Extremity Tourniquet Self-Application by Antarctica Zodiac Crew Members.

Search and rescue teams and Antarctic research groups use protective cold-water anti-exposure suits (AES) when cruising on Zodiacs. Extremity tourniquet (ET) self-application (SA) donned with AESs has not been previously studied. Our study therefore assessed the SA of 5 commercial ETs (CAT, OMNA, RATS, RMT, and SWAT-T) among 15 volunteers who donned these suits. Tourniquet's SA ability, ease of SA, tolerance, and tourniquet preference were measured. All ETs tested were self-applied to the upper extremity except for the SWAT, which was self-applied with the rest to the lower extremity. Ease- of- SA mean values were compared using the Friedman and Durbin-Conover post hoc tests (P < 0.001). Regarding the upper extremity, OMNA achieved the highest score of 8.5 out of 10, while RMT, and SWAT received lower scores than other options (P < 0.001). For lower extremities, SWAT was found to be inferior to other options (P < 0.01). Overall, OMNA was the best performer. The RATS showed significantly lower tolerance than the other groups in repeated- measures ANOVA with a Tukey post hoc test (P < 0.01). Additionally, out of the 5 ETs tested, 60% of subjects preferred OMNA. The study concluded that SA commercial ETs are feasible over cold-water anti-exposure suits in the Antarctic climate.

Tourniquet self-application assessment in cold weather conditions.

BACKGROUND: Our study aimed to assess the ability of nonmedical civilians to self-apply extremity tourniquets in cold weather conditions while wearing insulating technical clothing after receiving basic training. METHODS: A field study was conducted among 37 voluntary participants of an expedition party to the Spanish Antarctic base. The researchers assessed the participant's ability to self-apply five commercial extremity tourniquets (CAT, OMNA, RMT, SWAT-T, and RATS) over cold-weather clothing and their achieved effectiveness for vascular occlusion. Upper extremity self-application was performed with a single-handed technique (OHT), and lower extremity applying a two-handed technique (THT). Perceptions of self-application ease mean values ± standard deviation (SD) were compared by applying a 5% statistical significance threshold. Frequency count determined tourniquet preference. RESULTS: All the tested ETs, except the SWAT-T, were properly self-applied with an OHT, resulting in effective vascular occlusion in the upper extremity. The five devices tested were self-applied correctly in the lower extremities using THT. The ratcheting marine-designed OMNA ranked the highest for application easiness on both the upper and lower extremities, and the windlass CAT model was the preferred device by most participants. CONCLUSIONS: Civilian extremity tourniquet self-application on both upper and lower extremities can be accomplished in cold weather conditions despite using cold-weather gloves and technical clothing after receiving brief training. The ratcheting marine-designed OMNA ranked the highest for application ease, and the windlass CAT model was the preferred device.

Extremity Tourniquet Training at High Seas.

BACKGROUND: Future navy officers require unique training for emergency medical response in the isolated maritime environment. The authors issued a workshop on extremity bleeding control, using four different commercial extremity tourniquets onboard a training sail ship. The purposes were to assess participants' perceptions of this educational experience and evaluate self-application simplicity while navigating on high seas. METHODS: A descriptive observational study was conducted as part of a workshop issued to volunteer training officers. A post-workshop survey collected their perceptions about the workshops' content usefulness and adequacy, tourniquet safety, self-application simplicity, and device preference. Tourniquet preference was measured by frequency count while the rest of the studied variables on a one-to-ten Likert scale. Frequencies and percentages were calculated for the studied variables, and application simplicity means compared using the ANOVA test (p < 0.05). RESULTS: Fifty-one Spanish training naval officers, aged 20 or 21, perceived high sea workshop content's usefulness, adequacy, and safety level at 8.6/10, 8.7/10, and 7.5/10, respectively. As for application simplicity, CAT and SAM-XT were rated equally with a mean of 8.5, followed by SWAT (7.9) and RATS (6.9), this one statistically different from the rest (p < 0.01). Windlass types were preferred by 94%. CONCLUSIONS: The training sail ship's extremity bleeding control workshop was perceived as useful and its content adequate by the participating midshipmen. Windlass types were regarded as easier to apply than elastic counterparts. They were also preferred by nine out of every ten participants.

