Validity of the Self- Mini Nutritional Assessment (Self- MNA) for the Evaluation of Nutritional Risk. A Cross- Sectional Study Conducted in General Practice.

INTRODUCTION: Malnutrition is a frequent condition in the elderly especially in hospitals and in nursing homes, and even among the free-living elders the prevalence is not negligible (5-10%). Awareness towards malnutrition is still limited. The lack of time for nutritional assessment by the overcommitted healthcare personnel, including the general practitioners (GPs), may represent one possible explanation for limited recognition of malnutrition. Therefore, a self-administered instrument could be useful in raising alert on the GPs and allow early detection of malnutrition and early care provision. The aim of the present study was to analyze the validity of the Self-MNA that takes cue from the Mini Nutritional Assessment- Short Form (MNA-SF) and has been adapted to be self-administered by free-living elderly subjects. METHODS: Participants were recruited from patients referring to the GP offices in Italy. Nutritional evaluation was performed through the administration of Full-MNA, MNA-SF and Self-MNA. The comorbidity level was assessed through the Cumulative Illness Rating Scale (CIRS). The level of difficulty in filling out the test was reported by the participants, and the time spent to complete the Self-MNA was also registered. RESULTS: A total of 226 subjects, 125 women and 101 men (75.1 ±8 and 75.3 ± 8 years old, respectively; p=0.89) were enrolled, and 214 (94.7%) of them completed the Self-MNA. According with the Full-MNA test score, 8.4% of women and 3.5% of men were classified as malnourished, whereas 32.7% of women and 31.4% of men were at risk of malnutrition. Agreement between Self-MNA and Full-MNA, and Self-MNA vs. MNA-SF was classified as "moderate" (k = 0.476 and 0.496 respectively; p < 0.001). Self-MNA showed a fair predictive value compared to the Full-MNA and MNA-SF tests (76.6 and 79.9%, respectively) with a barely adequate sensitivity (70.9 and 75.4%, respectively). The analysis of the characteristics of FN (false negative: subjects who were considered at risk of malnutrition or malnourished at Full-MNA but not at Self-MNA) showed that the clinical and functional aspects of these subjects (age, comorbidity and severity, time necessary to complete the Self-MNA, decrease in food intake, severe illness in the past 3 months, dementia and depression, fluid intake, need for feeding assistance, arm and calf circumferences) were very similar to the characteristics of true positive subjects. Patients required 6.7 ± 4.5 minutes to complete the test and 25 subjects (11.7%) needed more than 10 minutes, up to a maximum of 30 minutes. Patients who stated a greater difficulty were older (79.8 ± 7 vs. 73.5 ± 7 years; p<0.001), they were more «malnourished¼ at Full-MNA (10.7 vs. 1,7%; p= 0.006) and clinical status was characterized by a higher severity index (1.72 ± 0.6 vs. 1.41 ± 0.4; p= 0.008). CONCLUSION: In the present study we investigated the validity of the Self-MNA in a sample of free-living elderly subjects. The results obtained confirm the validity of the test that may represent a useful tool for the GPs, although some important limitations need to be considered, limiting its use in clinical practice.

Moderate alcohol use and health: a consensus document.

AIMS: The aim of this consensus paper is to review the available evidence on the association between moderate alcohol use, health and disease and to provide a working document to the scientific and health professional communities. DATA SYNTHESIS: In healthy adults and in the elderly, spontaneous consumption of alcoholic beverages within 30 g ethanol/d for men and 15 g/d for women is to be considered acceptable and do not deserve intervention by the primary care physician or the health professional in charge. Patients with increased risk for specific diseases, for example, women with familiar history of breast cancer, or subjects with familiar history of early cardiovascular disease, or cardiovascular patients should discuss with their physician their drinking habits. No abstainer should be advised to drink for health reasons. Alcohol use must be discouraged in specific physiological or personal situations or in selected age classes (children and adolescents, pregnant and lactating women and recovering alcoholics). Moreover, the possible interactions between alcohol and acute or chronic drug use must be discussed with the primary care physician. CONCLUSIONS: The choice to consume alcohol should be based on individual considerations, taking into account the influence on health and diet, the risk of alcoholism and abuse, the effect on behaviour and other factors that may vary with age and lifestyle. Moderation in drinking and development of an associated lifestyle culture should be fostered.

General practitioners and management of patients with respiratory diseases in a real life survey.

