Stressors and Silver Linings during COVID-19: Implications for Supporting Families with Young Children in a Post-Pandemic World.

OBJECTIVES: To better understand impacts of the COVID-19 pandemic and resulting economic and social disruptions on families, we analyzed qualitative data capturing perspectives from parents of young children. METHODS: This study analyzes interviews of parents of children aged 1-3.5 years at enrollment, recruited from four primary care systems serving mainly lower-income Hispanic families in Los Angeles, California. Interviews were conducted over 15 months beginning September 2020. Analyses focused on the open-ended question: Please describe in your own words how the COVID-19 pandemic has affected you and your family. We used iterative, multi-step processes to identify emergent qualitative themes. RESULTS: A total of 460 parent responses were collected and coded. Key themes and subthemes were tested for interrater reliability, with Kappa ranging from 0.74 to 0.91. Thematic analysis revealed two groups of responses, one emphasizing stress and one emphasizing "silver linings." Parents cited a range of stressors, from fear of COVID-19 to social isolation. Those emphasizing "silver linings" also referenced formal or informal supports - especially government/community assistance programs and childcare access - that enabled stronger family ties and positive lifestyle modifications. CONCLUSIONS FOR PRACTICE: Experiences of families with young children during COVID-19 were not uniform. Economic stability and reliable childcare may be critical mediators of family stress. Results affirm that the pandemic's impacts were distributed through channels largely built on, and possibly exacerbating, existing disparities. For lower-income families with young children, funding for public and private programs that target economic stability and childcare assistance may merit prioritization in future socio-economic disruptions.

Unveiling the Clinical Benefits of High-Volume Hemodiafiltration: Optimizing the Removal of Medium-Weight Uremic Toxins and Beyond.

Dialysis treatment has improved the survival of patients with kidney failure. However, the hospitalization and mortality rates remain alarmingly high, primarily due to incomplete uremic toxin elimination. High-volume hemodiafiltration (HDF) has emerged as a promising approach that significantly improves patient outcomes by effectively eliminating medium and large uremic toxins, which explains its increasing adoption, particularly in Europe and Japan. Interest in this therapy has grown following the findings of the recently published CONVINCE study, as well as the need to understand the mechanisms behind the benefits. This comprehensive review aims to enhance the scientific understanding by explaining the underlying physiological mechanisms that contribute to the positive effects of HDF in terms of short-term benefits, like hemodynamic tolerance and cardiovascular disease. Additionally, it explores the rationale behind the medium-term clinical benefits, including phosphorus removal, the modulation of inflammation and oxidative stress, anemia management, immune response modulation, nutritional effects, the mitigation of bone disorders, neuropathy relief, and amyloidosis reduction. This review also analyzes the impact of HDF on patient-reported outcomes and mortality. Considering the importance of applying personalized uremic toxin removal strategies tailored to the unique needs of each patient, high-volume HDF appears to be the most effective treatment to date for patients with renal failure. This justifies the need to prioritize its application in clinical practice, initially focusing on the groups with the greatest potential benefits and subsequently extending its use to a larger number of patients.

Antispasmodic Effect of Valeriana pilosa Root Essential Oil and Potential Mechanisms of Action: Ex Vivo and In Silico Studies.

Infusions of Valeriana pilosa are commonly used in Peruvian folk medicine for treating gastrointestinal disorders. This study aimed to investigate the spasmolytic and antispasmodic effects of Valeriana pilosa essential oil (VPEO) on rat ileum. The basal tone of ileal sections decreased in response to accumulative concentrations of VPEO. Moreover, ileal sections precontracted with acetylcholine (ACh), potassium chloride (KCl), or barium chloride (BaCl2) were relaxed in response to VPEO by a mechanism that depended on atropine, hyoscine butylbromide, solifenacin, and verapamil, but not glibenclamide. The results showed that VPEO produced a relaxant effect by inhibiting muscarinic receptors and blocking calcium channels, with no apparent effect on the opening of potassium channels. In addition, molecular docking was employed to evaluate VPEO constituents that could inhibit intestinal contractile activity. The study showed that α-cubebene, ß-patchoulene, ß-bourbonene, ß-caryophyllene, α-guaiene, γ-muurolene, valencene, eremophyllene, and δ-cadinene displayed the highest docking scores on muscarinic acetylcholine receptors and voltage-gated calcium channels, which may antagonize M2 and/or M3 muscarinic acetylcholine receptors and block voltage-gated calcium channels. In summary, VPEO has both spasmolytic and antispasmodic effects. It may block muscarinic receptors and calcium channels, thus providing a scientific basis for its traditional use for gastrointestinal disorders.

