Preservación de la función eréctil tras la uretroplastia: ¿escisión y anastomosis primaria o injerto de mucosa oral? / The best method for erection function in urethroplasty; is excision and primary anastomosis or buccal mucosal graft urethroplasty?

Introducción El objetivo de este estudio es evaluar y comparar la función eréctil (FE) tras la uretroplastia por escisión y anastomosis primaria (UEAP) y la uretroplastia con injerto de mucosa oral (UIMO) en la estenosis de uretra bulbar. Métodos Se identificó retrospectivamente a los pacientes tratados mediante uretroplastia. Se determinaron como criterios de inclusión en el estudio la edad entre 18 y 70 años y ser sexualmente activo. Los criterios de exclusión fueron la disfunción eréctil grave preoperatoria, estenosis distinta de la uretra bulbar, incompatibilidad psicosocial, estenosis uretral relacionada con fractura pélvica y tiempo de seguimiento inferior a un año. Como criterio de valoración primario, se utilizó el International Index of Erectile Function-5 (IIEF-5) para la comparación de la FE en el preoperatorio y en el 3.°, 6.° y 12.° mes tras la intervención quirúrgica. El criterio de valoración secundario fue el efecto de los datos demográficos, las características de la estenosis y del tratamiento sobre la FE. Resultados Tras aplicar los criterios de inclusión y exclusión, se identificó a 50 pacientes. De ellos, 30 fueron tratados mediante UEAP y 20 mediante UIMO. Al 3.er mes de la intervención, la FE mostró una disminución estadísticamente significativa en el grupo UEAP. En ambos grupos de pacientes se observó una mejoría de los efectos negativos postoperatorios sobre la EF en el 6.° mes, que recuperaron su nivel basal a los 12 meses. Conclusión Las técnicas UEAP y UIMO tienen un efecto similar sobre la FE a medio y largo plazo y ambas pueden utilizarse con seguridad y eficacia en el grupo de pacientes adecuado. (AU)

Introduction The aim of this study is to evaluate and compare erection function (EF) after excision and primary anastomosis urethroplasty (EPAU) and buccal mucosal graft urethroplasty (BMGU) in bulbar urethral stricture. Methods Patients who underwent urethroplasty were identified retrospectively. The criteria for inclusion in the study were determined as being over 18 years old and under 70 years old, being sexually active. Exclusion criteria are: preoperative severe erectile dysfunction, stricture outside the bulbar urethra, psychosocial incompatibility, urethral stricture related to pelvic fracture, follow-up time less than a year. As the primary endpoint, the International Index of Erectile Function-5 (IIEF-5) was determined as a comparison of EF in the preoperative and 3rd, 6th and 12th months after surgery. The secondary endpoint was the evaluation of the effects of demographic data, stricture and treatment characteristics on EF. Results Fifty patients were identified considering the inclusion/exclusion criteria. It was observed that there were 30 patients who underwent EPAU and 20 patients who underwent BMGU. At the third month after surgery, EF showed a statistically significant decrease in the EPAU group. In both patient groups, it was observed that the early negative effects after the operation in EF started to improve in the 6th month and returned to the baseline level by the first year. Conclusion EPAU and BMGU techniques have a similar effect on EF in the medium and long term. Both methods can be used safely and effectively in the appropriate patient group. (AU)

Utilidad del índice nutricional pronóstico como criterio de selección para la vigilancia activa en el cáncer de próstata / Could Prognostic Nutritional Index be a new criteria for active surveillance of prostate cancer?

