Association between a comprehensive smoking ban and hospitalization for acute myocardial infarction: An observational study in the Autonomous Community of Valencia, Spain.

OBJECTIVE: To assess the association between a comprehensive smoking ban and hospitalization rates for acute myocardial infarction (AMI). METHODS: An observational study was conducted to assess changes in hospital admission rates for AMI in the Autonomous Community of Valencia, Spain (population 5 million), during the period 1995-2013. Law 28/2005 prohibited smoking in all enclosed spaces (public and private), and Law 42/2010 extended the ban to bars and restaurants as well as children's playgrounds and access areas of schools and hospitals. Data on hospital admissions were obtained from the Hospital Discharge Database (CMBD) of the Autonomous Community. Annual hospital admission rates per 100000 population for AMI (ICD-9-CM code 410) for men and women were calculated. RESULTS: Adjusted hospital admission rates per 100000 population for AMI decreased markedly from 141.1 in 2005 to 119.2 in 2007, with a further reduction to 102.9 in 2013. Reductions in hospital admission were recorded in both men and women, but the downward trends were stronger in women. CONCLUSION: The Spanish comprehensive smoking ban was associated with a marked reduction in the adjusted rate of hospital admissions due to AMI in the Autonomous Community of Valencia. This decrease in the number of persons requiring in-patient care due to AMI is important from both a health care and a societal perspective.

Los factores relacionados con la mortalidad en pacientes con disfagia ayudan en la toma de decisiones dietéticas y nutricionales / Factors associated with mortality in patients with dyspahgia helpin making dietary and nutritional choices

Objetivo: Conocer en los pacientes con disfagia ingresados en un Hospital de Media y Larga Estancia, qué factores, valorados al ingreso, están relacionados con fallecer durante su hospitalización y pueden orientar la intervención dietética y nutricional. Material y método: Estudio de cohorte retrospectivo, observacional y descriptivo de pacientes diagnosticados de disfagia por el Método de Exploración Clínica Volumen- Viscosidad (MECVV). Se recogieron variables demográficas y clínicas, estancia, éxitus, revaloraciones de disfagia y tratamientos. Resultados: Se incluyeron 182 pacientes, con edad media de 78 años, fallecieron el 50%. En el análisis univariante se asociaron significativamente con el éxitus: edad >= 85 años, diagnóstico previo de disfagia, padecer enfermedad oncológica, elevada comorbilidad (Charlson entre 2-5 y > 5 puntos), baja funcionalidad previa a hospitalización (Índice de Barthel < 40 puntos), MNA < 17 puntos, albúmina < 3 g/dl, alta puntuación del CONUT (de 5-12 puntos), tratamiento con: opioide, neuroléptico o antidepresivo al realizar el MECVV, y objetivo asistencial al ingreso. En análisis multivariante obtuvieron significación: edad, enfermedad oncológica, comorbilidad, y albúmina como factores de riesgo para fallecer, y llevar antidepresivo como factor protector. Se aplicó análisis de contraste con Curva ROC. El área bajo la curva fue 0,740 y el intervalo de confianza (IC) 0,668-0,811. Conclusiones: En pacientes con disfagia, los datos referidos valorados al ingreso, pueden ayudar a definir más adecuada y precozmente objetivos asistenciales. En los casos con mayor riesgo de fallecer se priorizará una ingesta segura y de confort, y en aquellos con bajo riesgo, además deberá ser eficaz para intentar mejorar al máximo su estado nutricional (AU)

Objective: To know what factors evaluated at the moment of admission are related with mortality among in-patients with dysphagia, during their stay in a longterm care hospital and may guide the dietary and nutritional intervention. Material and methods: Retrospective, observational and descriptive cohort study over patients with dysphagia diagnosed by Volumen-Viscosity Clinical Exploration Method (VVCEM). Demographic and clinical variables were gathered, stay, mortality, when their dysphagia was re-evaluated and treatments. Results: 182 patients were included, medium age of 78 years old, 50% of them died. Following factors were significantly associate with death by univariant analysis: aged 85 or older, previous diagnosis of dysphagia, oncological disease, high comorbidity (Charlson between 2-5 and > 5 points), low functionality before hospitalization (Barthel Index < 40), MNA < 17 points, albumen < 3 g/ dl, high score in CONUT (5-12 points), to be on opioids, neuroleptics, antidepressants while performing VVCEM, and the assistance aim when admission. Following factors had signification for risk to die by multi-variant analysis: age, oncological disease, comorbidity and albumen, but taking antidepressants turned out to be a protective factor. Analysis of contrast was applied by curve ROC. The area under the curve was 0.740 and the confidence interval (CI) 0.668-0.811. Conclusions: The above-mentioned information that may be evaluated in patients with dysphagia when admission, may help to define of more suitable and precocious form our welfare aims. In those cases with major risk of dying, it should prioritize comfort and safe swallowing. In those cases with low risk, in addition, should be effective improve to the maximum their nutritional condition (AU)

[Factors associated with mortality in patients with dysphagia help in making dietary and nutritional choices]. / Los factores relacionados con la mortalidad en pacientes con disfagia ayudan en la toma de decisiones dietéticas y nutricionales.