Wild Fruits of Crataegus monogyna Jacq. and Sorbus aria (L.) Crantz: From Traditional Foods to Innovative Sources of Pigments and Antioxidant Ingredients for Food Products.

Hawthorn (Crataegus monogyna Jacq.) and whitebeam (Sorbus aria (L.) Crantz) are wild species traditionally used as ethnic foods in the Mediterranean area. Their red berries, and mainly the peels, may be used as ingredients due to their color (replacing other synthetic colorants) or functional properties. Some previous studies analyze all edible fruits, but there is very little literature on the composition and properties of the pulpless epidermis of the fruits of C. monogyna and no literature concerning the fruits of S. aria. Total phenolic compounds (TPC) and families of hydroxybenzoic acids, hydroxycinnamic acids, flavonols, and total monomeric anthocyanins were determined in the epidermis of C. monogyna and S. aria fruits. The in vitro antioxidant capacity was also determined using QUENCHER (Quick-Easy-New-CHEap-Reproducible) methodology. Anthocyanins profiles were analyzed in hydroalcoholic extracts through HPLC/MS. C. monogyna fruits presented higher content of TPC than S. aria, with hydroxybenzoic acids (2870.6 mg GAE/100g dw) as the major family, followed by flavonols (771.4 mg QE/100 g dw) and hydroxycinnamic acids (610.3 FAE/100 g dw). Anthocyanins were found in 251.7 mg cyanidin-3-glucoside/100 g dw, characterized by the content of cyanidin-O-hexoxide and peonidin-O-hexoxide. The levels of these compounds correlated with higher values of a* parameter (higher intensity of reddish color). These fruits also showed higher antioxidant capacity by Q-Folin-Ciocalteu and Q-FRAP. S. aria peels had fewer phenolic compounds, particularly anthocyanins (33.7 mg cyanidin-3-glucoside/100 g dw), containing different cyanidin derivatives. From these results, new insights about the composition of the epidermis of these wild fruits are provided, and their potential as ingredients for the food industry is corroborated.

Wild sweet cherry, strawberry and bilberry as underestimated sources of natural colorants and bioactive compounds with functional properties.

Wild edible fruits, neglected by the development of commercial agriculture, have recently aroused as a good source of natural colorants and bioactive compounds. These novel uses could cover the recent demand for healthier foods with functional properties. Prunus avium, Fragaria vesca and Vaccinium myrtillus wild fruits were characterized by individual anthocyanin profile and color CIELAB parameters, as well as phenolic fraction. In addition, some bioactivities were evaluated. In P. avium cyanidin-O-deoxyhexosyl-pentoside was the representative anthocyanin, in F. vesca pelargonidin-3-O-glucoside and in V. myrtillus delphinidin-O-hexoside. The three wild edible fruits showed interesting antioxidant activity especially in OxHLIA assays. V. myrtillus was the fruit with the best results for the bacterial growth inhibition, while F. vesca with better fungal growth inhibition. These results evidenced the richness of these wild fruits in bioactive compounds and pigments with antioxidant capacity, therefore, their potential use as natural colorants for healthier food products design.

Sindrome de Cushing iatrogénico por automedicación prolongada con corticoides / Iatrogenic Cushing's syndrome due to prolonged self-medication with corticosteroids

El Síndrome de Cushing (SC) se define como el conjunto de manifestaciones biológicas y clínicas derivado de la exposición a concentraciones circulantes anormalmente elevadas y mantenidas de glucocorticoides, ya sean estos de producción endógena o exógena. La principal causa es iatrogénica por uso prolongado de glucocorticoides.

Dwarf Kiwi (Actinidia arguta Miq.), a Source of Antioxidants for a Healthy and Sustainable Diet.