Objetivo Determinar el valor del índice nutricional pronóstico (INP) en la selección de pacientes para vigilancia activa (VA) en cáncer de próstata. Métodos Entre septiembre de 2020 y junio de 2022, se analizaron retrospectivamente los datos de 125 pacientes que se sometieron a prostatectomía laparoscópica asistida por robot. Todos los pacientes eran candidatos aptos para VA antes de la operación. Con base en los resultados patológicos obtenidos en la prostatectomía laparoscópica asistida por robot, los pacientes fueron asignados a 2 grupos. Los pacientes que cumplían con los criterios para VA se asignaron al grupo 1 y los demás se asignaron al grupo 2. Se compararon datos demográficos, valores de INP y parámetros hematológicos de los grupos. Resultados El 38% (n:48) de los pacientes cumplió los criterios del grupo 1 y el 62% (n:77) cumplió los criterios del grupo 2. Se encontró un incremento de grado y estadio (upgrade y upstage) en 76 (61%) y 26 (21%) pacientes, respectivamente. No hay diferencias significativas entre los grupos en cuanto a edad, IMC, PSA, densidad de PSA, volumen prostático y PI-RADS. El primer grupo obtuvo un valor de INP más alto. El valor de 49,45 se calculó mediante análisis ROC como el valor de corte ideal de INP para predecir la reclasificación a un grado y estadio más alto del cáncer de próstata (p<0,001). De acuerdo con el análisis de regresión tanto univariante como multivariante, se encontró que el INP era un predictor de exclusión de la VA (p<0,001). Conclusión Los incrementos de grado y estadio se detectan con mayor frecuencia en pacientes con valores bajos de INP. El uso del valor INP en la selección de pacientes para VA aumentará la tasa de éxito en la selección de los candidatos óptimos. (AU)

Objective To evaluate the importance of the Prognostic Nutritional Index(PNI) value for patient selection of active surveillance (AS) in prostate cancer. Methods Between September 2020 and June 2022, the data of 125-patients who underwent Robot-Assisted-Laparoscopic-Prostatectomy were retrospectively analyzed. All patients were suitable for AS preoperatively. Using the pathological results of Robot-Assisted-Laparoscopic-Prostatectomy, patients have been divided 2 groups. Patients who met the criteria for AS were defined as the first group, others were defined second. Demographic datas, PNI values and hematological parameters of the groups were compared. Results 38%(n:48) patients were found suitable for the group 1, and 62%(n:77) were found suitable for the group 2. Upgrading and upstaging were found at 76 patients (61%) and 26 (21%), respectively. There is no significant difference between groups on age, BMI, PSA, PSA-density, prostate volume, and PIRADS. PNI value was found higher at first group. The value of 49.45 was calculated by ROC analysis as the ideal PNI cut-off value for predicting upgrading and upstaging of prostate cancer(P<.001).According to the both univariate and multivariate regression analysis, PNI was found a predictor for exclusion from AS (P<.001). Conclusion Upgrading and upstaging are detected at a higher rate in patients with low PNI values. The use of PNI value in the selection of patients to AS will increase the success rate of ideal patient selection. (AU)

Local allergic rhinitis in children.

Local allergic rhinitis (LAR) is one of the endotypes of rhinitis. Despite much data about epidemiology diagnosis and treatment in adult patients with LAR, there is little information on children. Many studies indicate the need for such an assessment of the phenomenon in children, which results in one meta-analysis based on young patients selected from cohorts of patients of different ages.

Hand-arm vibration: Swedish carpenters' perceptions of health and safety management.

BACKGROUND: Workers in the construction industry are highly exposed to vibration from handheld equipment, which can have negative effects on the nerves and blood vessels in the hands. Employers in this industry often fail to comply with legislation regarding vibration exposure. AIMS: To assess carpenters' perceptions of proactive health and safety (H&S) management regarding hand-arm vibration exposure at construction sites in Sweden. METHODS: The carpenters answered a questionnaire on their perception of the implementation of H&S management, on symptoms indicating injury and on the use of vibrating equipment. RESULTS: One hundred and ninety-four carpenters from 4 construction companies and 18 construction sites completed the questionnaire. Attitudes to H&S management were generally positive. However, 36% of the carpenters reported that the H&S regulations and routines did not function in practice, and 40% claimed they did not receive necessary information on the exposure and effects of vibration. Most respondents (74%) perceived a high risk of injury in general in their work. Younger carpenters, carpenters employed at smaller companies and carpenters with symptoms indicating injury or with higher vibration exposure reported more negative perceptions. CONCLUSIONS: In general, the carpenters were positive about management's commitment to H&S management. However, the results indicate deficiencies in the way in which this commitment is applied in practice at the workplace. This highlights the importance of raising awareness concerning vibration exposure and possible injuries, and strengthening proactive H&S programmes, especially in smaller companies.

Explaining the complex impact of the Covid-19 pandemic on children with overweight and obesity: a comparative ecological analysis of parents' perceptions in three countries.

