Evaluation of nutritional status using the minimum dietary diversity for women of reproductive age (MDD-W) tool in breastfeeding mothers in Madagascar.

OBJECTIVES: Women of reproductive age in low-income countries are especially nutritionally vulnerable given the strain that pregnancy and lactation places on the body. The aim of this study was to identify dietary diversity and its associated factors among mothers with young children. METHODS: It is a cross-sectional study conducted in Ampefy, Madagascar from 1 November 2022 to 31 March 2023. Dietary diversity was determined using the minimum dietary diversity for women of reproductive age tool. Data were collected through face-to-face interviews using validated structured questionnaires, and anthropometric status was examined. Frequencies and percentages were calculated, and the comparison of variables was performed between mothers with acceptable and unacceptable dietary diversity using the chi-square test for qualitative variables. A logistic regression analysis was also conducted. RESULTS: A total of 437 mothers with young children participated in the study, resulting in a response rate of 95.0%. The mean age of the participants was 25.84 years (SD = 6.30). The study revealed that 32.95% of participants had unacceptable dietary diversity scores and the associated profile included low education, no transport, homebirth not by personal choice, not breastfeeding within the first hour of birth, not breastfeed exclusively for 6 months, no dietary changes during pregnancy or lactation, and no use of folic acid supplements. CONCLUSION: This study's findings underscore the importance of providing nutrition information to women, in order to improve dietary diversity and overall maternal and child health.

Macroscopic Parameters of Fuel Sprays Injected in an Optical Reciprocating Single-Cylinder Engine: An Approximation by Means of Visualization with Schlieren Technique.

This paper proposes a sensor system for an internal combustion engine based on a new vision-based algorithm supported by the Schlieren sensorization technique, which allows to acquire the macroscopic parameters of the fuel spray injected in a reciprocating internal combustion engine under unmanned aerial vehicle-like conditions. The sensor system proposed here is able to automatically determine the spray cone angle, its area and its penetration. In addition, the external surface and the volume of the fuel spray is estimated together with the injector opening delay and the ignition delay. The developed algorithm was experimentally tested using a conventional diesel fuel in a single-cylinder engine with an optically adapted head but with easy application and other configurations of reciprocating internal combustion engines. These spray macroscopic parameters allow to analyze, among others, the effect of the spray on the development of both the injection and combustion processes under different operating conditions. The estimation of the external surface of the spray makes it possible to determine the amount of fuel in the spray that is in contact with the surrounding air, with the possibility to link this parameter to the combustion efficiency and emission reduction. Consequently, obtaining the injector opening delay and the ignition delay are important parameters in the combustion phenomenon. In addition, the ignition delay has a great influence on both the engine design and its performance in the study of the air-fuel blending process, in the efficient combustion process and in the reduction of emissions.

New Breeding Technologies in Grasses.

Plant breeding is continuously evolving to develop new cultivars with the desired traits in the most efficient way [...].

Discovering Loci for Breeding Prospective and Phenology in Wheat Mediterranean Landraces by Environmental and eigenGWAS.

Knowledge of the genetic basis of traits controlling phenology, differentiation patterns, and environmental adaptation is essential to develop new cultivars under climate change conditions. Landrace collections are an appropriate platform to study the hidden variation caused by crop breeding. The use of genome-wide association analysis for phenology, climatic data and differentiation among Mediterranean landraces led to the identification of 651 marker-trait associations that could be grouped in 46 QTL hotspots. A candidate gene analysis using the annotation of the genome sequence of the wheat cultivar 'Chinese Spring' detected 1097 gene models within 33 selected QTL hotspots. From all the gene models, 42 were shown to be differentially expressed (upregulated) under abiotic stress conditions, and 9 were selected based on their levels of expression. Different gene families previously reported for their involvement in different stress responses were found (protein kinases, ras-like GTP binding proteins and ethylene-responsive transcription factors). Finally, the synteny analysis in the QTL hotspots regions among the genomes of wheat and other cereal species identified 23, 21 and 7 ortho-QTLs for Brachypodium, rice and maize, respectively, confirming the importance of these loci.

Radioprotective Effects from Propolis: A Review.

