Relação entre apoio social e sono de pessoas idosas cuidadoras em vulnerabilidade social / Relationship between social support and sleep of elderly caregivers in social vulnerability / Relación entre apoyo social y sueño de adultos mayores cuidadores con vulnerabilidad social

Objetivo: analisar a relação entre apoio social e qualidade do sono de pessoas idosas que cuidam de outros idosos em ambiente de vulnerabilidade social. Método: estudo transversal realizado com 65 cuidadores entrevistados por meio de instrumento de caracterização, Índice de Katz, Escala de Lawton e Brody, Índice de Qualidade do Sono de Pittsburgh e Escala de Apoio Social do Medical Outcomes Study, com dados analisados com testes de comparação e de correlação. Resultados: a maioria eram mulheres, cônjuges do idoso cuidado e possuíam sono de má qualidade. Observou-se correlação fraca e inversa entre má qualidade do sono e a dimensão interação social positiva (Rho=-0,27; p=0,028). Identificou-se relação significativa entre: apoio material e disfunção diurna (p=0,034); apoio afetivo e eficiência do sono (p=0,026); interação social positiva e qualidade subjetiva do sono (p=0,001) e disfunção diurna (p=0,008). Conclusão: Quanto maior a interação social positiva, melhor é a qualidade do sono.

Objective: to analyze the relationship between social support and sleep quality of elderly individuals who care for other elderly individuals in a socially vulnerable environment. Method: a cross-sectional study conducted with 65 caregivers interviewed using a characterization instrument, Katz Index, Lawton and Brody Scale, Pittsburgh Sleep Quality Index, and Medical Outcomes Study Social Support Scale, with data analyzed using comparison and correlation tests. Results: the majority were women, spouses of the elderly being cared for, and had poor sleep quality. A weak and inverse correlation was observed between poor sleep quality and the positive social interaction dimension (Rho=-0.27; p=0.028). Significant relationships were identified between: material support and daytime dysfunction (p=0.034); emotional support and sleep efficiency (p=0.026); positive social interaction and subjective sleep quality (p=0.001), as well as daytime dysfunction (p=0.008). Conclusion: The higher the positive social interaction, the better the sleep quality.

Objetivo: analizar la relación entre el apoyo social y la calidad del sueño de personas mayores que cuidan de otras personas mayores en entornos socialmente vulnerables. Método: estudio transversal realizado con 65 cuidadores entrevistados mediante un instrumento de caracterización, Índice de Katz, Escala de Lawton y Brody, Índice de Calidad del Sueño de Pittsburgh y Escala de Apoyo Social del Medical Outcomes Study, los datos fueron analizados mediante pruebas de comparación y correlación. Resultados: la mayoría eran mujeres, cónyuges del adulto mayor que recibe el cuidado y tenían mala calidad del sueño. Se observó una correlación débil e inversa entre la mala calidad del sueño y la dimensión de interacción social positiva (Rho=-0,27; p=0,028). Se identificó que había relación significativa entre: apoyo material y disfunción diurna (p=0,034); apoyo afectivo y eficiencia del sueño (p=0,026); interacción social positiva y calidad subjetiva del sueño (p=0,001) y disfunción diurna (p=0,008). Conclusión: Cuanto mayor sea la interacción social positiva, mejor será la calidad del sueño.

Revisión narrativa del modelo de desarrollo positivo para adultos emergentes chilenos / A narrative review of the positive development model for Chilean emerging adults / Revisão narrativa do modelo de desenvolvimento positivo para adultos emergentes chilenos

Introducción: El desarrollo positivo es un estadio de ajuste psicosocial que acentúa las potencialidades y los recursos entre jóvenes y sus contextos próximos. En Australia, se desarrolló el primer modelo de desarrollo positivo para adultos emergentes, el cual consta de cinco componentes (competencia social, satisfacción con la vida, confianza y tolerancia con los otros, confianza hacia autoridades e instituciones, acción y compromiso cívico), pero no ha sido investigado en Chile. Objetivo: Analizar la evidencia disponible en la literatura científica sobre los cinco componentes del modelo de desarrollo positivo en adultos emergentes universitarios de Chile. Materiales y métodos: Revisión narrativa de la literatura publicada entre 2013 y 2023, en bases de datos Web of Science, Scopus, SciELO, Redalyc y Dialnet. Resultados: Se obtuvieron 83 artículos, de los cuales 53 cumplieron los requisitos de inclusión; en su mayor parte fueron estudios cuantitativos (81,13%) y en español (75,47%). Se evidenció una disparidad en la cantidad de estudios por temática; se encuentra mayor investigación en satisfacción con la vida y acción y compromiso cívico. Conclusiones: Existen brechas en la literatura científica chilena en el estudio del desarrollo positivo; además de que se discuten particularidades idiosincrásicas y desafíos asociados a la etapa de adultez emergente.

Introduction: Positive development is a stage of psychosocial adjustment that accentuates the potentials and resources of young people and their close contexts. The first positive development model for emerging adulthood was developed in Australia, which includes five components: social; life satisfaction; trust and tolerance of others; trust in the authorities and institutions; and action and civic engagement. However, this model has not been investigated in Chile. Objective: To analyze the evidence available in the scientific literature on the five components of the positive development model in emerging adults universities. Materials and methods: A narrative review of the literature published between 2013 and 2023 in the Web of Science, Scopus, SciELO, Redalyc, and Dialnet databases was conducted. Results: 83 articles were selected, of which 53 met the inclusion criteria; most of them were qualitative studies (81.13%) and in Spanish (75.47%). There is an evident disparity in terms of the number of studies and topics, e.g., there is more research on life satisfaction and civic action and commitment. Conclusions: There are gaps in the Chilean scientific literature in the study of positive development. In addition, idiosyncratic particularities and challenges associated with the stages of emerging adulthood are discussed.

