Health-related quality of life in patients with home nutritional support.

BACKGROUND: Home nutritional support (HNS) aims to improve or maintain the patient's quality of life. Given the high social cost of such treatment, however, it is important to investigate whether the perceived quality of life of patients receiving HNS does in fact reflect these objectives. The present study aimed to evaluate the health-related quality of life (HRQoL) of patients who receive HNS. METHODS: A multicentre, cross-sectional study of 267 patients was carried out. HRQoL was evaluated using the EuroQoL-5-Dimensions (EQ-5D) questionnaire. The Visual Analogue Scale (VAS) was used to complement the EQ-5D, aiming to provide an overall estimation of patient quality of life. RESULTS: The EQ-5D questionnaire showed that 25% of the subjects valued their HRQoL at between -0.08 and 0.15, 50% at between 0.16 and 0.69 and 25% at between 0.70 and 1. Results from the VAS showed that 75% of patients claimed to have a HRQoL > 40. The median for the VAS was 50. Pathologies were oncological (44.0%), neurological (36.6%) and others (19.3%). The results obtained demonstrate that neurological patients placed a lower value on their HRQoL compared to those of other groups (P < 0.001). In addition, women rated their quality of life lower than men in all pathologies (P = 0.006). CONCLUSIONS: Perceived HRQoL varied depending on pathology and sex. It was difficult to draw conclusions concerning the impact of HNS because of a lack of baseline data and relevant validated measurement tools. The present study highlights the need for more research into the relationship between HNS and HRQoL.

Artificial Nutritional Support Registries: systematic review.

INTRODUCTION: The nutritional registries are data bases through which we obtain the information to understand the nutrition of populations. Several main nutrition societies of the world have these types of registries, outstanding the NADYA (Home artificial and Ambulatory nutrition) group in Spain. The object of this study is to determine by means of a systematic review, the existent scientific production in the international data bases referred to nutritional support registries. METHODS: Descriptive transversal study of the results of a critical bibliographic research done in the bioscience data bases: MEDLINE, EMBASE, The Cochrane Library, ISI (Web of Sciences), LILACS, CINHAL. RESULTS: A total of 20 original articles related to nutritional registries were found and recovered. Eleven registries of eight countries were identified: Australia, Germany, Italy, Japan, Spain, Sweden, United Status and United Kingdom. The Price Index was of 65% and all the articles were published in the last 20 years. CONCLUSIONS: The Price Index highlights the innovativeness of this practice. The articles related to nutritional support are heterogeneous with respect to data and population, which exposes this as a limitation for a combined analysis.

[Population wills about the decisions and cares at the end of life]. / Voluntades de la población sobre los cuidados y decisiones al final de la vida.

OBJECTIVE: To know the wishes and willings of the general population at the end of life under the assumption of suffering a terminal disease. METHOD: Crosswise quanti-qualitative study. An opinion poll has been made under the assumption of suffering a terminal disease with 10 questions about the wishes of the population at the end of life Descriptive techniques have been used as well as chi(2) Pearson, chi(2) Fisher and Student's T tests for the analysis. Also, analysis of the comments contents techniques have been used. RESULTS: 403 polls have been analyzed with an age mean of 38.2 years. 63.8% of the people prefer to end their life at home IC 95%, [59.1%-68.5%]. The majority prefer their partners as care giver 43.4% IC 95% [38.6-48.3]. The 85.9% IC 95% [82.5-89.3] would not wish to be undergone to either resuscitation maneuvers or other ways to extend their lifes to the maximum. The 49.4% IC 95% [44.5-54.3] would want to receive special nutritional support. CONCLUSIONS: It was observed that the oldest population refuses to talk about their own death. The vast majority of the polled people would want to die at home with their partner's cares. Half of the people want to be feed artificially until the end of their days.

[National registry of home enteral nutrition in Spain 2007]. / Registro de Nutrición Enteral Domiciliaria en España en el año 2007.