OBJECTIVE: To know what factors evaluated at the moment of admission are related with mortality among in-patients with dysphagia, during their stay in a longterm care hospital and may guide the dietary and nutritional intervention. MATERIAL AND METHODS: Retrospective, observational and descriptive cohort study over patients with dysphagia diagnosed by Volumen-Viscosity Clinical Exploration Method (VVCEM). Demographic and clinical variables were gathered, stay, mortality, when their dysphagia was re-evaluated and treatments. RESULTS: 182 patients were included, medium age of 78 years old, 50% of them died. Following factors were significantly associate with death by univariant analysis: aged 85 or older, previous diagnosis of dysphagia, oncological disease, high co-morbidity (Charlson between 2-5 and > 5 points), low functionality before hospitalization (Barthel Index < 40), MNA < 17 points, albumen < 3 g/ dl, high score in CONUT (5-12 points), to be on opioids, neuroleptics, antidepressants while performing VVCEM, and the assistance aim when admission. Following factors had signification for risk to die by multi-variant analysis: age, oncological disease, co-morbidity and albumen, but taking antidepressants turned out to be a protective factor. Analysis of contrast was applied by curve ROC. The area under the curve was 0.740 and the confidence interval (CI) 0.668-0.811. CONCLUSIONS: The above-mentioned information that may be evaluated in patients with dysphagia when admission, may help to define of more suitable and precocious form our welfare aims. In those cases with major risk of dying, it should prioritize comfort and safe swallowing. In those cases with low risk, in addition, should be effective improve to the maximum their nutritional condition.

Objetivo: Conocer en los pacientes con disfagia ingresados en un Hospital de Media y Larga Estancia, qué factores, valorados al ingreso, están relacionados con fallecer durante su hospitalización y pueden orientar la intervención dietética y nutricional. Material y método: Estudio de cohorte retrospectivo, observacional y descriptivo de pacientes diagnosticados de disfagia por el Método de Exploración Clínica Volumen- Viscosidad (MECVV). Se recogieron variables demográficas y clínicas, estancia, éxitus, revaloraciones de disfagia y tratamientos. Resultados: Se incluyeron 182 pacientes, con edad media de 78 años, fallecieron el 50%. En el análisis univariante se asociaron significativamente con el éxitus: edad >= 85 años, diagnóstico previo de disfagia, padecer enfermedad oncológica, elevada comorbilidad (Charlson entre 2-5 y > 5 puntos), baja funcionalidad previa a hospitalización (Índice de Barthel < 40 puntos), MNA < 17 puntos, albúmina < 3 g/dl, alta puntuación del CONUT (de 5-12 puntos), tratamiento con: opioide, neuroléptico o antidepresivo al realizar el MECVV, y objetivo asistencial al ingreso. En análisis multivariante obtuvieron significación: edad, enfermedad oncológica, comorbilidad, y albúmina como factores de riesgo para fallecer, y llevar antidepresivo como factor protector. Se aplicó análisis de contraste con Curva ROC. El área bajo la curva fue 0,740 y el intervalo de confianza (IC) 0,668-0,811. Conclusiones: En pacientes con disfagia, los datos referidos valorados al ingreso, pueden ayudar a definir más adecuada y precozmente objetivos asistenciales. En los casos con mayor riesgo de fallecer se priorizará una ingesta segura y de confort, y en aquellos con bajo riesgo, además deberá ser eficaz para intentar mejorar al máximo su estado nutricional.

[Saccharin test for the study of mucociliary clearance: reference values for a Spanish population]. / Test de la sacarina en el estudio del aclaramiento mucociliar. Valores de referencia en una población española.