[Anaemia and the elderly: Critical review of its definition and prevalence]. / Anciano y anemia: revisión crítica de su definición y prevalencia.

BACKGROUND AND OBJECTIVES: The prevalence of anaemia is an important health indicator, although there is little rigorous information gathered on the elderly population, particularly in those over 80 years old. The same criteria that are used in the general population are often used to define anaemia in the elderly. The epidemiological data collected by the WHO in 1968 (that have been used to generalise this criteria), did not include the population over 65 years-old. Two objectives are established, which includes a critical review of the available evidence on whether the criteria used to define anaemia in the adult population can be extrapolated to the elderly, and a review of publications on the prevalence of anaemia in the elderly over 80 years-old. MATERIAL AND METHODS: A systematic bibliographic search was performed on the established objectives. RESULTS: Although the WHO criteria, based on data from 1968, are widely used, other possible cut-off points have been proposed for elderly people. A total of 20 studies were found that were conducted in North America and Europe, with only 70,000 patients, and different age criteria. The prevalence of anaemia ranges between 3% and 63%, depending on the diagnostic criteria, age, and whether they were institutionalised or not. CONCLUSIONS: Anaemia is a very prevalent disease in elderly patients. The collection of large databases is necessary to determine more adequate diagnostic criteria.

Influence of gender, age and residence altitude on haemoglobin levels and the prevalence of anaemia. / Influencia del sexo, la edad y la altitud de residencia en los niveles de hemoglobina y la prevalencia de anemia.

INTRODUCTION: There are gaps in our knowledge of the normative levels of haemoglobin and the prevalence of anaemia in our geographical area, and in certain population subgroups. OBJECTIVES: To study the mean values of haemoglobin in a mountainous Spanish region, according to sex, age range and residence altitude, and the prediction of anaemia according to the WHO thresholds and other proposals. MATERIAL AND METHODS: Cross-sectional descriptive study of all patients aged >14 residents in the Huesca healthcare Sector with ≥1 laboratory report in the 5 years of inclusion; multivariate analysis to determine the influence of demographic factors on haemoglobin values. RESULTS: 583,856 laboratory reports of 90,800 patients (coverage 89.1%) residing between 281 and 1305 meters: 54.6% female; mean age 52.6 years. Hb mean: 14.1 g/dl (males:15.0/females:13.4). Prevalence of anaemia: 8.99% (males: 7.8%/females:10.0%). It was more frequent in women (1.6 times) and increased markedly with age: >65 years:16.5%; ≥75 years: 21.7%; ≥80 years: 25.7%; >90 years 35%. It increased 1.02 times per year, and 0.99 times per meter of altitude. In residents ≥1000 m, anaemia prevalence fell by half. CONCLUSIONS: We obtained data from sub-populations that were previously not well described; anaemia in the elderly requires consideration. The influence of altitude does not seem to be fully considered within the correction framework proposed by WHO. Broader studies should be planned in order to obtain adequate parameters for the elderly and residents at high altitudes in Spain, as both groups represent an important proportion of the population, to avoid potential underdiagnosis of anaemia and overdiagnosis of other pathologies.

[Estimation of arterial oxygen saturation in relation to altitude]. / Estimación de la saturación arterial de oxígeno en función de la altitud.

BACKGROUND AND OBJECTIVES: Arterial Oxygen Saturation (AOS) predicts altitude sickness. OBJECTIVES: To estimate the AOS values with relation to altitude. Furthermore, make a graph to use during activity which assesses the AOS for each altitude and the normal range. PATIENTS AND METHOD: Values of AOS were assessed during eight high mountain activities in the Alps, Himalaya, Caucasus and Andes; 53 mountaineers participated, 17 of them in more than one activity; 761 measurements of AOS were registered. RESULTS: A Logistic Regression Model was made to estimate the AOS values dependent on altitude, adjusted to possible related factors. A strong lineal relationship exists between altitude and AOS (R2=.83, P<.001); .7 points more in women. The AOS in a particular altitude is not related to age, weight, height, smoking, heart rate, or even with previous experiences in mountains. The calculation of the AOS responds to the follow equation: Blood Oxygen Saturation=103.3-(altitude × .0047)+(Z), being Z=.7 in men and 1.4 in women. A scatter plot was made to relate the estimated altitude with the AOS, with their normal limits values: percentiles 2.5 and 97.5. CONCLUSIONS: The simple calculation of the AOS estimated for a particular altitude with the proposed graphic can help in the early decision-making onsite.