OBJECTIVE: To communicate the results from the registry of Home-Based Enteral Nutrition of the NADYASENPE group in 2007. MATERIAL AND METHODS: We included every patient in the registry with home enteral nutrition any time from January 1st to December 31st of 2007. RESULTS: The number of patients with home enteral nutrition in 2007 was 5,107 (52% male) from 28 different hospitals. 95.4% of them were 15 yr or older, with a mean age of 67.96 +/- 18.12, and 4.2 +/- 3.38 among patients aged 14 yr or less. The most common underlying diseases were neurological (37.8%) and neoplastic diseases (29.3%). Enteral nutrition was administered p.o. in most patients (63.5%), followed by nasogastric tube (25.9%), while gastrostomy was only used in 9.2%. The mean time in enteral nutrition support was 9.4 months and the most common reasons for withdrawal were death (58.7%) and switching to oral intake (32%). Activity was limited in 31.4% of patients and 36.01% were house-bound. Most patients needed partial (26.51%) or total (37.68%) care assistance. Enteral formula was provided by hospitals to 69.14% of patients and by pharmacies to 30.17% of them, while disposable material was provided by hospitals to 81.63% and by Primary Care to the remaining patients. CONCLUSIONS: In 2007, there has been an increase of more than 30% of patients registered with home enteral nutrition comparing with 2006, without any big difference in other data, but a higher proportion of patients with enteral nutrition p.o.

[Information in Home Nutrition: the importance of the registries]. / Información en Nutrición Domiciliaria: la importancia de los registros.

The importance of the registries is determined by its data. In order for a registry to meet its objectives quality in codification, transcription and analysis is essential. These premises applied to a home nutrition registry give an information able to meet all the researchers' targets. The NADYA Group registry of the Spanish Society of Parenteral and Enteral Nutrition in Spain tries to measure home artificial nutrition, its indications, methods and ways of administration and other variables. From their studies we may conclude that Parenteral Nutrition is underutilized at present, probably due to a lack of supporting structures able to meet all the needs of home patients. However, tube enteral nutrition is increasing, which represents a reduction in hospital costs and, more important represents an improvement of the patients quality of life and, in turn, also of their relatives.

[Bibliometric study of the Journal Nutrición Hospitalaria for the period 2001-2005: Part 1, Analysis of the scientific production]. / Estudio bibliométrico de la revista Nutrición Hospitalaria en el periodo 2001 a 2005: Parte I, Análisis de la producción científica.

OBJECTIVE: To assess the scientific activity and information production of the journal Nutrición Hospitalaria, for the period 2001-2005 by means of a Bibliometric study. METHOD: Cross-sectional descriptive study of the results obtained from the analysis of the articles published in the journal Nutrición Hospitalaria. The data were obtained by consulting the electronic version through the Web. In those cases in which there was a link breakdown, and thus, the inability to have access to the electronic document the printed version was consulted. All the documental possibilities were taken into account with the exception of communications to congresses. RESULTS: A total of 345 articles were published, 187 (54.20%) being original articles. The geographical distribution of the first author was Spanish in 287 articles (83.19%) and Latin American in 27 (7.83%). Most of the articles are from health care centers (172 articles (49.86%)), and the cooperation index being 4.15. Madrid is the most productive province, for both the absolute and adjusted frequencies. The median number of references per article is 18, the mean being 23.52 (95% CI 20.93 - 26.10). The predominant language was Spanish, with 308 articles (89.28%). CONCLUSION: Nutrición Hospitalaria may be considered as a reference journal regarding information and scientific communication on Nutrition for both the Spanish and Latin American communities. The bibliometric parameters studied compare with those verified for the remaining top of the list Spanish scientific journals on health sciences.

[Bibliometric study of the journal Nutrición Hospitalaria for the period 2001--2005: Part 2, consumption analysis; the bibliographic references]. / Estudio bibliométrico de la revista Nutrición Hospitalaria en el periodo 2001 a 2005: parte 2, análisis de consumo; las referencias bibliográficas.

OBJECTIVE: To describe and assess the consumption of the information consulted and cited in the articles published in the journal Nutrición Hospitalaria for the period 2001--2005 by means of bibliometric analysis. METHOD: Cross-sectional descriptive analysis of the results obtained from the analysis of the lists of bibliographic references of the articles published at Nutrición Hospitalaria. We studied the most cited journals, the signatures index, the type of document referred, the publication language, the distribution of geographical origin, and obsolescence and readiness index. We took into account all types of documents with the exception of Communications to Congresses. RESULTS: 345 articles were published at Nutr Hosp, containing 8,113 bibliographic references, with a median of 18, a maximum of 136 and minimum of 0 BR per article. The mean (rate of publications per published article during the specified period) is 23.52 (95% IC 20.93-26.10) and the mean at 5% is 20.66 per article. The 25th and 75th percentiles are 6 and 32, respectively, the interquartile interval being 26 BR per document. The semi-period of Burton and Kebler is 7 years and the Price Index is 38.18%. CONCLUSION: The bibliographic references, the consumption of information, of the articles published at Nutrición Hospitalaria present parameters similar to other journals on health science. However, good data on obsolescence are observed, which reveal the good validity of most of the references studied.