Introdução: O desenvolvimento positivo é uma fase de ajustamento psicossocial que acentua o potencial e os recursos dos jovens e dos seus contextos imediatos. Na Austrália, foi desenvolvido o primeiro modelo de desenvolvimento positivo para adultos emergentes, que consiste em cinco componentes (social, satisfação com a vida, confiança e tolerância com os outros, confiança nas autoridades e instituições, ação e envolvimento cívico), mas ainda não foi investigado no Chile. Objetivo: Analisar as evidências disponíveis na literatura científica sobre os cinco componentes do modelo de desenvolvimento positivo em adultos universitários emergentes no Chile. Materiais e métodos: Revisão narrativa da literatura publicada entre 2013 e 2023, nas bases de dados Web of Science, Scopus, SciELO, Redalyc e Dialnet. Resultados: foram obtidos 83 artigos, dos quais 53 atenderam aos requisitos de inclusão; A maioria deles eram estudos quantitativos (81,13%) e em espanhol (75,47%). Ficou evidente uma disparidade no número de estudos por tema; Há mais pesquisas sobre satisfação com a vida e ação e compromisso cívico. Conclusões: Existem lacunas na literatura científica chilena no estudo do desenvolvimento positivo; Além disso, são discutidas particularidades e desafios idiossincráticos associados à fase da idade adulta emergente.

NT-proBNP in systemic right ventricles: a new cutoff level for risk stratification?

INTRODUCTION AND OBJECTIVES: The role of N-terminal pro-B-type natriuretic peptide (NT-proBNP) in the risk prediction of patients with systemic right ventricles (sRV) is not well defined. The aim of this study was to analyze the prognostic value of NT-proBNP in patients with an sRV. METHODS: The prognostic value of NT-proBNP was assessed in 98 patients from the SERVE trial. We used an adjusted Cox proportional hazards model, survival analysis, and c-statistics. The composite primary outcome was the occurrence of clinically relevant arrhythmia, heart failure, or death. Correlations between baseline NT-proBNP values and biventricular volumes and function were assessed by adjusted linear regression models. RESULTS: The median age [interquartile range] at baseline was 39 [32-48] years and 32% were women. The median NT-proBNP was 238 [137-429] ng/L. Baseline NT-proBNP concentrations were significantly higher among the 20 (20%) patients developing the combined primary outcome compared with those who did not (816 [194-1094] vs 205 [122-357]; P = .003). In patients with NT-proBNP concentrations > 75th percentile (> 429 ng/L), we found an exponential increase in the sex- and age-adjusted hazard ratio for the primary outcome. The prognostic value of NT-proBNP was comparable to right ventricular ejection fraction and peak oxygen uptake on exercise testing (c-statistic: 0.71, 0.72 and 0.71, respectively). CONCLUSIONS: In patients with sRVs, NT-proBNP concentrations correlate with sRV volumes and function and may serve as a simple tool for predicting adverse outcomes.

Association of frailty with the use of health services in older adults: a secondary analysis of the Mexican Health and Aging Study.

BACKGROUND: Frailty has been related to adverse outcomes, but evidence on its association with the use of health services is still scarce. OBJECTIVE: The purpose of this work was to determine the association of frailty with the use of health services in Mexican adults older than 60 years. MATERIAL AND METHODS: Analysis of the Mexican Health and Aging Study for the years 2015 (baseline) and 2018 (follow-up). Frailty was defined with the frailty index. The following outcomes were included: hospitalization, medical visits, major surgery, minor surgical procedures, and dental visits. Competing risk and count analyses (negative binomial regression) were performed. RESULTS: A total of 8,526 individuals were included, whose average age was 70.8%; 55.8% corresponded to the female gender. According to the results, hospitalization days and the number of minor procedures were associated with frailty. CONCLUSIONS: Frailty could be useful in the planning of health services for older adults. On the other hand, its evaluation would allow prioritizing care for those who are at higher risk of adverse outcomes.

ANTECEDENTES: La fragilidad se ha relacionado con desenlaces adversos, pero aún es escasa la evidencia sobre su asociación con el uso de servicios de salud. OBJETIVO: Evidenciar la asociación de la fragilidad con el uso de servicios de salud en adultos mexicanos mayores de 60 años. MATERIAL Y MÉTODOS: Análisis del Estudio Nacional sobre Salud y Envejecimiento en México para 2015 (basal) y 2018 (seguimiento). La fragilidad se definió con el índice de fragilidad. Fueron incluidos los siguientes desenlaces: hospitalización, visitas médicas, cirugía mayor, procedimientos quirúrgicos menores y visitas al dentista. Se utilizaron modelos de riesgos competitivos y de número de eventos (regresión negativa binomial). RESULTADOS: Se incluyeron 8526 individuos, cuya edad promedio fue de 70.8 %; 55.8 % correspondió al sexo femenino. De acuerdo con los resultados, los días de hospitalización y el número de procedimientos menores se asociaron a fragilidad. CONCLUSIONES: La fragilidad podría ser un parámetro útil en la planeación de los servicios de salud para los adultos mayores. Por otro lado, su evaluación permitiría priorizar la atención a quienes presenten mayor riesgo de desenlaces adversos.

Effects of a health promotion intervention in a Mexican population with celiac disease / Efectos de una intervención de promoción de salud en población mexicana con enfermedad celíaca / Efeitos de uma intervenção de promoção da saúde numa população mexicana com doença celíaca

Objective: To evaluate the effect of a health promotion care model in adolescents and young adults with Celiac Disease. Method: This is a quasi-experimental study with 152 pretest and 136 posttest participants aged between 15 and 35 years. The data were collected virtually between August and September 2023 through three questionnaires: sociodemographic, the Celiac Symptom Index and the Health Promoter Lifestyle Profile II - Spanish version. The variables were evaluated using the Wilcoxon test, with significance p < 0.05. Results: Regarding the celiac symptom index, statistically significant differences were found with a large effect size, where the pretest scores were higher than the posttest scores (p<0.001). Regarding lifestyle, it was found that health-promoting behaviors presented statistically significant differences with a large effect size; pretest scores were lower than posttest scores (p<.001). Conclusion: Carrying out educational interventions to promote health in people with celiac disease improves their lifestyle and reduces the symptoms of the disease, so the present study confirmed this hypothesis.