[Study protocol concerning the determining factors of physical and psychosocial destabilisation in the elderly]. / Protocolo de estudio sobre condicionantes de desestabilización física y psicosocial en los mayores.

OBJECTIVE: The main objective of this study is to define the factors associated with frailty and psychosocial imbalance in elderly people who live in the community. METHODS: Multicentre prospective study with a representative sample of subjects older than 75 years who live in the community in the province of Huesca (Spain). 5-year follow-up with biannual assessment. Standardised individual assessment carried out by GPs trained to assess depression, anxiety, cognitive impairment, psychotic symptoms, sarcopenia, social network, dependence for basic and instrumental activities of daily living, physical severity, risk of dependence and quality of life. Further assessment two and five years later to quantify adverse events: institutionalisation, functional impairment or mortality. Possible risk factors will be assessed: gender, age, social status, functional status, mental status and physical severity. Predictive and individual risk models will be designed in order to identify elderly people with high psychosocial frailty and destabilisation risk. CONCLUSIONS: An understanding of the possible risk factors would facilitate the identification of elderly subjects at greater risk of psychosocial frailty, thereby enabling preventive activities to be implemented aimed at reducing frailty and associated adverse events (institutionalisation, mortality, etc.).

[Diagnostic yield of cognitive tests applied in primary care. Consistency and validity of screening tests]. / Rendimiento diagnóstico de los test cognitivos aplicados desde atención primaria. Concordancia y validez de los test de cribado.

OBJECTIVE: To estimate the prevalence of cognitive impairment in elderly people living in the community. To assess the diagnostic yield of the main cognitive screening tests in Primary Care: the Mini Mental State Examination (MMSE), the Clock Drawing Test (CDT), the Verbal Fluency Test (VFT) and the Informant Questionnaire test (IQ). We also calculated their correlation and validity. DESIGN: Descriptive study based on a personal interview by professionals using a standardised method to assess cognitive impairment. PARTICIPANTS: A total of 293 men and women, who were older than 64 years old and residing in the province of Huesca. The sample was recruited by systematic random sampling from the database of personal health care card. MAIN MEASUREMENTS: We analysed social and demographic variables (age, educational level, marital status) and the assessment of cognitive impairment by means of MMSE, CDT, VF, IQ tests. RESULTS: The prevalence of cognitive impairment with MMSE was 18.1% (95% CI: 15.3-24.4%). The correlation between MMSE and the other cognitive screening tests was moderate: CDT kappa=0.40; VF kappa=0.33; IQ kappa=0.36. Using the MMSE as a gold standard and the prior diagnosis of CI, the sensitivity of CDT was 78.3% and the specificity was 76.9%, 80%; there was 70% sensitivity and 76.7% specificity for the VF; and 71.4% for IQ respectively. The area under the VF ROC curve was significantly higher than the other tests. CONCLUSIONS: The agreement between cognitive impairment screening tests was moderate. The VF yielded better diagnostic accuracy.

[Predictive value of the quality of life questionnaire in the elderly]. / Validez predictiva de mortalidad del cuestionario de calidad de vida en ancianos.

OBJECTIVE: To evaluate the predictive value of the quality of life (QOL) questionnaire at 8 years and analyse which of its 5 dimensions better predict adverse results in health. DESIGN: Descriptive, longitudinal, and retrospective study. SETTING: Three basic health areas in Cuenca province, Spain. PARTICIPANTS: We randomly selected 519 subjects over 64 years, taking addresses in which more than 1 person over 64 years resided as a sample marker. MAIN MEASUREMENTS: The QOL questionnaire was used to evaluate the quality of life of the subjects in 1994 and in 2002. Main results. Between 1994 and 2002, 25% of the participants died, 2.6% were institutionalised and there 3.6% losses. The QOL questionnaire has a mortality predictive capacity at 8 years, the cut off point of its global index being situated around 13 points. The sensitivity of the model is poor (41.5%), with a high specificity (93.5%) and a good classification percentage of 80.3%. The positive and negative probability ratios were 6.36 and 0.62, respectively. Using a Cox regression model, it is seen that of the 5 dimensions of the QOL test, activities of daily living show a relationship with mortality (risk ratio or OR=1.3; 95% confiance interval [CI], 1.049-1.611), mental health (OR=1.048; 95% CI, 1.054-1.620), and economic resources (OR=0.806; 95% CI, 0.648-1.003). CONCLUSIONS: The QOL questionnaire has a mortality predictive capacity at 8 years.

