Eficacia y eficiencia de las unidades geriátricas de agudos: un tópico clásico revisitado

Previous meta-analyses have shown that the hospital admission of older patients in acute geriatric units (AGU) compared to admission to other conventional units, significantly reduced the risk of functional deterioration during hospitalization, increasing the possibility of returning home, with an added reduction in cost of hospitalization. A new meta-analysis on the subject has recently been published in Age and Aging, which adds six new studies to the five clinical trials analyzed in previous meta-analyses. This article analyzes the results of this new meta-analysis, delving into the characteristics of the new studies included and making some considerations on the implications for care in the future development of AGU.     

Concordance of cancer drug therapy information derived from routinely collected hospital admissions data and the Systemic Anti-Cancer Therapy (SACT) dataset,for older women diagnosed with early invasive breast cancer in England

BackgroundEvaluating uptake of oncological treatments, and subsequent outcomes, depends on data sources containing accurate and complete information about cancer drug therapy (CDT). This study aimed to evaluate the consistency of CDT information in the Hospital Episode Statistics Admitted Patient Care (HES-APC) and Systemic Anti-Cancer Therapy (SACT) datasets for early invasive breast cancer (EIBC).MethodsThe study included women (50 + years) diagnosed with EIBC in England from 2014 to 2019 who had surgery within six months of diagnosis. Concordance of CDT recorded in HES-APC (identified using OPCS codes) and SACT was evaluated at both patient-level and cycle-level. Factors associated with CDT use captured only in HES-APC were assessed using statistical models.ResultsThe cohort contained 129,326 women with EIBC. Overall concordance between SACT and HES-APC on CDT use was 94 %. Concordance increased over the study period (91–96 %), and there was wide variation across NHS trusts (lowest decile of trusts had concordance≤77 %; highest decile≥99 %). Among women receiving CDT, 9 % (n = 2781/31693) of use was not captured in SACT; incompleteness was worst (18 %=47/259) among women aged 80 + and those diagnosed in 2014 (21%=1121/5401). OPCS codes in HES-APC were good at identifying patient-level and cycle-level use of trastuzumab or FEC chemotherapy (fluorouracil, epirubicin, cyclophosphamide), with 89 % and 93 % concordance with SACT respectively (patient-level agreement). Among cycles of solely oral CDT recorded in SACT, only 24 % were captured in HES-APC, compared to 71 % for intravenous/subcutaneous CDT.ConclusionsCombining information in HES-APC and SACT provides a more complete picture of CDT treatment in women aged 50 + receiving surgery for EIBC than using either data source alone. HES-APC may have particular value in identifying CDT use among older women, those diagnosed less recently, and in NHS trusts with low SACT data returns.     

The influence of mechanical vibration on local and central balance control

Fall prevention has an indispensable role in enhancing life expectancy and quality of life among older adults. The first step to prevent falls is to devise reliable methods to identify individuals at high fall risk. The purpose of the current study was to assess alterations in local postural muscle and central sensory balance control mechanisms due to low-frequency externally applied vibration among elders at high fall risk, in comparison with healthy controls, as a potential tool for assessing fall risk. Three groups of participants were recruited: healthy young (n = 10; age = 23 ± 2 years), healthy elders (n = 10; age = 73 ± 3 years), and elders at high fall risk (n = 10; age = 84 ± 9 years). Eyes-open and eyes-closed upright standing balance performance was measured with no vibration, 30 Hz, and 40 Hz vibration of Gastrocnemius muscles. When vibratory stimulation was applied, changes in local-control performance manifested significant differences among the groups (p < 0.01). On average between conditions, we observed 97% and 92% less change among high fall risk participants when compared to healthy young and older adults, respectively. On the other hand, vibration-induced changes in the central-control performance were not significant between groups (p ≥ 0.19). Results suggest that local-control deficits are responsible for balance behavior alterations among elders at high fall risk and healthy individuals. This observation may be attributable to deterioration of short-latency reflexive loop in elders at high fall risk. On the other hand, we could not ascribe the balance alterations to problems related to central nervous system performance or long-latency responses.     

La salud de las personas mayores en España durante la crisis económica

Introduction

Numerous studies have shown that economic crises are linked to a worsening of health conditions of the population. During the current economic crisis in Spain, there have been significant cuts in social and health services and a general worsening of the emotional well-being of the population. All these changes could have an impact on the health of the population, especially in the most vulnerable groups like older people.

中国常见蜚蠊种类及其为害、利用与防治的调查研究

蜚蠊是昆虫纲中一个较小的目,全世界已知五千余种,中国有记载的约二百种,五十年代后期上海医学院对本地区的蜚镰作了调查报道,七十年代初国内许多地区蜚蠊为害严重,不少单位开始采制标本对它进行研究.本文对中国室内常见蜚蠊种类的鉴定、生活习性、地理分布及其传播疾病、经济意义和防治方法作了综合报道,其中包括德国小蠊的两个近似种及一个中国新纪录属、种.     