[Spanish Registry of Home-based Parenteral Nutrition during 2006 (NADYA-SENPE Group)]. / Registro de la Nutrición Parenteral Domiciliaria (NPD) en España del año 2006 (Grupo NADYA-SENPE).

OBJECTIVE: To report the data of the Home Parenteral Nutrition (HPN) registry of the NADYA-SENPE working group for the year 2006. METHODOLOGY: We compiled the data from the on-line registry introduced by the responsible Units for the monitoring of HPN from January 1st to December 31st 2006. RESULTS: 103 patients with HPN were registered (47 males and 56 females), belonging to 19 hospitals. Average age for the 91 patients older than 14 years old was 53.3 +/- 14.9 years old, and that for the 12 patients under 14 years old was 2 +/- 0 years old. Most frequent pathology was neoplasm (29%), followed by intestinal motility disorders (13%). The reason for HPN provision was short bowel syndrome (40%), intestinal obstruction (22%), and malabsorption (21%). Tunneled catheters were mostly used (45%), followed by implanted port-catheters (32%). Catheter related infections were the most frequent complications, with a rate of 0.85 episodes / 10(3) days. HPD was provided for more than two years in 50% of the cases. By the end of 2006, 70.9% of the patients remained active; exitus was the most frequent reason to end HPN (53%). Complementary oral or enteral nutrition was provided to 52% of the patients. 48% of the patients had a normal activity level, and a 55% were autonomous. PN formula was supplied by the hospital in 82% of the cases, while this number was 78% for fungible materials. 27% of the patients were eligible for intestinal transplant. CONCLUSIONS: We observe an increase in registered patients with respect to previous years, with a very different prevalence among regions. Neoplasia remains as the main pathology since 2003. We observe a decrease in catheter-related infections with respect to the 2004-2005 period.

[Registry of home-based enteral nutrition in Spain for the year 2006 (NADYA-SENPE Group)]. / Registro de la Nutrición Enteral Domiciliaria en España en el año 2006 (Grupo NADYA-SENPE).

OBJECTIVE: To communicate the results obtained from the registry of Home-Based Enteral Nutrition (HBEN) of the NADYA-SENPE group for the year 2006. MATERIAL AND METHODS: Recompilation of the data from the HBEN registry of the NADYA-SENPE group from January 1st to December 31st of 2006. RESULTS: During the year 2006, 3,921 patients (51% men) from 27 hospital centers were registered. Ninety-seven percent were older than 14 years. The mean age for those < 14 years was 4.9 +/- 3.9 (m +/- SD) and in those > or = 14 years, it was 68.5 +/- 18.2 years. The most common underlying disease was neurological pathology (42%), followed by cancer (28%). Enteral nutrition was administered p.o. in 44% of the patients, through nasogastric tube in 40%, gastrostomy in 14%, and jejunostomy in 1%. The average time of nutritional support was 8.8 months. The most common reasons for ending the therapy were patient's death (54%) and switching to oral feeding (32%). Thirty-one percent of the patients presented a limited activity and 40% were confined to bed/coach. Most of the patients required partial (25%) or total (43%) care assistance. The nutritional formula was provided by the hospital in 62% of the cases and from the reference pharmacy in 27%. The fungible material was provided by the hospital in 80% of the cases and by primary care in the remaining patients. CONCLUSIONS: Although the number of registered patients is slightly higher than that from the last years, there are no important changes in the patients characteristics, or way of administration and duration of enteral nutrition.

[Malnutrition of home-based hospital patients]. / Desnutrición en los enfermos de hospitalización a domicilio.

OBJECTIVE: We pretend to know the nutritional state in all patients that are being treated in the the Home Care Services Hospital Based (HCSHB) units, be which is their entrance causes and we also pretend to know the prevalence of undernutrition. SECONDARY OBJECTIVE: To know the prevalence of nutritional treatments in the HCSHB units, their relationship with the nutritional state, the pathology and the patient's origin inside the sanitary environment. ENVIRONMENT: A Multicentric study, in which the HCSHB units of three hospitals of the Valencia Community have intervened. PATIENT: 40 patients that remained in that moment entered by different causes in the HCSHB units. VARIABLES: Sex, age. Origin service, pathology, Subjective Global Valuation (SGV), IMC, nutritional support, type of nutritional support, albumin, Cholesterol, lymphocytes. RESULTS: The half age has been of 77,45 years (SD 11 years) with 67,5% of males. The patients, in all the cases, came from hospital Services, being the pathology responsible for the entrance mainly the oncological 32,5%, surgical 7,5%, neurological 7,5% and 52,5% others. According to GSV 52.5% present a good nutritional status, 37.5% had a suspect of under nourishment and 10% had a clear under nourishment. The IBM for the 12.5% of the patients is < or = 20 and the IBM for the 42.5% < or = 22. The 35% were receiving nutritional support, supplements the 78% and oral enteral nutrition the 14% of the patients. We have found a lineal relation between the IBM and the levels of albumin that the patients presented, also with the figures of cholesterol and it has not been found any relationship with the lymphocytes number.