BACKGROUND: The Covid-19 pandemic has changed children's eating and physical activity behaviours. These changes have been positive for some households and negative for others, revealing health inequalities that have ramifications for childhood obesity. This study investigates the pandemic's impact on families of children aged 2-6 years with overweight or obesity. METHODS: Drawing on interviews conducted as part of a randomised controlled trial (RCT) for childhood obesity, thematic analysis was used to examine how parents of pre-schoolers perceived changes in their eating, screentime and physical activity behaviours between the first and second waves of Covid-19. Parents (n = 70, representing 68 families) were interviewed twice during a period of 6 months in three countries with markedly different pandemic policies - Sweden, Romania, and Spain. The analysis is informed by Bronfenbrenner's ecological systems theory, which embeds home- and school-based influences within societal and policy contexts. RESULTS: The findings show that, although all participants were recruited from an RCT for families of children with excess weight, they reported different responses to the pandemic's second wave, with some children engaging in healthier eating and physical activity, and others engaging in comfort eating and a more sedentary lifestyle. Differences in children's obesity-related behaviours were closely related to differences in parents' practices, which were, in turn, linked to their emotional and social wellbeing. Notably, across all sites, parents' feeding and physical activity facilitation practices, as well as their emotional and social wellbeing, were embedded in household resilience. In resilient households, where parents had secure housing and employment, they were better able to adapt to the challenges posed by the pandemic, whereas parents who experienced household insecurity found it more difficult to cope. CONCLUSIONS: As the Covid-19 pandemic is turning into a long-term public health challenge, studies that address household resilience are crucial for developing effective prevention and treatment responses to childhood obesity.

How do young children eat after an obesity intervention? Validation of the Child Eating Behaviour Questionnaire using the Rasch Model in diverse samples from Australia and Sweden.

Child eating behaviours have consistently been linked to child weight status. Yet, changes in child eating behaviours during early obesity treatment are rarely evaluated. Psychometric evaluation of the Child Eating Behaviour Questionnaire (CEBQ) is common, but results are sample-dependent and included items may not capture the full range of the underlying traits. Rasch analysis can overcome these disadvantages. The aim of this paper was to assess child eating behaviours measured by the CEBQ after a 12-month obesity intervention applying the Rasch model for the validation of the CEBQ. The Rasch-based fit statistics were applied in children from two samples, Australian and Swedish (n = 1724). Changes in eating behaviours amongst children aged 4-6 years were examined in the More and Less RCT for obesity treatment (n = 177), which compared a parenting programme (with and without boosters) against standard treatment. Parents completed the CEBQ at four time points over 12-months. Linear mixed models were applied to estimate treatment effects on the CEBQ, refined according to Rasch, over time. We found that the validity of CEBQ was confirmed after removing 4 items (item fit statistics outside range 0.5-1.5). When the refined CEBQ was used in the assessment of the RCT, there were no differences in parental reports of changes in children's eating behaviours between the parenting programme and standard treatment (group-by-time interactions p > 0.05). However, in the total sample food approach behaviours decreased while fussy eating behaviours increased (p < 0.05). In conclusion, the refined CEBQ proved to be a valid tool for examining parent-reported child eating behaviours. Early obesity treatment may decrease eating behaviours associated with higher child weight. Future research should address the associations between changes in child weight status and eating behaviours.

Serum periostin relates to type-2 inflammation and lung function in asthma: Data from the large population-based cohort Swedish GA(2)LEN.

BACKGROUND: Periostin has been suggested as a novel, phenotype-specific biomarker for asthma driven by type 2 inflammation. However, large studies examining relationships between circulating periostin and patient characteristics are lacking and the suitability of periostin as a biomarker in asthma remains unclear. AIM: To examine circulating periostin in healthy controls and subjects with asthma from the general population with different severity and treatment profiles, both with and without chronic rhinosinusitis (CRS), in relation to other biomarkers and clinical characteristics. METHODS: Serum periostin was examined by ELISA in 1100 subjects aged 17-76 from the Swedish Global Allergy and Asthma European Network (GA(2)LEN) study, which included 463 asthmatics with/without chronic rhinosinusitis (CRS), 98 individuals with CRS only, and 206 healthy controls. Clinical tests included measurement of lung function, Fraction of exhaled NO (FeNO), IgE, urinary eosinophil-derived neurotoxin (U-EDN), and serum eosinophil cationic protein (S-ECP), as well as completion of questionnaires regarding respiratory symptoms, medication, and quality of life. RESULTS: Although median periostin values showed no differences when comparing disease groups with healthy controls, multiple regression analyses revealed that periostin was positively associated with higher FeNO, U-EDN, and total IgE. In patients with asthma, an inverse relationship with lung function was also observed. Current smoking was associated with decreased periostin levels, whereas increased age and lower body mass index (BMI) related to higher periostin levels in subjects both with and without asthma. CONCLUSION: We confirm associations between periostin and markers of type 2 inflammation, as well as lung function, and identify novel constitutional factors of importance to the use of periostin as a phenotype-specific biomarker in asthma.