Propolis is a natural bee-produced substance with antimicrobial, anti-inflammatory, and wound-healing properties, containing some components from the leaves, buds and resins of plants. It has been used for centuries for various health benefits. In this manuscript, our group reviewed the radioprotective effect of propolis using PubMed and Embase, and our review was conducted according to the PRISMA statement. Finally, 27 articles were included in this review, which includes the radioprotective effect of propolis from cell-based studies (n = 8), animal models (n = 14), and human trials (n = 5). Results reflected that the dosage forms of propolis extracted in the scientific literature were ethanolic extracts of propolis, a water-soluble derivate of propolis, or capsules. The efficacy of the radioprotective properties from propolis is extracted from the bibliography, as several compounds of this resinous mixture individually or synergistically are possible candidates that have the radioprotective effect. In fact, studies prior to 2011 lacked a comprehensive characterization of propolis due to the variability in active compounds among different batches of propolis and were limited to analytical techniques. Furthermore, in this manuscript, we have selected studies to include primarily propolis types from Brazil, Croatia, Egypt, European countries, and those commercialized in Spain. They all contained ethanolic extract of propolis (EEP) and were influenced by different dosage forms. EEP showed a significant presence of lipophilic bioactive compounds like flavones, flavonols, and flavanones.

Active legs: Impact of physical activity as an adjuvant treatment in the healing of venous ulcers in primary care: a RCT protocol study.

BACKGROUND: Venous ulcers usually present a torpid evolution with a negative impact on patients' quality of life. In primary care, they account for 2.5% of nursing consultations and their treatment represents high costs for national health systems. These patients usually have a low level of physical activity, with muscle pump dysfunction of the lower limbs, which may improve with increased physical activity. The purpose of this study is to analyse the effectiveness of a structured intervention involving physical activity and exercise (Active Legs) as an adjuvant treatment in improving healing of chronic venous ulcers at 3 months follow-up. METHODS: A randomized, multicentre clinical trial. A total of 224 individuals receiving primary nursing care with a diagnosis of venous ulcer, with a diameter of 1 cm or greater and an ankle-brachial index between 0.8 and 1.3, able to comply with the study requirements and consenting to participate, will be sequentially included (112 per group). Both groups will receive the standard treatment in primary care, with cleansing, debridement and healing in a moist environment together with multilayer compression therapy. The intervention group will also receive a structured educational intervention involving lower limb physical exercise and daily ambulation guidelines. The primary response variables will be complete healing -understood as complete and sustained epithelialisation for at least 2 weeks- and time to healing. The secondary variables will be degree of healing, ulcer area, quality of life, pain and variables related to the healing process, prognosis, and recurrences. Sociodemographic variables, adherence to treatment and satisfaction variables will also be recorded. Data will be collected at baseline, at 3 months and at 6 months follow-up. Survival analysis (Kaplan-Meier and Cox) will be performed to measure primary effectiveness. Intention-to-treat analysis. DISCUSSION: If the intervention is effective, a cost-effectiveness analysis could be conducted and implemented as an additional intervention in the usual venous ulcer treatment in primary care. TRIAL REGISTRATION: NCT04039789. [ https://ClinicalTrials.gov ]. 07/11/2019.

The Potential Roles of Extracellular Vesicles as Biomarkers for Parkinson's Disease: A Systematic Review.

Parkinson's disease (PD) is a slowly progressive neurodegenerative disorder, characterized by the misfolding and aggregation of α-synuclein (α-syn) into Lewy bodies and the degeneration of dopaminergic neurons in the substantia nigra pars compacta. The urge for an early diagnosis biomarker comes from the fact that clinical manifestations of PD are estimated to appear once the substantia nigra has deteriorated and there has been a reduction of the dopamine levels from the striatum. Nowadays, extracellular vesicles (EVs) play an important role in the pathogenesis of neuro-degenerative diseases as PD. A systematic review dated August 2022 was carried out with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses with the aim to analyze the potential role of EVs as biomarkers for PD. From a total of 610 articles retrieved, 29 were eligible. This review discusses the role of EVs biochemistry and their cargo proteins, such as α-syn and DJ-1 among others, detected by a proteomic analysis as well as miRNAs and lncRNAs, as potential biomarkers that can be used to create standardized protocols for early PD diagnosis as well as to evaluate disease severity and progression.