Objetivo: Evaluar el efecto de un modelo de cuidado de promoción de salud en adolescentes y adultos jóvenes con Enfermedad Celíaca. Método: Se trata de un estudio cuasiexperimental con 152 participantes pretest y 136 postest con edades comprendidas entre 15 y 35 años. Los datos fueron recolectados de manera virtual entre agosto y septiembre de 2023 a través de tres cuestionarios: sociodemográfico, del Índice de Síntomas Celíacos y del Perfil de estilo de vida Promotor de Salud II - versión en español. Las variables fueron evaluadas mediante la prueba de Wilcoxon, con significancia p < 0,05. Resultados: Con relación al índice de síntomas celíacos, se encontraron diferencias estadísticamente significativas con un tamaño del efecto grande, donde las puntuaciones pretest fueron mayores que las puntuaciones postest (p<0,001). En cuanto al estilo de vida, se encontraron que las conductas promotoras de la salud presentaron diferencias estadísticamente significativas con un tamaño del efecto grande, las puntuaciones pretest fueron inferiores a las puntuaciones postest (p<.001). Conclusión: Realizar intervenciones educativas para promover la salud en personas celíacas mejora su estilo de vida y reduce los síntomas de la enfermedad, por lo que el presente estudio confirmó esta hipótesis.

Objetivo: Avaliar o efeito de um modelo de atenção de promoção da saúde em adolescentes e adultos jovens com Doença Celíaca. Método: Trata-se de um estudo quase-experimental com 152 participantes pré-teste e 136 pós-teste com idades entre 15 e 35 anos. Os dados foram coletados virtualmente entre agosto e setembro de 2023 por meio de três questionários: sociodemográfico, Celiac Symptom Index e Health Promoter Lifestyle Profile II - versão em espanhol. As variáveis ​​foram avaliadas pelo teste de Wilcoxon, com significância p < 0,05. Resultados: Em relação ao índice de sintomas celíacos, foram encontradas diferenças estatisticamente significativas com grande tamanho de efeito, onde os escores do pré-teste foram superiores aos escores do pós-teste (p<0,001). Em relação ao estilo de vida, constatou-se que os comportamentos de promoção da saúde apresentaram diferenças estatisticamente significativas, com um grande tamanho de efeito inferior aos resultados do pós-teste (p<0,001). Conclusão: A realização de intervenções educativas para promoção da saúde em pessoas com doença celíaca melhora o seu estilo de vida e reduz os sintomas da doença, pelo que o presente estudo confirmou esta hipótese.

Bronchodilator administration by pressurized inhaler during invasive mechanical ventilation in adults: A scoping review.

OBJECTIVE: To identify the administration characteristics and connection methods of bronchodilators by pressurized inhalers to the ventilatory circuit of patients under invasive mechanical ventilation. METHODS: A scope review was conducted following the PRISMA for Scoping Review, using the PubMed, Embase Elsevier, Cochrane Library, and Lilacs databases without language restrictions, up to July 2023. Eligible sources included reviews and consensuses (based on clinical studies), experimental and observational studies involving adult patients admitted to the intensive care unit and undergoing invasive mechanical ventilation, regardless of the underlying condition, who used bronchodilator drugs contained in pressurized inhalers. Information regarding inhalation technique, pressurized inhalers connection mode to the circuit, and patient care were collected by 2 researchers independently, with discrepancies resolved by a third reviewer. Studies involving bronchodilators combined with other pharmacological classes in the same device, as well as reviews containing preclinical studies, were excluded. RESULTS: In total, 23 publications were included, comprising 19 clinical trials and 4 non-randomized experimental studies. Salbutamol (albuterol) was the bronchodilator of study in the majority of the articles (n=18), and the spacer device was the most commonly used to connect the pressurized inhaler to the circuit (n=15), followed by an in-line adapter (n=3), and a direct-acting device without chamber (n=3). Concerning the pressurized inhaler placement in the circuit, 18 studies positioned it in the inspiratory limb, and 19 studies synchronized the jet actuation with the start of the inspiratory phase. Agitation of the pressurized inhaler before each actuation, waiting time between actuations, airway suction before administration, and semi-recumbent patient positioning were the most commonly described measures across the studies. CONCLUSIONS: This review provided insights into the aspects related to inhalation technique in mechanically ventilated patients, as well as the most prevalent findings and the existing gaps in knowledge regarding bronchodilator administration in this context. The evidence indicates the need for further research on this subject.

[Effect of training with immersive virtual reality on the risk of falling in the elderly: a systematic review]. / Efecto del entrenamiento con realidad virtual inmersiva en el riesgo de caída de personas mayores: una revisión sistemática.

Aging entails changes in the human body, generating a decrease in physical capabilities, including the risk of falls. New therapies are currently emerging for the risk of falls and immersive virtual reality is one of them, giving the user a realistic feeling of a virtual environment. This systematic review aims to investigate the effects of immersive virtual reality on the risk of falling in older people. Randomized controlled clinical trials were included, with at least one intervention group that used immersive virtual reality, age >60 years and without multiple serious pathologies. Articles published until November 2023 were included, in accordance with the PRISMA guideline and including the PICO strategy, in the electronic databases PubMed, Scielo, Scopus, Semantic Scholar and Science Direct. From a total of 413 articles, 7 studies were selected, which met the pre-established inclusion and exclusion criteria. Of the studies reviewed, the majority found significant improvements in tests that measure risk of falls, only one study did not find improvements in this variable but did find improvements for walking speed and functional reach test. Despite the limited literature, it seems that these interventions can have a positive effect, becoming a good tool to reduce the risk of falling in older people.

Diagnostic utility of the Alvarado scale in older adults with suspected acute appendicitis.

BACKGROUND: Acute appendicitis remains as a differential diagnosis in older patients with abdominal pain. The Alvarado scale may assist to guide the diagnosis and treatment of this entity. The operative characteristics of the scale are little known in this population. METHOD: We conducted a systematic review of original studies published between 1986 and 2022 evaluating the diagnostic performance of the Alvarado scale in older adults with suspected acute appendicitis. The review was conducted according to the PRISMA statement. The evaluation of the methodological quality of the studies was performed according to the ROBINS-I criteria. RESULTS: Four original studies of retrospective design including 480 patients were identified. The heterogeneity and poor methodological quality limited an aggregate statistical analysis (meta-analysis). The value of the ROC curve of the scale varies between 0.799 and 0.969. From the available studies, the value of the ROC curve is lower in comparison to the RIPASA scale and comparable to the Lintula scale. CONCLUSIONS: The evidence on the diagnostic performance of the Alvarado scale in older adults is limited. The poor methodological quality of the available studies calls for a prudent use of this tool in this population. Our findings offer opportunities for future research.