The feasibility of using dwarf kiwi fruits (Actinia arguta Miq.) as a healthy and sustainable food, compared to other types of commercial kiwi fruits, was evaluated in the present study. The overall antioxidant capacity of these fruits was assessed by either extraction-dependent methods (ABTS, ORAC) or the direct method called Quick, Easy, New, CHEap, Reproducible (QUENCHER) (DPPH, FRAP, Folin-Ciocalteu), applied for the first time to analyze kiwi fruits. With this methodology, all the molecules with antioxidant capacity are measured together in a single step, even those with high molecular weight or poor solubility in aqueous extraction systems, such as antioxidant dietary fiber. The effect of kiwi extracts on physiological and induced intracellular reactive oxygen species (ROS) production on IEC-6 cells was also analyzed, as well as total phenolic content (TPC) by Fast Blue BB, flavonols, hydroxycinnamic acids, and hydroxybenzoic acids. A. arguta fruits showed the highest values in all the antioxidant assays, being remarkably higher than the other kiwi species for Q-FRAP and Q-DPPH. Dwarf kiwi showed the highest potential in reducing physiological ROS and the highest values of TPC (54.57 mgGAE/g), being hydroxybenzoic acids the main phenolic family found (2.40 mgGAE/g). Therefore, dwarf kiwi fruits are a natural source of antioxidants compared to conventional kiwi fruits, being a sustainable and healthy alternative to diversify fruits in the diet.

Clinical Efficacy of SARS-CoV-2 Vaccination in Hemodialysis Patients.

Introduction: The COVID-19 pandemic is a global public health problem. Patients with end-stage renal disease on hemodialysis are at a higher risk of infection and mortality than the general population. Worldwide, a vaccination campaign has been developed that has been shown to reduce severe infections and deaths in the general population. However, there are currently limited data on the clinical efficacy of vaccinations in the hemodialysis population. Methods: A national multicenter observational cohort was performed in Chile to evaluate the clinical efficacy of anti-SARS-CoV-2 vaccination in end-stage renal disease patients on chronic hemodialysis from February 2021 to August 2021. In addition, the BNT162b2 (Pfizer-BioNTech) and CoronaVac (Sinovac) vaccines were evaluated. The efficacy of vaccination in preventing SARS-CoV-2 infection, hospitalizations, and deaths associated with COVID-19 was determined. Results: A total of 12,301 patients were evaluated; 10,615 (86.3%) received a complete vaccination (2 doses), 490 (4.0%) received incomplete vaccination, and 1196 (9.7%) were not vaccinated. During follow-up, 1362 (11.0%) patients developed COVID-19, and 150 died (case fatality rate: 11.0%). The efficacy of the complete vaccination in preventing infection was 18.1% (95% confidence interval [CI]:11.8-23.8%), and prevention of death was 66.0% (95% CI:60.6-70.7%). When comparing both vaccines, BNT162b2 and CoronaVac were effective in reducing infection and deaths associated with COVID-19. Nevertheless, the BNT162b2 vaccine had higher efficacy in preventing infection (42.6% vs. 15.0%) and deaths (90.4% vs. 64.8%) compared to CoronaVac. Conclusion: The results of our study suggest that vaccination against SARS-CoV-2 in patients on chronic hemodialysis was effective in preventing infection and death associated with COVID-19.

Bioactive Compounds in Rosehip (Rosa canina) Powder with Encapsulating Agents.

Rosa canina pseudo-fruits contain interesting bioactive compounds. This work aims to evaluate the use of different biopolymers as encapsulating agents on the content of organic acids, minerals, fibers, phenols, carotenoids, and the antioxidant activity of the powdered product. Fruits were ground and freeze-dried with or without biopolymers (maltodextrin, resistant maltodextrin, cyclodextrin, and pea protein). Rosehip formulated purees with encapsulating agents are an interesting food ingredient rich in fiber and minerals that could be used in the food industry in order to obtain different functional foods. Results obtained in this study show that all formulated samples are a good source of potassium, calcium, magnesium, and manganese. Both rosehip without biopolymers and rosehip with pea protein formulations are also a good source of Zn. Formulation with pea protein can be claimed as a good source of Fe. All formulations are food ingredients with a very high content of ascorbic acid. Comparing the encapsulating agents, depending on the studied bioactive compound samples behaved differently. In conclusion, it can be indicated that pea protein is recommended as an encapsulating agent since the rosehip with pea protein sample has the highest content of fiber, minerals, organic acids, and carotenoids among the encapsulating agents studied.

Valeriana pilosa Roots Essential Oil: Chemical Composition, Antioxidant Activities, and Molecular Docking Studies on Enzymes Involved in Redox Biological Processes.

