Quality of life in elderly people after a hip fracture: a prospective study.

BACKGROUND: Hip fracture is an important social and medical problem due to its increasing prevalence, the consequences for health and the economic impact on the health care system, but there is no doubt that it also has repercussions on health-related quality of life (HRQoL). Hence the importance of understanding and determining the impact of the condition on everyday life from the perspective of the patient's physical, emotional and social well-being. PURPOSE: To determine the impact of hip fracture on HRQoL of people over the age of 65 1 month after surgery, related factors and the effects on functional ability and mood. METHODS: Prospective observational study conducted in the traumatology units of two university hospitals in the province of Cáceres with consecutive sampling of all patients over the age of 65 admitted for hip fracture surgery during the study period. Sociodemographic and clinical data were recorded at the time of admission and prospectively at the follow-up visit 1 month later. Clinical, social, quality of life (EQ-5D-), basic functional and instrumental capacity (Barthel Index (BI) and Lawton & Brody Scale), and geriatric depression (Yesavage) variables were collected. RESULTS: The study included 224 patients with a median age of 84.6 years (SD ± 6.1), 76.3% were female. Charlson's comorbidity was 5.3 (SD ± 1.2). The EQ-5D index decreased from 0.62 (SD ± 0.35) to 0.16 at 1 month follow up (SD ± 0.20) p <  0.001. The mean Visual Analog Scale (VAS) score of EQ-5D decreased from 72.8 (SD ±15.8) to 48.3 (SD ± 17.2) p <  0.001. All dimensions of EQ-5D showed a significant reduction from the time of pre-fracture status to 1 month after surgery. Independent factors associated with HRQoL 1 month after surgery were pre-fracture status Barthel Index score, Lawton and Brody scale, presence of depression, and type of surgery. CONCLUSIONS: After a hip fracture, patients experience considerable deterioration in their HRQoL, especially in self-care, daily activities, and mobility. There is also a significant decline in functional capacity for both the basic and instrumental activities of daily living. One month after surgery, HRQoL is a long way from pre-fracture levels.

Preclinical assessment methodology using a dental simulator during dental students' first and third years.

The aim of the present study was to analyze the parameters recorded by the Simodont dental trainer and methacrylate block grades during preclinical practicums to validate whether manual skills can be assessed by both methodologies, over a period of two years and to obtain a preclinical evaluation methodology for all the parameters that measure Simodont performance in each of the prepared figures. To this end, the methacrylate block practice's criteria and evaluation scale were used as predictors. A total of 82 students who completed the first year of dentistry were followed for 2 years. Their performance on the same task (i.e., cavity preparation of three figures in the Simodont and methacrylate blocks) was then reevaluated in the third year. Manual skill improvement was detected in all the students. The parameters measured by the Simodont were used as predictors of the methacrylate block evaluation's results, performed by a professor. Multiple linear regression models for each of the figures and years evaluated in the study were proposed. The present study demonstrates that both methodologies can detect manual skill improvement in dental students. Additionally, the Simodont practice can be reliably evaluated.

Long-chain omega-3 polyunsaturated fatty acid dietary intake is positively associated with bone mineral density in normal and osteopenic Spanish women.

The regular consumption of long-chain omega-3 polyunsaturated fatty acids (LCO3-PUFAs) results in general health benefits. The intake of LCO3-PUFAs has been reported to contribute to bone metabolism. We aimed to investigate the relationships between dietary intakes of LCO3-PUFAs and bone mineral density (BMD) in Spanish women aged 20-79 years old. A total of 1865 female subjects (20-79 years old) were enrolled, and lumbar (L2, L3, L3 and total spine), hip (femoral neck (FN), femoral trochanter (FT) and Ward's triangle (WT)) bone mineral density (BMD) were measured by dual energy X-ray absorptiometry (DXA). Dietary intakes of total energy, calcium, vitamin D, alpha-linolenic acid (ALA), eicosapentaenoic acid (EPA), docosahexaenoic acid (DHA), and n-6 fatty acids (linoleic acid (LA) and arachidonic acid (AA)) were assessed by a self-administered food frequency questionnaire (FFQ). Spearman's rank correlations between LCO3-PUFAs and BMD were estimated. Partial correlations controlling for age, weight, height, dietary calcium, vitamin D, menopausal status and energy were calculated. A multiple regression analysis was computed to assess significant associations with BMD in this population. After adjustment for potential confounding factors, there were positive correlations between ALA, EPA and DHA intake and BMD. According to the WHO diagnosis criteria for osteoporosis, in this population of normal and osteopenic women, the dietary intake of ALA was also significantly associated with BMD at the hip. In normal women, the dietary intake of DHA was also significantly associated with BMD at the lumbar spine. No significant associations between LCO3-PUFAs and BMD were detected in the lumbar spine of osteopenic or osteoporotic women. The dietary intake of LCO3-PUFAs was positively associated with BMD in Spanish women at both the hips and the lumbar spine. We highlight that the intake of LCO3-PUFAs is not significantly associated with BMD in osteoporotic women; however, the intake of LCO3-PUFAs seems to be positively associated with BMD at both the hips and the lumbar spine in normal and osteopenic women.