ANTECEDENTES: La apendicitis aguda es un diagnóstico diferencial en el adulto mayor con dolor abdominal. La escala de Alvarado se utiliza para orientar el diagnóstico y el tratamiento. Las características operativas de la escala son poco conocidas en este grupo de pacientes. MÉTODO: Revisión sistemática de estudios originales publicados entre 1986 y 2022 que evaluaron el rendimiento diagnóstico de la escala de Alvarado en adultos mayores con sospecha de apendicitis aguda, con base en la declaración PRISMA. La evaluación de la calidad metodológica de los estudios se realizó con los criterios ROBINS-I. RESULTADOS: Se identificaron cuatro estudios originales de diseño retrospectivo que incluyen 480 pacientes. La heterogeneidad y la baja calidad metodológica limitaron un análisis estadístico agregado (metaanálisis). El valor de la curva ROC de la escala varía entre 0.799 y 0.969. En los estudios disponibles, el valor de la curva ROC es inferior al de la escala RIPASA y similar al de la escala de Lintula. CONCLUSIONES: La evidencia que sustenta el rendimiento diagnóstico de la escala de Alvarado en los adultos mayores es limitada. La pobre calidad de los estudios disponibles advierte sobre el uso prudente de esta herramienta en este grupo poblacional. Los hallazgos identificados ofrecen oportunidades de investigación futura.

Malnutrition: muscle wasting, inflammation, RDW, and their relation with adverse outcomes.

OBJECTIVE: The objective of the study was to explore red cell distribution width (RDW) as a surrogate marker of inflammation, alone and in conjunction with muscle wasting to predict malnutrition-related adverse outcomes. METHODS: This was a single-center observational study including adult hospitalized patients. Demographic variables, malnutrition criteria, and RDW were captured within 24 hours of hospital admission. Correlation tests and regression models were performed between these variables (RDW and muscle wasting) and adverse outcomes (in-hospital mortality and unplanned transfer to critical care areas (CCA). RESULTS: Five hundred and forty-five patients were included in the final analysis. Muscle wasting showed an independent association with adverse outcomes in every regression model tested. RDW alone showed fair predictive performance for both outcomes' significance and the adjusted model with muscle wasting showed association only for unplanned transfer to CCA. CONCLUSION: RDW did not improve the prediction of adverse outcomes compared to muscle wasting assessed by physical examination and simple indexes for acute and chronic inflammation. Malnourished patients presented higher RDW values showing a possible metabolic profile (higher inflammation and lower muscle). It is still unknown whether nutrition support can influence RDW value over time as a response marker or if RDW can predict who may benefit the most from nutritional support.

OBJETIVO: Explorar el ancho de distribución eritrocitaria (ADE) como un marcador subrogado de inflamación, individualmente y en conjunto con el desgaste muscular, para predecir resultados adversos asociados a la desnutrición. MÉTODO: Estudio unicéntrico, observacional, incluyendo pacientes adultos hospitalizados. Se capturaron variables demográficas, criterios de desnutrición y el ADE en las primeras 24 horas de ingreso. Se realizaron pruebas de correlación y modelos de regresión entre dichas variables (ADE y desgaste) y resultados adversos (mortalidad hospitalaria y traslado no planeado a áreas críticas). RESULTADOS: Se incluyeron 545 pacientes. El desgaste muscular mostró asociación independiente con los resultados adversos en cada modelo. El ADE individualmente mostró un desempeño aceptable para la predicción de ambos resultados, y en modelos ajustados con desgaste muscular mostró asociación únicamente con traslado no planeado a áreas críticas. CONCLUSIONES: El ADE no mejoró la predicción de resultados adversos comparado con el desgaste muscular por exploración física e índices simples de inflamación. Los pacientes con desnutrición presentaron mayores valores de ADE, mostrando un posible perfil metabólico (mayor inflamación y menos músculo). Aún se desconoce si el soporte nutricional puede influenciar el ADE como un marcador de respuesta o si puede predecir una respuesta favorable al soporte nutricional.

Guía de práctica clínica informada en la evidencia para el abordaje de la obesidad en adultos. Versión completa. Mayo de 2024 / Evidence-informed clinical practice guide for adult obesity. Full Version. May 2024

En esta guía titulada: "Guía de práctica clínica informada en la evidencia para el abordaje de la obesidad en adultos" se presenta todo el proceso que se desarrolló para su adaptación, de acuerdo con el "Manual para el desarrollo de guías de la Organización Mundial de la Salud" y la "Guía para adaptar y aplicar directrices informadas por la evidencia en su segunda edición de la OPS año 2023". Las recomendaciones propuestas, fueron validadas por un panel con la participación de profesionales expertos clínicos del Sistema Nacional de Salud., asociaciones médicas y representantes de los pacientes. El abordaje del tratamiento de la obesidad en esta guía contribuirá a mejorar la calidad de atención de la población salvadoreña

This guide entitled "Evidence-informed clinical practice guide for the management of obesity in adults" presents the entire process that was developed for its adaptation, according to the "Manual for the development of guidelines of the World Health Organization" and the "Guide to adapt and apply guidelines informed by evidence in its second edition of PAHO year 2023". The proposed recommendations were validated by a panel with the participation of expert clinical professionals from the National Health System, medical associations and patient representatives. The approach to the treatment of obesity in this guide will contribute to improving the quality of care for the Salvadoran population

Guía de práctica clínica informada en la evidencia para el abordaje de la obesidad en adultos. Versión resumida. Mayo de 2024 / Evidence-informed clinical practice guide for the adult approach to obesity. Summary version. May 2024

En esta guía titulada: "Guía de práctica clínica informada en la evidencia para el abordaje de la obesidad en adultos" se presenta todo el proceso que se desarrolló para su adaptación, de acuerdo con el "Manual para el desarrollo de guías de la Organización Mundial de la Salud" y la "Guía para adaptar y aplicar directrices informadas por la evidencia en su segunda edición de la OPS año 2023". Las recomendaciones propuestas, fueron validadas por un panel con la participación de profesionales expertos clínicos del Sistema Nacional de Salud., asociaciones médicas y representantes de los pacientes. El abordaje del tratamiento de la obesidad en esta guía contribuirá a mejorar la calidad de atención de la población salvadoreña