Maternal profile according to Mediterranean diet adherence and small for gestational age and preterm newborn outcomes.

OBJECTIVE: The objective was to evaluate maternal Mediterranean diet (MD) pattern adherence during pregnancy and its association with small for gestational age (SGA) and preterm birth. A secondary objective of the current study was to describe the sociodemographic, lifestyle and obstetric profile of the mothers studied as well as the most relevant paternal and newborn characteristics. DESIGN: The current study is a two-phase retrospective population-based study of maternal dietary habits during pregnancy and their effect on newborn size and prematurity. The descriptive first phase examined maternal dietary habits during pregnancy along with the maternal sociodemographic, lifestyle and obstetric profile in a cross-sectional period study. In the second phase, newborn outcomes were evaluated in a nested case-control study. Adherence to MD during pregnancy was measured with the Spanish version of Kidmed index. SETTING: Obstetrics ward of the La Fe Hospital in Valencia. PARTICIPANTS: All mother-child pairs admitted after delivery during a 12-month period starting from January 2018 were assessed for eligibility. A total of 1118 provided complete outcome data after signing informed consent. RESULTS: 14·5 % met the criteria of poor adherence (PA); 34·8 %, medium adherence (MA); and 50·7 %, optimal adherence (OA). Medium adherence to MD was associated in the adjusted scenarios with a higher risk of giving birth to a preterm newborn. No association was found between MD adherence and SGA. CONCLUSIONS: Early intervention programmes geared towards pregnant women, where women were aided in reaching OA to MD, might reduce the risk of preterm newborn.

Cybersecurity in ICT Supply Chains: Key Challenges and a Relevant Architecture.

The specific demands of supply chains built upon large and complex IoT systems, make it a must to design a coordinated framework for cyber resilience provisioning, intended to guarantee trusted supply chains of ICT systems, built upon distributed, dynamic, potentially insecure, and heterogeneous ICT infrastructures. As such, the solution proposed in this paper is envisioned to deal with the whole supply chain system components, from the IoT ecosystem to the infrastructure connecting them, addressing security and privacy functionalities related to risks and vulnerabilities management, accountability, and mitigation strategies, as well as security metrics and evidence-based security assurance. In this paper, we present FISHY as a preliminary architecture that is designed to orchestrate existing and beyond state-of-the-art security appliances in composed ICT scenarios. To this end, the FISHY architecture leverages the capabilities of programmable networks and IT infrastructure through seamless orchestration and instantiation of novel security services, both in real-time and proactively. The paper also includes a thorough business analysis to go far beyond the technical benefits of a potential FISHY adoption, as well as three real-world use cases highlighting the envisioned benefits of a potential FISHY adoption.

Trends in mortality due to pressure ulcers in Spain, over the period 1999-2016.

AIM: to analyse trends in mortality by Pressure Ulcers (PU) in Spain, between 1999 and 2016. METHODS: Mortality due to PU in residents in Spain over 65, where a PU was underlying/basic cause of death, was analysed. Data for populations and deaths were gathered from the Spanish National Statistics Institute. Variables were age, sex, year of death and underlying/basic cause of death. Age-adjusted mortality rates were calculated (direct method), with 2013 European standard population. To analyse temporal trends and to detect significant changes, joinpoint regression models were adjusted to estimate average annual percentage change of Age-Adjusted mortality Rates for each segment detected. An analysis was performed for those over 65, and by the age groups 65-84, and over 84 years. RESULTS: A total of 11,238 deaths due to PU in people over 65, between 1999 and 2016, were analysed. There was a general decrease for both, women and men, over the period. From the Joinpoint analysis, for men, two changes were detected in those over 65, with a significant decrease observed until 2008. For those over 84, was a significant decrease of 4.4% on average per year. For women, a significant decrease is observed in all age groups, with a change of trend in 2007. CONCLUSION: This study provides a general overview of the epidemiology of PU mortality in Spain. It may serve as a confirmation of the good health policies carried out in the past on PU, given that we observe a generalised decrease in mortality from PUs over the period. Mortality was higher in women at the beginning of the period but without differences at the end, compared with men. Changes occurred over time could be explained by implementation of patient safety policies.