AIM: The prevalence of respiratory diseases has been assessed in community based epidemiological studies. General practice is the ideal position to intercept chronic respiratory illness and manage the first level of follow up as well. Aim of this study was to obtain General Practitioners (GPs) data about management and clinical setting of patients with respiratory diseases. METHODS: This is a prospective observational study; 272 Italian GPs were involved and equally distributed on the Italian territory. The interviews were performed by means of a questionnaire consisting in which consisted of 25 questions regarding individual demographics, catchment area, professional behavior, health attitudes. RESULTS: Each GP reported that about 13% of the pooled patients had a respiratory disease. Concerning as for chronic respiratory illnesses, spirometry was frequently prescribed and in these patients 63% of the interviewed GPs thought that the lung functional test was fundamental. GPs also reported the importance of improving health education, well aware of its importance in the prevention of respiratory diseases; and furthermore in improving the current health system organization. As for with regard to cigarette smoke, interviewed GPs reported that the 26% of their assisted subjects were smokers and the commitment to discouraging the smoking habit was very high. CONCLUSION: This is a large National survey that involved GPs and real life data about management of patients with respiratory diseases. The role of GPs in the management of chronic respiratory patients represents an important tool valuable in increasing primary care identification, education and treatment of respiratory diseases.

[Obesity and Eating Disorders. Indications for the different levels of care. An Italian Expert Consensus Document]. / Documento di Consensus. Obesità e Disturbi dell'Alimentazione Indicazioni per i diversi livelli di trattamento.

This paper is an Italian Expert Consensus Document on multidimensional treatment of obesity and eating disorders. The Document is based on a wide survey of expert opinion. It presents, in particular, considerations regarding how clinicians go about choosing the most appropriate site of treatment for a given patient suffering from obesity and/or eating disorders: outpatient, partial hospitalization, residential rehabilitation centre, inpatient hospitalization. In a majority of instances obesity and eating disorders are long-term diseases and require a multiprofessional team-approach. In determining an initial level of care or a change to a different level of care, it is essential to consider together the overall physical condition, medical complications, disabilities, psychiatric comorbidity, psychology, behaviour, family, social resources, environment, and available services. We first created a review manuscript, a skeleton algorithm and two rating scales, based on the published guidelines and the existing research literature. As the second point we highlighted a number of clinical questions that had to be addressed in the specific context of our National Health Service and available specialized care units. Then we submitted eleven progressive revisions of the Document to the experts up to the final synthesis that was approved by the group. Of course, from point to point, some of the individual experts would differ with the consensus view. The document can be viewed as an expert consultation and the clinical judgement must always be tailored to the particular needs of each clinical situation. We will continue to revise the Document periodically based on new research information and on reassessment of expert opinion to keep it up-to-date. The Document was not financially sponsored.

Efficacy of intervention strategies in a brachial plexus global avulsion model in the rat.

The treatment of brachial plexus avulsion lesions invariably involves the use of neurotization procedures. Although some of these therapeutic strategies have been used for the past 20 years to restore selective function to the injured extremity, the individual efficacy of these nerve transfers has not been measured objectively, thereby rendering the prognostication of outcomes for these techniques a major problem. Using a true global avulsion model, the present study compares outcomes of the various neurotization procedures for the first time. The strength of this experimental model is that each nerve transfer tested leads to a common terminal pathway involving a single target-namely, the biceps muscle. Thus, quantitative measurements of biceps restoration will provide strong clues to the power of axonal regrowth of that particular motor pool. This study also introduces the Terzis grooming test, a modified behavioral test that can be quantified and that can provide an overall functional scale in the assessment of outcome. Thirty-five Sprague-Dawley rats were divided into seven groups, with each group testing a different motor donor for biceps reinnervation. The ipsilateral brachial plexus was globally avulsed in all animals, with the exception of the ipsilateral C7 group, and the respective motor donor coapted in an end-to-end fashion to the musculocutaneous nerve. Functional outcomes were measured by the Terzis grooming test, electromyography, biceps muscle force measurements, motor end plate counts, and quantitative axonal morphometry. The values of the different parameters were expressed as a standard score on a common scale. The relative standings of each group on each parameter were compared. Superior outcome was observed in the phrenic, the hypoglossal, and the ipsilateral C7 groups.

[Effect of renal and liver failure on blood levels of vitamin A, its precursor (beta-carotene) and its carrier proteins (prealbumin and retinol binding protein)]. / Influenza dell'insufficienza renale ed epatica sul tasso ematico della vitamina A, dei suoi precursori (beta-carotene) e dei suoi vettori proteici (PA e RBP).

Plasma beta-carotene and retinol assay was performed by high pressure liquid chromatography (HPLC) in subjects with chronic renal failure or liver cirrhosis. In the same subjects blood prealbumin (PA) and retinol binding protein (RBP) were determined by immunological technique. A considerable increase of retinol and in a lesser extent of beta-carotene was noted in the blood of patients with renal insufficiency. In cirrhotic patients it was shown a marked decrease both of beta-carotene and retinol plasma concentrations. PA and RBP there were greatly increased in renal failure and decreased in liver cirrhosis. This results suggest that kidney and liver chronic failure interfere with vitamin A metabolism throughout their action on metabolic processes of synthesis and elimination of PA and RBP.