This guide entitled "Evidence-informed clinical practice guide for the management of obesity in adults" presents the entire process that was developed for its adaptation, according to the "Manual for the development of guidelines of the World Health Organization" and the "Guide to adapt and apply guidelines informed by evidence in its second edition of PAHO year 2023". The proposed recommendations were validated by a panel with the participation of expert clinical professionals from the National Health System, medical associations and patient representatives. The approach to the treatment of obesity in this guide will contribute to improving the quality of care for the Salvadoran population

Morbidity and mortality of elderly patients with pancreaticobiliary disease according to age and comprehensive geriatric assessment: A prospective observational study / Morbilidad y mortalidad de pacientes de edad avanzada con enfermedad pancreaticobiliar con relación a su edad y la evaluación geriátrica integral: un estudio prospectivo observacional

Background This study was designed to analyze the influence of age and comprehensive geriatric evaluation on clinical results of pancreaticobiliary disease management in elderly patients. Methods A prospective observational study has been undertaken, including 140 elderly patients (over 75 years) with benign pancreaticobiliary disease. Patients were divided according to age in the following groups: group 1: 75–79 years old; group 2: 80–84 years old; group 3: 85 years and older. They underwent a comprehensive geriatric assessment with different scales: Barthel Index, Pfeiffer Index, Charlson Index, and Fragility scale, at admission and had been follow-up 90 days after hospital discharge to analyze its influence on morbidity and mortality. Results Overall, 140 patients have been included (group 1=51; group 2=43 and group 3=46). Most of them, 52 cases (37.8%), had acute cholecystitis, followed by 29 cases of acute cholangitis (20.2%) and acute pancreatitis with 25 cases (17.9%). Significant differences has been observed on complications in different age groups (p=0.033). Especially in patients with a Barthel Index result ≤60, which suggests that these less functional patients had more severe complications after their treatment (p=0.037). The mortality rate was 7.1% (10 patients). Conclusions No significant differences were found between age, morbidity and mortality in elderly patients with pancreaticobiliary disease. Comprehensive geriatric scales showed some utility in their association with specific complications. (AU)

Antecedentes Este estudio fue diseñado para analizar la influencia de la edad y la evaluación geriátrica integral en los resultados clínicos del manejo de la enfermedad pancreatobiliar en pacientes de edad avanzada. Métodos Se ha realizado un estudio observacional prospectivo en el que se incluyeron 140 pacientes de edad avanzada (mayores de 75 años) con enfermedad pancreatobiliar benigna. Los pacientes se dividieron según la edad en los siguientes grupos: Grupo 1: 75-79 años; Grupo 2: 80-84 años; Grupo 3: 85 años y más. Se les realizó una valoración geriátrica integral con diferentes escalas: Barthel Index, Pfeiffer Index, Charlson Index y Fragility scale, al ingreso y seguimiento 90 días después del alta hospitalaria para analizar su influencia en la morbimortalidad. Resultados En total, se incluyeron 140 pacientes (Grupo 1=51; Grupo 2=43 y Grupo 3=46). La mayoría de ellos, 52 casos (37,8%), presentaron colecistitis aguda, seguido de colangitis aguda con 29 casos (20,2%) y pancreatitis aguda con 25 casos (17,9%). Se han observado diferencias significativas en las complicaciones en diferentes grupos de edad (p=0,033). Especialmente en pacientes con un índice de Barthel ≤60, lo que sugiere que estos pacientes menos funcionales tuvieron complicaciones más severas después de su tratamiento (p=0,037). La tasa de mortalidad fue de 7,1% (10 pacientes). Conclusiones No se encontraron diferencias significativas entre la edad, la morbilidad y la mortalidad en pacientes ancianos con enfermedad pancreatobiliar. Las escalas geriátricas integrales mostraron cierta utilidad en su asociación con complicaciones específicas. (AU)

Approach to the elderly patient with vertebral fracture due to bone fragility. / Abordaje del adulto mayor con fractura vertebral por fragilidad ósea.

Osteoporosis is a metabolic and systemic disease characterized by alterations at the level of bone tissue with loss of bone mineral density, changes in microarchitecture, mineralization and remodeling that determine greater bone fragility and risk of fracture. Falls in the elderly are a risk factor closely related to fragility fractures and numerous studies demonstrate this relationship. Vertebral fractures are a major cause of morbidity and mortality. The epidemiology differs from osteoporotic fractures at other skeletal sites, as only one-third are clinically recognized. In the elderly, the approach to osteoporotic vertebral fracture involves comprehensive evaluation of the patient, since it is both a cause and a consequence of multiple geriatric syndromes. This fracture, in its acute phase and subsequently, can lead to destabilization of other organs and systems of the elderly, medical complications at different levels, functional deterioration, dependence, and even the need for institutionalization. Therefore, it is important to carry out a multiple assessment of patients with vertebral fractures, addressing not only the history and risk factors of osteoporosis, but also those factors that lead to falls, as well as a comprehensive geriatric assessment and the complications closely associated with it. In this chapter we address each of these aspects that are necessary in the individual and multidimensional approach to the elderly patient with vertebral fracture due to bone fragility.

EXECUTIVE FUNCTIONS IN YOUNG ADULTS AGED 19 TO 24 YEARS WITH BREAST CANCER: AN EXPLORATORY REVIEW OF THE LITERATURE BETWEEN 2015 AND 2020 / FUNCIONES EJECUTIVAS EN ADULTOS JÓVENES DE 19 A 24 AÑOS CON CÁNCER DE MAMA: REVISIÓN EXPLORATORIA DE LITERATURA ENTRE 2015 Y 2020

With the growth and aging of the population, along with economic growth and changes in lifestyles associated with increased quality of life, the main burden of disease shifted from infectious diseases to noncommunicable and complex diseases. However, it is cancer that has increased its incidence in the world population, especially in low- and middle-income countries, where 70% of cancer deaths occur.  The research is articulated to sustainable development goal three, in particular on the effect of cancer on cognitive functioning, because cancer pain impairs cognitive functioning. A simple review for executive functions and breast cancer in PROSPERO indicated an absence of reviews on this topic. Reason why, our aim is to describe executive functions and treatment effect by chemotherapy/radiotherapy in young adult breast cancer patients between 2015 and 2020 in the scientific literature. Materials and methods: exploratory literature review according to PRISMA protocol for exploratory reviews. Articles published in Scopus, PubMed, ScienceDirect, scielo, google academic, in Spanish, English, French. With the keywords: ("Executive Function") AND ("Neoplasms") OR "breast cancer" OR "Drug Therapy," AND ("Young Adult"), searches were performed until February 4, 2020. Results: 16 articles included in the review. Clinical and methodological heterogeneity was found on patients' executive functions and treatment. However, we did find executive function impairment among patients assessed by both treatment and cancer. Conclusions: A systematic review on the subject and meta-analysis are suggested to identify the effect size, accompanied by the statistical evidence identified in the studies. Colombia could investigate this topic because there is no Colombian research.

