Maximum Anterior Tongue Strength and Maximum Lip Strength in Healthy Spanish Adults: A Proposal of Reference Values.

Adequate tongue and lip strengths are needed for normal speech, chewing, and swallowing development. The aim was to evaluate the influence of sex and age on maximum anterior tongue strength (MTS) and maximum lip strength (MLS) in healthy Spanish adults to establish reference values that can be used in clinical practice.This cross-sectional study comprises 363 subjects (mean age 47.5 ± 20.7 years) distributed by sex (258 women and 105 men) and across three age groups: Young (18-39 years), middle-aged (40-59 years), and older adults (> 59 years). MTS and MLS were determined using the Iowa Oral Performance Instrument (IOPI). The mean MTS was 49.63 ± 13.81 kPa, regardless of sex, and decreased with age. The mean MLS was statistically higher for men (28.86 ± 10.88 kPa) than for women (23.37 ± 6.92 kPa, p = 0.001), regardless of age.This study provides the first reference values for the standardized measurement of MTS and MLS in a healthy adult Spanish-speaking population using the IOPI.

The influence of lifestyle, diet, and reproductive history on age at natural menopause in Spain: Analysis from the EPIC-Spain sub-cohort.

OBJECTIVE: To determinate the role of lifestyle factors, recent diet, menstrual factors, and reproductive history in age at natural menopause in adult Spanish women. METHODS: In total, 12 562 pre-menopausal women were available for analysis from the EPIC-Spain sub-cohort. Women were recruited between 1992 and 1996 in five regions of Spain (Asturias, Granada, Murcia, Navarra, and San Sebastian) and, for these analyses, were followed for 3 years. Questionnaires on diet, lifestyle, anthropometric measurements, and reproductive and exogenous hormones history were collected at baseline. Menopause status was updated at a median of 3 years of follow-up. RESULTS: After a median of 3 years of follow-up 1166 women became postmenopausal. An earlier age at menopause was observed in current smokers (HR: 1.29; 95%CI 1.08-1.55) and in non-users of oral contraceptives (HR: 1.32; 95%CI 1.01-1.57). A later age at menopause was observed in women with irregular menses (HR: 0.71; 95%CI 0.56-0.91) and in women with a higher number of pregnancies (HR: 0.74; 95%CI 0.56-0.94). CONCLUSIONS: Our results confirm that women who smoked had an earlier age at natural menopause, while use of oral contraceptives, higher number of pregnancies, and irregularity of menses were associated with a prolonged reproductive lifespan. No associations were observed for dietary habits assessed after the age of 40 years.

Increasing incidence of thyroid cancer in Great Britain, 1976-2005: age-period-cohort analysis.

Increases in the incidence of thyroid cancer have been previously reported. The purpose of the present study was to examine temporal trends in the incidence of primary thyroid cancer diagnosed in 0-49 year olds in parts of Great Britain during 1976-2005. Data on 4,337 cases of thyroid cancer were obtained from regional cancer registries. Age-standardized incidence rates (ASRs) were calculated. Negative binomial regression was used to examine effects of age, sex, drift (linear trend), non-linear period and non-linear cohort. The best fitting negative binomial regression model included age (P < 0.001), sex (P < 0.001) and drift (P < 0.001). Non-linear period (P = 0.648) and non-linear cohort (P = 0.788) were not statistically significant. For males aged 0-14, the ASR increased from 0.2 per million persons per year in 1976-1986 to 0.6 in 1997-2005. For males aged 15-29 and 30-49 the ASRs increased from 1.9 to 3.3 and from 7.4 to 12.7, respectively. For females aged 0-14, the corresponding ASR increased from 0.3 to 0.5. For females aged 15-29 and 30-49 the ASRs increased from 6.9 to 12.4 and from 21.2 to 42.3, respectively. For all age groups, there has been a linear increase in incidence of thyroid cancer, which has led to a doubling of the number of cases diagnosed over a twenty year span. The reasons for this increase are not well understood, but it is consistent with findings from other countries.

Pressure Ulcers Risk Assessment According to Nursing Criteria.