[Social inequality and changes in quality of life among the elderly in rural areas of the Province of Cuenca (Spain) between 1994 and 2002]. / Desigualdades sociales y cambios en la calidad de vida de los ancianos en el medio rural de Cuenca entre 1994 y 2002.

OBJECTIVE: To evaluate changes in quality of life (QoL) in a sample of elderly community-dwelling individuals. Overall QoL was evaluated, in addition to the dimensions of physical health (PH), mental health (MH), activities of daily living (ADL), economic resources (ER) and social resources (SR). MATERIALS AND METHODS: Of a sample of 918 persons aged more than 64 years old in the Province of Cuenca (Spain), QoL was measured in 519 in 1994 by means of the Quality of Life for the Elderly (QLE) questionnaire, developed from the OARS-MFAQ Older Americans Resources and Services Multidimensional Functional Assesment Questionaire. In 2002, with a 3.6% loss, the QLE was administered again in all participants that were still alive and non-institutionalized. The results were compared for the two periods and the factors associated with variation in QoL were estimated by means of multiple regression analysis. RESULTS: Of the 519 participants at baseline, 130 died (25%) and 14 (12.7%) were institutionalised. Elderly individuals who were still alive in 2002 showed a general worsening in their overall QoL, specifically in the variables of ADL, PH and MH. However, after adjusting for age, we found that overall QoL was better in 2002 than in 1994. Logistic regression revealed that the factors associated with a lesser decrease in QoL were education, being male, lower age, and being widowed. CONCLUSIONS: QoL in community-dwelling elderly individuals in the Province of Cuenca improved between 1994 and 2002.

[Screening for factors relating to the development of mental disorders in the geriatric population (PSICOTARD)]. / Detección de factores relacionados con el desarrollo de trastornos mentales en la población geriátrica (PSICOTARD).

OBJECTIVES: To detect the physical, psychological, social-demographic, and functional factors that may involve risk of developing mental disorder in the elderly, to determine the magnitude of each factor and to do the groundwork for a future longitudinal study that will enable us to define the elderly with psychological fragility in the autonomous region and to design predictive models for mental deterioration in the elderly. DESIGN: Descriptive study based on personal interviews by professionals using a standardised method. SETTING: Twenty-eight primary care health centres in the province of Huesca, Spain, with an ageing rate over 24.6%. PARTICIPANTS: Three-hundred and twenty-six patients over 64 years and resident in the province of Huesca, Spain. INTERVENTION: Personal interview conducted by health professionals (30 family doctors and a trainee psychologist). The following will be appraised: the presence of cognitive impairment (Mini-Mental State Examination), depression (Yesavage Geriatric Depression Scale), anxiety (Goldberg Scale of Anxiety), and presence of delusions, hallucinations, obsessions and hypochondria (Geriatric Mental State-GMS). MAIN MEASUREMENTS: The prevalence of the risk factors will be calculated: social and demographic variables (age, sex, marital status, education, living alone), functional status (Barthel index), the severity of physical disability (Cumulative Illness Rating Scale), pathological records (somatic and psychological), and stressful life events in the preceding year. A logistical regression model will be calculated to determine the weight of the effect of each factor adjusted for all the rest. Individual risk will be calculated for the development of each mental disorder (depression, anxiety, cognitive deterioration/dementia, psychotic symptoms, obsessions). DISCUSSION: The reliability of the questionnaire is ensured by use of diagnostic tests of proven validity and reliability, prior training of researchers and use of a data-gathering pilot study.