Con el crecimiento y envejecimiento de la población, junto al crecimiento económico y los cambios en los estilos de vida asociados al incremento en la calidad de vida, la principal carga de morbilidad pasó de las enfermedades infecciosas a las no transmisibles y complejas. Sin embargo, es el cáncer incrementó su incidencia en la población mundial, especialmente en países de ingresos bajos y medios, dónde el 70% de las muertes por cáncer se presentan.  La investigación se articula al objetivo de desarrollo sostenible tres, en particular sobre el efecto del cáncer sobre el funcionamiento cognitivo, debido a que el dolor por cáncer deteriora el funcionamiento cognitivo. Una revisión sencilla por funciones ejecutivas y cáncer de mama en PROSPERO indicó una ausencia de revisiones en este tema. Razón por la cual, nuestro objetivo es describir las funciones ejecutivas y el efecto del tratamiento por quimioterapia/radioterapia en pacientes con cáncer de mama en adultos jóvenes entre 2015 y 2020 en la literatura científica. Materiales y métodos: Revisión exploratoria de literatura según protocolo PRISMA para revisiones exploratorias. Artículos publicados en Scopus, PubMed, ScienceDirect, scielo, google académico, en idioma español, inglés, francés. Con las palabras clave: ("Executive Function") AND ("Neoplasms") OR "breast cancer" OR "Drug Therapy," AND ("Young Adult"), las búsquedas se realizaron hasta el 4 de febrero de 2020. Resultados: 16 artículos incluidos en la revisión. Se encontró heterogeneidad clínica y metodológica sobre las funciones ejecutivas de los pacientes y el tratamiento. Sin embargo, sí se encontró afectación de funciones ejecutivas entre los pacientes evaluados tanto por el tratamiento cómo por el cáncer. Conclusiones: Se sugiere una revisión sistemática sobre el tema y meta-análisis para identificar el tamaño del efecto, acompañado de la evidencia estadística identificada en los estudios. Colombia podría investigar sobre esta temática debido a que no hay investigaciones colombianas.

Com o crescimento e o envelhecimento da população, juntamente com o desenvolvimento económico e as mudanças nos estilos de vida associadas ao aumento da qualidade de vida, o principal fardo da doença mudou de doenças infecciosas para doenças não transmissíveis e complexas. No entanto, é o câncer que aumentou a sua incidência na população mundial, especialmente nos países de baixa e média renda, onde 70% das mortes por câncer ocorrem. A pesquisa está articulada com o Objectivo de Desenvolvimento Sustentável 3, em particular sobre o efeito do câncer sobre o funcionamento cognitivo, porque a dor do cancro prejudica a função cognitiva. Uma simples revisão para funções executivas e câncer de mama em PROSPERO indicou uma ausência de comentários sobre este tópico. A razão pela qual, nosso objetivo é descrever as funções executivas e o efeito do tratamento por quimioterapia/radioterapia em pacientes jovens adultos com câncer de mama entre 2015 e 2020 na literatura científica. Materiais e métodos: revisão da literatura exploratória de acordo com o protocolo PRISMA para revisões exploratórias. Artigos publicados em Scopus, PubMed, ScienceDirect, scielo, google academic, em espanhol, inglês, francês. Com as palavras-chave: ("Função Executiva") E ("Neoplasmas") OU "câncer de mama" OU" Terapia de drogas," E ("Jovem Adulto"), as pesquisas foram realizadas até 4 de fevereiro de 2020. Resultados: 16 artigos incluídos na revisão. Foi encontrada heterogeneidade clínica e metodológica nas funções executivas e no tratamento dos pacientes. No entanto, descobrimos que a função executiva foi prejudicada entre os pacientes avaliados tanto pelo tratamento como pelo câncer. Conclusões: Sugere-se uma revisão sistemática do assunto e meta-análise para identificar o tamanho do efeito, acompanhada das provas estatísticas identificadas nos estudos. A Colômbia poderia investigar este assunto porque não há pesquisa colombiana.

Asociación de fuerza prensil y extensores de rodilla con estado nutricional de adultos mayores pertenecientes a la comunidad / Association of grip strength and knee extensors with nutritional status of community-dwelling older adults

Antecedentes y objetivo: Determinar la asociación de fuerza prensil de mano y extensores de rodilla con el estado nutricional de adultos mayores de la comunidad. Material y métodos: Estudio observacional transversal. Se analizó peso y talla de 847 adultos mayores según índice de masa corporal y se clasificaron en cuatro categorías nutricionales según el Ministerio de Salud de Chile. Se evaluó la fuerza prensil de mano y extensores de rodilla para ambas extremidades. La fuerza fue normalizada por masa corporal y se utilizó la correlación de Spearman entre índice de masa corporal y fuerza muscular. Resultados: La muestra fue de 582 mujeres y 265 hombres con edad promedio de 71,72±7,09. Las mujeres presentaron un índice de masa corporal de 30,03±5,48 y los hombres 27,64±4,05, la categoría más numerosa fue normopeso (n = 288) y la menor bajo peso (n = 74). La fuerza prensil de mano presentó mayor correlación que extensores de rodilla, específicamente, fuerza prensil de mano derecha (r: -0,40). La mayor correlación y significancia la presentó la categoría obesa para todas las mediciones de fuerza, resultando la fuerza prensil de mano derecha como la más alta (r: -0,29). Conclusiones: El aumento del estado nutricional de los adultos mayores influye negativamente sobre la fuerza muscular. La mejor asociación entre índice de masa corporal y fuerza muscular fue la prensión de mano derecha. Resalta el hallazgo del aumento de la esperanza de vida a medida que disminuye el IMC de la muestra. Futuros estudios deberían generar percentiles y valores normalizados en población chilena.(AU)