老年男性原发性高血压患者脉压与颈动脉狭窄的相关分析

目的：探讨老年男性原发性高血压（EH）患者脉压（PP）与动脉粥样硬化性颈动脉狭窄（CS）的关系。方法：对入选的157例伴有颈动脉粥样硬化的老年男性EH患者行颈动脉超声检查,并收集行颈动脉超声检查前1年内的多次血压水平及临床资料,根据颈动脉狭窄程度分为：CS〈50％组（n=66）及CS≥50％组（n=91）,并进一步将颈动脉狭窄程度分级（I—V级）,分析颈动脉狭窄的危险因素及与脉压的相关性。结果：①CS≥50％组收缩压（SBP）及PP显著高于CS〈50％组,而舒张压（DBP）显著低于CS〈50％组（P〈0．05）,CS≥50％组的独立危险因素是外周动脉疾病（OR：4．543,95％CI：1．415．14．590）及脉压（OR：1．096,95％CI：1．038．1．157）;②CS分级与PP（r=0．402,P〈0．01）及血浆纤维蛋白原（FIB）（r=0．200,P〈0．05）呈正相关,经校正年龄、体重指数（BMI）、SBP、DBP、总胆固醇（TO）、甘油三酯（TG）、高密度脂蛋白胆固醇（HDL-c）、低密度脂蛋白胆固醇（LDL-c）、D-二聚体（D-dimer）、血尿酸（UA）、空腹血糖（FBG）、氨基酸末端脑利钠肽前体（NT-proBNP）、总胆红素（TBIL）及直接胆红素（DBIL）等危险因素后,CS分级仍与PP及FIB有关。结论：老年男性原发性高血压患者脉压与颈动脉狭窄有关,治疗高血压的同时应当尽量减小脉压。     

10周核心力量练习对男性中老年人平衡能力的影响

目的：探讨核心力量练习对中老年男性平衡能力的影响,为运动锻炼改善老年人平衡能力和降低跌倒风险提供依据。方法：选取16名50~60岁男性中老年人,随机分为试验组（核心力量练习）和对照组,每组8人。利用悬吊绳和瑜伽垫进行动、静态支撑与推拉练习以及徒手下肢力量等间歇性组合核心力量训练,共练习10周,每周4~5次,每次50~60 min。对照组保持原有生活习惯。锻炼前后测定受试者静态平衡和动态平衡等指标。结果：①锻炼后试验组闭眼单脚站立时间和动态平衡得分较锻炼前显著升高分别为（9.00±2.27） s、（10.63±1.69） s,P<0.01;（77.38±10.94）、（89.50±5.53）,P<0.01。②锻炼后试验组星形伸展平衡测试（SEBT）,右腿支撑时左腿在8个方向、左腿支撑时右腿在6个方向的SEBT值均较锻炼前显著增加（P<0.01）。结论：10周核心力量练习显著提高男性中老年人的动、静态平衡能力。     

Fasting ghrelin does not predict food intake after short-term energy restriction

Objective: To study the role of ghrelin as a hunger signal during energy restriction and to test the hypothesis that changes in fasting leptin concentrations during energy restriction are associated with changes in fasting ghrelin concentrations. Research Methods and Procedures: Thirty‐five healthy, lean men (23 ± 3 years of age; BMI: 22.3 ± 1.6 kg/m²) participated in a controlled intervention study. Fasting ghrelin and leptin concentrations were measured before and after 2 days of 62% energy restriction and after a 2‐day period of ad libitum food intake. Energy intake during the latter period was assessed. Results: On average, ghrelin concentrations did not change (0.05 μg/liter; 95% confidence interval, ?0.03; 0.12) during energy restriction. Changes in ghrelin concentration during energy restriction were not associated with energy intake during the ad libitum period (r = 0.07; not significant). Ad libitum energy intake was, however, associated with the change in ghrelin concentrations during the same period (r = ?0.34; p = 0.05). Ghrelin and leptin concentrations were not associated. In addition, the ratio of percentage changes in ghrelin and leptin during energy restriction was not correlated with ad libitum food intake after energy restriction (r = ?0.26; p = 0.14). Discussion: Fasting ghrelin concentrations did not rise after a 2‐day energy restriction regimen. Moreover, changes in ghrelin concentrations during energy restriction were not associated with subsequent ad libitum food intake, suggesting that fasting ghrelin does not act as a hunger signal to the brain. The data did not support our hypothesis that leptin suppresses ghrelin levels.     

Associations between aortic calcification and components of body composition in elderly men

Objective: To investigate associations among body composition, cardiovascular risk factors, and atherosclerosis in middle‐aged and elderly men for the identification of potential pathogenic links. Research Methods and Procedures: The study included 168 white men 44 to 86 years old. Severity of aortic calcification (AC) was graded on lateral radiographs, and body fat and lean mass were measured by DXA. Information on demographic and lifestyle characteristics also was gathered. Results: A strong and independent inverse association was found between AC and peripheral lean mass (PLM), even after adjusting for age and BMI (p < 0.05). Independently of the influence of PLM, AC was directly correlated with truncal fat mass (p < 0.05). Furthermore, AC was inversely associated with tertiles of the free androgen index (p < 0.05). In a multiple regression model, age and serum cholesterol (p < 0.01) contributed directly, and truncal fat mass tended also to contribute directly (p = 0.09), whereas PLM contributed borderline inversely (p = 0.06) to the variation of AC (R = 0.635, p < 0.0001). Discussion: Severity of AC is strongly dependent on age and further modulated by an array of traditional cardiovascular risk factors. Sarcopenia and truncal fat mass are reciprocal correlates of atherosclerosis of borderline statistical significance in multivariate models. To clarify whether sarcopenia is an atherogenic risk factor or rather a parallel consequence of low‐grade inflammation also promoting atherogenic trends, further longitudinal studies in larger sample sizes of men and women are needed.