Developing new hospital-at-home models based on Comprehensive Geriatric Assessment: Implementation recommendations by the Working Group on Hospital-at-Home and Community Geriatrics of the Catalan Society of Geriatrics and Gerontology

Last decade, the Government of Catalonia have urged an integrated care strategy for planning the care model to older populations living with frailty, multimorbidity and advanced illnesses. Based on international evidence that was reviewed by a group of experts from the Catalan Society of Gerontology and Geriatrics, we summarised some recommendation to adapt hospital-at-home care to older populations in our system. We defined Comprehensive Geriatric Assessment (CGA) hospital-at-home (HaH) as a specialised home hospitalisation service formed by interdisciplinary teams, characterised by using the clinical methodology of CGA, and by adapting geriatric units’ protocols for the provision of person-centred care at home. Main benefits of CGA-HaH in these populations are: response to heath crises according to individualised care plans based on the situational diagnosis carried out by Primary Care teams; provision of a comprehensive health and social approach tailored to the complexity of cases and situations; and adaptation of multipurpose hospitalisation, by working on different person-centred care, aspects, such as caregivers support on care provision, focusing on function or home adaptation.     

Actualización en el manejo de la degeneración macular asociada a la edad

Age-related macular degeneration is the leading cause of legal blindness in people over 50 in developed countries. It is a multifactorial disease resulting from the interaction of genetic and environmental factors, and the age is the only worldwide admitted risk factor. The socioeconomic impact of the disease reaches enormous proportions, if we take into account the high cost of the available antiangiogenic therapy, the strict schedule of medical visits that it requires, and the impairment that it gives rise to. The response to treatment and the visual outcomes improve with early management of the retinal lesions, thus the early diagnosis of the disease in its initial phases, based on self-control with an Amsler grid and with regular ophthalmologic assessments, is essential.     

Induced Floral and Extrafloral Nectar Production Affect Ant‐pollinator Interactions and Plant Fitness

Thousands of plant species throughout tropical and temperate zones secrete extrafloral nectar to attract ants, whose presence provides an indirect defense against herbivores. Extrafloral nectaries are located close to flowers and may modify competition between ants and pollinators. Here, we used Lima bean (Phaseolus lunatus L.) to study the plants interaction between ants and flower visitors and its consequences for plant fitness. To test these objectives, we carried out two field experiments in which we manipulated the presence of ants and nectar production via induction with jasmonic acid (JA). We then measured floral and extrafloral nectar production, the number of patrolling ants and flower visitors as well as specific plant fitness traits. Lima bean plants under JA induction produced more nectar in both extrafloral nectaries and flowers, attracted more ants and produced more flowers and seeds than non‐induced plants. Despite an increase in floral nectar in JA plants, application of this hormone had no significant effects on flower visitor attraction. Finally, ant presence did not result in a decrease in the number of visits, but our results suggest that ants could negatively affect pollination efficiency. In particular, JA‐induced plants without ants produced a greater number of seeds compared with the JA‐treated plants with ants.     

Linfoma esplénico presentado como pancreatitis aguda en una paciente de 84 años: reporte de un caso

A case is presented of an 84 year-old woman who was admitted to the Emergency Department due to an episode of non-calculous acute pancreatitis. In the aetiological study, the presence of a splenic lymphoma was documented, which had a compressive effect on the pancreas. After resolving the symptoms, she was scheduled for a splenectomy with a good technical result. At six months after admission the patient was in an excellent clinical and functional condition. This case highlights the unusual clinical presentation of this haematological disease, and the need to evaluate all the available therapeutic options in selected elderly patients.     

The genetic structure of hawthorn-infesting Rhagoletis pomonella populations in Mexico: implications for sympatric host race formation

The genetic origins of species may not all trace to the same time and place as the proximate cause(s) for population divergence. Moreover, inherent gene-flow barriers separating populations may not all have evolved under the same geographical circumstances. These considerations have lead to a greater appreciation of the plurality of speciation: that one geographical mode for divergence may not always be sufficient to describe a speciation event. The apple maggot fly, Rhagoletis pomonella , a model system for sympatric speciation via host-plant shifting, has been a surprising contributor to the concept of speciation mode plurality. Previous studies have suggested that past introgression of inversion polymorphism from a hawthorn-fly population in the trans-Mexican volcanic belt (EVTM) introduced diapause life-history variation into a more northern fly population that subsequently contributed to sympatric host race formation and speciation in the United States (US). Here, we report results from a microsatellite survey implying (i) that volcanic activity in the eastern EVTM may have been responsible for the initial geographical isolation of the Mexican and northern hawthorn-fly populations c . 1.57 mya; and (ii) that flies in the Sierra Madre Oriental Mountains (SMO) likely served as a conduit for past gene flow from the EVTM into the US. Indeed, the microsatellite data suggest that the current US population may represent a range expansion from the northern SMO. We discuss the implications of these findings for sympatric race formation in Rhagoletis and speciation theory.     

Valor pronóstico de los instrumentos de evaluación de enfermedad avanzada y de final de vida en ancianos ingresados en un centro sociosanitario

Objective

To apply 3 advanced chronic disease evaluation tools in elderly patients admitted to an intermediate and long-term care centre, and evaluate its relationship with mortality.

Los géneros Praectenodonta, Praenucula y Notonucula (Palaeotaxodonta : Bivalvia) en el Siluro-Devónico de Bolivia

Taxonomy of 57 bivalves, internal and external molds is described in this paper, corresponding to three paleotaxodontids genera Praectenodonta, Praenucula and Notonucula. Samples were collected from nine sites, where stratigraphic columns were measured in Silurian to Devonian series from Altiplano, Cordillera Oriental and Interandean of Bolivia. For the first time in Bolivia, Praectenodonta and Notonucula have been identified. Four species have been described, three of them are new: Praectenodonta boliviensis n. sp., Praenucula quichua n. sp. and Notonucula altiplanica n. sp. Paleogeography of new species and genera is proposed.     

Escalas de valoración del dolor en pacientes con demencia. Instrumentos de ayuda para el fisioterapeuta,el médico,el enfermero y el terapeuta ocupacional

The purpose of this study was to determine which scales are being used to evaluate pain in old people suffering from dementia.     

Estudio de la vulnerabilidad neuronal selectiva en el sistema nervioso central humano

Introduction

The concept of ‘selective neuronal vulnerability’ refers to the differential sensitivity of neuronal populations in the nervous system to stresses that cause cell damage and lead to neurodegeneration. Because oxidative stress play a causal role in the physiological aging process, and it is often invoked as an aetiopathogenic and/or pathophysiological mechanism for neurodegeneration, in the present work we propose that the molecular bases of selective neuronal vulnerability is linked with cell adaptations related to oxidative stress.

Material and methods

The grey substance of 5 different regions from healthy human subjects (n = 7) were selected: i) to evaluate their membrane fatty acid profile by chromatographic methods, ii) to determine their membrane susceptibility to peroxidation, and iii) to recognise potential mechanisms involved in its regulation.

Results

The results showed significant inter-regional differences in the fatty acid profile, basically due to the content of mono- and highly polyunsaturated fatty acids; changes that, in turn, induce significant differences in theirs susceptibilities to peroxidation, as well as differences that can be ascribed to the desaturase activity.

Conclusion

Thus, the cross-regional comparative approach seems to confirm the idea that the level of cell membrane unsaturation may be a key trait associated with selective neuronal vulnerability.