Aim: To determine the association of hand grip strength and knee extensor strength with the nutritional status of community-dwelling older adults. Material and methods: Observational cross-sectional study. Weight and height of 847 older adults were analyzed according to body mass index and classified into four nutritional categories according to the Chilean Ministry of Health. Hand grip and knee extensors strength for both extremities were evaluated. Strength was normalized by body mass. Spearman's correlation between body mass index and muscle strength was used. Results: The sample was 582 women, 265 men and an average age of 71.72±7.09. The women had a BMI of 30.03±5.48 and the men of 27.64 ± 4.05, the most numerous category was normal weight (n = 288) and the lowest low weight (n = 74). Hand grip strength presented a higher correlation than knee extensors, specifically, right hand grip strength (r: −0.40). The highest correlation and significance were presented by the obese category for all strength measurements, with right hand grip strength being the highest (r: −0.29). Conclusions: The increase in the nutritional status of older adults has a negative influence on muscle strength. The best association between body mass index and muscle strength was the right hand grip. The finding of the increase in life expectancy as the nutritional status of the sample decreases stands out. Future studies are needed to generate percentiles and normalized values in the Chilean population.(AU)

Social inequalities, advanced maternal age, and birth weight. Evidence from a population-based study in Spain.

OBJECTIVE: To examine whether advanced maternal age (≥40 years) is linked to an increased likelihood of low or high birth weight among native and foreign-born mothers giving birth in Spain. METHOD: A cross-sectional study was conducted using a novel database provided by the Spanish National Statistics Office which links the 2011 Census with information on individual births (2011-2015) from the Vital Statistics (Natural Movement of the Population). First, multinomial logistic regression models were used to estimate the potential association between maternal age and the likelihood of having a baby with low or high birth weight. Second, average adjusted predictions of giving birth to children with low, high, and adequate weight for the origin and the maternal age at birth were also calculated. RESULTS: Findings indicate that women with advanced maternal age showed an increased probability of giving birth to low birth weight infants. Conversely, mothers aged below <30 years had an elevated risk for high birth weight infants. When considering maternal migratory status, the findings were mixed. On one hand, foreign-born mothers showed a higher likelihood of delivering infants with high birth weight; on the other, they displayed a lower risk of low birth weight among newborns in comparison to Spanish natives. CONCLUSIONS: The study addresses two key aspects. First, it highlights the increased risk of low birth weight in mothers delivering at an advanced age. Second, it emphasizes the importance of accounting for maternal migratory status when investigating the association between age at birth and birth weight outcomes among immigrant mothers.

Asociación entre los marcadores lipídicos en la infancia/ adolescencia y los eventos cardiovasculares en la adultez: una revisión sistemática / Association between lipid markers in childhood/ adolescence and cardiovascular events in adulthood: A systematic review

Introducción. La asociación entre los marcadores lipídicos en la infancia/adolescencia y la incidencia de eventos clínicos cardiovasculares en la adultez está poco explorada en la literatura. El objetivo de esta revisión sistemática fue analizar la evidencia disponible sobre este tema. Población y métodos. Esta revisión sistemática se realizó de acuerdo con las guías PRISMA. Se realizó una búsqueda bibliográfica para detectar los estudios que evaluaron la asociación entre los niveles lipídicos en la edad pediátrica y la incidencia de eventos cardiovasculares en la edad adulta. No hubo restricciones idiomáticas ni geográficas en la búsqueda. Resultados. En total, cinco estudios observacionales (todas cohortes prospectivas) que incluyeron 43 540 pacientes fueron identificados y considerados elegibles para este estudio. Cuatro estudios evaluaron el nivel de triglicéridos; todos reportaron una asociación significativa entre este marcador en la edad pediátrica y los eventos cardiovasculares en la adultez. Un estudio reportó la misma asociación con el nivel de colesterol total, mientras que otro evidenció el valor predictivo de la lipoproteína (a) para el mismo desenlace clínico. Un solo estudio evaluó el colesterol asociado a lipoproteínas de alta densidad (C-HDL), sin encontrar una relación con el punto final de interés. El análisis del colesterol asociado a lipoproteínas de baja densidad (C-LDL) arrojó resultados contradictorios, aunque la asociación fue significativa en los estudios con un tamaño muestral más grande y con un mayor número de eventos durante el seguimiento. Conclusión. Los datos de esta revisión sugieren que las alteraciones de los marcadores lipídicos en la infancia y la adolescencia se asocian con un mayor riesgo cardiovascular en la adultez temprana y media.

Introduction. The association between lipid markers in childhood/adolescence and the incidence of clinical cardiovascular events in adulthood has been little explored in the bibliography. The objective of this systematic review was to analyze available evidence on this topic. Population and methods. This systematic review was conducted in accordance with the PRISMA guidelines. A comprehensive bibliographic search was done to find studies assessing the association between lipid levels in childhood and the incidence of cardiovascular events in adulthood. There were no language or geographic restrictions. Results. A total of 5 observational studies (all prospective cohorts) including 43 540 patients were identified and considered eligible for this study. Four studies assessed triglyceride levels; all reported a significant association between this lipid marker in childhood and cardiovascular events in adulthood. A study reported the same association with total cholesterol level, while another showed the predictive value of lipoprotein (a) for the same clinical outcome. Only one study assessed high-density lipoprotein cholesterol (HDL-C), but it did not find an association with the endpoint of interest. The analysis of lowdensity lipoprotein cholesterol (LDL-C) showed contradictory results, although the association was significant in the studies with a larger sample size and a higher number of events during follow-up. Conclusion. According to this review, alterations in lipid markers in childhood and adolescence are associated with a higher cardiovascular risk in early and middle adulthood.

Promoción de actividades físicas para adultos mayores: Una estrategia educativa para estudiantes de Gerontología

En la actualidad, existe una tendencia progresiva al envejecimiento de la población. El propósito de esta investigación consistió exponer una estrategia educativa para los estudiantes del 5.º nivel de Gerontología que contribuya a la promoción de la actividad física en el adulto mayor. La investigación se enmarcó en una metodología mixta y un diseño descriptivo de corte transversal. Se emplearon métodos científicos que en el orden teórico se encuentran análisis-síntesis, inductivo-deductivo y el sistémico estructural, y como métodos empíricos la revisión documental, la observación, la encuesta y entrevistas, las cuales fueron aplicadas a una muestra de 38 sujetos y revelan la importancia de la actividad física como estrategia que permite alcanzar un envejecimiento activo y con calidad de vida en la tercera edad. Según estos resultados, la aplicación de una estrategia educativa estructurada en tres etapas y dos fases contribuye a la autogestión del aprendizaje de los estudiantes, donde el contexto profesional se convierte en un auténtico espacio de formación.