[Conclusions of the III SENPE Debate Forum on specialized nutritional support: ethical issues]. / Conclusiones del III Foro de Debate SENPE. Soporte nutricional especializado: aspectos eticos.

Conclusions of the III SENPE-Abbott Debate Forum on several ethical issues of specialized nutritional support in hospitalized patients and outpatients. An insight in the principle of equity is given depending on geographical location, in its indications both as a primary therapy and palliative care, and in informed consent.

[Complications of enteral nutrition at home. Results of a multicentre trial]. / Complicaciones de la nutrición enteral domiciliaria. Resultados de un estudio multicéntrico.

AIM: In spite of the increasing number of home enteral nutrition (HEN) patients, only few articles had reported the frequency of complications related to this treatment. Our multicentric study analyzes the HEN complications in relation to access device and time of treatment. METHOD: 92 HEN patients from 8 hospitals were randomly selected. Patients were distributed in relation to the time of treatment and access device (nasogastric tube and percutaneous or surgical gastrostomies). After an educational program, they were filled in an initial questionnaire and repeated it the days 15 and 30. They received a mean of 1650 Kcal of enteral solution. A total of 2760 HEN prospective days were analyzed. RESULTS: In prospective study 42% of patients had some complication (112 episodes). The most frequent were gastrointestinal (55%) and mechanical (29%); 0.16 complications of patient-year were registered. The most common complications were: extraction (15%), constipation (13%), vomiting (12%) and diarrhoea (10%). The gastrostomy group had more gastrointestinal complications. In retrospective evaluation, percutaneous gastrostomy group had the lowest ratio of complications and nasogastric tube group required more tube replacements (4 vs 2) and had 1.96 episodes/patient (percutaneous group 1.85 and surgical gastrostomy 3.1 episodes/patient). CONCLUSION: HEN is safe with low incidence of complications. An adequate educational program is very important and we expect, in the future, to establish an proper National Home Care System.

[Artificial nutrition in the home. Annual information 1996.Group NADYA-SENPE]. / Nutrición artificial domiciliaria. Informe Anual 1996. Grupo NADYA-SENPE.

Using a simplified questionnaire from the NADYA group, data referring to age, sex, diagnosis, access route, duration, form of administration, complications, and quality of life have been gathered from 1,400 patients (57% male, 43% female) who receive home enteral nutrition, and from 38 patients (20% male and 18% female) who receive home parenteral nutrition. All of these patients come from the 1996 national registry. The most common indication for home enteral nutrition are neoplasias (39%) followed by neurological alterations (33%). The most common access route is oral (48%), followed by a nasogastric tube in 34%, PEG in 10% and surgical ostomies in 7%. The average treatment duration is 6 months. There is an index of 0.74 complications/patient-year (gastrointestinal 0.28 and mechanical alterations 0.19). At the end of the year 58% of the patients continued to use at home enteral nutrition, with a death rate of 17%. The majority of the treated patients presented a severe social disability (28%) or was bed-ridden (22%). The most common indications for home parenteral nutrition are: neoplasia (42%), Crohn_s disease (10%), and mesenteric ischemia (10%). AIDS (8%), radical enteritis (5%), and motility disorders (5%) are less common. In 42% of the cases tunneled catheters are used, and port-a-cath are used in 53%. The average treatment duration is 6.9 months. 1.06 hospitalizations/patient-year have been registered in relation to the nutritional treatment (mainly catheter sepsis). A mortality of 29% is registered, and there is recovery of the oral route in 7.9% of the cases. 50% of the patients present a severe social disability.

[25 Years in nutrition and food research in the Iberoamerican knowledge area]. / 25 Años de investigación en nutrición y alimentación en el espacio Iberoamericano del conocimiento.

