Predictors of Rehabilitation Referral Among Cardiovascular Surgical Patients.

Objective: Cardiovascular disease (CVD) continues to be the leading cause of mortality globally. Cardiac rehabilitation (CR) programs act by modifying the evolution of CVD and mortality; however, CR programs are under-used. The aim was to determine the profile of patients that received rehabilitation after cardiac surgery. Patients and Methods: A retrospective observational study was conducted from January 2017 to December 2017 at a single center. The study sample was chosen among patients admitted to the Intensive Care Unit of the Hospital Gregorio Marañón/Gregorio Marañón General University Hospital. Socio-demographic and clinical variables were collected. Results: In the present study, 336 patients underwent cardiac surgery of which 63.8% were men and 87.1% had ≥1 cardiovascular risk factors. Of the total cohort, 24.7% were operated for ischemic heart disease, 47.9% valvulopathy, 11% underwent combined surgery, 3.6% cardiac transplantation, 6.5% aneurysms, and 3.9% congenital disease. In-hospital respiratory rehabilitation was prescribed to all patients. Only 4.8% of the patients received motor rehabilitation and 13.8% were referred to CR. We found higher referral rates among patients with more cardiovascular risk factors, <65 years of age, and those undergoing coronary surgery and heart transplantation. Age, ischemic heart disease, and overweight were independent predictors of CR referral. Conclusion: The benefit of CR programs after cardiac surgery is widely described; however, the referral rate to CR remains low. It is crucial to optimize referral protocols for these patients.

Transport of commercial endosulfan through a column of aggregated vineyard soil by a water flux simulating field conditions.

Endosulfan is a potentially harmful, degradation resistant pesticide that is found in soils where it has been used. Despite being hydrophobic and having high affinity for soil matrix components, it has also been found in groundwater. To investigate this behavior, we studied the passage of a commercial emulsified formulation through a column of aggregated vineyard soil under simulated light rain. Breakthrough data were obtained using gas chromatography with electron capture detection to determine the concentration of endosulfan in samples extracted from the column periodically at several depths. These data, and analogous data obtained previously for the passage of bromide, were analyzed using the program CXTFIT v.2. Analysis of the bromide data strongly suggested the existence of preferential flow paths in the column. The endosulfan data were adequately accounted for by a model in which the preferential flow and nonpreferential flow regions are almost isolated from each other. These regions differ also as regards both the partition of endosulfan between soil and soil solution and the rate at which reversibly adsorbed endosulfan is transformed into irreversibly adsorbed endosulfan. The "irreversibility" sink term accounts also for biological and chemical degradation of endosulfan. The findings imply that soil humidity favors the transport of commercial endosulfan by the formation and maintenance of preferential flow paths in soil, controlling both the presence of endosulfan in groundwater and its high persistence in soil.

Comparison of solid-phase extraction and solid-phase microextraction for carbofuran in water analyzed by high-performance liquid chromatography-photodiode-array detection.

In this study a direct solid-phase microextraction (SPME) procedure has been developed for the determination of carbofuran in water. Experimental parameters such as selection of SPME coating, effect of temperature, effect of salt addition and solvent desorption were studied and optimized. Analytical parameters such as linearity, precision, detection and quantitation limits, and matrix effects for solid-phase extraction (SPE) and SPME methods were evaluated for comparison purposes with the aim of selecting the most appropriate depending on the detection capabilities required. SPE and SPME were followed by high-performance liquid chromatography with diode-array detection, using a 50 x 4.6 mm I.D. guard column and a 150 x 4.6 mm I.D. analytical column, both packed with C18 silica. Both methods can be applied to real samples and give the same results, but SPE allows the detection of lower carbofuran concentrations (0.06 microg/L) as compared to

Application of single-drop microextraction and comparison with solid-phase microextraction and solid-phase extraction for the determination of alpha- and beta-endosulfan in water samples by gas chromatography-electron-capture detection.