[Behavior of vitamin A, beta-carotene, retinol binding protein and prealbumin in the plasma of hypo- and hyperthyroid subjects]. / Comportamento della vitamina a, dela beta-carotene, della proteina legante il retinolo e della prealbumina nel plasma di soggetti ipo ed ipertiroidei.

Plasma concentrations of beta-carotene and retinol, determined by HPLC, and of transport proteins, ascertained by immunodiffusion technique, in hypo and hyperthyroid subjects are reported. In hypothyroid subject a considerable increase in carotene was noted. This was not the case for retinol. In hyperthyroids both beta-carotene and retinol levels were found to be normal. Transport protein (PA and RBP) levels were found to be lower only in cases of hyperthyroidism but unchanged for hypothyroids. According to the Authors the results show that the alteration in plasma carotene levels to be found in hypothyroid subjects is not the direct consequence of a lack of thyroid hormone in the metabolism of vitamin A but the indirect effect of thyroid disease.

[Oral load test with beta-carotene in normal and dysthyroid subjects]. / La prova da carico per os con beta-carotene nei soggetti normali e distiroidei.

An oral load of beta-carotene (500 mg) was administered to four normal, four hypo and four hyperthyroid subjects. Plasma beta-carotene content was determined at the 2nd, 4th, 6th, 8th, 10th, 12th and 24th hour after administration and at every 24th hour thereafter for 5 consecutive days. Plasma assays were performed by HPLC. No significant differences were revealed by Student's T test for one group to the other. The authors sustain that, as there is no impairment in intestinal uptake of beta-carotene in disthyroid subjects, the elsewhere described increase in carotinemia in hypothyroids is due to other mechanisms.

[Changes induced by parturition in serum cholesterol and triglycerides in obese and normal weight women]. / Modificazioni indotte dal parto sul colesterolo e sui trigliceridi sierici in donne obese e normopeso.

It is shown that total cholesterol levels in the blood before and immediately after delivery in obese and normal weighing women remain within normal values. Conversely blood triglycerides levels, higher than normal prior to delivery, are shown to drop back to normal values within three days (p 0.001). This is not thought to be attributable to labor stress.

[Effect of parturition on serum glycerol and non-esterified fatty acids in obese and normal weight women]. / Influenza del parto sul contenuto silrico di glicerolo e di acidi grassi non esterificati in donne obese e normopeso.

Serum glycerol and NEFA content variations are examined before and after labor in obese and normal weighing women (35 subjects). Blood glycerol and NEFA are shown to increase before delivery. Glycerol values are shown to drop to normal immediately after delivery, while NEFA values diminish to a lesser extent. Statistical analysis shown that blood glycerol increase could be pregnancy-dependent in both normal weighing and obese women, but that NEFA increase could be pregnancy-dependent in normal weighing women only. Obesity increases blood glycerol and NEFA concentration considerably, thus masking the effects of pregnancy.

[Serum content of vitamin A binding proteins (prealbumin and retinol binding proteins) in normal and pathological conditions]. / Contenuto sterico delle proteine vettrici la vitamina A (PA e RBP) in condizioni normali e patologiche.

Blood PA and RBP content were estimated in 100 normal subjects (50 men and 50 women). Mean values of 28.2 and 3.75 mg/dl were ascertained for PA and RBP, respectively. The molar ratio RBP/PA was calculated as 0.31 +/- 0.05. Serum concentrations of PA and RBP are seen to be sex-dependent (20% higher in males). Hyperthyroid subjects exhibit a decrease in the two vitamin A-binding proteins whereas no modification could be revealed for hypothyroid states. In patients on maintenance hemodialysis mean serum PA and RBP concentrations were remarkably higher than normal, whereas liver cirrhotic subjects showed a highly significant depression of mean serum RBP and PA values.

Constipation and obesity: a statistical analysis.

Constipation frequency was investigated among 1897 subjects (874 males and 1023 females), ranging in age from 6 to 70 years, chosen at random between city inhabitants and farmers. Bowel habit was studied in 966 obese patients (390 males and 576 females). The authors followed for the diagnosis of constipation either the commonest and restrictive criterion of the weekly bowel actions or the clinical one which implies also others parameters, like hard or small stools, difficulties of expulsion or feeling of incomplete evacuation after defecation. The statistical analysis showed that constipation frequency is 8.3% in obese patients and 1.5% in normal-weighting, according to weekly bowel actions criterion: the difference is statistically significative (p less than 0.001).

Blood glycerol meaning in obese patients.

The authors studied the behaviour of blood glycerol concentration after glycerol i.v. infusion in obese and normal subjects. The aim of research was to clarify the meaning of blood glycerol increase observed by some one in obese subjects. Results obtained showed that in obese subjects there is not any abnormal behaviour of blood glycerol concentration after infusion and that in none of patients studied was observed any significative increase of basal blood glycerol concentration values.