Age shock index as an early predictor of cardiovascular death in acute coronary syndrome patients.

BACKGROUND: The shock index (SI), reflecting heart rate (HR) to SBP ratio, is established for predicting adverse outcomes in acute coronary syndrome (ACS) patients. Exploring the age shock index (ASI), obtained by multiplying SI with age, could offer further insights into ACS prognosis. OBJECTIVES: Assess ASI's effectiveness in predicting in-hospital death in individuals with ACS. METHODS: This study encompassed patients with acute myocardial infarction, drawn from a national registry spanning October 2010 to January 2022. The optimal ASI threshold was established using receiver operating characteristic (ROC) curve analysis. The primary outcome was in-hospital mortality. RESULTS: A total of 27 312 patients were enrolled, exhibiting a mean age of 66 ±â€…13 years, with 72.3% being male and 47.5% having ST-elevation myocardial infarction. ROC analysis yielded an area under the curve (AUC) of 0.80, identifying the optimal ASI cutoff as 44. Multivariate regression analysis, adjusting for potential confounders, established ASI ≥ 44 as an independent predictor of in-hospital death [hazard ratio: 3.09, 95% confidence interval: 2.56-3.71, P  < 0.001]. Furthermore, ASI emerged as a notably superior predictor of in-hospital death compared to the SI (AUC ASI  = 0.80 vs. AUC SI  = 0.72, P  < 0.0001), though it did not outperform the Global Registry of Acute Coronary Events (GRACE) score (AUC ASI  = 0.80 vs. AUC GRACE  = 0.85, P  < 0.001) or thrombolysis in myocardial infarction (TIMI) risk index (AUC ASI  = 0.80 vs. AUC TIMI  = 0.84, P  < 0.001). CONCLUSION: The ASI offers an expedient mean to promptly identify ACS patients at elevated risk of in-hospital death. Its simplicity and effectiveness could render it a valuable tool for early risk stratification in this population.

Physical Activity, Body Image, and Its Relationship with Academic Performance in Adolescents.

Academic success in adolescence is a strong predictor of well-being and health in adulthood. A healthy lifestyle and moderate/high levels of physical activity can influence academic performance. Therefore, we aimed to assess the relationship between the physical activity levels and body image and academic performance in public school adolescents. The sample consisted of 531 secondary school students in Porto (296 girls and 235 boys) aged between 15 and 20 years. The study variables and instruments were satisfaction with body image (The Body Image Rating Scale), assessment of physical activity (International Physical Activity Questionnaire for Adolescents (IPAQ-A), assessment of academic performance (academic achievement), school motivation (Academic Scale Motivation). The statistical analysis performed was descriptive analysis, an analysis of covariance, and a logistic regression. Regarding the results obtained, although there was no association between physical activity level and academic performance, it was observed in 10th grade students that the school average was higher for those practicing group or individual sports compared to students practicing artistic expression. Regarding the level of satisfaction with body image, we found different results in both genders. Our results support the importance of an active lifestyle, with the presence of regular physical activity being an important factor in improving academic performance.

Portable Digital Monitoring System for Sarcopenia Screening and Diagnosis.

Sarcopenia is a well-known highly prevalent muscle disease that severely impairs overall physical performance in elders, inducing a massive health-related economic burden. The widespread screening, diagnosis and treatment of sarcopenia are pivotal to restrain the disease progression and constrain its societal impact. Simple-to-use, portable, and reliable methods to evaluate sarcopenia are scarce, and sarcopenia-related assessments are typically done in several time-consuming stages. This study presents a portable digital system that enables a simple and intuitive method to evaluate sarcopenia-based on the European Working Group on Sarcopenia in Older People 2 (EWGSOP2) algorithm-including the four Find-Assess-Confirm-Severity (FACS) steps. The system comprises a mobile application (app); two wireless devices: a dynamometer (Gripwise) and a skinfold caliper (Lipowise); and a back-end website. To find cases, the SARC-F questionnaire is applied. To assess sarcopenia, the handgrip strength and the sit-to-stand tests are performed with the Gripwise and an application-embedded stopwatch, respectively. To confirm cases, anthropometric measures are performed, and muscle quantity is estimated with Lipowise. Finally, to assess severity, the app stopwatch grants the gait speed test application, evaluating physical performance. This step-by-step sarcopenia assessment results in a final grading according to the cut-off points of the EWGSOP2 criteria. All data is automatically encrypted and exported into a GDPR-compliant cloud platform, in which healthcare professionals can access and monitor their patients through the internet.