Prevalence and characteristics of older people with pressure ulcers and legs ulcers, in nursing homes in Barcelona.

BACKGROUND: Nursing home residents are vulnerable to chronic wounds. However, the prevalence data are scarce. AIM: The purpose of this study was to determine the prevalence of pressure ulcers and/or leg ulcers in nursing home residents, and describe the characteristics of the nursing homes, the residents and the wounds, as well as possible associations between these characteristics. METHODS: This was a cross-sectional survey of nursing home residents over the age of 65 in 168 facilities in Barcelona. Those presenting category II-IV pressure ulcers and/or leg ulcers were included. The data were collected by observation/examination. Descriptive, bivariate, and multivariate analyses were performed. RESULTS: The overall prevalence of pressure ulcers and leg ulcers combined was 4.4% (3.5% were pressure ulcers and 0.9% were leg ulcers). In small nursing homes with less nursing staff, the overall prevalence was greater than in large nursing homes (5.6% vs 3.8% [p = 0.01]). As expected, residents with pressure ulcers had higher pressure ulcer risk, worse dependence and cognitive status, urinary and faecal incontinence, and most were underweight. However, residents with leg ulcers had worse venous and arterial impairment and also were overweight. A multivariate analysis showed that pressure ulcers were statistically significantly associated with faecal incontinence (OR = 0.28, 95% CI = 0.09-0.81) and dyslipidaemia (OR = 0.21, 95% CI = 0.06-0.66), and leg ulcers were statistically significantly associated with venous insufficiency (OR = 4.93, 95% CI = 1.65-15.34). The characteristics of gluteal and ischial pressure ulcers, a high prevalence of infection, and a low reference to biofilm by nurses, in both types of wounds, suggest that these aspects are not adequately taken into account. CONCLUSIONS: Pressure ulcers and leg ulcers, mainly pressure ulcers, remain a public health problem in nursing homes. Further studies are required to confirm the associations found in this study.

Conceptual Framework for Incontinence-Associated Dermatitis Based on Scoping Review and Expert Consensus Process.

Incontinence-associated dermatitis (IAD) has been studied over the last decades, but gaps in the knowledge related to its identification, etiological agents, and risk factors remain. We carried out a scoping review about IAD that included systematic reviews, experimental, and observational studies about IAD and its potential risk factors. We retrieved 24 articles that described 100 potential risk factors and which were synthesized by the authors and proposed to a panel of experts. Panelists used a structured process of consensus development to create a conceptual framework of factors associated with IAD. This framework proposes that liquid fecal material, when combined with exposure to urine and stool, and bacterial contaminated urine are etiological factors for development of IAD. The framework also proposes 2 pathophysiological mechanisms and 8 main risk factors for IAD development. The proposed model could improve the quality of care for patients with or at risk of IAD, assisting healthcare professionals to identify at-risk patients, diagnose the type of lesion, and establish adequate and effective prevention and treatment measures.

Macrocyclic Pyclen-Based Gd3+ Complex with High Relaxivity and pH Response.

We report the synthesis and characterization of the macrocyclic ligand 2,2'-((2-(3,9-bis(carboxymethyl)-3,6,9-triaza-1(2,6)-pyridinacyclodecaphane-6-yl)ethyl)azanediyl)diacetic acid (H4L) and several of its complexes with lanthanide ions. The structure of the free ligand was determined using X-ray diffraction measurements. Two N atoms of the pyclen moiety in the trans position are protonated in the solid state, together with the exocyclic N atom and one of the carboxylate groups of the ligand. The relaxivity of the Gd3+ complex was found to increase from 6.7 mM-1 s-1 at pH 8.6 to 8.5 mM-1 s-1 below pH ≈ 6.0. Luminescence lifetime measurements recorded from H2O and D2O solutions of the Eu3+ complex evidence the presence of a single complex species in solution at low pH (∼5.0) that contains two inner-sphere water molecules. DFT calculations suggest that the coordination environment of the Ln3+ ion is fulfilled by the four N atoms of the pyclen unit, two oxygen atoms of the macrocyclic acetate groups, and an oxygen atom of an exocyclic carboxylate group. The two inner-sphere water molecules complete coordination number nine around the metal ion. At high pH (∼9.3), the lifetime of the excited 5D0 level of Eu3+ displays a biexponential behavior that can be attributed to the presence of two species in solution with hydration numbers of q = 0 and q = 1. The 1H NMR and DOSY spectra recorded from solutions of the Eu3+ and Y3+ complexes reveal a structural change triggered by pH and the formation of small aggregates at high pH values.