Valeriana pilosa is usually employed in Peruvian folk medicine in the form of infusion to treat stomach pain, and has antispasmodic, relaxing, sleep-promoting, and sedative properties, as well as is an anti-inflammatory. In this study, Valeriana pilosa essential oil (VPEO) was obtained by hydrodistillation, analyzed by GC and GC/MS, and 47 compounds were identified. Major oil components were α-patchoulene (5.8%), α-humulene (6.1%), seychellene (7.6%), and patchoulol (20.8%). Furthermore, we assessed the in vitro antioxidant activities, molecular docking, and Ligand Efficiency studies on enzymes involved in cellular redox pathways such as CYP2C9, catalase, superoxide dismutase, and xanthine oxidase. Essential oil antioxidant activities were assessed by FRAP, ABTS•+, and DPPH• radical scavenging activity. VPEO displays high antioxidant activity as compared to essential oils of Valeriana jatamansi and Valeriana officinalis oil roots. In addition, molecular docking and ADMET prediction was employed to compare the absorption, metabolism, and toxicity properties of Valeriana pilosa compounds. In the molecular docking studies, limonene, p-cimene, carvone, α-cubebene, cyclosativene, α-guaiene, allo-aromadendrene, valencene, and eremophyllene were the compounds with the best docking score on CYP2C9 and xanthine oxidase. Thus, volatile components of Valeriana pilosa could be associated with the detected antioxidant activity, acting as putative inhibitors of CYP2C9 and xanthine oxidase.

Extrusion Cooking Effect on Carbohydrate Fraction in Novel Gluten-Free Flours Based on Chickpea and Rice.

Extrusion cooking allows the development of value-added products from pulses, such as gluten-free snacks with added functional properties. The main objective of this study was to evaluate the changes induced by the extrusion process on the carbohydrate fraction (total carbohydrates, soluble sugars and oligosaccharides, dietary fiber, and arabinoxylans) of novel flour formulations based on chickpeas and rice enriched with different dietary fiber sources. Moreover, the influence of the addition of fiber-rich ingredients, such as Fibersol® and passion fruit, on the analyzed compounds was also evaluated. Sucrose was the main soluble sugar found in analyzed formulations, and raffinose was the prevalent oligosaccharide, followed by stachyose. The content of total α-galactosides tended to be higher after extrusion cooking. As a consequence of the extrusion treatment, the content of total and soluble dietary fiber was statistically increased in most of the analyzed samples. In general, no significant changes were observed in total arabinoxylan content as a consequence of the extrusion process, while the content of water-soluble arabinoxylans was significantly increased in extruded formulations. It was observed that the content of total available carbohydrates, stachyose, and water-soluble arabinoxylans were significantly influenced by the addition of passion fruit, Fibersol®, and both. The incorporation of these ingredients in gluten-free formulations based on chickpeas and rice allows one to obtain suitable functional formulations for the development of innovative, gluten-free, extruded snack-type products, which could be an interesting alternative for people with celiac disease.

Nutritional and Phytochemical Composition of Mediterranean Wild Vegetables after Culinary Treatment.

Studies are scarce on the nutritional and phytochemical composition of wild edible Mediterranean plants after culinary processing. This work provides the nutritional composition after culinary treatment (including dietary fiber and mineral composition) and bioactive compounds (folates, vitamin C and organic acids) of wild Rumex pulcher L., Silene vulgaris (Moench) Garcke. leaves, and wild Asparagus acutifolius L., Bryonia dioica Jacq., Humulus lupulus L., Tamus communis L. young shoots. Shoots better preserved their nutrients than leaves, due to their different tissue structure. Fresh and cooked wild greens present high dietary fiber values, and remained at remarkable levels after boiling. Na, K, Mg and Zn were lost in about 50% due to culinary processing, while Ca, Cu, Fe and Mn were more stable. Boiled leaves of S. vulgaris remained as a good Mn source. A portion of 100 g of most of the cooked analyzed species could cover a relevant percentage of the daily requirement of folates (R. pulcher and A. acutifolius providing more than 80%) and vitamin C (T. communis and A. acutifolius providing more than 35%).

Rheological, chemical and sensory characterization of fortified cookies with edible flour of Xuta (Jatropha curcas L.).