From a reactive to a proactive safety approach. Analysis of medication errors in chemotherapy using general failure types.

A better understanding of why medication errors (MEs) occur will mean that we can work proactively to minimise them. This study developed a proactive tool to identify general failure types (GFTs) in the process of managing cytotoxic drugs in healthcare. The tool is based on Reason's Tripod Delta tool. The GFTs and active failures were identified in 60 cases of MEs reported to the Swedish national authorities. The most frequently encountered GFTs were defences, procedures, organisation and design. Working conditions were often the common denominator underlying the MEs. Among the active failures identified, a majority were classified as slips, one-third as mistakes, and for a few no active failure or error could be determined. It was found that the tool facilitated the qualitative understanding of how the organisational weaknesses and local characteristics influence the risks. It is recommended that the tool be used regularly. We propose further development of the GFT tool. We also propose a tool to be further developed into a proactive self-evaluation tool that would work as a complement to already incident reporting and event and risk analyses.

Low grandparental social support combined with low parental socioeconomic status is closely associated with obesity in preschool-aged children: a pilot study.

While the influence of parental socioeconomic status (SES) on children's weight status is well known, the impact of other family-related aspects such as parental and grandparental social support is less understood. This study investigates the importance of parents' SES and social support (functional and structural) for weight status in a clinical sample of preschoolers 4-6 years old with obesity (n = 39, 56% girls; 73% of parents were overweight/obese, 50% were of non-Swedish origin). Linear regression analyses, simple and multiple, were performed on SES and social support with child BMI SDS (body mass index standard deviation score) as the dependent variable. The results show that parents' income and low emotional support from paternal grandparents were significantly associated with more severe obesity. The association between parental income and the child's BMI SDS was stronger among parents who had low emotional support from their own parents. In conclusion, grandparental social support may be protective against childhood obesity.

Microcirculatory responses of sacral tissue in healthy individuals and inpatients on different pressure-redistribution mattresses.

OBJECTIVE: The aim of this study was to explore the interaction between interface pressure, pressure-induced vasodilation, and reactive hyperaemia with different pressure-redistribution mattresses. METHOD: A cross-sectional study was performed with a convenience sample of healthy young individuals, and healthy older individuals and inpatients, at a university hospital in Sweden. Blood flow was measured at depths of 1mm, 2mm, and 10mm using laser Doppler flowmetry and photoplethysmography. The blood flow, interface pressure and skin temperature were measured in the sacral tissue before, during, and after load while lying on one standard hospital mattress and three different pressure-redistribution mattresses. RESULTS: There were significant differences between the average sacral pressure, peak sacral pressure, and local probe pressure on the three pressure-redistribution mattresses, the lowest values found were with the visco-elastic foam/air mattress (23.5 ± 2.5mmHg, 49.3 ± 11.1mmHg, 29.2 ± 14.0mmHg, respectively). Blood flow, measured as pressure-induced vasodilation, was most affected in the visco-elastic foam/air group compared to the alternating pressure mattress group at tissue depths of 2mm (39.0% and 20.0%, respectively), and 10mm (56.9 % and 35.1%, respectively). Subjects in all three groups, including healthy 18-65 year olds, were identified with no pressure-induced vasodilation or reactive hyperaemia on any mattress (n=11), which is considered a high-risk blood flow response. CONCLUSION: Interface pressure magnitudes considered not harmful during pressure-exposure on different pressure-redistribution mattresses can affect the microcirculation in different tissue structures. Despite having the lowest pressure values compared with the other mattresses, the visco-elastic foam/air mattress had the highest proportion of subjects with decreased blood flow. Healthy young individuals were identified with the high-risk blood flow response, suggesting an innate vulnerability to pressure exposure. Furthermore, the evaluation of pressure-redistribution support surfaces in terms of mean blood flow during and after tissue exposure is not feasible, but assessment of pressure-induced vasodilation and reactive hyperaemia could be a new way to assess individualised physiological measurements of mechanisms known to be related to pressure ulcer development.