Specialised wound care clinics in Spain: distribution and characteristics.

OBJECTIVE: To determine the number of specialised wound care units/clinics (SWCUs) in Spain, at present, and to describe their most important characteristics. METHOD: This was an observational study with a descriptive-analytical, cross-sectional, multicentre approach, where the studied population consisted of SWCUs in Spain. A specific data-collection questionnaire was designed using a modified Delphi method, consisting of four rounds, with the collaboration of 10 wound experts. The final questionnaire included 49 items distributed across four dimensions/areas with a content validity index (CVI-Total for pertinence=0.96 and CVI-Total for relevance=0.94. RESULTS: A total of 42 SWCUs were included in the study. Most SWCUs were based in hospitals (n=15, 35.7%) or healthcare centres, covering a specific healthcare area (n=17, 40.5%). SWCU coordinators were primarily nurses (n=33, 78.6%). Staff members' professions in SWCUs included registered nurses (n=38 units, 92.7%), nursing assistants (n=8 units, 19.5%), podiatrists (n=8 units, 19.5%), vascular surgeons (n=7 units, 17%), osteopaths (n=2 units, 4.8%) and medical doctors from different specialties (n=3 units, 7.2%). For wound aetiology, the most prevalent wounds managed were diabetic foot ulcers (n=38 units, 90.5%), followed by venous leg ulcers (n=36 units, 85.7%) and arterial ischaemic ulcers (n=36 units, 85.7%). A statistically significant association was found between the number of staff members in a SWCU and the existence of resistance/opposition barriers when developing a SWCU (Chi-square test, p=0.049; Cramér's V=0.34; 34%), as well as between resistance/opposition barriers when developing a SWCU and a nurse as coordinator of a SWCU (MacNemar test, p=0.007, Cramér's V=0.35; 35%). CONCLUSION: The typical SWCU implemented in Spain is located in a hospital or integrated in a healthcare structure that offers coverage to a whole health area and providing services for people with hard-to-heal wounds (wound management and prevention) and health professionals (advice, consultancy and training/education). Despite the growing number of SWCUs in Spain, the future of this new organisational model is uncertain, as there can be barriers to creating them and some deficiencies, such as low staff numbers, which need to be addressed.

Therapeutic index for local infections score (TILI): a new diagnostic tool.

OBJECTIVE: Local wound infections are a major challenge for patients and health professionals. Various diagnostic and therapeutic options are available. However, a generally accepted standard is still lacking in Europe. The aim was to develop an easy-to-use clinical score for the early detection of local wound infections, as a basis for decision-making on antiseptic therapy or decolonisation. METHOD: An interdisciplinary and interprofessional panel of experts from seven European countries was brought together to discuss the various aspects of diagnosing local wound infections. RESULTS: The result was the adoption of the Therapeutic Index for Local Infections (TILI) score, developed in Germany by Initiative Chronische Wunden e.V., specifically for health professionals not specialised in wound care. Available in six European languages, the TILI score could also be adapted for different European countries, depending on their specific national healthcare requirements. The six clinical criteria for local wound infection are erythema to surrounding skin; heat; oedema, induration or swelling; spontaneous pain or pressure pain; stalled wound healing; and increase and/or change in colour or smell of exudate. Meeting all criteria indicates that antiseptic wound therapy could be started. Regardless of these unspecific clinical signs, there are also health conditions for the clinical situation which are a direct indication for antimicrobial wound therapy. These include the presence of wound pathogens, such as meticillin-resistant Staphylococcus aureus, septic surgical wound or the presence of free pus. CONCLUSION: The development of the new internationally adapted TILI score, which could also be used by any caregiver in daily practice to diagnose local infections in acute and hard-to-heal wounds, is the result of expert consensus. However, the score system has to be validated through a clinical evaluation. This is to be performed in expert centres throughout Europe.

