Change in Red Blood Cell Distribution width During the Last Years of Life in Geriatric Patients.

OBJECTIVES: Most of the studies that evaluate the association between red blood cell distribution width (RDW) and mortality assess it on a single occasion instead of doing so through serial measurements. Very few studies have investigated repeated measurements of RDW and its prognostic value, and most of them are focused on patients with cardiovascular diseases. RDW is a dynamic value so we aimed at determining the prognostic value of sequential RDW assessment in the last years of life in patients enrolled in a Department of Geriatrics. DESIGN: This work is part of a prospective study derived from a cohort of 122 patients over 75 years hospitalized in 2005 for the purpose of assessing the prognostic significance of several comorbidity and prognostic indices. SETTING: Patients were consecutively recruited for the study at admission in a tertiary hospital and then followed up for at least 5 years. PARTICIPANTS: A total of 55 patients with repeated RDW assessments during all the five years before their death were selected from the total cohort of 122 patients. RESULTS: We found a strong correlation between progressive rise in RDW and mortality risk, especially during the last year of life. There was a gradual significant increase in the RDW values along the last five years of life, with means growing up from 14,8 (95% CI: 13,98-15.62) to 16,37 (15,80-16,94). CONCLUSION: In our cohort of geriatric patients, RDW is a dynamic variable that is modified during the last five years of life, irrespective of their age, and especially during the last year.

[Spirometry quality in preschool children]. / Calidad de la espirometría en preescolares.

BACKGROUND: Carrying out quality spirometric maneuvers in preschool children in both the diagnosis and follow-up of respiratory diseases continues to be very scarce. This is due to several reasons, including a lack of consensus on quality criteria and the acceptability of the test. The purpose of this study is therefore to obtain reference norms from a population of healthy preschool children from the Autonomous Community of Navarre (Spain). METHOD: A total of 114 healthy preschool children aged between 3 and 7 years of age, without prior experience in carrying out lung function tests, were included. RESULTS: A total of 76 were able to realize at least two acceptable spirometric maneuvers, and 60 of them maneuvers that were acceptable and reproducible, according to ATS/ERS criteria. This represents a global success percentage of 59%. The most common failing was premature and brusque termination of the spirometric maneuver, followed by an inadequate peak in breathing. CONCLUSIONS: Over half of the preschool children were able to realize quality spirometric maneuvers. Our data make it possible to recommend the proposed quality criteria as being suitable for routine use, and to encourage the use of spirometry in regular clinical practice within the setting of specialized care.

Calidad de la espirometría en preeescolares / Spirometry quality in preschool children

Fundamento: La realización de maniobras espirométricas de calidad en niños preescolares tanto en el diagnóstico como en el seguimiento de enfermedades respiratorias sigue siendo muy escaso, por diversas razones entre las que se encuentran la falta de un consenso en los criterios de calidad y aceptabilidad de la prueba. Por ello, se inició este estudio con el fin de obtener ecuaciones de referencia provenientes de una población de niños preescolares sanos de la Comunidad Foral de Navarra (España). Métodos: Se incluyeron un total de 114 niños preescolares sanos con edades comprendidas entre los 3 y los 7 años y sin experiencia previa en la realización de estudios de función pulmonar. Resultados: Un total de 76 fueron capaces de realizar al menos dos maniobras espirométricas de aceptables y de ellos 60 aceptables y reproducibles, de acuerdo a los criterios ATS/ERS, lo cual representa un porcentaje global de éxito de 59%. El fallo más habitual fue la terminación prematura y brusca de la maniobra espirométrica, seguido de un pico espiratorio inadecuado. Conclusiones: Más de la mitad de los preescolares fueron capaces de realizar espirometrías de calidad. Nuestros datos permiten recomendar los criterios de calidad propuestos, como adecuados para su uso rutinario, y fomentar el uso de la espirometría en la práctica clínica habitual, dentro del entorno de la atención especializada (AU)

Background: Carrying out quality spirometric maneuvers in preschool children in both the diagnosis and follow-up of respiratory diseases continues to be very scarce. This is due to several reasons, including a lack of consensus on quality criteria and the acceptability of the test. The purpose of this study is therefore to obtain reference norms from a population of healthy preschool children from the Autonomous Community of Navarre (Spain). Method: A total of 114 healthy preschool children aged between 3 and 7 years of age, without prior experience in carrying out lung function tests, were included. Results: A total of 76 were able to realize at least two acceptable spirometric maneuvers, and 60 of them maneuvers that were acceptable and reproducible, according to ATS/ERS criteria. This represents a global success percentage of 59%. The most common failing was premature and brusque termination of the spirometric maneuver, followed by an inadequate peak in breathing. Conclusions: Over half of the preschool children were able to realize quality spirometric maneuvers. Our data make it possible to recommend the proposed quality criteria as being suitable for routine use, and to encourage the use of spirometry in regular clinical practice within the setting of specialized care (AU)

[The short-term effects of air pollution on mortality: the results of the EMECAM project in greater Bilbao. Estudio Multicéntrico Español sobre la Relación entre la Contaminación Atmosférica y la Mortalidad]. / Efectos a corto plazo de la contaminación atmosférica sobre la mortalidad: resultados del proyecto EMECAM en el Gran Bilbao.

BACKGROUND: The objective of this study was to assess the short-term impact of air pollution with sulfur dioxide (SO2), total suspended particles (TSP), nitrogen dioxide (NO2) and black smoke (BS) on the daily number of deaths in the metropolitan area of Bilbao. METHODS: The EMECAM project protocol was followed. RESULTS: Increases in TSP, in both maximum hourly figures and daily averages, are significantly associated with increases in the daily number of deaths from all causes, from circulatory causes and from all causes among those older than 70. No differences between six-month periods were found. NO2 average levels were associated with daily mortality from respiratory causes in the entire period and during the warm season, and from all causes among those older than 70 in the cool months. CONCLUSIONS: TSP levels are associated with daily mortality in the metropolitan area of Bilbao. The relationship between NO2 and the number of deaths from respiratory causes, very high in the warm season, needs further research to assess its independence.