographical variables: gender, age, civil status, living with other people, educational level, and rural/urban setting. METHODS: Cross-sectional study performed in 660 autonomous, non-institutionalized elder adults in social center of the province of Valencia. The subjects were assessed at 12 social centers selected though stratified sample sets. The inclusion criteria were: being 65 years of older, living at home, having functional autonomy, residing for more than one year in the province of Valencia, attending periodically the social center, and willing to participate. The MNA scale was used for nutritional assessment. RESULTS: Of the 660 included subjects, 48.33% were males and 51.6% females; the mean age was 74.3 ± 6.57 years. 23.3% of the participants were at risk for malnutrition. The prevalence of malnutrition odds ratio was higher in: females as compared to men (OR = 1.43), subjects ≥ 85 years as compared to the 65-69 years group (OR = 2.27), widowed subjects as compared to those with a stable companion (OR = 1.82) and people with the lowest educational level as compared to those with some educational level (OR = 1.73).CONCLUSIONS: The prevalence of malnutrition risk in autonomous, non-institutionalized elder adults at social centers of the province of Valencia reaches one out of four people, being higher in widowed subjects (mostly elder women living alone) and in uneducated people (AU)

Early natural killer cell counts in blood predict mortality in severe sepsis.

INTRODUCTION: Host immunity should play a principal role in determining both the outcome and recovery of patients with sepsis that originated from a microbial infection. Quantification of the levels of key elements of the immune response could have a prognostic value in this disease. METHODS: In an attempt to evaluate the quantitative changes in the status of immunocompetence in severe sepsis over time and its potential influence on clinical outcome, we monitored the evolution of immunoglobulins (Igs) (IgG, IgA and IgM), complement factors (C3 and C4) and lymphocyte subsets (CD4+ T cells, CD8+ T cells, B cells (CD19+) and natural killer (NK) cells (CD3-CD16+CD56+)) in the blood of 50 patients with severe sepsis or septic shock at day 1, day 3 and day 10 following admission to the ICU. RESULTS: Twenty-one patients died, ten of whom died within the 72 hours following admission to the ICU. The most frequent cause of death (n = 12) was multiorgan dysfunction syndrome. At day 1, survivors showed significantly higher levels of IgG and C4 than those who ultimately died. On the contrary, NK cell levels were significantly higher in the patients who died. Survivors exhibited a progressive increase from day 1 to day 10 on most of the immunological parameters evaluated (IgG, IgA, IgM, C3, CD4+, CD8+ T cells and NK cells). Multivariate Cox regression analysis, including age, sex, APACHE II score, severe sepsis or septic shock status and each one of the immunological parameters showed that NK cell counts at day 1 were independently associated with increased risk of death at 28 days (hazard ratio = 3.34, 95% CI = 1.29 to 8.64; P = 0.013). Analysis of survival curves provided evidence that levels of NK cells at day 1 (> 83 cells/mm³) were associated with early mortality. CONCLUSIONS: Our results demonstrate the prognostic role of NK cells in severe sepsis and provide evidence for a direct association of early counts of these cells in blood with mortality.