In this research, the dough rheological properties of wheat flour mixed with defatted edible J. curcas flour to improve protein content in cookies were study. The wheat and J. curcas mix proportions were 100:0 (CT, control), 95:5% (T-5), 90:10% (T-10), 85:15% (T-15), 80:20% (T-20). The dough variables responds were strength, toughness, extensibility, tenacity extensibility index, water adsorption, development time, weakening grade, and mix tolerance index. In cookies, the physicochemical and hedonic characteristic were quantified. As the addition of J. curcas flour increased, the dough force and extensibility decreased up to 200.5 W × 10-4 J and 60 mm, but tenacity increased up to 16.46 mm, which in consequence increased the tenacity extensibility index in 1.75, respect to the control. Dough water adsorption and development time increased 7.62% and 1.00% while the weakening grade, mix tolerance index and stability decreased 60.17 UB, 79.2 UB and 2.1 min, respectively, when J. curcas flour was added up to 20%. In cookies water adsorption, protein, lipids and ashes increased 1.18%, 6.98%, 0.42%, 2.26%, respectively, when 20% J. curcas flour was added. The fortify cookies factor decreased 0.4 that correspond to a very good quality. The sensory evaluation indicated no differences in acceptability of fortify cookies with J. curcas flour. It can be concluded that it is suitable to mix up to 80:20% wheat and J. curcas flour because the alveographic and farinographic properties were in the require range to elaborate cookies, which increased 6.98% the protein content and maintained the physicochemical and hedonic acceptance.

Telephone-Based Developmental Screening and Care Coordination Through 2-1-1: A Randomized Trial.

BACKGROUND AND OBJECTIVES: Despite professional guidelines to conduct universal early childhood developmental screening, primary care providers often struggle with early identification of developmental delays, referrals to interventions, and connecting families to services. In this study, we tested the efficacy of telephone-based developmental screening and care coordination through 2-1-1 Los Angeles County, which is part of a national network of call centers, compared with usual care alone. METHODS: Children ages 12 to 42 months old who receive well-child care at a community health center serving predominantly Hispanic families were recruited and randomly assigned to intervention and control groups. Families in the intervention group were connected with 2-1-1, in which a trained care coordinator conducted developmental screening over the phone using the Parental Evaluation of Development Status Online system and made referrals to intervention services on the basis of developmental risk. The 2-1-1 care coordinator then followed-up with families to assist with connections to evaluations and services. After 6 months, primary outcomes included the following: (1) percentage of children referred for developmental evaluation and intervention services and (2) percentage of children actually receiving services. RESULTS: One hundred and fifty-two children were randomly assigned to intervention (n = 77) and control (n = 75) groups. On the basis of intention-to-treat analyses, significantly more children assigned to the intervention group were referred (32% vs 9%; P = .001) and were receiving services (16% vs 1%; P = .002) within 6 months compared with children assigned to usual care alone. CONCLUSIONS: Telephone-based developmental screening and care coordination through 2-1-1 appears to be an effective approach for increasing the numbers of young children referred to, and receiving, intervention services for developmental delays.

Automatic Outcome in Manual Dexterity Assessment Using Colour Segmentation and Nearest Neighbour Classifier.

Objective assessment of motor function is an important component to evaluating the effectiveness of a rehabilitation process. Such assessments are carried out by clinicians using traditional tests and scales. The Box and Blocks Test (BBT) is one such scale, focusing on manual dexterity evaluation. The score is the maximum number of cubes that a person is able to displace during a time window. In a previous paper, an automated version of the Box and Blocks Test using a Microsoft Kinect sensor was presented, and referred to as the Automated Box and Blocks Test (ABBT). In this paper, the feasibility of ABBT as an automated tool for manual dexterity assessment is discussed. An algorithm, based on image segmentation in CIELab colour space and the Nearest Neighbour (NN) rule, was developed to improve the reliability of automatic cube counting. A pilot study was conducted to assess the hand motor function in people with Parkinson's disease (PD). Three functional assessments were carried out. The success rate in automatic cube counting was studied by comparing the manual (BBT) and the automatic (ABBT) methods. The additional information provided by the ABBT was analysed to discuss its clinical significance. The results show a high correlation between manual (BBT) and automatic (ABBT) scoring. The lowest average success rate in cube counting for ABBT was 92%. Additionally, the ABBT acquires extra information from the cubes' displacement, such as the average velocity and the time instants in which the cube was detected. The analysis of this information can be related to indicators of health status (coordination and dexterity). The results showed that the ABBT is a useful tool for automating the assessment of unilateral gross manual dexterity, and provides additional information about the user's performance.