Physical activity and physical fitness according to loneliness levels in adults 50+ / Caraterização da atividade física e aptidão física de acordo com os níveis de solidão em adultos 50+

Loneliness is a perception of dissatisfaction that seems to be the result of a lack of significant re-lationships, with multiple potential causal factors. The current body of research is not conclusive in relation to the link between loneliness and physical activity (PA) and physical fitness (PF) in adults and seniors. The aim of this cross-sectional study is to characterize PA and PF according to levels of loneliness (Social Isolation versus Affinities). The 62 Portuguese individuals (64.68 ± 6.85 years; 68% women) were assessed for loneliness (University of California Los Angeles 16-item Loneliness Scale - UCLA-16). and classified in Social Isolation or Affinities, i.e., presence of significant social rela-tionships. PA was estimated using a questionnaire (International PA Questionnaire - Short Version - IPAQ-SV ) and PF was evaluated using the Senior Fitness Test (upper and lower body strength, upper and lower body flexibility, cardiorespiratory fitness, agility and dynamic balance). Descriptive statistics were used. The comparison between groups was performed using parametric (t-test, AN-COVA adjusted to sex and chi-square) and non-parametric tests (Mann-Whitney). The prevalence of social isolation was 53%. The individuals of the Affinities group spent more minutes per day on moderate and vigorous physical activity (MVPA) than the individuals of the Social Isolation group (0.00 [0.00 ­ 12.86] versus 11.43 [0.00 ­ 17.14] minutes, respectively; p = 0.041). After adjusting for sex, the differences were no longer significant. Loneliness groups were not different in relation to PF. PA appears to contribute to a better mental profile in adults and seniors. The results should be confirmed through studies with larger samples

A solidão é uma percepção de insatisfação que parece resultar da carência de relacionamentos significativos, sendo múltiplos os seus potenciais fatores causais. A atual evidência não é robusta no que diz respeito à associação da solidão com a atividade física (AF) e aptidão física (ApF) em adultos 50+. O objetivo deste estudo transversal é caracterizar a AF e ApF de acordo com a solidão. Os 62 indivíduos portugueses (64,68 ± 6,85 anos; 68% mulheres) foram avaliados para solidão (Escala de Solidão de 16 itens da Universidade da Califórnia em Los Angeles - UCLA-16) e classificados como Isolamento Social ou Afinidades, i.e., presença de relações socias significativas. A AF foi estimada por questionário (Questionário Internacional de AF - Versão Curta - IPAQ-SV ) e a ApF medida pela bateria Senior Fitness Test (força de membros superiores e inferiores, flexibilidade de membros superiores e membros inferiores, aptidão cardiorrespiratória e agilidade e equilíbrio dinâmico. Foram utilizadas estatísticas descritivas. A comparação entre grupos foi realizada através de testes paramétricos (teste-t, ANCOVA ajustada ao sexo e qui-quadrado) e não paramétricos (Mann-Whitney). A prevalência de isolamento social foi de 53%. O grupo Afinidades apresentou mais AF moderada a vigorosa comparativamente ao grupo Isolamento Social (11,43 [0,00 ­ 17,14] vs (0,00 [0,00 ­ 12,86], respetivamente; p = 0,041). Após ajuste para o sexo, as diferenças deixaram de ser significativas. Os grupos de solidão não foram diferentes relativamente à ApF. A AF parece contribuir para um melhor perfil mental de adultos e idosos, contudo, os resultados devem ser confirmados em estudos com amostras maiores

A hidratação à pessoa em agonia em cuidados continuados integrados: perceção da equipa de saúde / Hydration of the dying person in integrated long-term care: the health care team's perception