Pressure ulcers (PU) represent a health problem with a significant impact on the morbidity and mortality of immobilized patients, and on the quality of life of affected people and their families. Risk assessment of pressure ulcers incidence must be carried out in a structured and comprehensive manner. The Braden Scale is the result of an analysis of risk factors that includes subscales that define exactly what should be interpreted in each one. The healthcare work with evidence-based practice with an objective criterion by the nursing professional is an essential addition for the application of preventive measures. Explanatory models based on the different subscales of Braden Scale purvey an estimation to level changes in the risk of suffering PU. A binary-response logistic regression model, supported by a study with an analytical, observational, longitudinal, and prospective design in the Granada-Metropolitan Primary Healthcare District (DSGM) in Andalusia (Southern Spain), with a sample of 16,215 immobilized status patients, using a Braden Scale log, is performed. A model that includes the mobility and activity scales achieves a correct classification rate of 86% (sensitivity (S) = 87.57%, specificity (SP) = 81.69%, positive predictive value (PPV) = 91.78%, and negative preventive value (NPV) = 73.78%), while if we add the skin moisture subscale to this model, the correct classification rate is 96% (S = 90.74%, SP = 88.83%, PPV = 95.00%, and NPV = 80.42%). The six subscales provide a model with a 99.5% correct classification rate (S = 99.93%, SP = 98.50%, PPV = 99.36%, and NPV = 99.83%). This analysis provides useful information to help predict this risk in this group of patients through objective nursing criteria.

Monitoring Immobilized Elderly Patients Using a Public Provider Online System for Pressure Ulcer Information and Registration (SIRUPP): Protocol for a Health Care Impact Study.

BACKGROUND: Pressure ulcers represent a major challenge to patient safety in the health care context, presenting high incidence (from 7% to 14% in Spain) and increased financial costs (€400-600 million/year) in medical treatment. Moreover, they are a significant predictor of mortality. The prevention of pressure ulcers in long-term care centers and patients' own homes is proposed as a priority indicator of health care quality. Early stage risk assessment and database recording are both crucial aspects of prevention, classification, diagnosis, and treatment. OBJECTIVE: This project proposes a 3-year study of immobilized patients residing in the Granada-Metropolitan Primary Healthcare District (DSGM) and monitored via the Pressure Ulcer Information and Registration System (SIRUPP, Spanish initials). The project aims to estimate the incidence of PUs among immobilized elderly patients, analyze the health-related quality of life of these patients by using the Pressure Ulcer Quality of Life (PU-QoL) instrument in a sample of 250 patients, determine the average time to complete wound healing, estimate the rate of pressure ulcers-associated mortality, and assess the predictive value of the Braden and Mini Nutritional Assessment risk measurement scales in a sample of 1700 patients. METHODS: The DSGM runs SIRUPP, which is linked to patients' electronic health records. Currently, 17,104 immobilized patients are monitored under this system. Health-related quality of life will be measured by patient self-reports using the Spanish Pressure Ulcer Quality of Life questionnaire, following cross-cultural adaptation and psychometric validation with respect to the English-language version. RESULTS: The project commenced in June 2017 and is expected to conclude in April 2020. CONCLUSIONS: This study addresses two main health outcomes-the time needed for wound healing and the mortality associated with pressure ulcers-both of which might be accounted for by variations in clinical practice and the health-related quality of life of patients with pressure ulcers. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID): DERR1-10.2196/13701.

Is fluoride a risk factor for bone cancer? Small area analysis of osteosarcoma and Ewing sarcoma diagnosed among 0-49-year-olds in Great Britain, 1980-2005.

BACKGROUND: Artificial fluoridation of drinking water to improve dental health has long been a topic of controversy. Opponents of this public health measure have cited the possibility of bone cancer induction. The study objective was to examine whether increased risk of primary bone cancer was associated with living in areas with higher concentrations of fluoride in drinking water. METHODS: Case data on osteosarcoma and Ewing sarcoma, diagnosed at ages 0-49 years in Great Britain (GB) (defined here as England, Scotland and Wales) during the period 1980-2005, were obtained from population-based cancer registries. Data on fluoride levels in drinking water in England and Wales were accessed through regional water companies and the Drinking Water Inspectorate. Scottish Water provided data for Scotland. Negative binomial regression was used to examine the relationship between incidence rates and level of fluoride in drinking water at small area level. RESULTS: The study analysed 2566 osteosarcoma and 1650 Ewing sarcoma cases. There was no evidence of an association between osteosarcoma risk and fluoride in drinking water [relative risk (RR) per one part per million increase in the level of fluoride = 1·001; 90% confidence interval (CI) 0·871, 1·151] and similarly there was no association for Ewing sarcoma (RR = 0·929; 90% CI 0·773, 1·115). CONCLUSIONS: The findings from this study provide no evidence that higher levels of fluoride (whether natural or artificial) in drinking water in GB lead to greater risk of either osteosarcoma or Ewing sarcoma.