Bioimpedance Spectroscopy as a Practical Tool for the Early Detection and Prevention of Protein-Energy Wasting in Hemodialysis Patients.

OBJECTIVES: To evaluate whether body composition monitor (BCM) could be a practical instrument for nephrologists to assess nutritional status in patients on hemodialysis (HD) and whether it is more effective in identifying patients at highest risk of developing protein-energy wasting (PEW) alone or in combination with other tools currently used for that purpose. DESIGN: Observational cross-sectional study in 91 HD patients (60 ± 14 years, 70.3% male, 24 ± 4.1 kg/m2 body mass index) from 2 different locations. METHODS: Nutritional status was evaluated by anthropometric methods (biceps and triceps skinfold thickness, waist circumference, and arm muscular circumference), biochemical nutritional markers, malnutrition-inflammation score (MIS), and BCM. The patients were grouped into those with and without PEW by using classical criteria and then classified as being adequately or inadequately nourished according to a BCM flow chart to detect those requiring preferential nutritional intervention. A multivariate approach was used to calculate the risk of developing PEW. RESULTS: Anthropometric measurements revealed significantly lower body mass index (<23 kg/m2; odds ratios [OR] = 13.3 and P = 0.001) and arm muscular circumference < p10 (OR = 34, P < 0.001) in the PEW group. MIS was above 5 in all the patients classified as having PEW. BCM showed that fat tissue index < p10 was significantly lower in this group (OR = 1.52), and a decision tree using the lean tissue index < p10, fat tissue index < p10, and extracellular water > 15% revealed that 42.9% of the patients would need nutritional monitoring. On multivariate analysis, insufficient nutritional status detected by BCM decision tree was an independent prognostic factor for developing PEW. About 9.89% of the patients were classified as PEW, with MIS > 5, and insufficient nutritional status detected by BCM required preferential nutritional intervention. CONCLUSION: BCM is a practical instrument for nephrologists to assess nutritional status in patients on HD and is useful for the early prevention and detection of PEW, as is able to identify differences in body composition, predict clinically important outcomes, and classify patients requiring preferential nutritional intervention.

[Survival of older patients starting hemodialysis in Chile]. / Análisis de sobrevida en pacientes de edad avanzada que inician hemodiálisis crónica en Servicio de Salud Chileno.

UNLABELLED: The proportion of older people with end stage renal disease is increasing. Their prognosis is characterized by a high mortality and poor quality of life. AIM: To analyze the survival of patients starting chronic hemodialysis (CHD) according to their age. MATERIAL AND METHODS: Patients admitted to CHD in the East Metropolitan Health Service of Santiago in a 2-year period were analyzed. Four age groups were created, separating patients older than 70 years in a special group. RESULTS: During the study period, 459 patients were admitted to CHD and were followed for an average of 27 months. The frequency of cardiovascular comorbidity, cancer, and chronic renal disease of unknown cause (attributed to nephrosclerosis) increased along with age. Mortality was higher at older ages. There was a significant association between starting CHD with a catheter, Charlson comorbidity index and increasing age with mortality. For those aged over 80 years, mortality at three months and one year was 25 and 43% respectively. CONCLUSIONS: Age, Charlson index and vascular access are predictors of mortality in older adults entering hemodialysis. This study suggests the importance of considering comorbidities, assessment by specialists and creating an arteriovenous fistula in this age group.

Effect of Patient Navigation With or Without Financial Incentives on Viral Suppression Among Hospitalized Patients With HIV Infection and Substance Use: A Randomized Clinical Trial.