Infant growth is associated with parental education but not with parental adiposity - Early Stockholm Obesity Prevention Project.

AIM: To explore the simultaneous impact of parental adiposity and education level on infant growth from birth to 12 months, adjusting for known early-life risk factors for subsequent childhood obesity. METHODS: Baseline data for 197 one-year-old children and their parents, participating in a longitudinal obesity intervention, were used. Obesity risk groups, high/low, were defined based on parental body mass index (n = 144/53) and parental education (n = 57/139). Observational data on infant growth between 0 and 12 months were collected. The children's relative weight (body mass index standard deviation score) at 3, 6 and 12 months and rapid weight gain 0-6 months were analysed in regression models, with obesity risk as primary exposure variables, adjusting for gestational weight gain, birth weight, short exclusive breastfeeding and maternal smoking. RESULTS: Relative weight at 3, 6 and 12 months was associated with low parental education but not with parental adiposity. No significant associations were observed with rapid weight gain. None of the early-life factors could explain the association with parental education. CONCLUSION: Low parental education level is independently associated with infant growth, whereas parental obesity does not contribute to a higher weight or to rapid weight gain during the first year.

Nocturnal blood pressure non-dipping is prevalent in severely obese, prepubertal and early pubertal children.

AIM: To investigate the prevalence of nocturnal blood pressure dipping among obese prepubertal and early pubertal children and to analyse the relationship between dipping and measures of insulin-glucose metabolism or sleep-disordered breathing. METHODS: We studied 76 obese children (41% girls) under clinical care, with an average age of 10.4 ± 1.7 and a body mass index Z-score (BMI Z-score) of 6.2 ± 1.6. We performed a 24-h ambulatory blood pressure measurement. Non-dipping was defined as a nocturnal blood pressure reduction of <10%. We calculated measures of insulin-glucose metabolism from the performed frequently sampled intravenous glucose-tolerance test and from fasting blood samples. Overnight sleep polygraph recordings were performed to assess sleep-disordered breathing. RESULTS: Forty-two percent of the children were systolic non-dippers, and 17% were diastolic non-dippers. There were no associations between systolic or diastolic dipping and measures of insulin-glucose metabolism after adjustments for BMI Z-score, gender and pubertal status. There were no associations between dipping and measures of sleep-disordered breathing. CONCLUSION: Nocturnal non-dipping was two times higher among severely obese, prepubertal and early pubertal children, compared to previous reports among children in general. There were no associations between nocturnal dipping and insulin-glucose metabolism or measures of sleep-disordered breathing in this group.

Chronic rhinosinusitis in asthma is a negative predictor of quality of life: results from the Swedish GA(2)LEN survey.

BACKGROUND: Asthma and chronic rhinosinusitis (CRS) both impair quality of life, but the quality-of-life impact of comorbid asthma and CRS is poorly known. The aim of this study was to evaluate the impact of CRS and other relevant factors on quality of life in asthmatic subjects. METHODS: This Swedish cohort (age 17-76 years) consists of 605 well-characterized asthmatics with and without CRS, 110 individuals with CRS only, and 226 controls and is part of the Global Allergy and Asthma European Network (GA(2) LEN) survey. The Mini Asthma Quality of Life Questionnaire (mAQLQ), the Euro Quality of Life (EQ-5D) health questionnaire, spirometry, skin prick test (SPT), exhaled nitric oxide (FeNO), smell test, and peak nasal inspiratory flow were used. RESULTS: Subjects having both asthma and CRS have lower mAQLQ scores in all domains (P < 0.001) and a lower EQ-5D index value and EQ-5D VAS value (P < 0.001) compared to those with asthma only. Asthmatics with CRS have significantly lower FEV1%pred and FVC%pred (88.4 [85.1-91.7] and 99.9 [96.7-103.0], respectively) compared with asthma only (91.9 [90.3-93.4] and 104.0 [102.5-105.5], respectively P < 0.05). Multiple regression analysis shows that low asthma quality of life is associated with having CRS (P < 0.0001), lower lung function (P = 0.008), current smoking (P = 0.01), BMI > 30 kg/m2 (P = 0.04), high age (P = 0.03), and a negative SPT (P = 0.04). CONCLUSIONS: Comorbid CRS was a significant and independent negative predictor of quality of life in asthmatics. Other negative factors were lower lung function, current smoking, obesity, advanced age, and having nonatopic asthma.