OBJECTIVE: Mucociliary transport is an important defense mechanism for the airways. The aim of this study was to establish reference values for nasal mucociliary clearance time (MCT) by means of the saccharin test. SUBJECTS AND METHODS: A cross-sectional, descriptive, observational study was performed. The variables studied were nasal MCT, age, and sex. We included 249 healthy nonsmokers (134 male and 115 female subjects) aged over 10 years and stratified the sample by age. To establish reference values, percentiles were calculated and lower and upper limits of normal were established at percentiles 2.5 and 97.5, respectively. The association between nasal MCT and the main study variables was then investigated along with the reproducibility of the test. RESULTS: The following values for nasal MCT were obtained for the sample as a whole: mean (SD), 17.17 (8.43) minutes; median (interquartile range), 16 minutes (12-20 minutes), indicating that the central 50% of the sample fell within this 8-minute range; and maximum and minimum values of 4 to 54 minutes (range, 50 minutes). The upper and lower limits of normal were 6 and 36 minutes, respectively. In addition, it is noteworthy that only 6 subjects had a nasal MCT longer than 36 minutes. No significant differences between male and female subjects were found. Nasal MCT showed a positive correlation with age (rho=0.324; P=.0001). No significant differences were observed in the reproducibility test (P=.208). CONCLUSIONS: In addition to facilitating reliable data on mucociliary function, the saccharin test is easy to do, inexpensive, and reproducible. The data obtained from this study should allow the results of this test to be correctly interpreted for a given subject's age and so facilitate its use in clinical practice.

Test de la sacarina en el estudio del aclaramiento mucociliar. Valores de referencia en una población española / Saccharin test for the study of mucociliary clearance: reference values for a spanish population

OBJETIVO: El transporte mucociliar es un importante mecanismode defensa de las vías respiratorias. El objetivo deeste estudio ha sido obtener los valores de referencia deltiempo de transporte mucociliar nasal (TTMCN) medianteel test de la sacarina.SUJETOS Y MÉTODOS: Se ha realizado un estudio observacional,transversal y descriptivo. Las variables estudiadasfueron el TTMCN, la edad y el sexo. Se incluyó a 249 sujetos(134 varones y 115 mujeres) mayores de 10 años, sanos y nofumadores, que se asignaron a grupos según su edad. Parael análisis predictivo de los valores de normalidad se obtuvieronlos percentiles, estableciendo los límites de referenciapor los percentiles 2,5 y 97,5. Se analizó la asociación entreel TTMCN y las variables principales. Se estudió asimismola reproducibilidad del test.RESULTADOS: Del análisis global de la muestra destacanlos siguientes datos: mediana de 16 min; media ± desviaciónestándar de 17,17 ± 8,43 min; rango de 50 min (4-54); límitesde referencia de 6-36 min, y amplitud intercuartílica de 8min (un 50% central de la muestra entre 12 y 20 min). Esasimismo reseñable que sólo 6 sujetos tuvieron un TTMCNsuperior a 36 min. No se encontraron diferencias significativasentre varones y mujeres. El TTMCN mostró una correlaciónpositiva con la edad (rs = 0,324; p = 0,0001). No se observarondiferencias significativas (p = 0,208) en la pruebade reproducibilidad.CONCLUSIONES: El test de la sacarina es fácil de realizar,económico y reproducible, y facilita datos fiables de la funciónmucociliar. Los datos obtenidos en este trabajo permitenla correcta interpretación de los resultados de esta pruebasegún la edad del sujeto, lo que facilitará su uso

OBJECTIVE: Mucociliary transport is an important defensemechanism for the airways. The aim of this study was toestablish reference values for nasal mucociliary clearancetime (MCT) by means of the saccharin test.SUBJECTS AND METHODS: A cross-sectional, descriptive,observational study was performed. The variables studiedwere nasal MCT, age, and sex. We included 249 healthynonsmokers (134 male and 115 female subjects) aged over10 years and stratified the sample by age. To establishreference values, percentiles were calculated and lower andupper limits of normal were established at percentiles 2.5and 97.5, respectively. The association between nasal MCTand the main study variables was then investigated alongwith the reproducibility of the test.RESULTS: The following values for nasal MCT were obtainedfor the sample as a whole: mean (SD), 17.17 (8.43) minutes;median (interquartile range), 16 minutes (12-20 minutes),indicating that the central 50% of the sample fell within this8-minute range; and maximum and minimum values of 4 to54 minutes (range, 50 minutes). The upper and lower limits ofnormal were 6 and 36 minutes, respectively. In addition, it isnoteworthy that only 6 subjects had a nasal MCT longer than36 minutes. No significant differences between male and femalesubjects were found. Nasal MCT showed a positive correlationwith age ( =0.324; P=.0001). No significant differences wereobserved in the reproducibility test (P=.208).CONCLUSIONS: In addition to facilitating reliable data onmucociliary function, the saccharin test is easy to do,inexpensive, and reproducible. The data obtained from thisstudy should allow the results of this test to be correctlyinterpreted for a given subject’s age and so facilitate its usein clinical practice