IMPORTANCE: Substance use is a major driver of the HIV epidemic and is associated with poor HIV care outcomes. Patient navigation (care coordination with case management) and the use of financial incentives for achieving predetermined outcomes are interventions increasingly promoted to engage patients in substance use disorders treatment and HIV care, but there is little evidence for their efficacy in improving HIV-1 viral suppression rates. OBJECTIVE: To assess the effect of a structured patient navigation intervention with or without financial incentives to improve HIV-1 viral suppression rates among patients with elevated HIV-1 viral loads and substance use recruited as hospital inpatients. DESIGN, SETTING, AND PARTICIPANTS: From July 2012 through January 2014, 801 patients with HIV infection and substance use from 11 hospitals across the United States were randomly assigned to receive patient navigation alone (n = 266), patient navigation plus financial incentives (n = 271), or treatment as usual (n = 264). HIV-1 plasma viral load was measured at baseline and at 6 and 12 months. INTERVENTIONS: Patient navigation included up to 11 sessions of care coordination with case management and motivational interviewing techniques over 6 months. Financial incentives (up to $1160) were provided for achieving targeted behaviors aimed at reducing substance use, increasing engagement in HIV care, and improving HIV outcomes. Treatment as usual was the standard practice at each hospital for linking hospitalized patients to outpatient HIV care and substance use disorders treatment. MAIN OUTCOMES AND MEASURES: The primary outcome was HIV viral suppression (≤200 copies/mL) relative to viral nonsuppression or death at the 12-month follow-up. RESULTS: Of 801 patients randomized, 261 (32.6%) were women (mean [SD] age, 44.6 years [10.0 years]). There were no differences in rates of HIV viral suppression versus nonsuppression or death among the 3 groups at 12 months. Eighty-five of 249 patients (34.1%) in the usual-treatment group experienced treatment success compared with 89 of 249 patients (35.7%) in the navigation-only group for a treatment difference of 1.6% (95% CI, -6.8% to 10.0%; P = .80) and compared with 98 of 254 patients (38.6%) in the navigation-plus-incentives group for a treatment difference of 4.5% (95% CI -4.0% to 12.8%; P = .68). The treatment difference between the navigation-only and the navigation-plus-incentives group was -2.8% (95% CI, -11.3% to 5.6%; P = .68). CONCLUSIONS AND RELEVANCE: Among hospitalized patients with HIV infection and substance use, patient navigation with or without financial incentives did not have a beneficial effect on HIV viral suppression relative to nonsuppression or death at 12 months vs treatment as usual. These findings do not support these interventions in this setting. TRIAL REGISTRATION: clinicaltrials.gov Identifier: NCT01612169.

Análisis de sobrevida en pacientes de edad avanzada que inician hemodiálisis crónica en Servicio de Salud Chileno / Survival of older patients starting hemodialysis in Chile

The proportion of older people with end stage renal disease is increasing. Their prognosis is characterized by a high mortality and poor quality of life. Aim: To analyze the survival of patients starting chronic hemodialysis (CHD) according to their age. Material and Methods: Patients admitted to CHD in the East Metropolitan Health Service of Santiago in a 2-year period were analyzed. Four age groups were created, separating patients older than 70 years in a special group. Results: During the study period, 459 patients were admitted to CHD and were followed for an average of 27 months. The frequency of cardiovascular comorbidity, cancer, and chronic renal disease of unknown cause (attributed to nephrosclerosis) increased along with age. Mortality was higher at older ages. There was a significant association between starting CHD with a catheter, Charlson comorbidity index and increasing age with mortality. For those aged over 80 years, mortality at three months and one year was 25 and 43% respectively. Conclusions: Age, Charlson index and vascular access are predictors of mortality in older adults entering hemodialysis. This study suggests the importance of considering comorbidities, assessment by specialists and creating an arteriovenous fistula in this age group.

[Long-term outcomes with expanded criteria donors in kidney transplantation]. / Resultados a largo plazo en trasplante renal de donantes con criterios expandidos.

BACKGROUND: Kidney transplantation of expanded criteria deceased donors (DCE) has become a common clinical practice. However, DCE outcomes are inferior compared to kidney transplants from standard criteria donors (DCS). AIM: To evaluate intermediate and long-term outcomes of DCE transplanted patients. MATERIAL AND METHODS: Cadaveric kidney transplants were evaluated using a retrospective cohort of eight consecutive years. Complications and long-term function of the transplant were assessed in DCE and DCS kidney recipients. RESULTS: Of 213 patients analyzed, 34 (16%) underwent DCE transplantation. DCS recipients spent more time on the waiting list for transplantation (p = 0.04). DCE recipients showed higher frequency of surgical complications (p = 0.04), vascular complications (p = 0.02), acute transplant rejection (p = 0.05), and hospitalizations (p = 0.01). Creatinine (mg/dL) in DCE and DCS recipients was 2.3 and 1.5 respectively at year one (p < 0.01) and 2.6 and 1.6 respectively at year five (p < 0.01). Graft survival in the DCE group was significantly lower at 5 years (61 and 89% respectively, p < 0.01). CONCLUSIONS: DCE grafts are associated with lower survival, higher hospitalization rate and commonly develop surgical complications and rejections.