Therapeutic Index for Local Infections score validity: a retrospective European analysis.

OBJECTIVE: A score to identify local wound infections was developed by a panel of experts from seven European countries. The Therapeutic Index for Local Infections (TILI) score was designed for health professionals who are not specialised in wound care. This study was carried out to test the validity of the TILI score in everyday practice. METHOD: Content validity was analysed by means of evaluation by a panel of experts, individually and face-to-face, followed by a European multicentred, retrospective, observational study. Participating clinicians sent anonymised copies of completed TILI scores for patients with leg ulcers along with a photograph of the wound for analysis by two blinded reviewers. Concordance (Kappa index) and convergent criterion validity (sensitivity, specificity, accuracy, Youden's J Index and receiver operator characteristic (ROC) or area under the curve (AUC) curve) were calculated to construct validity and reliability. RESULTS: A total of 307 patients with leg ulcers from seven institutions in five European countries were included in this retrospective analysis. It was shown that the diagnosis of local wound infection could be documented well with five of the six clinical criteria included in the TILI score. By summing up these facultative criteria in comparison with any direct criteria that may be present, there would have been an indication for local antiseptic wound therapy in 22% of patients examined. CONCLUSIONS: The results show that the TILI score is concordant with the expert assessment of patients and with good diagnostic characteristics. Thus, the easy-to-use TILI score can now be used in the daily routine practice of health professionals to diagnose local wound infections.

New Nanotechnologies for the Treatment and Repair of Skin Burns Infections.

Burn wounds are highly debilitating injuries, with significant morbidity and mortality rates worldwide. In association with the damage of the skin integrity, the risk of infection is increased, posing an obstacle to healing and potentially leading to sepsis. Another limitation against healing is associated with antibiotic resistance mainly due to the use of systemic antibiotics for the treatment of localized infections. Nanotechnology has been successful in finding strategies to incorporate antibiotics in nanoparticles for the treatment of local wounds, thereby avoiding the systemic exposure to the drug. This review focuses on the most recent advances on the use of nanoparticles in wound dressing formulations and in tissue engineering for the treatment of burn wound infections.

[Effectiveness of double-layered compression therapy against crepe bandage for healing venous ulcers in primary care. Randomized clinical trial]. / Efectividad de la terapia compresiva de doble capa frente al vendaje de crepé en la cicatrización de úlceras venosas en atención primaria. Ensayo clínico aleatorizado.

OBJECTIVE: To evaluate if the two-layer bandage is more effective than the crepe bandage in the healing of venous ulcers after 12 weeks of follow-up. DESIGN: Randomized multicentre controlled clinical trial. LOCATION: 22 Primary Health Centers of Madrid. PARTICIPANTS: Over 18 years old, with diagnosis of venous ulcers. 93 patients were randomized, 56 in the double layer group and 37 in the crepe group. Withdrawals: 16 in double layer group, 7 in crepe group. INTERVENTIONS: Control group: usual clinical practice: treatment of the wound and bandage with crepe. Experimental group: same usual clinical practice for wound treatment and bandage with double layer. MAIN MEASUREMENTS: Primary outcome: complete healing at 12 weeks. SECONDARY OUTCOMES: severity of ulceration, health-related quality of life, adverse events. Blind evaluation of the response variable. RESULTS: Complete healing: in crepe group, 25, 67.5% (95% CI 50.2-81.9) and in double layer group, 32, 57.1% (95% CI 43.2-70.3). No evidence of a difference in both groups, RR=1.10 (95% CI 0.864-1.424). The basal severity of the ulcers is associated with the healing time. HR=0.86 (95% CI 0.78-0.94). Our data showed a significant improvement in health-related quality of life, total and in the of cosmesis and emotional dimensions. No evidence of a difference in both groups. We didn't find serious adverse events in any of the groups. CONCLUSIONS: We didn't find significant differences in the healing between the two bandages evaluated. Both are appropriate for ulcer healing and to improve the health-related quality of life.