Water contamination due to the wide variety of pesticides used in agriculture practices is a global environmental pollution problem. The 98/83 European Directive requires the measurement of pesticides residues at a target concentration of 1.0 microg/l in surface water and 0.1 microg/l in drinking water. In order to reach the level of detection required, efficient extraction techniques are necessary. The application of a new extraction technique: single-drop microextraction (SDME), followed by gas chromatography with electron-capture detection, was assessed for determining alpha-endosulfan and beta-endosulfan in water samples. Experimental parameters which control the performance of SDME, such as selection of microextraction solvent and internal standard, optimization of organic drop volume, effects of sample stirring, temperature and salt addition, and sorption time profiles were studied. Once SDME was optimized, analytical parameters such as linearity, precision, detection and quantitation limits, plus matrix effects were evaluated. The SDME method was compared with solid-phase microextraction and solid-phase extraction with the aim of selecting the most appropriate method for a certain application.

Optimization of solid-phase extraction and solid-phase microextraction for the determination of alpha- and beta-endosulfan in water by gas chromatography-electron-capture detection.

Water contamination due to the wide variety of pesticides used in agriculture practices is a global environmental pollution problem. The 98/83/European Directive requires to measure residues of pesticides at a target concentration of 1.0 microg/l in surface water and 0.1 microg/l in drinking water. In order to reach the level of detection required, efficient extraction techniques are required. Although solid-phase extraction (SPE) is the most common technique for isolation and concentration of pesticides from water, solid-phase microextraction (SPME) is being increasingly applied for this purpose. In this study, a direct-SPME procedure has been developed for the determination of alpha-endosulfan and beta-endosulfan in waters; experimental parameters such as selection of SPME coating, effect of temperature, effect of salt addition, optimization of the sample volume, adsorption and desorption profiles and desorption temperature were studied and optimized. Analytical parameters such as linearity, precision, detection and quantitation limits, and matrix effects for SPE and SPME methods were evaluated for comparison purposes with the aim of selecting the most appropriate for a certain application. Both extraction techniques, SPE and SPME, were followed by gas chromatography with electron-capture detector.

Daily physiological iron requirements in children.

Median daily iron absorption was determined in iron-replete males and females between 2 and 19 years of age from the upper and lower socioeconomic strata of the Venezuelan population. A comparison was made with iron absorption of well-nourished children, on the basis of hematological and anthropometric reference values from the U.S. The median absorption level, which was calculated from the increase in total body iron due to growth and the daily losses through exfoliation and menstruation, was also used to estimate the requirements of 95% of the population. When the requirements were expressed in terms of body weight, no significant difference in iron absorption was observed between the three Venezuelan and one U.S. groups, ranging from about 30 to 38 micrograms/kg/day in both sexes between 4 and 16 years of age. However, when the requirements were expressed without division by the weight factor, the requirements of the better nourished groups were somewhat higher than those of the Venezuelan lower socioeconomic population with, in addition, a threefold variation over the 5 to 16 year age range. These findings suggest that the total iron requirements of children at a certain age may be most adequately expressed in terms of the optimal body weight for that age.

[Tracking of body height, body weight, body mass index, blood lipids and glucose in upper strata girls in Caracas, Venezuela]. / Canalización de talla, peso, índice de masa corporal, lípidos y glucosa séricos en niñas de los estratos sociales altos de Caracas, Venezuela.

In the Caracas Longitudinal Study, the canalization of 24 girls that started follow-up at age 4, 43 at age 8, and 32 at age 12 in: height (H), weight (W), Body Mass Index (BMI), cholesterol (CHOL), triglycerides (TG) and glucose (GL), was studied using Schneiderman n Tracking Index (TI) and age to age correlations. TI presented a gradient H > W > BMI > CHOL and lower in TG and GL. TI of all variables diminished increased with age and in BMI and CHOL. Age to age correlations were significant at all ages in H, W. and BMI and higher in CHOL (p < 0.01) compared to TG and GL. The significant tracking of H, W, BMI and lipids, specially CHOL, is relevant in prevention of non-communicable chronic diseases.

[Assessment of maternal satisfaction with epidural analgesia during labour]. / Valoración de la satisfacción materna con la analgesia epidural para el trabajo del parto.