Dietary Intake of Cadmium, Lead and Mercury and Its Association with Bone Health in Healthy Premenopausal Women.

The bone is one of the relevant target organs of heavy metals, and heavy metal toxicity is associated with several degenerative processes, such osteoporosis and bone mineral alterations, that could lead to fractures. We aimed to study a presumed relationship between bone density, evaluated by quantitative bone ultrasound (QUS), dual-energy X-ray absorptiometry (DXA) and peripheral quantitative computed tomography (pQCT) and the dietary intake of cadmium, lead and mercury in healthy premenopausal women. A total of 158 healthy, non-smoking, premenopausal women were incorporated into the study. A validated food frequency questionnaire (FFQ) was administered to assess intake during the preceding seven days. The median predicted dietary cadmium intake among the 158 women studied was 25.29 µg/day (18.62-35.00) and 2.74 µg/kg body weight/week (b.w./w) (1.92-3.83). Dietary lead intake was 43.85 µg/day (35.09-51.45) and 4.82 µg/kg b.w./w (3.67-6.13). The observed dietary mercury intake was 9.55 µg/day (7.18-13.57) and 1.02 µg/kg b.w./w (0.71-1.48). Comparisons, in terms of heavy metal intake, showed no significant results after further adjusting for energy intake. No statistically significant correlations between heavy metal intake and the QUS, DXA and pQCT parameters were observed. Levels of dietary exposure of cadmium, lead and mercury were mostly within the recommendations. We did not find associations between the QUS, DXA and pQCT parameters and the dietary intake of the studied heavy metals in healthy premenopausal women.

Evaluation of the Dietary Intake of Cadmium, Lead and Mercury and Its Relationship with Bone Health among Postmenopausal Women in Spain.

BACKGROUND: Heavy metals, such as lead, cadmium, and mercury, are absorbed through contaminated food sources and water. Few studies have investigated the extent to which dietary heavy metals are associated with low bone mineral density. AIMS: We aimed to characterize the dietary intake of the heavy metals lead, cadmium and mercury among healthy, non-smoking postmenopausal women in Spain. Furthermore, we sought to establish a putative relationship between bone health and the intake of these heavy metals in this population. STUDY DESIGN: The daily intake of the heavy metals considered for the different food groups was calculated by accounting for food content and consumption in 281 postmenopausal women. Bone measurements were performed using a Quantitative Bone Ultrasound (QUS), a Dual-Energy X-ray Absorptiometry (DXA) and a Peripheral Quantitative Computed Tomography (pQCT). RESULTS: The average estimated dietary cadmium exposure among the 281 women studied was 29.87 µg/day (20.41-41.04) and 3.03 µg/kg body weight (b.w.; 2.17-4.40). Dietary lead exposure was 46.24 µg/day (38.11-54.77) and 4.87 µg/kg b.w. (4.00-6.14). The estimated dietary mercury exposure was 11.64 µg/day and 1.19 µg/kg b.w. (0.82-1.76). Participants were classified according to their heavy metal intake (above or below the respective medians). After further adjustment for potential confounding factors, no significant differences were found in all the measured parameters (p > 0.05). CONCLUSIONS: We did not find associations between bone health and the dietary intake of three heavy metals in postmenopausal women. Dietary intake of the measured heavy metals were within the recommended values.