INTRODUCTION: Research is usually considered a reliable indicator of the degree of development. Research in a problematic area such as food and nutrition for a given region, should have an impact on scientific production in agreement with the importance of the problem, the research capacity and the available resources for generating such a research. OBJECTIVE: To identify some indicators of Iberoamerican research in nutrition and food. METHOD: Retrospective study of Iberoamerican scientific production in nutrition and food in the last 25 years. The data were obtained from the bibliographic database Science Citation Index Expanded, Journal Citation Reports Science Edition Database 2011, both included in the Web of Knowledge (Thomson Reuters), and the database of the World Bank. RESULTS: 49,808 papers were registered, the 3.20% of the Health Sciences collection in SCI. The evolution was fitted to an exponential model, N&D (R² 0.962) and FS&T (R² 0.995). The average production in N&D per average population was higher in Spain with 0.659 papers/million. The highest rates of productivity and profitability were found in Guatemala with 12.963 papers/1000 researchers and 1.486 papers/million $ respectively. The average production in FS&T of the different countries per average population was higher in Cuba with 21.624 papers/million. The productivity index was higher in Uruguay with 25.999 papers/thousand researchers. The profitability index was higher in Guatemala with 0.271 papers/million $. CONCLUSION: There is exponential growth in the two categories studied N&D and FS&T. Productivity and profitability was higher in countries with low R&D (Research & Development) budget.

[Bibliometric and thematic analysis of the scientific literature about omega-3 fatty acids indexed in international databases on health sciences]. / Análisis bibliométrico y temático de la producción científica sobre ácidos grasos omega-3 indizada en las bases de datos internacionales sobre ciencias de la salud.

OBJECTIVE: To evaluate by bibliometric and thematic analysis the scientific literature on omega-3 fatty acids indexed in international databases on health sciences and to establish a comparative base for future analysis. METHOD: Searches were conducted with the descriptor (MeSH, as Major Topic) "Fatty Acids, Omega-3" from the first date available until December 31, 2010. Databases consulted: MEDLINE (via PubMed), EMBASE, ISI Web of Knowledge, CINAHL and LILACS. RESULTS: The most common type of document was originals articles. Obsolescence was set at 5 years. The geographical distribution of authors who appear as first author was EEUU and the articles were written predominantly in English. The study population was 90.98% (95% CI 89.25 to 92.71) adult humans. The documents were classified into 59 subject areas and the most studied topic 16.24% (95% CI 14.4 to 18.04) associated with omega-3, was cardiovascular disease. CONCLUSION: This study indicates that the scientific literature on omega-3 fatty acids is a full force area of knowledge. The Anglo-Saxon institutions dominate the scientific production and it is mainly oriented to the study of cardiovascular disease.

[Wikipedia and wikinutrition: key tools for the global promotion of nutrition]. / Wikipedia y Wikinutrición: herramientas clave para la promoción global de la nutrición.

Wikipedia is an encyclopedia collaboratively edited by volunteers from around the world built on the Web since 2003. Today is the sixth most visited site on the Internet, making it the biggest hit of participatory democracy in the field of information dissemination. The English edition, with more than 3 million items, has become an indispensable part of the Internet and the largest and most popular reference work. In this context, it could be argued that Wikipedia is a valuable tool for the general knowledge of the nutritional sciences terminology. At the same time, it does not only facilitate access to knowledge but also can generate it. It also permits to socialize these spaces for collaboration and development, contributing therefore to disclose science to the society. Consequently, in this article we present and discuss the main features of Wikipedia, emphasizing above all its role in food science and nutrition.

[Quality of life questionnaire related to nutritional status]. / Cuestionario de calidad de vida relacionado con el estado nutricional (CaVEN).

OBJECTIVE: To build and validate an instrument to measure the perceived quality of life in the nutritional status. MATERIAL AND METHODS: By focal groups and interviews with nutrition experts, the dimensions with greater affectation were identified. After the judge test, the CaVEN questionnaire was defined. For its valuation a multicentric study was performed, participating 7 Spanish hospitals. The internal structure of the questionnaire was evaluated by explanatory factorial analysis. Reliability was tested using the Cronbach α coefficient and the validity of the criteria with the nutritional Gold Standards. RESULTS: A questionnaire of 26 items with 6 health dimensions was built. It was applied to 68 patients that were valued in the Nutrition Units. The test KMO was 0.756, showing a good accuracy in the Factorial Analysis. The existence of principal dimension of inertia was found (Bartlett p < 0.01). The 6 dimensions showed an accumulative variance of 77.670. It was observed a direct relationship in the Subjective Global Valuation and CaVEN (p < 0.01) and with the "Mini Nutritional Assessment Short" (p = 0.02), which was interpreted as the greater affectation of the nutritional status, the lower the quality of life detected by the CaVEN. CONCLUSIONS: The CaVEN questionnaire has proved a useful tool for assessing the quality of life related to nutritional status, even in groups with little nutritional alterations.