Atualmente, há uma tendência progressiva de envelhecimento da população. O objetivo desta pesquisa foi apresentar uma estratégia educacional para estudantes do 5º nível de Gerontologia que contribua para a promoção da atividade física em idosos. A pesquisa foi enquadrada em uma metodologia mista e um desenho descritivo transversal. Foram utilizados os métodos científicos teórico, indutivo-dedutivo e sistêmico-estrutural, e os métodos empíricos foram revisão documental, observação, inquérito e entrevistas, que foram aplicados a uma amostra de 38 sujeitos e revelam a importância da atividade física como estratégia para alcançar o envelhecimento ativo e a qualidade de vida dos idosos. De acordo com esses resultados, a aplicação de uma estratégia educacional estruturada em três etapas e duas fases contribui para o autogerenciamento da aprendizagem dos alunos, em que o contexto profissional se torna um autêntico espaço de treinamento.

Currently, there is a progressive trend towards population aging. The purpose of this research was to present an educational strategy for students of the 5th level of Gerontology that contributes to the promotion of physical activity in older adults. The research was framed in a mixed methodology and a cross-sectional descriptive design. Scientific methods were used that in the theoretical order include analysis-synthesis, inductive-deductive and structural systemic and as empirical methods documentary review, observation, survey and interviews, applied to a sample of 38 subjects. The study revealed the importance of physical activity as a strategy that allows achieving active aging with quality of life. According to these results, the application of an educational strategy, structured in three stages and two phases, contributes to the self-management of student learning, where the professional context becomes an authentic training space.

El Papel del Mindfulness Rasgo en la Calidad de Vida de la Población Adulta: una Revisión Sistemática / The Role of Trait Mindfulness in the Quality of Life of the Adult Population: A Systematic Review

La presente revisión sistemática sintetizó la evidencia de la interacción de la calidad de vida con el mindfulness rasgo en población adulta. Para esto, basado en la metodología PRISMA, se consideraron artículos cuantitativos con resultados primarios de asociación entre calidad de vida y mindfulness en adultos de 18 a 65 años, publicados entre 1979 y 2022, en inglés y español. Se realizaron búsquedas en Scopus, Web of Science, PubMed y PsycNet. El riesgo de sesgo se evaluó mediante una herramienta de puntuación del rigor metodológico. Al finalizar, 10 artículos cumplieron los criterios, los cuales evidencian que el mindfulness rasgo puede mejorar la calidad de vida de los adultos de forma moderada a alta, debido al proceso de aceptación y afrontamiento de manera consciente, sin juicios y reacciones, al minimizar efectos negativos como el estrés. Además, se identifican retos respecto a la conceptualización, medición e inclusión de terceras variables.(AU)

The present systematic review synthesizes the evidence of the interaction of quality of life with trait mindfulness in the adult population. Following the PRISMA methodology, quantitative articles with primary results on the association between quality of life and mindfulness in adults aged 18 to 65 years, published between 1979 and 2022 in English and Spanish, were considered. Searches were carried out in Scopus, Web of Science, PubMed, and PsycNet. The risk of bias was assessed using a methodological rigor scoring tool. In the end, 10 articles that met the criteria showed that the mindfulness trait may improve the quality of life of adults in a moderate to high way, due to the process of acceptance and coping in a conscious way, without judgments and reactions, minimizing negative effects such as stress. Additionally, challenges regarding the conceptualization, measurement, and inclusion of third variables were identified.(AU)

Condición física, clínica y fragilidad de adultos mayores en Cali, Colombia / Physical and clinical condition and fragility of older adults in Cali, Colombia

Introducción: A nivel mundial el envejecimiento de la población ha sido un tema de interés a investigar, debido a la carga de morbimortalidad y los costos en salud que ocasiona. Así, resulta relevante indagar sobre aquellos aspectos que hacen más vulnerables a los adultos mayores. Objetivo: Comparar la condición física y clínica según la fragilidad en adultos mayores de Cali, Colombia. Materiales y métodos: Estudio descriptivo transversal en adultos mayores de la ciudad de Cali, Colombia. El estudio tuvo aval ético institucional y todos los adultos mayores aceptaron participar firmando el consentimiento informado. Se usó la batería corta de desempeño físico (SPPB), y se compararon variables sociodemográficas, físicas y clínicas. y por nivel de fragilidad en vigoroso, prefrágil y frágil. Resultados: Se vincularon 470 adultos mayores con una edad promedio de 71,15±7,50 años, y en su mayoría del género femenino. Se presentaron diferencias estadísticamente significativas con un valor de p≤0,05 en la edad, estado socioeconómico, comuna, enfermedad, índice de masa corporal, actividad física, desempeño físico y riesgo de caídas; presentando mayor compromiso el grupo de fragilidad. Conclusión: El grupo de adultos mayores clasificados como frágiles presentaban menor condición física y clínica comparado con los grupos pre-frágiles y vigorosos. (AU)

Introduction: Worldwide, the aging of the population has been a topic of interest to investigate, due to the burden of morbidity and mortality and the health costs it causes. Thus, it is relevant to investigate those aspects that make older adults more vulnerable. Objective: To compare the physical and clinical condition according to frailty in older adults from Cali, Colombia. Materials and methods: Cross-sectional descriptive study in older adults from the city of Cali, Colombia. The study had institutional ethical endorsement and all the older adults agreed to participate by signing the informed consent. The short physical performance battery (SPPB) was used, and sociodemographic, physical and clinical variables and by level of frailty were compared in vigorous, pre-frail and frail. Results: Four hundred and seventy older adults with an average age of 71.15±7.50 years and mostly female were enrolled. There were statistically significant differences, P≤0.05 in age, socioeconomic status, commune, disease, body mass index, physical activity, physical performance, and risk of falls. The fragility group presented greater compromise. Conclusion: The group of older adults classified as frail had a lower physical and clinical condition compared to the pre-frail and vigorous groups. (AU)