OBJECTIVE: To measure the overall satisfaction of obstetrics patients with epidural analgesia during labour, and in particular, with the technique and other subjective factors. MATERIAL AND METHODS: An anonymous questionnaire was administered over a three-month period to patients who received analgesia to control pain during labour and who had vaginal delivery, in order to obtain information of the satisfaction with technique and their care. RESULTS: Of the 100 patients who responded to the questionnaire, 92% were satisfied with the technique. The mild satisfaction measured by SERVQHOS score was 3.98 (SD ± 0.64). The score for the subjective aspects was 4.10 (± 0.68), which was better than objective ones. The recommendation rate was 98% for satisfied patients and 85.7% for those who were not satisfied. There were no differences between Spanish and foreign patients in their evaluation of the satisfaction. CONCLUSIONS: The proportion of patients satisfied with the technique was very high, and was the top rated subjective aspect (treatment and public confidence).

[Relation among early maturation, body mass index and the longitudinal behavior of systolic blood pressure]. / Relación entre la maduración temprana, indice de masa corporal y el comportamiento longitudinal de la presión arterial sistólica.

In the Caracas Longitudinal Study, 53 girls- 8 to 11 years of age- who had been classified as early, average and late maturers were analyzed longitudinally with respect to Body Mass Index (BMI) and Systolic Blood Pressure (SBP). A longitudinal principal component analysis was used to summarize trends or intraindividual changes in BMI and SBP. A first component was identified for BMI, this component accounted for most of its total variance (94.65%). Girls were classified as normal in weight or at risk of overweight on the basis of this component. Three principal components were identified for SBP, that accounted for 91.83% of the total variance of this variable. The first component represented a measure of position across the whole age period, a "canalization pattern"; this component accounted for most of the total variance (45.65%). The second component revealed an unidirectional change in relative position of the values of the variable, a "decanalization pattern", and a third pattern summarized deviations around a position level: "recanalization pattern". Girls who showed a canalization pattern for SBP were those identified as early maturers and at risk of overweight.

[Behavior of some anthropometric, clinical and biochemical variables in boys and girls 8 to 12 years of age from the longitudinal study of the metropolitan area]. / Comportamiento de algunas variables antropométricas, clinicas y bioquimicas en varones y hembras de 8 a 12 años de edad del Estudio Longitudinal del Area Metropolitana.

A longitudinal principal components analysis was used to summarize trends or intraindividual changes in weight, height, blood pressure, serum cholesterol and triglycerides in 32 boys and 28 girls from the Caracas Longitudinal Study (1976-1982), who started follow-up at age 8. A first component was identified for each variable, it represents a measure of position across the whole age period, a "canalization pattern". This component accounted for most of the total variance. The second component represents an unidirectional change in relative position of the values of the variable, a "decanalization pattern", and a third pattern summarized deviations around a position level: "recanalization pattern". The results from the correlation analyses between the components indicate a positive and significant association between the identified trends. These patterns allow predictability of "high and low risk" factors of non-communicable chronic diseases.

Subtle neurological deficits and psychopathological findings in substance-abusing homeless and non-homeless veterans.

This study evaluated the hypothesis that homeless individuals would display higher levels of neurological deficits than non-homeless individuals, particularly in frontal lobe or executive functions. Eighteen acutely homeless, 15 chronically homeless, and 20 non-homeless individuals admitted to an inpatient psychiatric service received a battery of neurological and psychosocial measures. In comparison to non-homeless subjects with comparable levels of psychopathology, homeless individuals showed higher levels of hostility, prior criminal activity, and family history of psychiatric illness, but lower levels of depression. A positive relationship between hostility and neurological soft signs was observed among chronically homeless subjects. These results suggest that a substantial subset of nonpsychotic homeless veterans suffers from "occult" neurological deficits.