A technique based on laser Doppler flowmetry and photoplethysmography for simultaneously monitoring blood flow at different tissue depths.

The aim of this study was to validate a non-invasive optical probe for simultaneous blood flow measurement at different vascular depths combining three photoplethysmography (PPG) channels and laser Doppler flowmeter (LDF). Wavelengths of the PPG were near-infrared 810 nm with source-to-detector separation of 10 and 25 mm, and green 560 nm with source-to-detector separation of 4 mm. The probe is intended for clinical studies of pressure ulcer aetiology. The probe was placed over the trapezius muscle, and depths from the skin to the trapezius muscle were measured using ultrasound and varied between 3.8 and 23 mm in the 11 subjects included. A provocation procedure inducing a local enhancement of blood flow in the trapezius muscle was used. Blood flows at rest and post-exercise were compared. It can be concluded that this probe is useful as a tool for discriminating between blood flows at different vascular tissue depths. The vascular depths reached for the different channels in this study were at least 23 mm for the near-infrared PPG channel (source-to-detector separation 25 mm), 10-15 mm for the near-infrared PPG channel (separation 10 mm), and shallower than 4 mm for both the green PPG channel (separation 4 mm) and LDF.

Perceptions of family planning among low-income men in Western Kenya.

BACKGROUND: Men have rarely been involved in either receiving or providing information on sexuality, reproductive health or birth spacing. They have also been ignored or excluded in one way or the other from participating in many family planning programmes as family planning is viewed as a woman's affair. AIM: To describe the perceptions of family planning among low-income men in Western Kenya. METHODS: A qualitative study using focus group interviews and content analysis was conducted, with 64 men aged 15-54 years participating actively. FINDINGS: Perceptions of family planning were manifold. For example, some perceived it as meaning having the number of children one is able to provide for. Most men knew about traditional and modern methods of birth control, although their knowledge was poor and misconceived. Modern methods were thought to give side effects, discouraging family planning. Low instances of family planning were also because of the fact that culturally, children are considered wealth. A law advocating family size limitation was regarded as necessary for the future. CONCLUSION: Men's perceptions of family planning are manifold. Their knowledge about contraception is poor and sometimes misconceived. Preferences regarding a child's gender are strong, thus attitudes and cultural beliefs that might hinder family planning have to be considered. A policy on male contraception and contraceptive services is seen as necessary.

Fluticasone and ibuprofen do not add to the effect of salmeterol on organic dust-induced airway inflammation and bronchial hyper-responsiveness.

BACKGROUND: Exposure in a pig house causes airway inflammation and bronchial hyper-responsiveness which are not influenced by anti-asthma drugs, including a beta(2)-agonist (salmeterol). OBJECTIVES: We hypothesized that a glucocorticoid or a cyclo-oxygenase-inhibitor synergistically interacts with salmeterol offering a protection against dust-induced increased bronchial responsiveness and airway inflammation. As data did not confirm previous results a retrospective analysis of pooled data on dust-induced bronchial hyper-responsiveness from four other studies was performed. DESIGN: Fluticasone or ibuprofen was administered for 1 week and salmeterol or placebo was inhaled 1 h prior to a 3-h exposure in a pig barn in a double-blind, placebo-controlled, cross-over design (2-3 weeks apart) in 12 healthy subjects. Lung function, bronchial responsiveness to methacholine and inflammatory markers were evaluated before and after exposure. Pre- and postexposure bronchial responsiveness in nontreated subjects was retrospectively evaluated from four previous studies. SUBJECTS: Twelve healthy, nonatopic nonsmokers. RESULTS: Salmeterol partially protected against bronchial hyper-responsiveness but did not influence inflammatory markers. Fluticasone and ibuprofen did not add to these effects. The retrospective analysis showed that PD(20)FEV(1) after exposure in a pig barn is almost totally independent of pre-exposure PD(20)FEV(1)-level; all subjects end up at the same low postexposure PD(20)FEV(1). CONCLUSION: Contradictory to our previous results, salmeterol offered partial protection against enhanced bronchial responsiveness induced by exposure in a pig barn. This effect was not modified by fluticasone or ibuprofen. Our data clearly demonstrate that interventions altering bronchial responsiveness must be compared between groups with similar prechallenge bronchial responsiveness or in a cross-over design.