Short-term mortality in end-stage heart failure patients.

OBJECTIVES: This study is aimed at analyzing the impact of the main factors contributing to short and long-term mortality in patients at final stages of heart failure (HF). SETTING: Patients attended at any of the 279 primary health care centers belonging to the Institut Català de la Salut, in Catalonia (Spain). PARTICIPANTS: Patients with Advanced HF. DESIGN: Multicenter cohort study including 1148 HF patients followed for one-year after reaching New York Heart Association (NYHA) IV. MAIN MEASUREMENTS: The primary outcome was all-cause mortality. Multivariate logistic regression models were performed to assess the outcomes at 1, 3, 6, and 12 months. RESULTS: Mean age of patients was 82 (SD 9) years and women represented 61.7%. A total of 135 (11.8%) and 397 (34.6%) patients died three months and one year after inclusion, respectively. Male gender, age, and decreased body mass index were associated with higher mortality at three, six and twelve months. In addition, low systolic blood pressure levels, severe reduction in glomerular filtration, malignancy, and higher doses of loop diuretics were related to higher mortality from 6 to 12 months. The most important risk factor over the whole period was presenting a body mass index lower than 20kg/m2 (three months OR 3.06, 95% CI: 1.58-5.92; six months OR 4.42, 95% CI: 2.08-9.38; and 12 months OR 3.68, 95% CI: 1.76-7.69). CONCLUSIONS: We may conclude that male, age, and decreased body mass index determined higher short-term mortality in NYHA IV. In addition, low systolic blood pressure, reduced glomerular filtration, malignancy, and higher doses of loop diuretics contribute to increasing the risk of mortality at medium and long-term. Such variables are easily measurable and can help to decide the best way to face the most advances stages of the disease.

Epidemiology of venous leg ulcers in primary health care: Incidence and prevalence in a health centre-A time series study (2010-2014).

The aims of the study were to describe and analyse the temporal trend of the prevalence and incidence of venous leg ulcers (VLU) over the years 2010 to 2014, to determine healing times and temporal trends in the study period, and to evaluate related aspects such as the use of the Ankle-Brachial Pressure Index (ABPI) in a primary care health centre. This was a retrospective study based on a time series (years 2010-2014) of the prevalence and incidence of VLUs in people aged over 40 years in a primary care centre in Barcelona City. We reviewed 3920 electronic health records selecting patients, per year (2010-2014), with VLUs based on the ICD-10 diagnoses. For prevalence, we took into account any patient with an active VLU in the year of study. For incidence, we took into account patients with a new VLU in the year of study. A descriptive analysis was carried out based on each of the collected variables. The variables were examined according to the years of study (time series) by one-factor analysis of variance (anova) or Kruskal-Wallis non-parametric test, as appropriate. A survival analysis by Kaplan-Meier curves and log-rank test was also performed. A total of 139 patients met the VLU criteria. Among them, only 79.2% were classified as having a VLU and had a correct ICD diagnosis. The prevalence and incidence increased over the years, doubling in patients aged over 65 years. Incidence increased from 0.5 new cases per 1000 people/year in 2010 to 1 new case for every 1000 people/year in 2014. Moreover, the prevalence ranged between 0.8 and 2.2 patients with VLU for every 1000 people/year. During the study period, a total of 84.2% of the VLUs healed (117/139 VLU). Regarding average annual time to healing, the trend indicates that lesions took less time to heal (Kruskal-Wallis test, P = 0.004), ranging between 453,9 weeks in 2005 to 19 weeks in 2014. The use of ABPI also evolved and was found to be increasingly performed prior to the appearance of the lesion. The epidemiological profile of people affected by VLUs continues to be, mainly, that of women of an advanced age, over 70 years. The frequency of VLU occurrence rose continually over the years, but healing took less time, and use of ABPI improved. Assigning a reference nurse in the wounds unit and the organisational structure around this problem may have an influence on improving care and the approach to these types of lesions.