Valoración de la satisfacción materna con la analgesia epidural para el trabajo del parto / Assessment of maternal satisfaction with epidural analgesia during labour

Objetivos. Conocer el grado de satisfacción de las pacientes obstétricas a las que se les realiza la técnica epidural para el trabajo de parto. Material y métodos. Encuestas realizadas durante tres meses a las pacientes ingresadas en el Hospital Universitario Virgen de las Nieves (HUVN) a las que se les aplicó la técnica epidural para control del dolor para el parto. Resultados. Se recogieron 100 encuestas de un total de 105. La satisfacción media global de las pacientes (puntuación SERVQHOS) fue de 3,98 con una desviación estándar, DE±0,64 con mejor resultado en las cuestiones subjetivas: 4,10 con DE±0,68 y menor en las objetivas con 3,86 y DE±0,73. El 92% de las pacientes se mostraron satisfechas con la analgesia epidural, con un intervalo de confianza, IC al 95% entre 87-97%. El análisis de los factores demográficos no mostró asociación estadísticamente significativa entre la edad de las pacientes y un mayor grado de satisfacción; tampoco se encontraron diferencias estadísticamente significativas entre la nacionalidad y la valoración de la satisfacción con la técnica epidural. El grado de recomendación posterior fue de 98% en las pacientes satisfechas y 85,7% en las no satisfechas. Conclusiones. La proporción de pacientes satisfechas con la técnica fue muy elevada, siendo los aspectos subjetivos los mejor valorados (trato y confianza en profesionales)(AU)

Objective. To measure the overall satisfaction of obstetrics patients with epidural analgesia during labour, and in particular, with the technique and other subjective factors. Material and methods. An anonymous questionnaire was administered over a three-month period to patients who received analgesia to control pain during labour and who had vaginal delivery, in order to obtain information of the satisfaction with technique and their care. Results. Of the 100 patients who responded to the questionnaire, 92% were satisfied with the technique. The mild satisfaction measured by SERVQHOS score was 3.98 (SD±0.64). The score for the subjective aspects was 4.10 (± 0.68), which was better than objective ones. The recommendation rate was 98% for satisfied patients and 85.7% for those who were not satisfied. There were no differences between Spanish and foreign patients in their evaluation of the satisfaction. Conclusions. The proportion of patients satisfied with the technique was very high, and was the top rated subjective aspect (treatment and public confidence)(AU)

Peso en adolescentes del estudio longitudinal de Caracas: modelo preece-baines 1 / Pubertad grouth in weight in children from the Caracas longitudinal study: preece-baines model 1

Con Preece Baines (PB) se ajustó el peso en una submuestra de 46 varones y 34 niñas del Estudio Longitudinal de Caracas con eventos puberales según la gráfica de velocidad. Las variables biológicas, del método gráfico en las edades de mínimo incremento anual prepuberal y máximo incremento puberal, con una "t" para muestras disímiles de p<0,05. EA por PB1 fue: 10,5 en varones y 9,5 en niñas, significativamente más temprano (0,9 y 0,5 años) que la EA gráfica, y con velocidades más altas 3,3 y 2,9 Kg/año. El PVM por PB1 de 13,9 en varones y 12,4 en niñas, fue más tardió que por el gráfico y significativo en niñas (0,8 años), con velocidades de 8,7 Kg/año en varones y 7,3 Kg/año en niñas. El modelo PB1 ajustó bien los datos venezolanos, únicamente en la edad de arranque

Patrones de crecimiento de los venezolanos; dimorfismo sexual y ritmo de maduración / Patterns of growth of the venezuelan sexual dismorphism and rhythm of maturers

Se presentan algunos resultados del Proyecto Venezuela (1981-1987) y del Estudio Longitudinal del Area Metropolitana de Caracas (1976-1983). Las niñas iniciaron el brote puberal (BP) en talla y peso a los 9 1/2 años y alcanzaron la edad del punto de velocidad máxima (EPVM) a los 11 1/2 y 12 años, respectivamente, e iniciaron el desarrollo sexual (GM2) más de 1 año antes que el de los varones (G2:11 1/2 años). Las niñas resultaron más altas y pesadas entre los 11 y 13 años predominio puberal precoz debido al tempo rápido de las venezolanas- los hombres terminaron 12 1/2 cm y 8 Kg más altos y pesados a los 19 años. La secuencia de eventos: EPVM talla