Cuidar da pessoa em fase agónica exige que os profissionais de saúde tenham como objetivo central proporcionar o máximo conforto à pessoa doente, preservando a dignidade e respeitando o princípio da ortotanásia. Em situações de fim de vida as questões da nutrição e da hidratação geram dificuldades não só para os profissionais de saúde como para a pessoa que está a vivenciar a última etapa da vida e também para a família. Neste sentido, a decisão de hidratar ou não hidratar deve assentar numa abordagem individualizada, fundamentada numa avaliação rigorosa de cada situação e discutida em contexto de equipa de saúde. De facto, a pessoa em agonia continua a necessitar de um cuidado específico e especializado para manter a qualidade de vida até ao fim. Assim, colocamos a seguinte questão de investigação: Qual a perceção da equipa de saúde de uma unidade de cuidados continuados acerca da hidratação da pessoa em fase agónica? com o objetivo geral de conhecer a perceção da equipa de saúde de uma unidade de cuidados continuados acerca da hidratação da pessoa em fase agónica, e com a finalidade de contribuir para uma prestação de cuidados que priorize um fim de vida mais digno e humanizado. Metodologia: abordagem qualitativa, estudo de caso, utilizando a entrevista semiestruturada para a recolha de dados dirigida a profissionais de saúde (enfermeiros e médicos) a desenvolver funções em unidades de cuidados continuados. Utilizamos a análise de conteúdo segundo Bardin (2011), como procedimento para a analise dos dados. Os procedimentos ético-moral foram respeitados. Principais Resultados: verificamos que os participantes do estudo conceptualizam agonia como um período em que a pessoa experiencia as últimas horas de vida e que surge um conjunto de acontecimentos que precede a morte. Alguns dos participantes referem que agonia significa a última fase da doença terminal. Acerca do conceito de hidratação da pessoa em agonia, os participantes consideram que existe controvérsia associada à hidratação artificial, contudo a maioria dos participantes percecionam a hidratação como promotora do bem-estar e da dignidade da pessoa doente e não consideram que a hidratação agrave os sintomas. São várias as necessidades que a equipa de saúde menciona para promover a hidratação da pessoa em agonia, nomeadamente apelam para a existência de Guidelines de intervenção e para que a equipa de saúde tenha um propósito partilhado, bem como mais formação e um maior diálogo entre a equipa multidisciplinar. Salientam que definir os limites de intervenção é difícil, e que é fundamental a sensibilidade dos profissionais de saúde para fornecer um cuidado na sua integralidade. São vários os dilemas que os participantes expressaram perante a hidratação da pessoa em agonia, nomeadamente estar certo de que será o bem para o doente, bem como, lidar com as divergências de opiniões dos profissionais de saúde, lidar com a variabilidade de sintomas, entre outros. Consideram que são vários os benefícios da hidratação da pessoa em agonia, como por exemplo: a promoção do bem-estar, a manutenção do perfil metabólico, a promoção do conforto, o apoio nutricional, tranquilizar a família, o alívio do sofrimento, melhoria do estado de consciência, a diminuição da sensação de sede e a promoção da dignidade. Contudo alguns dos participantes indicam alguns malefícios da hidratação na pessoa em agonia tais como: o agravamento de sintomas, o aumento do sofrimento (défice de monitorização e défice de avaliação) e o agravamento de patologias. Conclusão: Cuidar da pessoa em agonia e olhar para a hidratação como um aspeto importante ou não para a promoção de um fim de vida condigno, realça a importância da reflexão critica, da aceitação e do compromisso em cuidar da pessoa na sua multidimensionalidade. É premente existir mudanças na forma de cuidar, devemos centrar as nossas abordagens nas necessidades presentes e para tal é necessário um ingrediente: Formação especializada.

Taking care of an end-of-life patient requires that health professionals have the main goal to provide the maximum comfort to the sick person, preserving his / her dignity and respecting the principle of orthothanasia. In end-of-life patients, issues like nutrition and hydration create difficulties, not only for health professionals but also for those who are experiencing last stage of life, as well as for their families. In this regard, decision to hydrate or not must be stablished on an individualized approach, based on a rigorous assessment of each situation and discussed in the context of a multidisciplinary healthcare team. In fact, terminally ill patients still needs specific and specialized care to maintain quality of life until the end. Therefore, we developed the following research question: What is the perception of the healthcare team of long-term care unit about hydration in end-of-life patients? with the general objective of acknowledging the perception of healthcare team of long-term care unit about hydration of terminally ill patient, with the purpose of contributing to a more prioritized healthcare, focused on a more dignified and humanized end of life. Methodology: qualitative approach, case study, using a semi-structured interview to capture data aimed at health professionals (nurses and doctors) and to develop functions in long-term care units. We used content analysis according to Bardin (2011), as a procedure for data analysis. Ethical-moral procedures were respected. Main Results: we verified that study's participants conceptualize late stage caregiving as a period of time which anticipate last hours of life and a set of events that precede death. Some participants reported that late stage caregiving meant the last phase of terminal illness. Regarding the concept of hydration in terminally ill patients, they consider that there is controversy associated with artificial hydration; however, the majority of the participants recognize hydration as promoting well-being and dignity of sick person and do not consider that hydration intensify the symptoms. There are several needs that healthcare team suggest to promote hydration in end-of-life patients, particularly guidelines, as well as more training and more dialogue between the multidisciplinary team. They emphasize that defining the limits of intervention is difficult, and the sensitivity of healthcare professionals is essential to provide comprehensive care. There are several dilemmas that participants expressed regarding hydration of terminal ill patient, particularly being sure that it will be good for the patient, as well as, dealing with the different opinions of healthcare professionals, concerning with the variability of symptoms, among others. They consider that there are several benefits of hydration, such as promoting well-being, maintaining the metabolic profile, promoting comfort, nutritional support, reassuring the family, relieving suffering, improving the state of consciousness, decreasing feeling of thirst and promoting dignity. However, some participants describe some harmful effects of hydration, such as worsening of symptoms, exacerbating discomfort (deficit in monitoring and evaluation deficit) and worsening medical conditions. Conclusion: Taking care of a terminal illness patient and looking at hydration as an important aspect or not to promote a dignified end of life, highlights the importance of critical reflection, respect and commitment to take care of the person in his multidimensional aspect. It is mandatory to change behaviours and focus our approach in one specific purpose: Specialized training.