Self-care ability and sense of coherence in older nutritional at-risk patients.

OBJECTIVE: To investigate self-care ability and sense of coherence in geriatric rehabilitation patients nutritionally screened using the Nutritional Form For the Elderly and to relate the patients' perceived health to self-care ability and sense of coherence. DESIGN: Cross-sectional study. SETTING: A geriatric rehabilitation ward in a hospital in western Sweden. SUBJECTS: A sample of 172 consecutively recruited patients (65+ years) fulfilled the inclusion criteria. One hundred forty-four patients were included in the study because 16 patients refused to take part and 12 could not complete the entire data collection procedure. METHODS: Interviews, using one instrument for nutritional screening and other instruments measuring self-care ability and sense of coherence and one question about perceived health, were performed. RESULTS: Patients at medium or high risk for undernutrition had lower self-care ability (P<0.001) and weaker sense of coherence (P=0.007) than patients at low risk for undernutrition. Lower self-care ability, being single and admitted from another hospital ward was found to be predictors for being at medium or high risk for undernutrition. Patients who perceived good health had higher self-care ability (P<0.001) and stronger sense of coherence (P<0.001) than patients who perceived ill health. CONCLUSIONS: There is an indication that older patients at low risk for undernutrition have a greater capability to care for themselves than patients at medium or high risk for undernutrition. Perceived ill health in older patients is associated with lower self-care ability and weaker sense of coherence.

Nutritional status in elderly people admitted to community residential homes: comparisons between two cohorts.

The aim was to describe nutritional status and socio-demographic and medical data in people who were newly admitted to community residential homes (cohort 2), and to compare the results with a previous study performed in the same municipality four years earlier (cohort 1). One hundred and twenty-seven people, 65 years of age, or older, newly admitted to residential homes in a municipality in the southern part of Sweden, were consecutively included. Nutritional status was assessed, using a combination of anthropometry and serum protein measurements and by Mini Nutritional Assessment (MNA). The results showed that 32% of the residents in cohort 2 were assessed as protein-energy malnourished (PEM), compared with 38% in cohort 1. Body mass index, psychological stress or acute disease, and reduced fluid intake were items in MNA which had power to predict PEM. Residents in cohort 2, diagnosed as having severe medical diseases, increased as well as residents with neuropsychological problems. Simultaneously, the number living in residential homes decreased, as compared to cohort 1. These differences indicate that the admission criteria have changed between cohorts 1 and 2.

The effect of fluticasone on the airway inflammatory response to organic dust.

Exposure to organic dust in a swine house causes acute airway inflammation and increased bronchial responsiveness to methacholine in healthy subjects. The aim of this study was to investigate whether an inhaled glucocorticoid, fluticasone propionate, alters the acute airway responses induced by exposure in a swine barn. In 15 healthy subjects, analysis of nasal lavage fluids, serum samples and bronchial methacholine responsiveness were performed before and after exposure to organic dust in a swine house for 3 h. Seven subjects received fluticasone propionate (500 microg b.i.d. by inhalation and 100 microg intranasally once daily) and eight subjects received placebo during the 2 weeks prior to exposure. Post-exposure plasma interleukin (IL)-6 levels and body temperature were significantly lower in the fluticasone group than in the placebo group. Intranasally administered fluticasone propionate significantly attenuated the plasma protein (assessed as albumin concentrations) leakage and IL-8 and tumour necrosis factor-alpha response induced by exposure. Fluticasone propionate inhalation exerted no influence on the increased bronchial responsiveness to methacholine induced by exposure. In conclusion, glucocorticoid treatment attenuated the inflammatory response to inhaled organic dust without influencing the increased bronchial responsiveness to methacholine.